TED2007
Laurie Garrett: Lessons from the 1918 flu
Laurie Garrett关于1918年大流感启示的报告
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2007年当全世界都在担心禽流感暴发的时候，“瘟疫即将来袭”的作者Laurie Garret 对TED大学一部分观众进行了有力的演讲。她从过去疾病大流行中得到的深刻见解突然比任何时候都更加有意义。
Laurie Garrett - Science journalist
Pulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health. Full bio
Pulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health. Full bio
Double-click the English transcript below to play the video.
00:12
So the first question is, why do we need to
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第一个问题是我们为什么要
00:14
even worry about a pandemic threat?
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担心疫情的暴发？
00:17
What is it that we're concerned about?
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我们关注的是什么？
00:19
When I say "we," I'm at the Council on Foreign Relations.
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我说“我们”是指我所在的对外关系委员会
00:22
We're concerned in the national security community,
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我们也包括国家安全委员会，
00:24
and of course in the biology community and the public health community.
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当然还有生物学委员会和公共卫生委员会。
00:27
While globalization has increased travel,
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全球化使旅行增加，
00:29
it's made it necessary that everybody be everywhere,
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因此任何一个人可以在任何时候
00:32
all the time, all over the world.
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到达世界上的任何一个地方，
00:34
And that means that your microbial hitchhikers are moving with you.
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也就是说你所携带的微生物与你一起周游世界。
00:37
So a plague outbreak in Surat, India
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印度苏拉特瘟疫的暴发
00:39
becomes not an obscure event, but a globalized event --
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不仅是印度的一场灾难，而且变成了全球的灾难—
00:42
a globalized concern that has changed the risk equation.
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全球性的关注改变了风险等级。
00:45
Katrina showed us
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Katrina飓风告诉我们
00:47
that we cannot completely depend on government
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不能完全依赖政府
00:49
to have readiness in hand, to be capable of handling things.
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有现行的办法应对突发事件，
00:52
Indeed, an outbreak would be multiple Katrinas at once.
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的确，一场疫情的暴发相当于多次Katrinas飓风同时发生。
00:56
Our big concern at the moment is a virus called H5N1 flu --
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目前我们最大的担心是一种叫做H5N1的流感病毒，
00:59
some of you call it bird flu --
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有些人称其为禽流感
01:01
which first emerged in southern China, in the mid-1990s,
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最早在20世纪90年代中期出现于中国南方，
01:04
but we didn't know about it until 1997.
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但直到1997年我们才对它有所认识。
01:07
At the end of last Christmas only 13 countries had seen H5N1.
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去年圣诞节后期，只有13个国家出现了H5N1病毒，
01:11
But we're now up to 55 countries in the world,
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但是现在多达55个国家都
01:13
have had this virus emerge,
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出现了这种病毒，
01:15
in either birds, or people or both.
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在鸟类中、或人类中或鸟类和人类之间发现了这种病毒。
01:18
In the bird outbreaks we now can see
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通过在鸟类中爆发的禽流感现象，我们可以很清楚地看到
01:20
that pretty much the whole world has seen this virus
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除了美洲，
01:23
except the Americas.
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几乎全世界都暴发了禽流感。
01:25
And I'll get into why we've so far been spared in a moment.
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下面我就要讲为什么我们会暂时幸免。
01:29
In domestic birds, especially chickens,
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在家禽中，特别是鸡类，
01:31
it's 100 percent lethal.
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禽流感的致死率是100%。
01:33
It's one of the most lethal things we've seen
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它是近几个世纪以来
01:35
in circulation in the world
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我们在世界上见过的
01:37
in any recent centuries.
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致死性最高的病毒之一。
01:39
And we've dealt with it by killing off lots and lots and lots of chickens,
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为此，我们宰杀了大量的鸡，
01:42
and unfortunately often not reimbursing the peasant farmers
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但不幸的是经常不能给予农民足够的补偿，
01:45
with the result that there's cover-up.
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结果造成农民隐瞒疫情。
01:47
It's also carried on migration patterns
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病毒同样
01:49
of wild migratory aquatic birds.
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沿着候鸟的迁徙路线而传播。
01:52
There has been this centralized event
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中国有个叫程海湖的地方
01:54
in a place called Lake Chenghai, China.
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就曾经出现了这种病毒的集中暴发。
01:56
Two years ago the migrating birds
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两年前，候鸟
01:58
had a multiple event
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发生了一场复杂的事件，
02:00
where thousands died because of a mutation occurring
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由于病毒发生了变异
02:02
in the virus,
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数千候鸟死亡，
02:04
which made the species range broaden dramatically.
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使得所感染的物种范围急剧扩大。
02:07
So that birds going to Siberia, to Europe, and to Africa
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这些候鸟再把病毒带到西伯利亚、欧洲和非洲等地，
02:10
carried the virus, which had not previously been possible.
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这种情况在以前是不可能发生的。
02:13
We're now seeing outbreaks in human populations --
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我们现在看到的就是在人类爆发的禽流感。
02:17
so far, fortunately, small events,
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幸运的是，到目前为止，只是小规模的事件，
02:20
tiny outbreaks, occasional clusters.
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偶尔有聚集爆发的现象。
02:23
The virus has mutated dramatically in the last two years
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在过去的两年里，病毒已经明显的突变成
02:26
to form two distinct families, if you will,
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两个截然不同的家族，
02:29
of the H5N1 viral tree
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正如你想的那样
02:31
with branches in them,
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H5N1就是其中的分支之一。
02:33
and with different attributes that are worrying.
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并且H5N1有着让人心神不安的特点。
02:35
So what's concerning us? Well, first of all,
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那么什么让我们如此焦虑呢？首先，
02:37
at no time in history have we succeeded in making
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历史上从来没有人能
02:40
in a timely fashion, a specific vaccine
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为超过2.6亿人成功制备过
02:42
for more than 260 million people.
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适时、特异性的疫苗。
02:45
It's not going to do us very much good in a global pandemic.
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疾病全球大流行时，这对我们帮助不大。
02:48
You've heard about the vaccine we're stockpiling.
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大家可能都听说过，我们正在储备疫苗。
02:51
But nobody believes it will actually be particularly effective
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但是疫情一旦爆发了，没人会相信
02:53
if we have a real outbreak.
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这种方法真的有效。
02:55
So one thought is:
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所以，一种观点认为
02:57
after 9/11, when the airports closed,
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911之后，机场被关闭
02:59
our flu season was delayed by two weeks.
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流感季节往后推迟了两周。
03:01
So the thought is, hey, maybe what we should do is just
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那么有人就认为，我们应该马上关闭机场
03:03
immediately -- we hear there is H5N1 spreading from human to human,
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因为我们听说H5N1正在人群中传播，
03:07
the virus has mutated to be a human-to-human transmitter --
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病毒已经突变成了人-人传染。
03:09
let's shut down the airports.
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hey,我们马上关闭机场吧。
03:11
However, huge supercomputer analyses,
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然而，超型计算机分析了
03:15
done of the likely effectiveness of this,
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这种做法的有效性。
03:17
show that it won't buy us much time at all.
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结果表明，这并不能给我们多少喘息之机。
03:19
And of course it will be hugely disruptive in preparation plans.
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并且还会给防止病毒的准备计划带来巨大的破坏。
03:23
For example, all masks are made in China.
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举个例子，所有的口罩都是中国制造的。
03:26
How do you get them mobilized around the world
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如果你把机场关闭了，
03:28
if you've shut all the airports down?
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你怎么把口罩运输到世界各地？
03:30
How do you get the vaccines moved around the world
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你又怎么把那些疫苗的药品运输到世界的每个角落？
03:32
and the drugs moved, and whatever may or not be available that would work.
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无论这些是否有用，
03:35
So it turns out that shutting down the airports is counterproductive.
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关闭机场看起来是反其道而行。
03:39
We're worried because this virus, unlike any other flu
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我们对此颇为头疼，因为这种病毒和我们以往研究的任何一种流感都不一样，
03:42
we've ever studied, can be transmitted by eating raw meat
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这种流感能通过食用
03:46
of the infected animals.
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被感染动物的生肉而传播。
03:48
We've seen transmission to wild cats and domestic cats,
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我们已经发现它能传染野猫和家猫，
03:51
and now also domestic pet dogs.
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现在还能传染宠物狗。
03:54
And in experimental feedings to rodents and ferrets,
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我们在啮齿类和鼬类的实验性喂养实验中发现，
03:57
we found that the animals exhibit symptoms never seen with flu:
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这些动物受感染后，表现出前所未有的流感症状---
04:01
seizures, central nervous system disorders, partial paralysis.
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癫痫、中央神经系统紊乱以及局部麻痹。
04:04
This is not your normal garden-variety flu.
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这并不是那些常见的变化多端的流感。
04:07
It mimics what we now understand
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通过我们对1918年病毒重塑了解到的，
04:09
about reconstructing the 1918 flu virus,
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这种病毒仿佛模拟了上次1918年
04:11
the last great pandemic,
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流感大流行，
04:13
in that it also jumped directly from birds to people.
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在那次流感大流行中，流感病毒也是从鸟类直接传播到人身上的。
04:15
We had evolution over time,
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随着时间的流逝病毒进化了，
04:17
and this unbelievable mortality rate in human beings:
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流感对人类的难以置信的病死率也“进化”了。
04:21
55 percent of people who have become infected
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事实上，55%感染了H5N1病毒
04:23
with H5N1 have, in fact, succumbed.
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的人都已经死亡。
04:27
And we don't have a huge number of people
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而且，感染了病毒却没有发病的
04:29
who got infected and never developed disease.
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不是很多。
04:32
In experimental feeding in monkeys
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在实验性喂养猴子的实验中
04:34
you can see that it actually downregulates
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可以得知病毒实际上下调了
04:36
a specific immune system modulator.
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一个特异的免疫系统调控子的水平，
04:38
The result is that what kills you
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所以，至你于死地的
04:40
is not the virus directly, but your own immune system overreacting, saying,
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不是病毒，而是你的免疫系统的过度反应，
04:43
"Whatever this is so foreign I'm going berserk."
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也就是说：无论这种物质是不是异己，我都将其彻底铲除。
04:46
The result: most of the deaths
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结果就是，大部分的死者
04:48
have been in people under 30 years of age,
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是30岁以下的
04:50
robustly healthy young adults.
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健康的青壮年。
04:53
We have seen human-to-human transmission
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大家已经知道人-人传染
04:55
in at least three clusters --
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至少要三种方式。
04:57
fortunately involving very intimate contact,
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幸运的是，这都涉及到近距离的接触
05:00
still not putting the world at large at any kind of risk.
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这还没有把世界置于更大的危险之中。
05:03
Alright, so I've got you nervous.
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我让你们紧张了吗？
05:05
Now you probably assume, well the governments are going to do something.
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现在你可以假设，政府要做点什么了吧。
05:08
And we have spent a lot of money.
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我们已经花了很多钱。
05:10
Most of the spending in the Bush administration
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实际上，布什政府的钱大部分
05:12
has actually been more related to the anthrax results
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都花在了应对炭疽
05:16
and bio-terrorism threat.
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和生物恐怖袭击上面了。
05:18
But a lot of money has been thrown out at the local level and at the federal level
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而且还有很多钱扔到了地方政府及联邦政府
05:21
to look at infectious diseases.
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对传染病的研究上。
05:23
End result: only 15 states
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最终结果就是，疫情发生时只有15个州
05:25
have been certified to be able to do mass distribution
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有资质进行
05:27
of vaccine and drugs in a pandemic.
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疫苗和药品的分发。
05:30
Half the states would run out of hospital beds
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一半的州在一两周之内
05:32
in the first week, maybe two weeks.
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就会没有床位了。
05:34
And 40 states already have an acute nursing shortage.
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40个州已经面临严重的护理人员短缺的局面，
05:37
Add on pandemic threat, you're in big trouble.
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一旦疫情爆发，麻烦就大了。
05:39
So what have people been doing with this money?
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那么，人们在拿这些钱干嘛呢？
05:41
Exercises, drills, all over the world.
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全世界范围内的演习和训练。
05:43
Let's pretend there's a pandemic.
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让我们假设疫情爆发了。
05:45
Let's everybody run around and play your role.
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所有人都要行动起来发挥作用。
05:47
Main result is that there is tremendous confusion.
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主要结果是出现了非常混乱的局面。
05:50
Most of these people don't actually know what their job will be.
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这些人中大多数并不真正了解他们的工作是什么。
05:53
And the bottom line, major thing that has come through
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甚至于每次演习都出现的重要问题是，
05:55
in every single drill: nobody knows who's in charge.
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没人知道总指挥是谁。
05:58
Nobody knows the chain of command.
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没人知道命令下达的途径。
06:00
If it were Los Angeles, is it the mayor, the governor,
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如果洛杉矶爆发疫情，市长，州长，
06:03
the President of the United States, the head of Homeland Security?
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美国总统，还是国土安全部部长是总指挥呢？
06:06
In fact, the federal government says it's a guy called
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事实上，联邦政府说是一个叫做
06:08
the Principle Federal Officer,
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首席联邦官员的家伙
06:11
who happens to be with TSA.
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而他刚好在美国运输安全局
06:13
The government says
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联邦政府说
06:14
the federal responsibility will basically be
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他的职责基本上就是
06:17
about trying to keep the virus out, which we all know is impossible,
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努力把病毒阻隔在国外，我们都知道这是不可能的。
06:20
and then to mitigate the impact
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然后是主要减轻疫情
06:22
primarily on our economy.
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对经济的影响。
06:25
The rest is up to your local community.
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剩下的就是地方上的事了。
06:27
Everything is about your town, where you live.
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所有的事都取决于你所居住的郡。
06:30
Well how good a city council you have,
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那么你们的市议会做得怎么样呢？
06:32
how good a mayor you have -- that's who's going to be in charge.
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你们的将要担负重任的市长做得怎么样呢？
06:36
Most local facilities would all be competing
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大部分的地方机构都将竞相
06:38
to try and get their hands on their piece
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争取分一杯羹
06:40
of the federal stockpile of a drug called Tamiflu,
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得到联邦储备的一种叫做达菲的药品
06:43
which may or may not be helpful -- I'll get into that --
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这种药可能有用也可能没用（接下来我会讲到）
06:45
of available vaccines, and any other treatments,
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还有任何其他治疗方法
06:48
and masks, and anything that's been stockpiled.
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还有口罩，储备的所有物资。
06:51
And you'll have massive competition.
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竞争将是激烈的。
06:54
Now we did purchase a vaccine, you've probably all heard about it,
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现在我们的确买到了一种疫苗，你们可能都听说过，
06:56
made by Sanofi-Aventis.
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由赛诺菲安万特公司制造的。
06:58
Unfortunately it's made against the current form of H5N1.
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不幸的是，它仅仅针对目前流行的H5N1病毒株。
07:01
We know the virus will mutate. It will be a different virus.
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我们知道病毒是会变异的。它会成为一种新的病毒。
07:04
The vaccine will probably be useless.
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疫苗很可能就失去作用了。
07:07
So here's where the decisions come in.
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这就引出了我们下面的结论。
07:09
You're the mayor of your local town.
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如果你是你们当地那个镇的镇长。
07:11
Let's see, should we order that all pets be kept indoors?
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我们应该下令让人们把宠物都圈在家里吗？
07:14
Germany did that when H5N1 appeared in Germany last year,
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去年德国出现H5N1的时候德国人这样做过，
07:17
in order to minimize the spread
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以尽可能减少
07:19
between households by household cats, dogs and so on.
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由家养的宠物猫宠物狗等引发的家庭间传播。
07:23
What do we do when we don't have any containment rooms
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在没有任何层流室
07:27
with reverse air that will allow the healthcare workers
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可以让医务人员
07:29
to take care of patients?
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照顾病人的情况下，我们该怎么办呢？
07:31
These are in Hong Kong; we have nothing like that here.
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香港有。我们这里没有任何类似的设施。
07:33
What about quarantine?
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隔离如何呢？
07:35
During the SARS epidemic in Beijing quarantine did seem to help.
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北京SARS流行期间，隔离似乎的确有用。
07:38
We have no uniform policies
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我们整个美国都没有
07:40
regarding quarantine across the United States.
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相同的关于隔离的政策。
07:42
And some states have differential policies, county by county.
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在一些州里不同的郡有不同的政策。
07:46
But what about the no-brainer things? Should we close all the schools?
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但是那些傻瓜会怎么做呢？难道我们应该关闭所有的学校吗？
07:49
Well then what about all the workers? They won't go to work
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所有的上班族怎么办呢？他们不会去上班的，
07:51
if their kids aren't in school.
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如果他们的孩子不上学的话。
07:53
Encouraging telecommuting? What works?
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鼓励远程办公吗？什么才有用呢？
07:55
Well the British government did a model of telecommuting.
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英国政府设计了一个远程办公模式。
07:58
Six weeks they had all people in the banking industry
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六周的时间里，他们让银行业所有从业人员
08:01
pretend a pandemic was underway.
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假装处在疫情流行的状态中。
08:03
What they found was, the core functions --
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他们发现那些核心功能，
08:05
you know you still sort of had banks,
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你知道在一定程度上银行业务仍在运转。
08:07
but you couldn't get people to put money in the ATM machines.
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但你不能让人把钱放进ATM机里。
08:10
Nobody was processing the credit cards.
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没人处理信用卡业务。
08:12
Your insurance payments didn't go through.
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没人处理保险业务。
08:14
And basically the economy would be in a disaster state of affairs.
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经济基本处于灾难性的状态中。
08:17
And that's just office workers, bankers.
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那还只是上班族，银行家。
08:21
We don't know how important hand washing is for flu --
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我们不知道对于流感来说洗手有多重要——
08:24
shocking. One assumes it's a good idea to wash your hands a lot.
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震惊吧。有人认为经常洗手是个好主意。
08:27
But actually in scientific community there is great debate
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但是实际上，科学界有个大讨论，
08:29
about what percentage of flu transmission between people
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是关于流感人际传播有多大比例
08:32
is from sneezing and coughing
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是通过打喷嚏和咳嗽，
08:34
and what percentage is on your hands.
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多大比例是通过手的接触。
08:36
The Institute of Medicine tried to look at the masking question.
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医学研究所试图研究口罩的问题。
08:40
Can we figure out a way, since we know we won't have enough masks
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既然我们知道口罩不够用，我们能找到一种解决办法吗？
08:42
because we don't make them in America anymore,
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因为美国不再生产口罩了，
08:44
they're all made in China --
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所有的都是中国生产的。
08:46
do we need N95? A state-of-the-art, top-of-the-line,
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我们需要N95吗？一种“技术先进、领先水平、
08:49
must-be-fitted-to-your-face mask?
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契合脸部轮廓”的口罩？
08:52
Or can we get away with some different kinds of masks?
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或者我们能用别的种类的口罩代替吗？
08:55
In the SARS epidemic, we learned in Hong Kong
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在SARS流行期间，我们知道在香港
08:57
that most of transmission was because
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大部分传播是因为
08:59
people were removing their masks improperly.
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人们摘口罩时不正确的方法。
09:01
And their hand got contaminated with the outside of the mask,
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他们的手被口罩外侧污染了，
09:03
and then they rubbed their nose. Bingo! They got SARS.
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然后就去用手擦鼻子。中招了！他们得了SARS。
09:06
It wasn't flying microbes.
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并不是由于飞沫传播。
09:09
If you go online right now, you'll get so much phony-baloney information.
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如果你现在上网，你能找到那么多的虚假信息。
09:12
You'll end up buying -- this is called an N95 mask. Ridiculous.
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最后你就会买这种所谓的N95口罩。可笑。
09:17
We don't actually have a standard
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实际上我们都没有一个
09:19
for what should be the protective gear for the first responders,
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防护装备标准给第一批疫情响应者参考，
09:22
the people who will actually be there on the front lines.
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而他们将是抗击疫情的一线人员。
09:25
And Tamiflu. You've probably heard of this drug,
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接下来是达菲。你们很可能已经听说过这种药品，
09:27
made by Hoffmann-La Roche, patented drug.
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由Hoffmann-La Roche研制的专利药品。
09:30
There is some indication
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有迹象表明，
09:32
that it may buy you some time in the midst of an outbreak.
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在流行病爆发时它可以给你一些喘息之机。
09:35
Should you take Tamiflu for a long period of time,
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你应该长期服用这种达菲吗？
09:37
well, one of the side effects is suicidal ideations.
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其实，达菲的其中一个副作用是引发自杀念头。
09:40
A public health survey analyzed the effect
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一个公共卫生调查分析认为
09:44
that large-scale Tamiflu use would have,
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大规模使用达菲
09:46
actually shows it counteractive
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实际上将对
09:48
to public health measures, making matters worse.
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公共卫生措施起反作用，使事态恶化。
09:51
And here is the other interesting thing:
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另一个有意思的事情是：
09:53
when a human being ingests Tamiflu, only 20 percent
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当一个人服用达菲后，只有其中20%
09:55
is metabolized appropriately
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通过新陈代谢适当转化
09:57
to be an active compound in the human being.
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为人体的活性化合物。
09:59
The rest turns into a stable compound,
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其余的转变为稳定化合物，
10:03
which survives filtration into the water systems,
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在过滤中幸存下来并进入到水系中，
10:06
thereby exposing the very aquatic birds that would carry flu
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从而使他们暴露给那些能够携带流感病毒的水鸟
10:09
and providing them a chance
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给它们以
10:11
to breed resistant strains.
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产生耐药株的可能。
10:13
And we now have seen Tamiflu-resistant strains
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现在我们已经在
10:16
in both Vietnam in person-to-person transmission,
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越南人际传播
10:19
and in Egypt in person-to-person transmission.
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和埃及人际传播的疫情中发现了达菲耐药株。
10:21
So I personally think that our life expectancy
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所以我个人认为将达菲视为
10:24
for Tamiflu as an effective drug
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一种特效药
10:27
is very limited -- very limited indeed.
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是非常有限的——的确非常有限。
10:29
Nevertheless most of the governments
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尽管如此，大部分政府
10:31
have based their whole flu policies
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还是将它们的全部流感对策
10:33
on building stockpiles of Tamiflu.
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建立在储备达菲上。
10:35
Russia has actually stockpiled enough
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俄罗斯实际上已经储备了足够
10:37
for 95 percent of all Russians.
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95%的俄国人使用的达菲。
10:39
We've stockpiled enough for 30 percent.
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我们已经储备了足够30%的人使用的达菲。
10:41
When I say enough, that's two weeks worth.
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我说够用，是指够两个星期用。
10:43
And then you're on your own because
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之后就只能听天由命了，因为
10:45
the pandemic is going to last for 18 to 24 months.
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疫情将持续18-24个月。
10:47
Some of the poorer countries
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一些比较穷的
10:49
that have had the most experience with H5N1 have built up stockpiles;
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饱受禽流感冲击的国家建立起储备后，
10:52
they're already expired. They are already out of date.
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达菲也已经失效了。它们已经过期了。
10:55
What do we know from 1918,
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从1918年
10:57
the last great pandemic?
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上一次大规模的疫情中我们能知道什么呢？
10:59
The federal government abdicated most responsibility.
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联邦政府放弃了大部分职责。
11:02
And so we ended up with this wild patchwork of regulations
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结果留下了一个支离破碎的混乱的管理局面
11:05
all over America.
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在整个美国。
11:07
Every city, county, state did their own thing.
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每个城市，每个郡，每个州都在各行其是。
11:09
And the rules
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规则
11:11
and the belief systems were wildly disparate.
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和想法大相径庭。
11:14
In some cases all schools, all churches,
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在有些案例中所有的学校，教堂，
11:17
all public venues were closed.
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和公共集会场所都被关闭了。
11:19
The pandemic circulated three times in 18 months
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18个月的时间里疫情反复了三次，
11:22
in the absence of commercial air travel.
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即使当时并没有商业航空旅行。
11:24
The second wave was the mutated, super-killer wave.
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第二波变异株极具杀伤力。
11:27
And in the first wave we had enough healthcare workers.
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第一波时我们还有足够的医护人员。
11:30
But by the time the second wave hit
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但是第二波袭来时，
11:32
it took such a toll among the healthcare workers
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医护人员损失惨重，
11:35
that we lost most of our doctors and nurses that were on the front lines.
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我们失去了抗击疫情前线的大部分的医生和护士。
11:39
Overall we lost 700,000 people.
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死亡人数总计70万人。
11:41
The virus was 100 percent lethal to pregnant women
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对孕妇来说，这种病毒是100%致命的。
11:44
and we don't actually know why.
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而且我们不是很清楚原因。
11:46
Most of the death toll was 15 to 40 year-olds --
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大多数的死亡案例介于15-40岁之间——
11:49
robustly healthy young adults.
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健康的青壮年。
11:51
It was likened to the plague.
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就像瘟疫一样。
11:53
We don't actually know how many people died.
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实际死亡人数我们不是很清楚。
11:55
The low-ball estimate is 35 million.
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保守估计是三千五百万。
11:58
This was based on European and North American data.
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这个数字是根据欧洲和北美洲的数据统计的。
12:01
A new study by Chris Murray at Harvard
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哈佛大学的Chris Murray的一项最新研究
12:03
shows that if you look at the databases that were kept
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表明，如果你看看在印度
12:05
by the Brits in India,
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由英国人维护的数据库的话，
12:07
there was a 31-fold greater death rate among the Indians.
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就会发现印度人的死亡率是平均水平的31倍。
12:11
So there is a strong belief that in places of poverty
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所以，一个坚定地信念是在贫穷地区
12:14
the death toll was far higher.
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死亡人数更高。
12:16
And that a more likely toll
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死亡人数更可能是
12:18
is somewhere in the neighborhood of 80 to 100 million people
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大约八千万到一亿，
12:20
before we had commercial air travel.
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在我们开通商业航空旅行前。
12:23
So are we ready?
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那么，我们准备好了吗？
12:25
As a nation, no we're not.
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作为一个国家来说，我们还没有。
12:27
And I think even those in the leadership
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我确定即使是那些领导人
12:29
would say that is the case,
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也会说事实上
12:31
that we still have a long ways to go.
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我们还差得很远。
12:33
So what does that mean for you? Well the first thing is,
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那么，这对你来说意味着什么呢？第一件事就是，
12:35
I wouldn't start building up personal stockpiles of anything --
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别为你自己、
12:38
for yourself, your family, or your employees --
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你的家人或者你的员工建立任何个人储备，
12:42
unless you've really done your homework.
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除非你真的做足了功课。
12:45
What mask works, what mask doesn't work.
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什么口罩有用？什么口罩没用？
12:47
How many masks do you need?
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你需要多少口罩呢？
12:49
The Institute of Medicine study felt that
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医学研究所研究认为
12:51
you could not recycle masks.
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口罩不能反复使用。
12:53
Well if you think it's going to last 18 months,
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那么，如果你觉得疫情将持续18个月的话，
12:56
are you going to buy 18 months worth of masks
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你会为你家里的每个人
12:58
for every single person in your family?
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买足够18个月使用的口罩吗？
13:01
We don't know -- again with Tamiflu,
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关于达菲，我们仍不知道
13:05
the number one side effect of Tamiflu is
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其主要的副作用是
13:07
flu-like symptoms.
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流感样症状。
13:09
So then how can you tell
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那么，你怎样才能分辨
13:11
who in your family has the flu
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谁得了流感呢
13:13
if everybody is taking Tamiflu?
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如果家里人都服用达菲的话？
13:16
If you expand that out to think of a whole community,
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如果扩大到整个社区，
13:19
or all your employees in your company,
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或者你公司的所有员工的话，
13:22
you begin to realize how limited
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你就会开始意识到
13:24
the Tamiflu option might be.
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选择达菲其作用可能将多么有限。
13:26
Everybody has come up to me and said,
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所有人都来跟我讲，
13:28
well I'll stockpile water or, I'll stockpile food, or what have you.
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我要储备水，或者我要储备食物，或者你储备了什么。
13:32
But really? Do you really have a place
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但是真的吗？你真的有地方
13:35
to stockpile 18 months worth of food? Twenty-four months worth of food?
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储备18个月的食物吗？24个月的食物吗？
13:38
Do you want to view the pandemic threat
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你要像
13:40
the way back in the 1950s
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过去20世纪50年代冷战时期
13:42
people viewed the civil defense issue,
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的人们看待民防设施那样，
13:44
and build your own little bomb shelter for pandemic flu?
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建立你自己的小小防空洞来对付流感疫情吗？
13:47
I don't think that's rational.
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我认为那是不理智的。
13:49
I think it's about having to be prepared
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我觉得必须是以社区做准备，
13:51
as communities, not as individuals --
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不是以个人，
13:53
being prepared as nation,
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要以国家做准备，
13:55
being prepared as state, being prepared as town.
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以州来做准备，以城镇做准备。
13:58
And right now most of the preparedness
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就目前来说，大部分准备工作
14:00
is deeply flawed.
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都存在严重缺陷。
14:02
And I hope I've convinced you of that,
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我希望我已经说服了你们，
14:04
which means that the real job is go out and
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真正的工作是
14:06
say to your local leaders,
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去跟你们的地方长官，
14:08
and your national leaders,
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你们的国家领导人说，
14:10
"Why haven't you solved these problems?
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“为什么你还没解决这些问题？
14:12
Why are you still thinking that
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为什么你们仍然认为
14:14
the lessons of Katrina do not apply to flu?"
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卡特里娜飓风的教训不会在流感疫情中重演？”
14:17
And put the pressure where the pressure needs to be put.
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把压力施加在需要施压的地方。
14:21
But I guess the other thing to add is,
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但是我猜另一个需要补充的是，
14:23
if you do have employees, and you do have a company,
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如果你真的有雇员，真的有一个公司，
14:25
I think you have certain responsibilities
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我觉得你有责任
14:28
to demonstrate that you are thinking ahead for them,
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去证明你在为他们早做打算，
14:30
and you are trying to plan.
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你在努力安排。
14:32
At a minimum the British banking plan showed that
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英国的银行模式至少表明
14:36
telecommuting can be helpful.
343
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远程办公可能有用。
14:38
It probably does reduce exposure
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可能它真的减少了暴露，
14:40
because people are not coming into the office and coughing on each other,
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因为人们不再进到办公室里对着彼此咳嗽，
14:43
or touching common objects
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或者接触公共物品，
14:46
and sharing things via their hands.
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经由他们的手共用物品。
14:48
But can you sustain your company that way?
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但是你能那样维持你的公司吗？
14:52
Well if you have a dot-com, maybe you can.
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如果你有一个网站的话，也许你可以。
14:55
Otherwise you're in trouble.
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否则你就麻烦了。
14:58
Happy to take your questions.
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很高兴回答你们的问题。
15:00
(Applause)
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（掌声）
15:04
Audience member: What factors determine the duration of a pandemic?
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观众：决定疫情持续时间长短的因素是什么呢？
15:09
Laurie Garret: What factors determine the duration of a pandemic, we don't really know.
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Laurie Garret：我们不是很清楚决定疫情持续时间长短的因素是什么。
15:13
I could give you a bunch of flip, this, that, and the other.
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我可以给你一堆草率的说法，这个，那个，还有别的。
15:16
But I would say that honestly we don't know.
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但是我可以坦率地说我们真的不知道。
15:19
Clearly the bottom line is
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显然至少
15:21
the virus eventually attenuates,
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病毒的毒性最终会减弱，
15:24
and ceases to be a lethal virus to humanity,
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对人类不再是致命的病毒，
15:29
and finds other hosts.
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然后找到其他宿主。
15:31
But we don't really know how and why that happens.
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但我们并不十分清楚这些是如何发生的，为什么发生。
15:33
It's a very complicated ecology.
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真是个很复杂的生态学问题。
15:36
Audience member: What kind of triggers are you looking for?
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观众：你在寻找什么样的起因呢？
15:39
You know way more than any of us.
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你知道的比我们这里任何一个人都多。
15:41
To say ahh, if this happens then we are going to have a pandemic?
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可以说，如果这个起因发生了，流行病就将发生。
15:45
LG: The moment that you see any evidence
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LG：当你发现任何
15:47
of serious human-to-human to transmission.
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人际传播的证据时。
15:50
Not just intimately between family members
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不仅是亲密的
15:52
who took care of an ailing sister or brother,
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照顾生病的兄弟姐妹的家庭成员之间，
15:56
but a community infected --
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而是一个社区被传染
15:58
spread within a school,
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在一个学校里传播，
16:00
spread within a dormitory, something of that nature.
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在一个集体宿舍区里传播，有那种特征的事件。
16:03
Then I think that there is universal agreement
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我觉得然后就由WHO
16:06
now, at WHO all the way down:
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从上而下形成普遍共识，
16:08
Send out the alert.
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发出警报。
16:12
Audience member: Some research has indicated that statins can be helpful.
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观众：有些研究表明他汀类药物可能有用。
16:16
Can you talk about that?
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你能谈谈这个吗？
16:18
LG: Yeah. There is some evidence that taking Lipitor
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LG：好的。有证据支持服用
16:20
and other common statins for cholesterol control
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他汀类药剂或者其他普通的控制胆固醇含量的抑制素
16:23
may decrease your vulnerability
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可能会降低
16:27
to influenza.
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流感的易感性。
16:29
But we do not completely understand why.
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但我们不能完全明白原因。
16:32
The mechanism isn't clear.
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机制尚不明确。
16:34
And I don't know that there is any way
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而且我不知道
16:39
responsibly for someone to start
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让某人开始给
16:42
medicating their children
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他们自己的孩子服用
16:44
with their personal supply of Lipitor or something of that nature.
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他汀类药剂或者其他有那种特性的东西是否是负责任的行为。
16:48
We have absolutely no idea what that would do.
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我们完全不知道后果如何。
16:50
You might be causing some very dangerous outcomes
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也许会给你的孩子带来非常严重的后果，
16:53
in your children, doing such a thing.
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这样做的话。
16:56
Audience member: How far along are we in being able to determine
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观众：需要多长时间才能鉴定出
16:58
whether someone is actually carrying, whether somebody has this
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一个人是否是病毒携带者，或是否已经感染这种病毒？
17:00
before the symptoms are full-blown?
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症状完全出现之前
17:02
LG: Right. So I have for a long time said
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LG:哦。很早以前我就说过，
17:05
that what we really needed was a rapid diagnostic.
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我们真正需要的就是快速诊断程序。
17:08
And our Centers for Disease Control
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我们的疾病控制中心
17:11
has labeled a test they developed
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已经把他们自己研发的实验列为
17:14
a rapid diagnostic.
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快速诊断程序。
17:16
It takes 24 hours in a very highly developed laboratory,
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这个检测在一个非常先进的实验室
17:20
in highly skilled hands.
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由技术娴熟的操作人员完成的话需要24小时。
17:22
I'm thinking dipstick.
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而我所想的是试纸诊断。
17:24
You could do it to your own kid. It changes color.
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大家可用试纸自己给孩子做测试。测试的结果是通过试纸颜色的改变
17:26
It tells you if you have H5N1.
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来告诉你是否感染了H5N1。
17:28
In terms of where we are in science
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就目前科学上的
17:32
with DNA identification capacities and so on,
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DNA鉴定及其他高端技术的鉴定能力来讲，
17:36
it's not that far off.
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快速诊断程序离我们不会太遥远了。
17:38
But we're not there. And there hasn't been the kind of investment to get us there.
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目前我们还没有这种快速的诊断程序，并且也没有投资方支持和赞助我们实现这个目标。
17:43
Audience member: In the 1918 flu I understand that
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观众：在1918年的流感中，我了解到
17:46
they theorized that there was some attenuation
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研究人员从理论上推测：病毒毒力已经有些衰减
17:50
of the virus when it made the leap into humans.
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当其传染到人群时。
17:52
Is that likely, do you think, here?
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您认为现在可能吗？
17:54
I mean 100 percent death rate
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我的意思是100%的致死率
17:58
is pretty severe.
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是相当严重的。
18:00
LG: Um yeah. So we don't actually know
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LG:哦。事实上，我们并不知道
18:04
what the lethality was
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1918年病毒株
18:07
of the 1918 strain to wild birds
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对野鸟的致死率如何，
18:11
before it jumped from birds to humans.
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当其从鸟传染到人之前。
18:13
It's curious that there is no evidence
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令人好奇的是，没有任何证据表明
18:15
of mass die-offs of chickens
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全美范围内鸡或家禽
18:17
or household birds across America
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大量死亡事件发生在
18:20
before the human pandemic happened.
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人类流行病爆发之前。
18:22
That may be because those events
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这也可能是大量死亡事件
18:24
were occurring on the other side of the world
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发生在地球另一个地方，
18:26
where nobody was paying attention.
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在那里，人们没有给予关注。
18:28
But the virus clearly
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但是病毒确实是在
18:32
went through one round around the world
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全球范围内
18:34
in a mild enough form
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以一种温和的形式传播了一圈，
18:36
that the British army in World War I
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正如英国军队所证实的那样：在一战中，
18:39
actually certified that it was not a threat
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这场流行病并没有威胁性
18:42
and would not affect the outcome of the war.
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也不会影响战争的结果。
18:45
And after circulating around the world
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病毒在全球范围内传播一圈后
18:47
came back in a form that was tremendously lethal.
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又以一种巨大致死力的方式再次传播。
18:52
What percentage of infected people were killed by it?
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感染人群里到底有多大死亡率，、
18:55
Again we don't really know for sure.
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我们仍不确定。
18:58
It's clear that if you were malnourished to begin with,
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但明确的是，如果营养不良，
19:00
you had a weakened immune system,
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免疫力低下，
19:02
you lived in poverty in India or Africa,
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生活在印度或非洲等贫困地区，
19:05
your likelihood of dying was far greater.
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那么死亡的机率就大大增加。
19:08
But we don't really know.
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但是事实如何，我们确实不知道。
19:11
Audience member: One of the things I've heard is that
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观众：我所听到的是，
19:13
the real death cause when you get a flu is the associated pneumonia,
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感染流感后，真正的死因是流感导致的肺炎。
19:16
and that a pneumonia vaccine
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而肺炎疫苗
19:18
may offer you 50 percent better chance of survival.
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能带来50%的生存机率。
19:22
LG: For a long time, researchers in emerging diseases
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LG:在很长一段时间内，致力于研究新发疾病的研究人员
19:26
were kind of dismissive of the pandemic flu threat
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都有点轻视流感的威胁，
19:28
on the grounds that
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因为他们认为
19:30
back in 1918 they didn't have antibiotics.
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1918年的流感之所以有那么大的威胁性是因为没有抗生素，而不是病毒本身。
19:32
And that most people who die of regular flu --
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每年很多人死于普通流感，
19:35
which in regular flu years
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全球死于普通流感的人数
19:37
is about 360,000 people worldwide,
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大约是36万，
19:40
most of them senior citizens --
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其中大部分死者年事已高。
19:42
and they die not of the flu but because the flu gives an assault to their immune system.
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他们死因不是流感本身，而是流感侵袭了他们的免疫系统。
19:46
And along comes pneumococcus
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随后就感染了肺炎球菌，
19:48
or another bacteria, streptococcus
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或其他的细菌，如链球菌，
19:50
and boom, they get a bacterial pneumonia.
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这些细菌大量增殖，然后流感患者就得了细菌性肺炎。
19:52
But it turns out that in 1918 that was not the case at all.
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但是1918年的流感并不是这么回事。
19:55
And so far in the H5N1 cases in people,
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到目前为止，对于感染H5N1的人群来说，
19:58
similarly bacterial infection
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类似的细菌感染
20:00
has not been an issue at all.
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还不是个问题，
20:02
It's this absolutely phenomenal disruption of the immune system
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免疫系统被严重破坏才是主要因素，
20:07
that is the key to why people die of this virus.
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这就是流感患者死亡的关键所在。
20:10
And I would just add
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最后我在补充一点，
20:12
we saw the same thing with SARS.
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在SARS爆发时我们发现了同样的问题。
20:14
So what's going on here is your body says,
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所以你的身体状况决定你的命运，
20:17
your immune system sends out all its sentinels and says,
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免疫系统释放出所有的防御信号，这些信号可能会反馈到
20:21
"I don't know what the heck this is.
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“我不知道这到底是什么，
20:23
We've never seen anything even remotely like this before."
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我从未见过与之类似的东西。”
20:26
It won't do any good to bring in the sharpshooters
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此时，免疫系统不会起到什么好的作用，
20:29
because those antibodies aren't here.
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因为体液中没有相应的免疫抗体。
20:31
And it won't do any good to bring in the tanks and the artillery
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而且，动员出所有可消灭病毒的细胞也不会起到什么作用，
20:34
because those T-cells don't recognize it either.
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因为那些T细胞也不会识别病毒。
20:37
So we're going to have to go all-out thermonuclear response,
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所以，体内将要进行的是剧烈的热反应，
20:40
stimulate the total cytokine cascade.
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启动细胞因子的级联反应效应。
20:43
The whole immune system swarms into the lungs.
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整个免疫系统将集中在肺部。
20:46
And yes they die, drowning in their own fluids, of pneumonia.
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而患者最终死于肺炎。
20:49
But it's not bacterial pneumonia.
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但这并不是细菌性肺炎，
20:51
And it's not a pneumonia that would respond to a vaccine.
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不能够对疫苗产生免疫反应的肺炎。
20:55
And I think my time is up. I thank you all for your attention.
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时间到了，谢谢大家。
20:58
(Applause)
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鼓掌
ABOUT THE SPEAKER
Laurie Garrett - Science journalistPulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health.
Why you should listen
Laurie Garrett has made a career of uncovering science and policy news that is almost too depressing to know: emerging and re-emerging diseases, and the world's general inability to deal with them. In the process, she has uncovered gaping lapses in public health and policy.
Garrett is the author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. As a science writer for Newsday, Garrett won a Pulitzer, a Peabody and two Polk awards; in 2004, she joined the Council on Foreign Relations as Senior Fellow for Global Health. She is an expert on public health -- and the fascinating ways that health policy affects foreign policy and national security.
Laurie Garrett | Speaker | TED.com