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江城武汉正经历一场大考：新型冠状病毒感染的肺炎疫情防控工作，紧张进行之际，作为疫情重灾区，武汉正式“封城”。



1月23日凌晨，武汉市新型冠状病毒感染的，肺炎疫情防控指挥部通告称，自23日10时起，全市城市公交、地铁、轮渡、长途客运暂停运营；无特殊原因，市民不要离开武汉，机场、火车站离汉通道暂时关闭，恢复时间另行通告。

而根据报道，目前全国确诊，病例达到2034例，治愈49例，死亡56例（其中确诊病例含未，明确地区169例），而且数字还在增加中……而在102年前的1918年的，西班牙大流感，堪称人类历史上最严重，的传染病。据统计，整个1918年大流感，时期，全球超过十亿人，感染流感病毒，有4000万人死亡。



今天分享的，这个ted演讲者,从事全球流行疾病，观察的laurie garrett从历次大规模病毒感染中发掘出了一些，非常可贵的经验教训，这些经验，从一定程度上可以帮助我们更加科学，地预防和防范本次新型冠状病毒肺炎的传播和治疗。

挑战病魔人能胜天么？人类能战胜这些，致命疾病么？这个ted讲者也提出了一些，惊奇的疗法。一起来看看吧。

In 2007, as the world worried about a possible avian flu epidemic, Laurie Garrett, author of "The Coming Plague," gave this powerful talk to a small TED University audience. Her insights from past pandemics are suddenly more relevant than ever.



第一个问题是我们为什么要 担心疫情的暴发? 我们关注的是什么? 我说“我们”是指我所在，的对外关系委员会 我们也包括，国家安全委员会， 当然还有生物学委员会，和公共卫生委员会。全球化使旅行增加， 因此任何一个人可以，在任何时候 到达世界上的，任何一个地方， 也就是说你所携带的，微生物与你一起周游世界。印度苏拉特瘟疫的暴发 不仅是印度的一场灾难，而且变成了全球的灾难— 全球性的关注改变，了风险等级。katrina飓风告诉，我们 不能完全依赖政府 有现行的办法应对，突发事件， 的确，一场疫情的暴发相当于，多次katrinas飓风同时发生。

So the first question is, why do we need to even worry about a pandemic threat? What is it that we re concerned about? When I say "we," I m at the Council on Foreign Relations. We re concerned in the national security community, and of course in the biology community and the public health community. While globalization has increased travel, it s made it necessary that everybody be everywhere, all the time, all over the world. And that means that your microbial hitchhikers are moving with you. So a plague outbreak in Surat, India becomes not an obscure event, but a globalized event -- a globalized concern that has changed the risk equation. Katrina showed us that we cannot completely depend on government to have readiness in hand, to be capable of handling things. Indeed, an outbreak would be multiple Katrinas at once.

目前我们最大的担心是，一种叫做h5n1的流感病毒， 有些人称其为禽流感 最早在20世纪90年代中期出现，于中国(于中国)南方， 但直到1997年我们才对，它有所认识。去年圣诞节后期，只有13个国家出现了，h5n1病毒， 但是现在多达，55个国家都 出现了这种病毒， 在鸟类中、或人类中或鸟类和人类之间，发现了这种病毒。通过在鸟类中爆发的，禽流感现象，我们可以很清楚地看到 除了美洲， 几乎全世界都，暴发了禽流感。下面我就要讲为什么，我们会暂时幸免。

Our big concern at the moment is a virus called H5N1 flu -- some of you call it bird flu -- which first emerged in southern China, in the mid-1990s, but we didn t know about it until 1997. At the end of last Christmas only 13 countries had seen H5N1. But we re now up to 55 countries in the world, have had this virus emerge, in either birds, or people or both. In the bird outbreaks we now can see that pretty much the whole world has seen this virus except the Americas. And I ll get into why we ve so far been spared in a moment.

在家禽中，特别是鸡类， 禽流感的致死率是100%。它是近几个世纪以来 我们在世界上见过的 致死性最高的病毒之一。为此，我们宰杀了大量的鸡， 但不幸的是经常不能给予农民，足够的补偿， 结果造成农民隐瞒疫情。病毒同样 沿着候鸟的迁徙，路线而传播。中国有个叫程海湖的地方 就曾经出现了这种病毒，的集中暴发。两年前，候鸟 发生了一场复杂的事件， 由于病毒发生了变异 数千候鸟死亡， 使得所感染的，物种范围急剧扩大。这些候鸟再把，病毒带到西伯利亚、欧洲和非洲等地， 这种情况在以前，是不可能发生的。

In domestic birds, especially chickens, it s 100 percent lethal. It s one of the most lethal things we ve seen in circulation in the world in any recent centuries. And we ve dealt with it by killing off lots and lots and lots of chickens, and unfortunately often not reimbursing the peasant farmers with the result that there s cover-up. It s also carried on migration patterns of wild migratory aquatic birds. There has been this centralized event in a place called Lake Chenghai, China. Two years ago the migrating birds had a multiple event where thousands died because of a mutation occurring in the virus, which made the species range broaden dramatically. So that birds going to Siberia, to Europe, and to Africa carried the virus, which had not previously been possible.

我们现在看到的就是在人类，爆发的禽流感。幸运的是，到目前为止，只是小规模的事件， 偶尔有聚集爆发的现象。在过去的两年里，病毒已经明显的突变成 两个截然不同的家族， 正如你想的那样 h5n1就是其中的分支，之一。并且h5n1有着让人，心神不安的特点。那么什么让我们如此，焦虑呢?首先， 历史上从来没有人能 为超过2.6亿人成功制备过 适时、特异性的疫苗。疾病全球大流行时，这对我们帮助不大。大家可能都听说过，我们正在储备疫苗。但是疫情一旦爆发了，没人会相信 这种方法真的有效。

We re now seeing outbreaks in human populations -- so far, fortunately, small events, tiny outbreaks, occasional clusters. The virus has mutated dramatically in the last two years to form two distinct families, if you will, of the H5N1 viral tree with branches in them, and with different attributes that are worrying. So what s concerning us? Well, first of all, at no time in history have we succeeded in making in a timely fashion, a specific vaccine for more than 260 million people. It s not going to do us very much good in a global pandemic. You ve heard about the vaccine we re stockpiling. But nobody believes it will actually be particularly effective if we have a real outbreak.

所以，一种观点认为 911之后，机场被关闭 流感季节往后推迟了两周。那么有人就认为，我们应该马上关闭机场 因为我们听说h5n1正在人群，中传播， 病毒已经突变成了人-人传染。hey,我们马上关闭机场吧。然而，超型计算机分析了 这种做法的有效性。结果表明，这并不能给我们多少，喘息之机。并且还会给防止病毒的准备计划，带来巨大的破坏。举个例子，所有的口罩都是中国，制造的。如果你把机场关闭了， 你怎么把口罩，运输到世界各地? 你又怎么把那些疫苗，的药品运输到世界的每个角落? 无论这些是否有用， 关闭机场看起来是反其，道而行。

So one thought is: after 9/11, when the airports closed, our flu season was delayed by two weeks. So the thought is, hey, maybe what we should do is just immediately -- we hear there is H5N1 spreading from human to human, the virus has mutated to be a human-to-human transmitter -- let s shut down the airports. However, huge supercomputer analyses, done of the likely effectiveness of this, show that it won t buy us much time at all. And of course it will be hugely disruptive in preparation plans. For example, all masks are made in China. How do you get them mobilized around the world if you ve shut all the airports down? How do you get the vaccines moved around the world and the drugs moved, and whatever may or not be available that would work. So it turns out that shutting down the airports is counterproductive.

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， 这种流感能通过食用 被感染动物的生肉而传播。我们已经发现它能，传染野猫和家猫， 现在还能传染宠物狗。我们在啮齿类和鼬类的实验性，喂养实验中发现， 这些动物受感染后，表现出前所未有的流感，症状--- 癫痫、中央神经系统紊乱以及局部，麻痹。这并不是那些常见的，变化多端的流感。通过我们对1918年，病毒重塑了解到的， 这种病毒仿佛模拟了，上次1918年 流感大流行， 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。随着时间的流逝，病毒进化了， 流感对人类的，难以置信的病死率也“进化”了。事实上，55%感染了H5N1病毒 的人都已经死亡。而且，感染了病毒却没有发病的 不是很多。

We re worried because this virus, unlike any other flu we ve ever studied, can be transmitted by eating raw meat of the infected animals. We ve seen transmission to wild cats and domestic cats, and now also domestic pet dogs. And in experimental feedings to rodents and ferrets, we found that the animals exhibit symptoms never seen with flu: seizures, central nervous system disorders, partial paralysis. This is not your normal garden-variety flu. It mimics what we now understand about reconstructing the 1918 flu virus, the last great pandemic, in that it also jumped directly from birds to people. We had evolution over time, and this unbelievable mortality rate in human beings: 55 percent of people who have become infected with H5N1 have, in fact, succumbed. And we don t have a huge number of people who got infected and never developed disease.

在实验性喂养猴子的，实验中 可以得知病毒实际上下调，了 一个特异的免疫系统，调控子的水平， 所以，至你于死地的 不是病毒，而是你的免疫系统，的过度反应， 也就是说：无论这种物质是不是异己，我都将其彻底铲除。结果就是，大部分的死者 是30岁以下的 健康的青壮年。大家已经知道人-人传染 至少要三种方式。幸运的是，这都涉及到近距离的接触 这还没有把世界置于，更大的危险之中。

In experimental feeding in monkeys you can see that it actually downregulates a specific immune system modulator. The result is that what kills you is not the virus directly, but your own immune system overreacting, saying, "Whatever this is so foreign I m going berserk." The result: most of the deaths have been in people under 30 years of age, robustly healthy young adults. We have seen human-to-human transmission in at least three clusters -- fortunately involving very intimate contact, still not putting the world at large at any kind of risk.

我让你们紧张了吗? 现在你可以假设，政府要做点什么了吧。我们已经花了很多钱。实际上，布什政府的钱大部分 都花在了应对炭疽 和生物恐怖袭击上面了。而且还有很多钱扔到了地方，政府及联邦政府 对传染病的研究上。最终结果就是，疫情发生时只有15个州 有资质进行 疫苗和药品的分发。一半的州在一两周之内 就会没有床位了。40个州已经面临严重，的护理人员短缺的局面， 一旦疫情爆发，麻烦就大了。

Alright, so I ve got you nervous. Now you probably assume, well the governments are going to do something. And we have spent a lot of money. Most of the spending in the Bush administration has actually been more related to the anthrax results and bio-terrorism threat. But a lot of money has been thrown out at the local level and at the federal level to look at infectious diseases. End result: only 15 states have been certified to be able to do mass distribution of vaccine and drugs in a pandemic. Half the states would run out of hospital beds in the first week, maybe two weeks. And 40 states already have an acute nursing shortage. Add on pandemic threat, you re in big trouble.

那么，人们在拿这些钱干嘛呢? 全世界范围内的演习，和训练。让我们假设疫情爆发了。所有人都要行动起来，发挥作用。主要结果是出现了，非常混乱的局面。这些人中大多数并不真正，了解他们的工作是什么。甚至于每次演习都，出现的重要问题是， 没人知道总指挥是谁。没人知道命令下达的途径。如果洛杉矶爆发疫情，市长，州长， 美国总统，还是国土安全部部长，是总指挥呢? 事实上，联邦政府说是一个叫做 首席联邦官员的家伙 而他刚好在美国运输安全局

So what have people been doing with this money? Exercises, drills, all over the world. Let s pretend there s a pandemic. Let s everybody run around and play your role. Main result is that there is tremendous confusion. Most of these people don t actually know what their job will be. And the bottom line, major thing that has come through in every single drill: nobody knows who s in charge. Nobody knows the chain of command. If it were Los Angeles, is it the mayor, the governor, the President of the United States, the head of Homeland Security? In fact, the federal government says it s a guy called the Principle Federal Officer, who happens to be with TSA.

联邦政府说 他的职责基本上就是 努力把病毒阻隔在国外，我们都知道这是不可能的。然后是主要减轻疫情 对经济的影响。剩下的就是地方上的事了。所有的事都取决于，你所居住的郡。那么你们的市议会，做得怎么样呢? 你们的将要担负重任的市长做，得怎么样呢? 大部分的地方机构，都将竞相 争取分一杯羹 得到联邦储备的一种叫做，达菲的药品 这种药可能有用，也可能没用(接下来我会讲到) 还有任何其他治疗方法 还有口罩，储备的所有物资。竞争将是激烈的。现在我们的确买到，了一种疫苗，你们可能都听说过， 由赛诺菲安万特，公司制造的。不幸的是，它仅仅针对目前流行，的h5n1病毒株。我们知道病毒是会变异的。它会成为一种新的病毒。疫苗很可能就失去作用了。这就引出了，我们下面的结论。

The government says the federal responsibility will basically be about trying to keep the virus out, which we all know is impossible, and then to mitigate the impact primarily on our economy. The rest is up to your local community. Everything is about your town, where you live. Well how good a city council you have, how good a mayor you have -- that s who s going to be in charge. Most local facilities would all be competing to try and get their hands on their piece of the federal stockpile of a drug called Tamiflu, which may or may not be helpful -- I ll get into that -- of available vaccines, and any other treatments, and masks, and anything that s been stockpiled. And you ll have massive competition. Now we did purchase a vaccine, you ve probably all heard about it, made by Sanofi-Aventis. Unfortunately it s made against the current form of H5N1. We know the virus will mutate. It will be a different virus. The vaccine will probably be useless. So here s where the decisions come in.

如果你是你们当地，那个镇的镇长。我们应该下令让人们，把宠物都圈在家里吗? 去年德国出现h5n1的时候德国人，这样做过， 以尽可能减少 由家养的宠物猫宠物狗等引发的，家庭间传播。在没有任何层流室 可以让医务人员 照顾病人的情况下，我们该怎么办呢? 香港有。我们这里没有任何类似，的设施。隔离如何呢? 北京SARS流行期间，隔离似乎的确有用。我们整个美国都没有 相同的关于隔离的政策。在一些州里不同的郡有，不同的政策。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? 所有的上班族怎么办呢?他们不会去上班的， 如果他们的孩子，不上学的话。鼓励远程办公吗?什么才有用呢?

You re the mayor of your local town. Let s see, should we order that all pets be kept indoors? Germany did that when H5N1 appeared in Germany last year, in order to minimize the spread between households by household cats, dogs and so on. What do we do when we don t have any containment rooms with reverse air that will allow the healthcare workers to take care of patients? These are in Hong Kong; we have nothing like that here. What about quarantine? During the SARS epidemic in Beijing quarantine did seem to help. We have no uniform policies regarding quarantine across the United States. And some states have differential policies, county by county. But what about the no-brainer things? Should we close all the schools? Well then what about all the workers? They won t go to work if their kids aren t in school. Encouraging telecommuting? What works?

英国政府设计了一个，远程办公模式。六周的时间里，他们让银行业所有，从业人员 假装处在疫情流行，的状态中。他们发现那些核心功能， 你知道在一定程度上银行业务，仍在运转。但你不能让人，把钱放进atm机里。没人处理信用卡业务。没人处理保险业务。经济基本处于灾难性的，状态中。那还只是上班族，银行家。

Well the British government did a model of telecommuting. Six weeks they had all people in the banking industry pretend a pandemic was underway. What they found was, the core functions -- you know you still sort of had banks, but you couldn t get people to put money in the ATM machines. Nobody was processing the credit cards. Your insurance payments didn t go through. And basically the economy would be in a disaster state of affairs. And that s just office workers, bankers.

我们不知道对于流感来说洗手，有多重要—— 震惊吧。有人认为经常洗手是，个好主意。但是实际上，科学界有个大讨论， 是关于流感人际，传播有多大比例 是通过打喷嚏和咳嗽， 多大比例是通过手的接触。医学研究所试图研究，口罩的问题。既然我们知道口罩不够用，我们能找到一种解决，办法吗? 因为美国不再生产口罩了， 所有的都是中国生产的。我们需要N95吗?一种“技术先进、领先水平、 契合脸部轮廓”的口罩? 或者我们能用别的，种类的口罩代替吗? 在SARS流行期间，我们知道在香港 大部分传播是因为 人们摘口罩时，不正确的方法。他们的手被口罩外侧，污染了， 然后就去用手擦鼻子。中招了!他们得了SARS。并不是由于飞沫传播。如果你现在上网，你能找到那么多的，虚假信息。最后你就会买这种，所谓的n95口罩。可笑。实际上我们都没有一个 防护装备标准给第一批疫情，响应者参考， 而他们将是抗击疫情，的一线人员。

We don t know how important hand washing is for flu -- shocking. One assumes it s a good idea to wash your hands a lot. But actually in scientific community there is great debate about what percentage of flu transmission between people is from sneezing and coughing and what percentage is on your hands. The Institute of Medicine tried to look at the masking question. Can we figure out a way, since we know we won t have enough masks because we don t make them in America anymore, they re all made in China -- do we need N95? A state-of-the-art, top-of-the-line, must-be-fitted-to-your-face mask? Or can we get away with some different kinds of masks? In the SARS epidemic, we learned in Hong Kong that most of transmission was because people were removing their masks improperly. And their hand got contaminated with the outside of the mask, and then they rubbed their nose. Bingo! They got SARS. It wasn t flying microbes. If you go online right now, you ll get so much phony-baloney information. You ll end up buying -- this is called an N95 mask. Ridiculous. We don t actually have a standard for what should be the protective gear for the first responders, the people who will actually be there on the front lines.

接下来是达菲。你们很可能已经听说过，这种药品， 由Hoffmann-La roche研制的专利，药品。有迹象表明， 在流行病爆发时它可以给你，一些喘息之机。你应该长期服用，这种达菲吗? 其实，达菲的其中一个副作用，是引发自杀念头。一个公共卫生调查，分析认为 大规模使用达菲 实际上将对 公共卫生措施起反作用，使事态恶化。另一个有意思的事情是：当一个人服用达菲后，只有其中20% 通过新陈代谢适当转化 为人体的活性化合物。其余的转变为稳定化合物， 在过滤中幸存下来，并进入到水系中， 从而使他们暴露给那些，能够携带流感病毒的水鸟 给它们以 产生耐药株的可能。现在我们已经在 越南人际传播 和埃及人际传播的疫情，中发现了达菲耐药株。所以我个人认为将，达菲视为 一种特效药 是非常有限的——的确非常有限。

And Tamiflu. You ve probably heard of this drug, made by Hoffmann-La Roche, patented drug. There is some indication that it may buy you some time in the midst of an outbreak. Should you take Tamiflu for a long period of time, well, one of the side effects is suicidal ideations. A public health survey analyzed the effect that large-scale Tamiflu use would have, actually shows it counteractive to public health measures, making matters worse. And here is the other interesting thing: when a human being ingests Tamiflu, only 20 percent is metabolized appropriately to be an active compound in the human being. The rest turns into a stable compound, which survives filtration into the water systems, thereby exposing the very aquatic birds that would carry flu and providing them a chance to breed resistant strains. And we now have seen Tamiflu-resistant strains in both Vietnam in person-to-person transmission, and in Egypt in person-to-person transmission. So I personally think that our life expectancy for Tamiflu as an effective drug is very limited -- very limited indeed.

尽管如此，大部分政府 还是将它们的，全部流感对策 建立在储备达菲上。俄罗斯实际上已经，储备了足够 95%的俄国人使用的达菲。我们已经储备了足够30%的人使用的达菲。我说够用，是指够两个星期用。之后就只能听天由命了，因为 疫情将持续18-24个月。一些比较穷的 饱受禽流感冲击的国家，建立起储备后， 达菲也已经失效了。它们已经过期了。从1918年 上一次大规模的疫情，中我们能知道什么呢? 联邦政府放弃了大部分，职责。结果留下了一个支离破碎的混乱，的管理局面 在整个美国。每个城市，每个郡，每个州都在各行其是。规则 和想法大相径庭。在有些案例中所有的学校，教堂， 和公共集会场所都被，关闭了。

Nevertheless most of the governments have based their whole flu policies on building stockpiles of Tamiflu. Russia has actually stockpiled enough for 95 percent of all Russians. We ve stockpiled enough for 30 percent. When I say enough, that s two weeks worth. And then you re on your own because the pandemic is going to last for 18 to 24 months. Some of the poorer countries that have had the most experience with H5N1 have built up stockpiles; they re already expired. They are already out of date. What do we know from 1918, the last great pandemic? The federal government abdicated most responsibility. And so we ended up with this wild patchwork of regulations all over America. Every city, county, state did their own thing. And the rules and the belief systems were wildly disparate. In some cases all schools, all churches, all public venues were closed.

18个月的时间里疫情，反复了三次， 即使当时并没有，商业航空旅行。第二波变异株极具杀伤力。第一波时我们还有足够，的医护人员。但是第二波袭来时， 医护人员损失惨重， 我们失去了抗击疫情前线的大部分，的医生和护士。死亡人数总计70万人。对孕妇来说，这种病毒是100%致命的。而且我们不是很清楚原因。大多数的死亡，案例介于15-40岁之间—— 健康的青壮年。就像瘟疫一样。实际死亡人数我们，不是很清楚。保守估计是三千五百万。这个数字是根据欧洲和北美洲的，数据统计的。

The pandemic circulated three times in 18 months in the absence of commercial air travel. The second wave was the mutated, super-killer wave. And in the first wave we had enough healthcare workers. But by the time the second wave hit it took such a toll among the healthcare workers that we lost most of our doctors and nurses that were on the front lines. Overall we lost 700,000 people. The virus was 100 percent lethal to pregnant women and we don t actually know why. Most of the death toll was 15 to 40 year-olds -- robustly healthy young adults. It was likened to the plague. We don t actually know how many people died. The low-ball estimate is 35 million. This was based on European and North American data.

哈佛大学的Chris murray的一项最新，研究 表明，如果你看看在印度 由英国人维护，的数据库的话， 就会发现印度人的，死亡率是平均水平的31倍。所以，一个坚定地信念是在，贫穷地区 死亡人数更高。死亡人数更可能是 大约八千万到一亿， 在我们开通商业航空，旅行前。那么，我们准备好了吗? 作为一个国家来说，我们还没有。我确定即使是那些领导人 也会说事实上 我们还差得很远。

A new study by Chris Murray at Harvard shows that if you look at the databases that were kept by the Brits in India, there was a 31-fold greater death rate among the Indians. So there is a strong belief that in places of poverty the death toll was far higher. And that a more likely toll is somewhere in the neighborhood of 80 to 100 million people before we had commercial air travel. So are we ready? As a nation, no we re not. And I think even those in the leadership would say that is the case, that we still have a long ways to go.

那么，这对你来说意味着什么呢?第一件事就是， 别为你自己、 你的家人或者你，的员工建立任何个人储备， 除非你真的做足了功课。什么口罩有用?什么口罩没用? 你需要多少口罩呢? 医学研究所研究认为 口罩不能反复使用。那么，如果你觉得疫情将，持续18个月的话， 你会为你家里的每个人 买足够18个月使用的，口罩吗?

So what does that mean for you? Well the first thing is, I wouldn t start building up personal stockpiles of anything -- for yourself, your family, or your employees -- unless you ve really done your homework. What mask works, what mask doesn t work. How many masks do you need? The Institute of Medicine study felt that you could not recycle masks. Well if you think it s going to last 18 months, are you going to buy 18 months worth of masks for every single person in your family?

关于达菲，我们仍不知道 其主要的副作用是 流感样症状。那么，你怎样才能分辨 谁得了流感呢 如果家里人都服用达菲，的话? 如果扩大到整个社区， 或者你公司的，所有员工的话， 你就会开始意识到 选择达菲其作用，可能将多么有限。所有人都来跟我讲， 我要储备水，或者我要储备食物，或者你储备了什么。但是真的吗?你真的有地方 储备18个月的食物吗?24个月的食物吗? 你要像 过去20世纪50年代，冷战时期 的人们看待民防设施那样， 建立你自己的小小防空洞来对付，流感疫情吗? 我认为那是不理智的。

We don t know -- again with Tamiflu, the number one side effect of Tamiflu is flu-like symptoms. So then how can you tell who in your family has the flu if everybody is taking Tamiflu? If you expand that out to think of a whole community, or all your employees in your company, you begin to realize how limited the Tamiflu option might be. Everybody has come up to me and said, well I ll stockpile water or, I ll stockpile food, or what have you. But really? Do you really have a place to stockpile 18 months worth of food? Twenty-four months worth of food? Do you want to view the pandemic threat the way back in the 1950s people viewed the civil defense issue, and build your own little bomb shelter for pandemic flu? I don t think that s rational.

我觉得必须是，以社区做准备， 不是以个人， 要以国家做准备， 以州来做准备，以城镇做准备。就目前来说，大部分准备工作 都存在严重缺陷。我希望我已经说服了你们， 真正的工作是 去跟你们的地方长官， 你们的国家领导人说， “为什么你还没，解决这些问题? 为什么你们仍然认为 卡特里娜飓风的教训不会在流感，疫情中重演?” 把压力施加在需要施压，的地方。但是我猜另一个，需要补充的是， 如果你真的有雇员，真的有一个公司， 我觉得你有责任 去证明你在，为他们早做打算， 你在努力安排。英国的银行模式至少表明 远程办公可能有用。可能它真的减少了暴露， 因为人们不再进到，办公室里对着彼此咳嗽， 或者接触公共物品， 经由他们的手共用物品。但是你能那样维持，你的公司吗? 如果你有一个网站的话，也许你可以。否则你就麻烦了。很高兴回答你们的问题。

I think it s about having to be prepared as communities, not as individuals -- being prepared as nation, being prepared as state, being prepared as town. And right now most of the preparedness is deeply flawed. And I hope I ve convinced you of that, which means that the real job is go out and say to your local leaders, and your national leaders, "Why haven t you solved these problems? Why are you still thinking that the lessons of Katrina do not apply to flu?" And put the pressure where the pressure needs to be put. But I guess the other thing to add is, if you do have employees, and you do have a company, I think you have certain responsibilities to demonstrate that you are thinking ahead for them, and you are trying to plan. At a minimum the British banking plan showed that telecommuting can be helpful. It probably does reduce exposure because people are not coming into the office and coughing on each other, or touching common objects and sharing things via their hands. But can you sustain your company that way? Well if you have a dot-com, maybe you can. Otherwise you re in trouble. Happy to take your questions.

观众：决定疫情持续时间长短，的因素是什么呢?

Audience member: What factors determine the duration of a pandemic?

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。我可以给你，一堆草率的说法，这个，那个，还有别的。但是我可以坦率地说，我们真的不知道。显然至少 病毒的毒性最终会减弱， 对人类不再是致命的病毒， 然后找到其他宿主。但我们并不十分清楚，这些是如何发生的，为什么发生。真是个很复杂，的生态学问题。

Laurie Garret: What factors determine the duration of a pandemic, we don t really know. I could give you a bunch of flip, this, that, and the other. But I would say that honestly we don t know. Clearly the bottom line is the virus eventually attenuates, and ceases to be a lethal virus to humanity, and finds other hosts. But we don t really know how and why that happens. It s a very complicated ecology.

观众：你在寻找什么样的起因呢? 你知道的比我们这里任何，一个人都多。可以说，如果这个起因发生了，流行病就将发生。

Audience member: What kind of triggers are you looking for? You know way more than any of us. To say ahh, if this happens then we are going to have a pandemic?

LG：当你发现任何 人际传播的证据时。不仅是亲密的 照顾生病的兄弟姐妹的，家庭成员之间， 而是一个社区被传染 在一个学校里传播， 在一个集体宿舍区里传播，有那种特征的事件。我觉得然后就由WHO 从上而下形成普遍共识， 发出警报。

LG: The moment that you see any evidence of serious human-to-human to transmission. Not just intimately between family members who took care of an ailing sister or brother, but a community infected -- spread within a school, spread within a dormitory, something of that nature. Then I think that there is universal agreement now, at WHO all the way down: Send out the alert.

观众：有些研究表明他汀，类药物可能有用。你能谈谈这个吗?

Audience member: Some research has indicated that statins can be helpful. Can you talk about that?

LG：好的。有证据支持服用 他汀类药剂或者其他，普通的控制胆固醇含量的抑制素 可能会降低 流感的易感性。但我们不能完全明白原因。机制尚不明确。而且我不知道 让某人开始给 他们自己的孩子服用 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。我们完全不知道后果如何。也许会给你的，孩子带来非常严重的后果， 这样做的话。

LG: Yeah. There is some evidence that taking Lipitor and other common statins for cholesterol control may decrease your vulnerability to influenza. But we do not completely understand why. The mechanism isn t clear. And I don t know that there is any way responsibly for someone to start medicating their children with their personal supply of Lipitor or something of that nature. We have absolutely no idea what that would do. You might be causing some very dangerous outcomes in your children, doing such a thing.

观众：需要多长时间才能鉴定出 一个人是否是病毒携带者，或是否已经感染这种病毒? 症状完全出现之前

Audience member: How far along are we in being able to determine whether someone is actually carrying, whether somebody has this before the symptoms are full-blown?

LG:哦。很早以前我就说过， 我们真正需要的就是快速，诊断程序。我们的疾病控制中心 已经把他们自己研发的，实验列为 快速诊断程序。这个检测在一个，非常先进的实验室 由技术娴熟的操作人员完成的，话需要24小时。而我所想的是试纸诊断。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 来告诉你是否，感染了h5n1。就目前科学上的 dna鉴定及其他高端，技术的鉴定能力来讲， 快速诊断程序离我们不会，太遥远了。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。

LG: Right. So I have for a long time said that what we really needed was a rapid diagnostic. And our Centers for Disease Control has labeled a test they developed a rapid diagnostic. It takes 24 hours in a very highly developed laboratory, in highly skilled hands. I m thinking dipstick. You could do it to your own kid. It changes color. It tells you if you have H5N1. In terms of where we are in science with DNA identification capacities and so on, it s not that far off. But we re not there. And there hasn t been the kind of investment to get us there.

观众：在1918年的流感中，我了解到 研究人员从理论上推测：病毒毒力已经有些衰减 当其传染到人群时。您认为现在可能吗? 我的意思是100%的致死率 是相当严重的。

Audience member: In the 1918 flu I understand that they theorized that there was some attenuation of the virus when it made the leap into humans. Is that likely, do you think, here? I mean 100 percent death rate is pretty severe.

LG:哦。事实上，我们并不知道 1918年病毒株 对野鸟的致死率如何， 当其从鸟传染到人之前。令人好奇的是，没有任何证据表明 全美范围内鸡或家禽 大量死亡事件发生在 人类流行病爆发之前。这也可能是大量死亡事件 发生在地球另一个地方， 在那里，人们没有给予关注。但是病毒确实是在 全球范围内 以一种温和的形式传播，了一圈， 正如英国军队所证实，的那样：在一战中， 这场流行病并没有威胁性 也不会影响战争的结果。病毒在全球范围，内传播一圈后 又以一种巨大致死力的，方式再次传播。感染人群里到底，有多大死亡率，、 我们仍不确定。但明确的是，如果营养不良， 免疫力低下， 生活在印度或非洲，等贫困地区， 那么死亡的机率就，大大增加。但是事实如何，我们确实不知道。

LG: Um yeah. So we don t actually know what the lethality was of the 1918 strain to wild birds before it jumped from birds to humans. It s curious that there is no evidence of mass die-offs of chickens or household birds across America before the human pandemic happened. That may be because those events were occurring on the other side of the world where nobody was paying attention. But the virus clearly went through one round around the world in a mild enough form that the British army in World War I actually certified that it was not a threat and would not affect the outcome of the war. And after circulating around the world came back in a form that was tremendously lethal. What percentage of infected people were killed by it? Again we don t really know for sure. It s clear that if you were malnourished to begin with, you had a weakened immune system, you lived in poverty in India or Africa, your likelihood of dying was far greater. But we don t really know.

观众：我所听到的是， 感染流感后，真正的死因是，流感导致的肺炎。而肺炎疫苗 能带来50%的生存机率。

Audience member: One of the things I ve heard is that the real death cause when you get a flu is the associated pneumonia, and that a pneumonia vaccine may offer you 50 percent better chance of survival.

LG:在很长一段时间内，致力于研究新发疾病，的研究人员 都有点轻视流感的威胁， 因为他们认为 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。每年很多人死于普通流感， 全球死于普通流感的人数 大约是36万， 其中大部分死者年事已高。他们死因不是流感本身，而是流感侵袭了他们，的免疫系统。随后就感染了肺炎球菌， 或其他的细菌，如链球菌， 这些细菌大量增殖，然后流感患者就，得了细菌性肺炎。但是1918年的流感，并不是这么回事。到目前为止，对于感染h5n1，的人群来说， 类似的细菌感染 还不是个问题， 免疫系统被严重破坏才是，主要因素， 这就是流感患者，死亡的关键所在。

LG: For a long time, researchers in emerging diseases were kind of dismissive of the pandemic flu threat on the grounds that back in 1918 they didn t have antibiotics. And that most people who die of regular flu -- which in regular flu years is about 360,000 people worldwide, most of them senior citizens -- and they die not of the flu but because the flu gives an assault to their immune system. And along comes pneumococcus or another bacteria, streptococcus and boom, they get a bacterial pneumonia. But it turns out that in 1918 that was not the case at all. And so far in the H5N1 cases in people, similarly bacterial infection has not been an issue at all. It s this absolutely phenomenal disruption of the immune system that is the key to why people die of this virus.

最后我在补充一点， 在sars爆发时我们，发现了同样的问题。所以你的身体状况决定，你的命运， 免疫系统释放出所有的，防御信号，这些信号可能会反馈到 “我不知道这到底是什么， 我从未见过与之类似，的东西。” 此时，免疫系统不会起到什么好的，作用， 因为体液中没有，相应的免疫抗体。而且，动员出所有可消灭病毒，的细胞也不会起到什么作用， 因为那些t细胞，也不会识别病毒。所以，体内将要进行的是，剧烈的热反应， 启动细胞因子的级联，反应效应。整个免疫系统将，集中在肺部。而患者最终死于肺炎。但这并不是细菌性肺炎， 不能够对疫苗产生免疫，反应的肺炎。时间到了，谢谢大家。

And I would just add we saw the same thing with SARS. So what s going on here is your body says, your immune system sends out all its sentinels and says, "I don t know what the heck this is. We ve never seen anything even remotely like this before." It won t do any good to bring in the sharpshooters because those antibodies aren t here. And it won t do any good to bring in the tanks and the artillery because those T-cells don t recognize it either. So we re going to have to go all-out thermonuclear response, stimulate the total cytokine cascade. The whole immune system swarms into the lungs. And yes they die, drowning in their own fluids, of pneumonia. But it s not bacterial pneumonia. And it s not a pneumonia that would respond to a vaccine. And I think my time is up. I thank you all for your attention.

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