耶魯教授：新冠肺炎進入關鍵節點，接下來應該如何打？

　　隨著新型冠狀性病毒感染者數量和多個國家都出現疫情的事實，世界衛生組織宣布將新型冠狀病毒疫情列為“國際關注的突發公共衛生事件” （Public Health Emergency of International Concern）。

　　對于新冠病毒藥物和疫苗研發，我們該抱有怎樣的期待？疫情的拐點何時到來？對于已經“自我隔離”了十余天的多數中國人而言，這場新型冠狀病毒的“全民阻擊戰”接下來應該如何打？

　　中國國際電視臺（CGTN）主持人鄒悅在《對話》欄目中采訪了耶魯大學公共健康和社會政策助理教授陳希，就疫情的當前防控和未來走勢提出了一些關鍵問題。

　　（下文為對話的英文摘錄和中文翻譯，摘錄時有刪改。）

　　01

　　Moderator: Mr. Chen, where are we in terms of this fight against a new coronavirus?

　　Chen: Yes, this virus outbreak has very much caught us off guard and it has spread very quickly and it’s very contagious, and the origin of this virus is still unknown. It looks like the death rate is lower than SARS but more people are impacted at a much faster speed. So we have very limited time to respond but I think the release of information about the human to human transmission led the government to take many measures, like the lockdown of the major cities. And there was some evidence showing that the lockdown has been effective because they found a lower number of transmissions, which means that people who were infected are infecting fewer people. So the number is going down, and that’s great. And also the Chinese government wanted to extend the holiday season in order to bypass the risk of transmission during the incubation time to make everyone safe. They also are taking very concrete measures in health policy like insurance reimbursement and are also trying their best to enforce the screening of people in primary care before they flood into the hospital.

　　主持人：陳教授，您認為我們目前抗擊新型冠狀病毒的斗爭處在什么階段？

　　陳希：新型冠狀病毒爆發非常突然，且其傳播速度非常之快，讓我們有些措手不及。目前也尚未找到病毒的源頭。相比SARS, 這次的病毒致死率相對較低但是傳染速度更快，以致于我們的反應時間非常有限。在確定該病毒具有人傳人的屬性后，我認為政府的確采取了很多措施，如封鎖病毒高發城市。有數據表明武漢封城對于緩解疫情傳播起到了有效的作用，這樣可以控制病毒不至于傳播更多的人。而且，政府也延長了春節假期度過病毒的潛伏期，以避免更大規模的感染。同時，中國的醫療體系也采取了有效手段，如醫保報銷，并且盡量嘗試在基層醫療對居民進行篩查，避免大量人群涌向大醫院。

　　02

　　Moderator: A lot of people are asking the same question: are we approaching the turning point? Because over the past 10 days we’ve seen cases jumping from a hundred to ten thousand. What do you make of the increased speed of infected cases in China?

　　Chen: I think the current data assessment shows that it’s still on the rise but we are closer to what we would call the “plateau” of this infection. So we see more fluctuations in the trend of new confirmed cases and new suspended cases which are good signals because that means we are closer to a more stabilized point where the new cases will be gradually stabilized and hopefully soon reducing. So we are closer and we should be confident although it will take more time, could be like 10 days or so.

　　主持人：中國抗擊新型冠狀病毒是否已經到了關鍵節點？在過去的10天內，受傳染人數從百人左右迅速上升到了超過一萬人，是什么造成了中國如此之快的感染速度？

　　陳希：我認為目前的數據表明受感染人數依然呈上升趨勢，但是已接近平穩期。能看出新增確診病例和疑似病例的數量上有所波動，這預示著疫情即將趨于穩定，之后數量將逐步下降。這個時候我們應該更加自信，當然這也需要大概10天左右的更長時間。

　　03

　　Moderator: A lot of people worry about the phenomenon of some people who may not show any symptoms but still could carry the virus, and they could be spreaders. How concerned are you about this?

　　Chen: Yes, I would say this is really indeed a concern, but I would say most of the cases have shown symptoms before they are infecting others. So I think a good way to enhance health education and to help promote the healthy behavior of individuals is to show the correct way to wear face masks and also encourage frequently washing hands. Those avoidance behaviors of protection will reduce the chance of being infected by those without symptoms. And this is also a concern for different countries in the U.S., Europe, and other countries； they also have found some symptomatic cases, so they are taking measures. And if that is the case, the patient should stay at home and be screened before they go into hospitals. They should take more cautious measures in order to avoid all people going to the hospital and causing further infection.

　　主持人：處于尚未有癥狀的潛伏期患者依然具有病毒傳播性，我們應該如何預防潛伏期傳播呢？

　　陳希：沒錯，這的確是一件很令人擔憂的事情。但是，好在大部分的患者都是在傳染其他人之前出現的癥狀。所以我認為一個有效的預防措施就是提高個人衛生教育，比如我們應該正確佩戴口罩、勤洗手等等。這些預防措施能夠降低被感染的風險。同樣，新型冠狀病毒在美國、歐洲等國家也相繼發現，所以他們也應該警惕潛伏期傳播的風險。如果患者處于潛伏期，應該將自己隔離在家中，并且在去醫院之前應該先進行體溫檢測，從而避免涌向醫院后的交叉感染。

　　04

　　Moderator: As you said, the epicenter Wuhan with a population of 11 million people is now in lockdown, and also the central government is encouraging people all over the country to have minimal travel. How long do you think this kind of restriction of movement will be in place in this massive, populous country?

　　Chen: I think the very critical time point was the starting date of the lockdown, meaning when the last group of people were leaving Wuhan, they would still have an incubation time period and that takes time for them to develop symptoms. So it really depends on the length of incubation and incubation time, which according to the current evidence, it could last from 4 days till 10 days. Thus, early February would be very dangerous for those individuals to be developing any symptoms. So, I would say it could be like a little bit later than February 2, which is the end of the public holiday. The government may have already considered this in deciding to extend the public holidays, especially for some certain occupations. And the government may want to screen the flow back for the people who are leaving Wuhan because that reduces the population density of the traffic transportation system.

　　主持人：正如您所言，擁有一千一百萬人口的武漢作為疫情爆發的中心已經被封城，中國政府也在建議盡量減少全國范圍人口的流動。您覺得這種限制將會持續多久呢？

　　陳希：我認為一個很重要的時間節點是封城前，有最后一批人群離開武漢，他們中有一部分人極有可能處于病毒潛伏期。根據目前的數據，潛伏期的時間一般在4天至10天左右。所以2月初是個非常危險的節點，這些人中可能會出現發病癥狀，我個人認為出現癥狀的時間會比2月2日再晚一些。政府已經考慮到了這一點，所以他們讓大部分企業延長了春節假期，并且加強對返程人口的體溫排查，以降低公共交通的人群密集度。

　　05

　　Moderator: But the lockdown happened on January the 23rd. And Wuhan’s mayor said 5 million travelers already left the city before the lockdown and they are all stranded in different places all over the world. And they are actually trying to stay quarantined, but still how worried should we be when these people are moving back to their city or moving elsewhere?

　　Chen: That’s a great question. So, when they return back, they already passed the incubation time. So they should be safe without transmitting the disease to others. So we should be more worried about things like stigma. The WHO Director-General mentioned that we should have more solidarity instead of stigma. So that means we really need to treat them without discrimination. And one more thing I worried a little bit about is those 5 million people, many of them went back to their home county, the villages. And we know that rural China is a weak point for infectious disease. We should monitor not only urban areas, but also keep a close eye on rural counties. That’s very important.

　　主持人：武漢封城是在1月23日，武漢市長說有500萬人群在封城之前從武漢離開并且涌向世界各地。雖然他們一部分人有效地進行了隔離，我們是否仍然需要擔心他們再回到武漢或者其他地方呢？

　　陳希：這是個很好的問題。當他們返城時，由于已經過了潛伏期，他們應該是沒有傳染給其他人的風險的。所以我們更應該擔心的是歧視問題。世界衛生組織總干事也提到我們在這個時候更應該同心協力而不是產生歧視。另一個我比較擔心的問題是，這500萬流動人口中，有許多人回到了鄉村。我們知道中國的鄉村目前處于病毒傳染的薄弱環節。我們不應該只關注城市，更應該做好鄉村的疫情防控，這一點尤為重要。

耶魯大學公共健康和社會政策助理教授陳希

　　06

　　Moderator: So Dr.Chen, it seems like a vaccine is still several months down the road, so medically what is the best way to treat those patients, and can the medical facilities handle tens of thousands of patients right now?

　　Chen: I think currently the healthcare system is overwhelmed, there is no effective cure and the vaccine needs at least a few months time to be developed. But there is some encouraging news: the declaration of an emergency of international concern will accelerate information sharing and collaboration in the scientific world to fasten the development of a vaccination and any kind of therapeutics. It takes time because it needs animal testing and human testing, but it will fasten this process.

　　I heard from the news that a vaccine will be developed within the next couple of months.

　　And there is encouraging news that the WHO and global communities are coming in to join this initiative. More and more pharmaceutical companies are joining. And the funders and donators are trying to fund those kinds of research and development.

　　主持人：陳教授，疫苗研發似乎還需要幾個月時間，從醫學上來說，治療這些病人最好的方式是什么？目前的醫療設施能應對上萬病人的治療嗎？

　　陳希：我認為目前的醫療系統負擔確實有些重，目前還沒有對癥的治療辦法，疫苗需要至少幾個月才能被研發出來。但是一個好消息是由于被宣布為“國際關注的突發公共衛生事件”，這將加速科學界的信息共享合作，從而加速疫苗和其他療法的研發。到目前為止，這需要時間，因為還需要大量的動物試驗和人體試驗。但國際上的關注會加快這一進程。

　　我也從新聞上獲悉，疫苗將在接下來的幾個月被研發出來。而且好消息是，世衛組織和其他全球社區都將參與進來。更多的制藥公司也在加入進來，而且一些資助者和捐贈者也在出資推動研發。

　　07

　　Moderator: We’ve actually been here before, 17 years ago, when China witnessed the outbreak of SARS. But in terms of the medical care system and scientific research capabilities, is China better off now than 17 years ago?

　　Chen: Yes, I would agree with that and also after SARS, China’s CDC developed a system they called the surveillance early warning system of infectious disease. So the system was linked in the local hospitals with the CDC directly. So any infectious disease cases, about 5 cases, then they are able to trigger this warning system. They have to press a button and fill out some information, then the national level of the CDC would receive it. However, this early warning system tends to be insensitive to new types of infectious diseases. In such cases, local medical workers even have difficulty reporting, which could weaken the functioning of the early alerting.

　　But I would say that we still need to strengthen our primary care system. In the last ten years, China just celebrated the 10th year anniversary of new healthcare reform. But that reform mostly focuses on empowering hospitals. So we still need time to develop the integrated care system to empower local care. So then people will have better care options to treat those mild symptoms instead of flooding into the hospitals, which will be very dangerous in the case of infectious diseases. People can be cross-infected.

　　主持人：其實我們遇到過這種狀況，17年前，中國經歷了非典的爆發。目前從醫療系統和科研能力的角度來看，中國的應對能力是否比17年前更強？

　　陳希：是的我同意，而且經過“非典”后，中國疾控中心開發了一個系統，他們叫這個系統為“中國傳染病與突發公共衛生事件監測信息系統（簡稱網絡直報系統）”，這套網絡直報系統會將各地醫院和疾控中心直接連接起來。所以一個地方發現了任何傳染病病例超過5例，就自動觸發核查機制。只要醫院就點擊報告病例，并填寫相應信息，中國國家疾控中心馬上就能收到。然而這個系統對于過去未曾發生過的傳染病類型不敏感，以致出現這種情況后當地醫務人員無法上報。因此，無法更有效地達到預警之目的。

　　但我想說，我們仍然需要加強初級保障系統。中國剛剛慶祝了新醫療改革十周年，不過這項改革大部分聚焦在加強醫院的管理，我們仍然需要時間去開發整合型的保障系統從而加強地方醫療保障，讓人們能有更好的醫療場所治療輕微的癥狀，而不是全都涌向大醫院。這對傳染性疫病來說非常危險，人們會交叉感染。

　　08

　　Moderator：And very briefly, what worries you the most and what encourages you the most at this moment?

　　Chen: What worries me the most is uncertainty. I think this epidemic could have brought us more infected cases and higher case fatality rates given vulnerable healthcare systems and a low level of preparedness in many countries, not only for China, but also countries with fragile health systems like the WHO Director -General mentioned. So I think that was part of the reason he was announcing this emergency.

　　And what encourages me the most is that the government really is taking timely measures to share the gene of the pathogen, and also very stringent measures to lock down major cities to cut the flow of transportation. That was unprecedented, otherwise we would be in a worse situation.

　　主持人：您能不能簡要和我們說說什么最讓您擔心，什么又能讓您看到一些希望？

　　陳希：最讓我擔心的是不確定性。我認為這次疫情真的在全球多國脆弱的醫療體系和不充分的應對下很可能帶來更多的傳染和更高的死亡率，不僅是在中國，也是世界衛生組織總干事提到的對于很多具有脆弱的衛生健康體系的國家。所以我想這也是為什么世界衛生組織宣布這一突發事件的部分原因。

　　最讓我覺得有希望的是政府采取了及時的措施分享病原體基因，而且也采取非常嚴格的措施把主要的城市封住以減少交通帶來的人員流動。這也是史無前例的，否則我們真的會陷入一個更不好的境遇。