Laurie Garrett: What can we learn from the 1918 flu?

199,368 views ・ 2009-04-30

TED


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00:12
So the first question is, why do we need to
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Prvo pitanje je, zašto se uopće moramo
00:14
even worry about a pandemic threat?
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brinuti o opasnosti od pandemije?
00:17
What is it that we're concerned about?
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Što nas to zabrinjava?
00:19
When I say "we," I'm at the Council on Foreign Relations.
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Kad kažem „mi“, ja sam u vijeću za vanjske odnose.
00:22
We're concerned in the national security community,
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Mi smo uključeni u nacionalnu sigurnost zajednice,
00:24
and of course in the biology community and the public health community.
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i, naravno, u biologiju zajednice i javno zdravstvo zajednice.
00:27
While globalization has increased travel,
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Kako je globalizacija povećala putovanje,
00:29
it's made it necessary that everybody be everywhere,
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učinila je potrebnim da svatko bude svagdje,
00:32
all the time, all over the world.
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stalno i diljem svijeta.
00:34
And that means that your microbial hitchhikers are moving with you.
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I to znači da se vaši bakterijski autostoperi pokreću s vama.
00:37
So a plague outbreak in Surat, India
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Stoga početak kuge u Suratu u Indiji
00:39
becomes not an obscure event, but a globalized event --
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ne postaje neprimjetan slučaj, nego globalni slučaj –
00:42
a globalized concern that has changed the risk equation.
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globalna briga koja je promijenila jednadžbu rizika.
00:45
Katrina showed us
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Katrina nam je pokazala
00:47
that we cannot completely depend on government
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da ne možemo u potpunosti ovisiti o vladinoj spremnosti
00:49
to have readiness in hand, to be capable of handling things.
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na rješavanje stvari.
00:52
Indeed, an outbreak would be multiple Katrinas at once.
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Zaista, pojava pandemije bila bi višestruka Katrina.
00:56
Our big concern at the moment is a virus called H5N1 flu --
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Trenutno je naša velika briga virus nazvan H5N1 gripa.
00:59
some of you call it bird flu --
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Neki je od vas zovu ptičja gripa.
01:01
which first emerged in southern China, in the mid-1990s,
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Ona je prvo izbila u južnoj Kini, sredinom devedesetih.
01:04
but we didn't know about it until 1997.
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Ali nismo znali za nju do 1997.
01:07
At the end of last Christmas only 13 countries had seen H5N1.
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Krajem prošlog Božića samo je trinaest zemalja vidjelo H5N1.
01:11
But we're now up to 55 countries in the world,
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Ali sada imamo 55 zemalja diljem svijeta
01:13
have had this virus emerge,
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gdje je virus izbio
01:15
in either birds, or people or both.
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ili u ptica, ili u ljudi, ili oboje.
01:18
In the bird outbreaks we now can see
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U izbijanjima kod ptica, možemo vidjeti
01:20
that pretty much the whole world has seen this virus
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da je gotovo cijeli svijet vidio ovaj virus,
01:23
except the Americas.
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osim Amerika.
01:25
And I'll get into why we've so far been spared in a moment.
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I doći ću do toga zašto smo dosada bili pošteđeni.
01:29
In domestic birds, especially chickens,
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Kod domaćih ptica, pogotovo kokoši,
01:31
it's 100 percent lethal.
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virus je 100 posto smrtonosan.
01:33
It's one of the most lethal things we've seen
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To je jedna od najsmrtonosnijih stvari koje smo vidjeli
01:35
in circulation in the world
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na djelu u svijetu
01:37
in any recent centuries.
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posljednjih stoljeća.
01:39
And we've dealt with it by killing off lots and lots and lots of chickens,
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I suočavali smo se s time tako što smo ubijali strahovito puno pilića
01:42
and unfortunately often not reimbursing the peasant farmers
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i nažalost, često bez naknade seljacima
01:45
with the result that there's cover-up.
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koja bi pokrila te troškove.
01:47
It's also carried on migration patterns
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Ubijanje je također provođeno na migracijskim uzorcima
01:49
of wild migratory aquatic birds.
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divljih vodenih ptica selica.
01:52
There has been this centralized event
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Bio je centralizirani slučaj u mjestu
01:54
in a place called Lake Chenghai, China.
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po imenu jezero Chenghai u Kini.
01:56
Two years ago the migrating birds
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Prije dvije godine ptice selice
01:58
had a multiple event
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su doživjele višestruki slučaj
02:00
where thousands died because of a mutation occurring
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kada su tisuće umrle zbog mutacija
02:02
in the virus,
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u virusu,
02:04
which made the species range broaden dramatically.
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što je drastično proširilo raspon vrsta.
02:07
So that birds going to Siberia, to Europe, and to Africa
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Te ptice koje idu u Sibir, Europu i Afriku
02:10
carried the virus, which had not previously been possible.
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prenijele su virus, što prije nije bilo moguće.
02:13
We're now seeing outbreaks in human populations --
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Sada vidimo izbijanja u ljudskoj populaciji.
02:17
so far, fortunately, small events,
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Dosad, srećom, mali slučajevi,
02:20
tiny outbreaks, occasional clusters.
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sitna izbijanja, povremeno grupe.
02:23
The virus has mutated dramatically in the last two years
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Virus je dramatično mutirao u zadnje dvije godine
02:26
to form two distinct families, if you will,
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i oblikovao dvije posebne „obitelji“, može se reći,
02:29
of the H5N1 viral tree
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H5N1 virusnog drveta
02:31
with branches in them,
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s granama na njemu
02:33
and with different attributes that are worrying.
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i s različitim zabrinjavajućim svojstvima.
02:35
So what's concerning us? Well, first of all,
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Dakle, što nas zabrinjava? Pa, kao prvo,
02:37
at no time in history have we succeeded in making
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ni u jednom vremenu u povijesti nismo uspjeli
02:40
in a timely fashion, a specific vaccine
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pravovremeno napraviti posebno cjepivo
02:42
for more than 260 million people.
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za više od 260 milijuna ljudi.
02:45
It's not going to do us very much good in a global pandemic.
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Neće nam pomoći jako puno u svjetskoj pandemiji.
02:48
You've heard about the vaccine we're stockpiling.
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Čuli ste o cjepivu koje skladištimo.
02:51
But nobody believes it will actually be particularly effective
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Ali nitko zapravo ne vjeruje da će biti osobito djelotvorno
02:53
if we have a real outbreak.
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ako budemo imali pravo izbijanje.
02:55
So one thought is:
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Zato je jedna misao:
02:57
after 9/11, when the airports closed,
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poslije 11. rujna zatvaranje je zračnih luka
02:59
our flu season was delayed by two weeks.
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odgodilo sezonu gripe za dva tjedna.
03:01
So the thought is, hey, maybe what we should do is just
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Stoga, pomisao je: hej možda ono što trebamo napraviti
03:03
immediately -- we hear there is H5N1 spreading from human to human,
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jest da samo smjesta – čuli smo da se H5N1 širi sa čovjeka na čovjeka,
03:07
the virus has mutated to be a human-to-human transmitter --
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virus je mutirao da bude prenosilac sa čovjeka na čovjeka –
03:09
let's shut down the airports.
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zatvorimo zračne luke.
03:11
However, huge supercomputer analyses,
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Međutim, ogromna analiza superračunala,
03:15
done of the likely effectiveness of this,
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načinjena prema mogućoj učinkovitosti ovoga,
03:17
show that it won't buy us much time at all.
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pokazuje da nam to uopće neće dati puno vremena.
03:19
And of course it will be hugely disruptive in preparation plans.
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I naravno, da će iznimno remetiti pripremu planova.
03:23
For example, all masks are made in China.
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Na primjer, sve maske izrađuju se u Kini.
03:26
How do you get them mobilized around the world
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Kako ćete ih dijeliti diljem svijeta
03:28
if you've shut all the airports down?
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ako ste zatvorili sve zračne luke?
03:30
How do you get the vaccines moved around the world
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Kako ćete raznijeti cjepiva diljem svijeta,
03:32
and the drugs moved, and whatever may or not be available that would work.
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i lijekove, i štogod bude ili ne bude dostupno i djelotvorno.
03:35
So it turns out that shutting down the airports is counterproductive.
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Dakle, ispada da je zatvaranje zračnih luka kontraproduktivno.
03:39
We're worried because this virus, unlike any other flu
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Zabrinuti smo zato što ovaj virus, za razliku od bilo koje gripe
03:42
we've ever studied, can be transmitted by eating raw meat
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koju smo ikada proučavali, može biti prenošen jedenjem sirovog mesa
03:46
of the infected animals.
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zaraženih životinja.
03:48
We've seen transmission to wild cats and domestic cats,
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Vidjeli smo prijenos na divlje mačke i domaće mačke,
03:51
and now also domestic pet dogs.
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a sada i na domaće pse.
03:54
And in experimental feedings to rodents and ferrets,
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I u eksperimentalnom hranjenju glodavaca i lasica
03:57
we found that the animals exhibit symptoms never seen with flu:
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otkrili smo da životinje pokazuju simptome nikad viđene kod gripe,
04:01
seizures, central nervous system disorders, partial paralysis.
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napadaje, poremećaje središnjeg živčanog sustava, djelomičnu paralizu.
04:04
This is not your normal garden-variety flu.
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Ovo nije uobičajena raznolikost gripe.
04:07
It mimics what we now understand
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To oponaša ono što danas znamo o
04:09
about reconstructing the 1918 flu virus,
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rekonstrukciji virusa gripe iz 1918. godine,
04:11
the last great pandemic,
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posljednju veliku pandemiju,
04:13
in that it also jumped directly from birds to people.
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koja je također prešla izravno s ptica na ljude.
04:15
We had evolution over time,
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Imali smo evoluciju tijekom vremena,
04:17
and this unbelievable mortality rate in human beings:
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i ova nevjerojatna stopa smrtnosti u ljudi.
04:21
55 percent of people who have become infected
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55 posto ljudi koji su bili zaraženi
04:23
with H5N1 have, in fact, succumbed.
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H5N1 su, u stvari, podlegli.
04:27
And we don't have a huge number of people
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I nemamo veliki broj ljudi
04:29
who got infected and never developed disease.
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koji se zarazio i nikad nije razvio bolest.
04:32
In experimental feeding in monkeys
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U eksperimentalnom hranjenju majmuna
04:34
you can see that it actually downregulates
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može se vidjeti da virus zapravo potpomaže razvoj
04:36
a specific immune system modulator.
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posebnog oblika imunološkog sustava.
04:38
The result is that what kills you
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Rezultat je da vas zapravo ubije,
04:40
is not the virus directly, but your own immune system overreacting, saying,
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ne virus izravno, već vlastiti imunološki sustav koje pretjerano reagira govoreći:
04:43
"Whatever this is so foreign I'm going berserk."
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„Štogod da je ovo strano, poludjet ću.“
04:46
The result: most of the deaths
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Rezultat, većina preminulih
04:48
have been in people under 30 years of age,
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imali su manje od trideset godina,
04:50
robustly healthy young adults.
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izrazito zdrave mlade odrasle osobe.
04:53
We have seen human-to-human transmission
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Vidjeli smo prijenos sa čovjeka na čovjeka
04:55
in at least three clusters --
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u barem tri slučaja – na sreću,
04:57
fortunately involving very intimate contact,
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uključivali su vrlo intiman kontakt
05:00
still not putting the world at large at any kind of risk.
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te nisu ugrozili ljudsku populaciju.
05:03
Alright, so I've got you nervous.
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Dobro, sada ste postali nervozni.
05:05
Now you probably assume, well the governments are going to do something.
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Vjerojatno pretpostavljate da će vlada nešto napraviti.
05:08
And we have spent a lot of money.
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I potrošili smo mnogo novca.
05:10
Most of the spending in the Bush administration
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Većina troškova Busheve administracije
05:12
has actually been more related to the anthrax results
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zapravo je bila vezana za proučavanje antraksa
05:16
and bio-terrorism threat.
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i prijetnje bio-terorizma.
05:18
But a lot of money has been thrown out at the local level and at the federal level
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I mnogo je novca bačeno na lokalnoj razini i na federalnoj razini
05:21
to look at infectious diseases.
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da bi se proučavalo zarazne bolesti.
05:23
End result: only 15 states
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Završni rezultat: za samo 15 država
05:25
have been certified to be able to do mass distribution
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potvrđeno je da su sposobne za masovnu distribuciju
05:27
of vaccine and drugs in a pandemic.
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cjepiva i lijekova u slučaju pandemije.
05:30
Half the states would run out of hospital beds
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Pola država ostat će bez bolničkih kreveta
05:32
in the first week, maybe two weeks.
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u prvom tjednu, možda u dva tjedna.
05:34
And 40 states already have an acute nursing shortage.
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I 40 država već ima kronični nedostatak njegovatelja.
05:37
Add on pandemic threat, you're in big trouble.
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Dodajte još i pandemijsku prijetnju i u velikoj ste nevolji.
05:39
So what have people been doing with this money?
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Što su ljudi radili s tim novcem?
05:41
Exercises, drills, all over the world.
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Vježbe, treninzi, diljem svijeta.
05:43
Let's pretend there's a pandemic.
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Pretvarajmo se da je pandemija.
05:45
Let's everybody run around and play your role.
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Neka svi trče uokolo i igraju svoju ulogu.
05:47
Main result is that there is tremendous confusion.
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Glavni rezultat je da postoji ogromna zbunjenost.
05:50
Most of these people don't actually know what their job will be.
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Većina ovih ljudi zapravo ne zna što će biti njihov posao.
05:53
And the bottom line, major thing that has come through
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Na kraju krajeva, glavna stvar koja se očitovala
05:55
in every single drill: nobody knows who's in charge.
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u svakoj vježbi jest da nitko ne zna tko je glavni zaduženi.
05:58
Nobody knows the chain of command.
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Nitko ne zna zapovjedni lanac.
06:00
If it were Los Angeles, is it the mayor, the governor,
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Ako je u Los Angelesu, je li gradonačelnik, guverner,
06:03
the President of the United States, the head of Homeland Security?
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predsjednik SAD-a, vođa Domovinske sigurnosti?
06:06
In fact, the federal government says it's a guy called
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Zapravo, savezna vlada kaže da je to momak
06:08
the Principle Federal Officer,
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s titulom Principle Federal Officer,
06:11
who happens to be with TSA.
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koji je u TSA-u.
06:13
The government says
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Vlada kaže da će
06:14
the federal responsibility will basically be
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savezna odgovornost u principu biti u pokušaju
06:17
about trying to keep the virus out, which we all know is impossible,
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da se zadrži virus vani, što svi znamo da je nemoguće,
06:20
and then to mitigate the impact
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i onda da ublaži utjecaj
06:22
primarily on our economy.
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na naše gospodarstvo.
06:25
The rest is up to your local community.
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Ostalo je mjesnoj zajednici.
06:27
Everything is about your town, where you live.
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Sve ovisi o tvom gradu, o mjestu gdje živiš.
06:30
Well how good a city council you have,
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Pa koliko je dobro gradsko vijeće koje imate?
06:32
how good a mayor you have -- that's who's going to be in charge.
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Koliko dobrog gradonačelnika imate; on će biti glavni zaduženi.
06:36
Most local facilities would all be competing
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Većina će se mjesnih postrojenja natjecati
06:38
to try and get their hands on their piece
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da dobiju dio
06:40
of the federal stockpile of a drug called Tamiflu,
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saveznih rezervi lijeka po imenu Tamiflu,
06:43
which may or may not be helpful -- I'll get into that --
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koji može a i ne mora biti od pomoći – doći ću do toga –
06:45
of available vaccines, and any other treatments,
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dostupnih cjepiva, ili bilo kojeg drugog tretmana,
06:48
and masks, and anything that's been stockpiled.
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maski, i svega što će biti uskladišteno.
06:51
And you'll have massive competition.
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I imat ćete ogromnu konkurenciju.
06:54
Now we did purchase a vaccine, you've probably all heard about it,
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Mi jesmo kupili cjepivo, sigurno ste čuli o tome,
06:56
made by Sanofi-Aventis.
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napravio ga je Sanofi-Aventis.
06:58
Unfortunately it's made against the current form of H5N1.
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Nažalost, napravljeno je protiv trenutačnog oblika H5N1.
07:01
We know the virus will mutate. It will be a different virus.
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Znamo da će virus mutirati. Bit će drugačiji virus.
07:04
The vaccine will probably be useless.
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Cjepivo će vjerojatno biti beskorisno.
07:07
So here's where the decisions come in.
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Dakle ovdje dolazi do odluke.
07:09
You're the mayor of your local town.
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Vi ste gradonačelnik vašeg grada.
07:11
Let's see, should we order that all pets be kept indoors?
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Da vidimo, da zapovjedimo da se svi ljubimci drže u zatvorenom?
07:14
Germany did that when H5N1 appeared in Germany last year,
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Njemačka je to napravila kad se H5N1 pojavio u Njemačkoj prošle godine,
07:17
in order to minimize the spread
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kako bi smanjili širenje
07:19
between households by household cats, dogs and so on.
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između kućanstava, preko kućnih mačaka, pasa i slično.
07:23
What do we do when we don't have any containment rooms
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Što radimo kada nemamo zatvorenih soba
07:27
with reverse air that will allow the healthcare workers
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s izmjenom zraka, koje će omogućiti zdravstvenim djelatnicima
07:29
to take care of patients?
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da se pobrinu za pacijente?
07:31
These are in Hong Kong; we have nothing like that here.
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One su u Hong Kongu. Nemamo ništa tome slično ovdje.
07:33
What about quarantine?
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Što s karantenama?
07:35
During the SARS epidemic in Beijing quarantine did seem to help.
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Tijekom epidemije SARS-a u Beijingu karantene nisu pomogle.
07:38
We have no uniform policies
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Nemamo ujednačenu politiku
07:40
regarding quarantine across the United States.
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koja se odnosi na karantene diljem SAD-a.
07:42
And some states have differential policies, county by county.
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Neke države imaju različitu politiku od okruga do okruga.
07:46
But what about the no-brainer things? Should we close all the schools?
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Što je s očitim stvarima? Trebam li zatvoriti sve škole?
07:49
Well then what about all the workers? They won't go to work
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Što sa svim radnicima? Oni neće otići na posao
07:51
if their kids aren't in school.
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ako njihova djeca nisu u školi.
07:53
Encouraging telecommuting? What works?
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Poticanje telekomunikacija? Što djeluje?
07:55
Well the British government did a model of telecommuting.
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Britanska vlada napravila je model telekomunikacija.
07:58
Six weeks they had all people in the banking industry
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Šest tjedana svi ljudi u bankarskoj industriji
08:01
pretend a pandemic was underway.
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pretvarali su se da je pandemija u tijeku.
08:03
What they found was, the core functions --
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Ono što su otkrili jesu osnovne funkcije,
08:05
you know you still sort of had banks,
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znate još uvijek ste imali banke,
08:07
but you couldn't get people to put money in the ATM machines.
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ali niste mogli dovesti ljude da stave novac u bankomate.
08:10
Nobody was processing the credit cards.
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Nitko nije obrađivao kreditne kartice.
08:12
Your insurance payments didn't go through.
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Vaše uplate za osiguranje nisu prolazile.
08:14
And basically the economy would be in a disaster state of affairs.
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I u osnovi, gospodarstvo bi bilo u katastrofalnom stanju.
08:17
And that's just office workers, bankers.
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A to je samo što se tiče uredskih radnika, bankara.
08:21
We don't know how important hand washing is for flu --
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Ne znamo koliko je pranje ruku važno za gripu –
08:24
shocking. One assumes it's a good idea to wash your hands a lot.
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šokantno. Za pretpostaviti je da je dobra zamisao često prati ruke.
08:27
But actually in scientific community there is great debate
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No zapravo, u znanstvenoj zajednici velika je debata
08:29
about what percentage of flu transmission between people
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o tome koliki postotak prijenosa gripe između ljudi
08:32
is from sneezing and coughing
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je od kihanja i kašljanja
08:34
and what percentage is on your hands.
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a koliki postotak je na vašim rukama.
08:36
The Institute of Medicine tried to look at the masking question.
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Medicinski Institut je pokušao razmotriti pitanje maski.
08:40
Can we figure out a way, since we know we won't have enough masks
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Možemo li smisliti način, s obzirom da nećemo imati dovoljno maski
08:42
because we don't make them in America anymore,
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jer ih više ne pravimo u Americi.
08:44
they're all made in China --
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Sve se prave u Kini.
08:46
do we need N95? A state-of-the-art, top-of-the-line,
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Trebamo li N95? Posljednje dostignuće, vrhunski izum,
08:49
must-be-fitted-to-your-face mask?
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maska koja mora pristajati vašem licu?
08:52
Or can we get away with some different kinds of masks?
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Ili možemo proći s nekom drugačijom vrstom maski?
08:55
In the SARS epidemic, we learned in Hong Kong
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Tijekom epidemije SARS -a, naučili smo u Hong Kongu
08:57
that most of transmission was because
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da je većina prijenosa gripe bila
08:59
people were removing their masks improperly.
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zbog nepravilnog skidanja maski.
09:01
And their hand got contaminated with the outside of the mask,
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Njihove su ruke bile kontaminirane s vanjske strane maske,
09:03
and then they rubbed their nose. Bingo! They got SARS.
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nakon čega su protrljali nos. Bingo! Dobili su SARS.
09:06
It wasn't flying microbes.
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To nije bio leteći mikrob.
09:09
If you go online right now, you'll get so much phony-baloney information.
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Ako sada odete na internet, dobit ćete mnoštvo lažnih i glupih informacija.
09:12
You'll end up buying -- this is called an N95 mask. Ridiculous.
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Na kraju ćete kupiti -- ovo se zove N95 maska. Smiješno.
09:17
We don't actually have a standard
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Zapravo nemamo standard
09:19
for what should be the protective gear for the first responders,
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o tome što bi trebala biti zaštitna oprema za one koji će se prvi suočiti s time,
09:22
the people who will actually be there on the front lines.
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ljude koji će zapravo biti na prvim linijama obrane.
09:25
And Tamiflu. You've probably heard of this drug,
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I Tamiflu. Vjerojatno ste čuli za ovaj lijek,
09:27
made by Hoffmann-La Roche, patented drug.
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napravljen od strane Hoffman – La Roche, patentiran lijek.
09:30
There is some indication
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Postoje neke naznake
09:32
that it may buy you some time in the midst of an outbreak.
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da vam može kupiti nešto vremena usred izbijanja epidemije.
09:35
Should you take Tamiflu for a long period of time,
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Ako uzimate Tamiflu duže vrijeme,
09:37
well, one of the side effects is suicidal ideations.
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jedna od nuspojava su suicidalne misli.
09:40
A public health survey analyzed the effect
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Istraživanje javnog zdravstva analiziralo je učinak
09:44
that large-scale Tamiflu use would have,
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koji bi imao uzimanje velikih količina Tamiflua,
09:46
actually shows it counteractive
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pokazujući zapravo da je suprotan
09:48
to public health measures, making matters worse.
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mjerama javnog zdravstva, pogoršava stanje.
09:51
And here is the other interesting thing:
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Također jedna zanimljiva stvar:
09:53
when a human being ingests Tamiflu, only 20 percent
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kada čovjek proguta Tamiflu, samo 20 posto je
09:55
is metabolized appropriately
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probavljeno pravilno,
09:57
to be an active compound in the human being.
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tako da bude aktivna tvar u ljudskom organizmu.
09:59
The rest turns into a stable compound,
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Ostatak se pretvara u stabilnu smjesu,
10:03
which survives filtration into the water systems,
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koja preživljava filtraciju u vodene sustave,
10:06
thereby exposing the very aquatic birds that would carry flu
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time se izlažući vodenim pticama koje će prenijeti gripu
10:09
and providing them a chance
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i pružiti im priliku da
10:11
to breed resistant strains.
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razviju otporne vrste.
10:13
And we now have seen Tamiflu-resistant strains
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Do sada smo vidjeli vrste otporne na Tamiflu
10:16
in both Vietnam in person-to-person transmission,
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u Vijetnamu, u prijenosu sa čovjeka na čovjeka,
10:19
and in Egypt in person-to-person transmission.
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i u Egiptu u prijenosu sa čovjeku na čovjeka.
10:21
So I personally think that our life expectancy
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Tako da osobno mislim da je očekivano trajanje
10:24
for Tamiflu as an effective drug
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Tamiflua kao učinkovitog lijeka
10:27
is very limited -- very limited indeed.
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vrlo ograničeno – zaista vrlo ograničeno.
10:29
Nevertheless most of the governments
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Ipak, većina je vlada
10:31
have based their whole flu policies
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utemeljila cijelu svoju politiku borbe protiv gripe
10:33
on building stockpiles of Tamiflu.
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na nagomilavanju zaliha Tamiflua.
10:35
Russia has actually stockpiled enough
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Rusija je skupila zalihe dovoljne
10:37
for 95 percent of all Russians.
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za 95 posto ukupnog stanovništva.
10:39
We've stockpiled enough for 30 percent.
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Mi smo skupili zalihe dovoljne za 30 posto stanovništva.
10:41
When I say enough, that's two weeks worth.
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Kad kažem „dovoljne“, mislim na zalihe u trajanju od dva tjedna.
10:43
And then you're on your own because
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A nakon toga ste prepušteni sami sebi jer će
10:45
the pandemic is going to last for 18 to 24 months.
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pandemija trajati od 18 do 24 mjeseca.
10:47
Some of the poorer countries
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Neke od siromašnijih zemalja
10:49
that have had the most experience with H5N1 have built up stockpiles;
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koje su imale najviše iskustva s virusom H5N1 skupile su zalihe
10:52
they're already expired. They are already out of date.
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kojima je sada već istekao rok trajanja.
10:55
What do we know from 1918,
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Što znamo iz 1918.godine,
10:57
the last great pandemic?
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vremena zadnje velike pandemije?
10:59
The federal government abdicated most responsibility.
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Federalna se vlada odrekla većine odgovornosti.
11:02
And so we ended up with this wild patchwork of regulations
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I tako smo završili s ovom ludom mješavinom propisa
11:05
all over America.
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širom cijele Amerike.
11:07
Every city, county, state did their own thing.
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Svaki grad, okrug, svaka je država radila po svome.
11:09
And the rules
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I zakoni,
11:11
and the belief systems were wildly disparate.
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kao i sustavi vjerovanja, bili su u najvećoj mjeri različiti.
11:14
In some cases all schools, all churches,
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U nekim su slučajevima sve škole, sve crkve,
11:17
all public venues were closed.
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sva javna mjesta bila zatvorena.
11:19
The pandemic circulated three times in 18 months
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Pandemija je kružila tri puta u 18 mjeseci
11:22
in the absence of commercial air travel.
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u odsutnosti komercijalnog zračnog prijevoza.
11:24
The second wave was the mutated, super-killer wave.
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Drugi je val bio mutirani, superubojiti val.
11:27
And in the first wave we had enough healthcare workers.
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U prvom smo valu imali dovoljno zdravstvenih radnika.
11:30
But by the time the second wave hit
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Ali, do trenutka kada je došao drugi val,
11:32
it took such a toll among the healthcare workers
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uzet je toliki danak među zdravstvenim radnicima
11:35
that we lost most of our doctors and nurses that were on the front lines.
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da smo izgubili većinu naših liječnika i medicinskih sestra koji su bili na prvim linijama bojišnice.
11:39
Overall we lost 700,000 people.
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Sveukupno smo izgubili 700 tisuća ljudi.
11:41
The virus was 100 percent lethal to pregnant women
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Virus je bio 100 posto smrtonosan za trudnice.
11:44
and we don't actually know why.
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I dalje, zapravo, ne znamo zašto.
11:46
Most of the death toll was 15 to 40 year-olds --
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Većina je umrlih bila u dobi od 15 do 40 godina –
11:49
robustly healthy young adults.
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to su bile snažne, mlade osobe.
11:51
It was likened to the plague.
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Bilo je to nalik kugi.
11:53
We don't actually know how many people died.
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Mi zapravo i ne znamo koliko je točno ljudi umrlo.
11:55
The low-ball estimate is 35 million.
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Niska je procjena oko 35 milijuna.
11:58
This was based on European and North American data.
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Ovo je temeljeno na europskim i sjevernoameričkim podacima.
12:01
A new study by Chris Murray at Harvard
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Nova studija Chrisa Murraya s Harvarda
12:03
shows that if you look at the databases that were kept
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pokazuje da, ako pogledate baze podataka
12:05
by the Brits in India,
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koje su Britanci vodili u Indiji –
12:07
there was a 31-fold greater death rate among the Indians.
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tamo je bila 31 posto veća stopa smrtnosti među Indijcima.
12:11
So there is a strong belief that in places of poverty
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Zato postoji čvrsto uvjerenje da je u siromašnim mjestima
12:14
the death toll was far higher.
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broj umrlih bio znatno veći.
12:16
And that a more likely toll
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I da je vjerojatnija brojka umrlih negdje
12:18
is somewhere in the neighborhood of 80 to 100 million people
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oko 80 do 100 milijuna ljudi,
12:20
before we had commercial air travel.
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prije nego što smo imali komercijalni zračni promet.
12:23
So are we ready?
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Stoga, jesmo li spremni?
12:25
As a nation, no we're not.
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Kao nacija, ne nismo.
12:27
And I think even those in the leadership
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I mislim da bi čak i vodstvo naše zemlje
12:29
would say that is the case,
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priznalo da je, u ovom slučaju,
12:31
that we still have a long ways to go.
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pred nama još dug put.
12:33
So what does that mean for you? Well the first thing is,
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Što to znači za vas? Prije svega,
12:35
I wouldn't start building up personal stockpiles of anything --
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ja ne bih započela s izgradnjom osobne zalihe ičega –
12:38
for yourself, your family, or your employees --
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za sebe, svoju obitelj ili svoje zaposlenike,
12:42
unless you've really done your homework.
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osim ako niste temeljito proučili svoju zadaću.
12:45
What mask works, what mask doesn't work.
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Koja je maska djelotvorna? Koja maska nije djelotvorna.
12:47
How many masks do you need?
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Koliko maski trebate?
12:49
The Institute of Medicine study felt that
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Institut za medicinu smatra
12:51
you could not recycle masks.
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da ne biste trebali reciklirati maske.
12:53
Well if you think it's going to last 18 months,
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Pa ako mislite da će pandemija trajati 18 mjeseci,
12:56
are you going to buy 18 months worth of masks
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hoćete li kupiti maski za 18 mjeseci,
12:58
for every single person in your family?
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za svakog člana svoje obitelji?
13:01
We don't know -- again with Tamiflu,
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S Tamifluom, opet, ne znamo,
13:05
the number one side effect of Tamiflu is
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jer su prva nuspojava Tamiflua simptomi
13:07
flu-like symptoms.
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slični onima kod gripe.
13:09
So then how can you tell
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Kako onda možete znati
13:11
who in your family has the flu
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tko u vašoj obitelji ima gripu,
13:13
if everybody is taking Tamiflu?
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ako svi uzimaju Tamiflu?
13:16
If you expand that out to think of a whole community,
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Ako proširite ovo razmišljanje na cijelu zajednicu
13:19
or all your employees in your company,
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ili na sve zaposlenike u vašoj kompaniji
13:22
you begin to realize how limited
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počinjete shvaćati koliko bi zapravo opcija
13:24
the Tamiflu option might be.
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s Tamifluom mogla biti ograničena.
13:26
Everybody has come up to me and said,
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Svi su mi došli i rekli da će
13:28
well I'll stockpile water or, I'll stockpile food, or what have you.
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nakupiti zalihe vode ili zalihe hrane.
13:32
But really? Do you really have a place
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Ali, ozbiljno? Imate li, zaista, mjesta
13:35
to stockpile 18 months worth of food? Twenty-four months worth of food?
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za zalihe hrane za 18 mjeseci? Ili zalihe hrane za 24 mjeseca?
13:38
Do you want to view the pandemic threat
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Želite li pristupiti opasnosti od pandemije
13:40
the way back in the 1950s
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na isti način kao što su 1950-ih
13:42
people viewed the civil defense issue,
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ljudi pristupili problemu civilne obrane
13:44
and build your own little bomb shelter for pandemic flu?
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i izgraditi svoja malena atomska skloništa za pandemiju gripe?
13:47
I don't think that's rational.
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Ne smatram to racionalnim.
13:49
I think it's about having to be prepared
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Mislim da moramo biti spremni
13:51
as communities, not as individuals --
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kao zajednica, a ne kao pojedinci,
13:53
being prepared as nation,
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spremni kao nacija,
13:55
being prepared as state, being prepared as town.
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kao država, kao grad.
13:58
And right now most of the preparedness
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A trenutna je pripravnost najvećim dijelom
14:00
is deeply flawed.
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prilično slaba.
14:02
And I hope I've convinced you of that,
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I nadam se da sam vas sada uvjerila u to,
14:04
which means that the real job is go out and
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što znači da je sada pravi zadatak izaći van i
14:06
say to your local leaders,
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reći svojim lokalnim vođama,
14:08
and your national leaders,
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reći svojim državnim vođama,
14:10
"Why haven't you solved these problems?
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"Zašto niste riješili ove probleme?
14:12
Why are you still thinking that
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Zašto još uvijek mislite da se
14:14
the lessons of Katrina do not apply to flu?"
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lekcije dobivene od uragana Katrine ne odnose na gripu?"
14:17
And put the pressure where the pressure needs to be put.
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I vršiti pritisak tamo gdje pritisak treba biti nametnut.
14:21
But I guess the other thing to add is,
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Ali pretpostavljam da trebam dodati da
14:23
if you do have employees, and you do have a company,
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ako imate svoje zaposlenike ili kompaniju,
14:25
I think you have certain responsibilities
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tada imate određenu odgovornost
14:28
to demonstrate that you are thinking ahead for them,
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pokazati im da razmišljate unaprijed za njih
14:30
and you are trying to plan.
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i da pokušavate nešto isplanirati.
14:32
At a minimum the British banking plan showed that
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Plan britanskih banki pokazao je da rad od kuće,
14:36
telecommuting can be helpful.
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putem računala, može biti prilično koristan.
14:38
It probably does reduce exposure
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Na taj način smanjuje se izloženost gripi
14:40
because people are not coming into the office and coughing on each other,
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jer ljudi ne dolaze u ured i ne kašlju jedni po drugima,
14:43
or touching common objects
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ne diraju zajedničke predmete
14:46
and sharing things via their hands.
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i ne dijele stvari iz ruke u ruku.
14:48
But can you sustain your company that way?
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Ali možete li radom na takav način održati svoju kompaniju?
14:52
Well if you have a dot-com, maybe you can.
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Ako imate računalnu firmu, vjerojatno možete.
14:55
Otherwise you're in trouble.
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Inače ste u nevolji.
14:58
Happy to take your questions.
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Rado ću odgovoriti na vaša pitanja.
15:00
(Applause)
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(Pljesak)
15:04
Audience member: What factors determine the duration of a pandemic?
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Publika: Koji čimbenici određuju trajanje pandemije?
15:09
Laurie Garret: What factors determine the duration of a pandemic, we don't really know.
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Laurie Garret: Mi zapravo ne znamo koji čimbenici određuju trajanje pandemije.
15:13
I could give you a bunch of flip, this, that, and the other.
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Mogla bih vam dati hrpu pretpostavki.
15:16
But I would say that honestly we don't know.
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Ali, umjesto toga, reći ću vam da iskreno ne znamo.
15:19
Clearly the bottom line is
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Jasno je da virus
15:21
the virus eventually attenuates,
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s vremenom slabi
15:24
and ceases to be a lethal virus to humanity,
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i prestaje biti smrtonosan za čovječanstvo
15:29
and finds other hosts.
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te pronalazi druge domaćine.
15:31
But we don't really know how and why that happens.
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Ali mi zapravo ne znamo kako i zašto se to događa.
15:33
It's a very complicated ecology.
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To je vrlo komplicirana ekologija.
15:36
Audience member: What kind of triggers are you looking for?
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Publika: Kakvu vrstu aktivatora tražite?
15:39
You know way more than any of us.
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Vi znate puno više nego bilo tko od nas.
15:41
To say ahh, if this happens then we are going to have a pandemic?
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Zbog čega ćete reći: "Ah, ako se ovo dogodi - doći će do pandemije?"
15:45
LG: The moment that you see any evidence
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LG: Onog trenutka kad vidite ozbiljan dokaz
15:47
of serious human-to-human to transmission.
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prijenosa sa čovjeka na čovjeka.
15:50
Not just intimately between family members
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Ne samo intimno, između članova obitelji
15:52
who took care of an ailing sister or brother,
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koji su se brinuli o bolesnoj sestri ili bratu,
15:56
but a community infected --
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već kad vidite zaraženu zajednicu -
15:58
spread within a school,
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širenja unutar škola,
16:00
spread within a dormitory, something of that nature.
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unutar studentskih domova, nešto te prirode.
16:03
Then I think that there is universal agreement
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Smatram da sada postoji opće slaganje
16:06
now, at WHO all the way down:
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sada u Svjetskoj zdravstvenoj organizaciji do kraja.
16:08
Send out the alert.
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Pošaljite upozorenje.
16:12
Audience member: Some research has indicated that statins can be helpful.
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Publika: Neka su istraživanja pokazala da uzimanje lijekova za smanjenje razine lipida u krvi može biti korisno.
16:16
Can you talk about that?
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Možete li reći nešto o tome?
16:18
LG: Yeah. There is some evidence that taking Lipitor
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LG: Da. Postoje neki dokazi da uzimanje Lipitora
16:20
and other common statins for cholesterol control
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i nekih sličnih lijekova za kontrolu kolesterola
16:23
may decrease your vulnerability
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može smanjiti vašu osjetljivost
16:27
to influenza.
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na gripu.
16:29
But we do not completely understand why.
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Ali ne razumijemo, u potpunosti, zašto.
16:32
The mechanism isn't clear.
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Taj mehanizam nam nije jasan.
16:34
And I don't know that there is any way
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I smatram da, ni na koji način,
16:39
responsibly for someone to start
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nitko ne bi trebao osjećati potrebu da počne
16:42
medicating their children
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liječiti svoju djecu
16:44
with their personal supply of Lipitor or something of that nature.
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s osobnom zalihom Lipitora ili nečeg sličnog.
16:48
We have absolutely no idea what that would do.
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Nemamo ni ideje do čega bi to moglo dovesti.
16:50
You might be causing some very dangerous outcomes
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Time bi mogli prouzročiti opasne nuspojave
16:53
in your children, doing such a thing.
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kod svoje djece.
16:56
Audience member: How far along are we in being able to determine
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Publika: Koliko smo napredovali u sposobnosti da zaključimo
16:58
whether someone is actually carrying, whether somebody has this
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da netko ima gripu,
17:00
before the symptoms are full-blown?
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prije nego što su simptomi u punom cvatu?
17:02
LG: Right. So I have for a long time said
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LG: Već sam prije dugo vremena rekla
17:05
that what we really needed was a rapid diagnostic.
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da je ono što zapravo trebamo brza dijagnoza.
17:08
And our Centers for Disease Control
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I naši centri za kontrolu zaraze
17:11
has labeled a test they developed
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razvili su test
17:14
a rapid diagnostic.
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za brzu dijagnozu.
17:16
It takes 24 hours in a very highly developed laboratory,
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On traje 24 sata u visoko opremljenom laboratoriju,
17:20
in highly skilled hands.
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u vrhunski vještim rukama.
17:22
I'm thinking dipstick.
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Ja razmišljam o mjernim štapićima.
17:24
You could do it to your own kid. It changes color.
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To biste mogli napraviti svome djetetu osobno. Oni mijenjaju boju.
17:26
It tells you if you have H5N1.
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Kažu vam ako imate H5N1.
17:28
In terms of where we are in science
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U uvjetima u kojima je trenutno znanost
17:32
with DNA identification capacities and so on,
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glede identifikacije pomoću DNK kapaciteta i slično,
17:36
it's not that far off.
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to i nije tako nemoguće.
17:38
But we're not there. And there hasn't been the kind of investment to get us there.
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Ali mi to nemamo. I ne postoje ulaganja bilo koje vrste koja bi nam to omogućila.
17:43
Audience member: In the 1918 flu I understand that
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Publika: Koliko sam shvatio,
17:46
they theorized that there was some attenuation
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kod gripe iz 1918. postojale su neke teorije
17:50
of the virus when it made the leap into humans.
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da je virus oslabio u trenutku kada je prešao na ljude.
17:52
Is that likely, do you think, here?
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Smatrate li da je to moguće i sada?
17:54
I mean 100 percent death rate
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Mislim, stopostotna stopa smrtnosti
17:58
is pretty severe.
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je prilično ozbiljna.
18:00
LG: Um yeah. So we don't actually know
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LG: Umm, da. Mi zapravo ne znamo
18:04
what the lethality was
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kolika je bila smrtnost za
18:07
of the 1918 strain to wild birds
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divlje ptice 1918. godine
18:11
before it jumped from birds to humans.
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prije nego što je virus prešao s njih na ljude.
18:13
It's curious that there is no evidence
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Zagonetno je to što nema dokaza
18:15
of mass die-offs of chickens
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o masovnom ugibanju kokoši
18:17
or household birds across America
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i ptica u kućanstvima diljem Amerike
18:20
before the human pandemic happened.
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prije nego što se dogodila pandemija među ljudima.
18:22
That may be because those events
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To može biti zato što su se ti događaji
18:24
were occurring on the other side of the world
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pojavljivali na drugoj strani svijeta,
18:26
where nobody was paying attention.
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gdje nitko nije obraćao pozornost.
18:28
But the virus clearly
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No, virus je očito
18:32
went through one round around the world
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prošao jedan krug oko svijeta
18:34
in a mild enough form
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u blagom obliku,
18:36
that the British army in World War I
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dovoljno blagom da britanska vojska za vrijeme Prvog svjetskog rata
18:39
actually certified that it was not a threat
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proglasi da on nije prijetnja
18:42
and would not affect the outcome of the war.
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i da neće utjecati na ishod rata.
18:45
And after circulating around the world
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I nakon tog kruženja oko svijeta
18:47
came back in a form that was tremendously lethal.
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vratio se u obliku koji je bio strahovito smrtonosan.
18:52
What percentage of infected people were killed by it?
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Koji je postotak zaraženih ljudi umro?
18:55
Again we don't really know for sure.
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Ponovno, nismo u potpunosti sigurni.
18:58
It's clear that if you were malnourished to begin with,
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Jasno je da ako ste bili pothranjeni,
19:00
you had a weakened immune system,
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imali oslabljen imunološki sustav,
19:02
you lived in poverty in India or Africa,
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živjeli u siromaštvu u Indiji ili Africi,
19:05
your likelihood of dying was far greater.
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vaša je vjerojatnost umiranja bila znatno veća.
19:08
But we don't really know.
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Ali mi zapravo ne znamo.
19:11
Audience member: One of the things I've heard is that
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Publika: Jedna od stvari koje sam čuo je da je
19:13
the real death cause when you get a flu is the associated pneumonia,
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pravi uzrok smrti kada dobijete gripu - upala pluća koja dođe s njom.
19:16
and that a pneumonia vaccine
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I da vam cjepivo protiv upale pluća
19:18
may offer you 50 percent better chance of survival.
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može osigurati 50 posto veću šansu preživljavanja.
19:22
LG: For a long time, researchers in emerging diseases
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LG: Dugo su vremena istraživači nastanka bolesti,
19:26
were kind of dismissive of the pandemic flu threat
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na neki način, odbacivali prijetnju od pandemije gripe
19:28
on the grounds that
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na temelju toga
19:30
back in 1918 they didn't have antibiotics.
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što 1918. godine nije bilo antibiotika.
19:32
And that most people who die of regular flu --
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I da su većina ljudi koji umru od obične gripe,
19:35
which in regular flu years
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što je oko
19:37
is about 360,000 people worldwide,
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360 tisuća ljudi širom svijeta godišnje,
19:40
most of them senior citizens --
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stariji građani.
19:42
and they die not of the flu but because the flu gives an assault to their immune system.
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I da oni ne umiru od gripe, već zato što gripa daje zadnji napad njihovom imunološkom sustavu.
19:46
And along comes pneumococcus
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A usput dolazi i pneumokok,
19:48
or another bacteria, streptococcus
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ili druga bakterija, streptokok i
19:50
and boom, they get a bacterial pneumonia.
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- bum, oni dobiju bakterijsku upalu pluća.
19:52
But it turns out that in 1918 that was not the case at all.
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Ali izgleda da 1918. godine to uopće nije bio slučaj.
19:55
And so far in the H5N1 cases in people,
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Tako i sada, u slučajevima H5N1 kod ljudi,
19:58
similarly bacterial infection
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slična bakterijska infekcija
20:00
has not been an issue at all.
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nije ključan problem.
20:02
It's this absolutely phenomenal disruption of the immune system
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Radi se o apsolutnom poremećaju imunološkog sustava
20:07
that is the key to why people die of this virus.
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i to je ključna stvar zbog koje ljudi umiru od ovog virusa.
20:10
And I would just add
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I htjela bih dodati da smo
20:12
we saw the same thing with SARS.
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istu stvar imali sa SARS-om.
20:14
So what's going on here is your body says,
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Dakle, ono što se ovdje događa je da vaše tijelo kaže,
20:17
your immune system sends out all its sentinels and says,
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vaš imunološki sustav kaže:
20:21
"I don't know what the heck this is.
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„Ne znam što je ovo.
20:23
We've never seen anything even remotely like this before."
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Nikad nismo vidjeli nešto ni približno slično ovome.“
20:26
It won't do any good to bring in the sharpshooters
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Neće vam biti nimalo bolje ako uvedete „iskusne strijelce“ u organizam -
20:29
because those antibodies aren't here.
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jer tih antitijela nema ovdje.
20:31
And it won't do any good to bring in the tanks and the artillery
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Ni uvođenje „tenkova i topništva“ neće rezultirati poboljšanjem
20:34
because those T-cells don't recognize it either.
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jer ih vaši T-limfociti neće prepoznati.
20:37
So we're going to have to go all-out thermonuclear response,
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Zato ćemo morati ići sve do termonuklearne reakcije,
20:40
stimulate the total cytokine cascade.
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stimulirati potpunu kaskadu citokina.
20:43
The whole immune system swarms into the lungs.
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Cijeli imunološki sustav nahrupi u pluća.
20:46
And yes they die, drowning in their own fluids, of pneumonia.
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I da, ljudi umiru utapajući se u vlastitoj tekućini, od upale pluća.
20:49
But it's not bacterial pneumonia.
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Ali to nije bakterijska upala pluća.
20:51
And it's not a pneumonia that would respond to a vaccine.
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I to nije upala pluća koja bi reagirala na cjepivo.
20:55
And I think my time is up. I thank you all for your attention.
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Mislim da mi je vrijeme isteklo. Zahvaljujem Vam svima na pozornosti.
20:58
(Applause)
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(Pljesak)
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