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

199,368 views ・ 2009-04-30

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