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

譯者: Chiru Chang 審譯者: Ching-Yi Wu

So the first question is, why do we need to

今天要談的第一個問題是

even worry about a pandemic threat?

我們何必擔心全球大流行的問題？

What is it that we're concerned about?

我們到底在擔心些什麼？

When I say "we," I'm at the Council on Foreign Relations.

我說的「我們」，是指「外交關係委員會」

We're concerned in the national security community,

我們關心國家安全的課題

and of course in the biology community and the public health community.

生物的課題，還有公共衛生的課題

While globalization has increased travel,

全球化的結果導致

it's made it necessary that everybody be everywhere,

交通量大增，許多人隨時隨地

all the time, all over the world.

在全世界大量的移動

And that means that your microbial hitchhikers are moving with you.

病原體也搭著便車跟著一起到處移動

So a plague outbreak in Surat, India

所以一個在印度Surat市爆發的瘟疫

becomes not an obscure event, but a globalized event --

不再只是個默默無名的事件，而是一個全球化的事件

a globalized concern that has changed the risk equation.

一個改變風險計算式的全球課題

Katrina showed us

卡崔娜颶風給我們的教訓是

that we cannot completely depend on government

我們不能完全依賴政府

to have readiness in hand, to be capable of handling things.

得隨時作好準備，有能力處理事件

Indeed, an outbreak would be multiple Katrinas at once.

如果爆發全球大流行，其嚴重性等於好幾個卡崔娜同時發生

Our big concern at the moment is a virus called H5N1 flu --

我們目前關注的問題是一個叫作H5N1的流感病毒

some of you call it bird flu --

有些人把他叫作禽流感

which first emerged in southern China, in the mid-1990s,

這個疾病1990年代中期在中國南部第一次出現

but we didn't know about it until 1997.

但是我們直到1997年才知道有這個疾病

At the end of last Christmas only 13 countries had seen H5N1.

到去年耶誕節為止只有13個國家有H5N1的案例

But we're now up to 55 countries in the world,

但目前已經竄升到55個

have had this virus emerge,

有些國家是在禽鳥身上出現

in either birds, or people or both.

有些在人身上出現，有些兩者都有

In the bird outbreaks we now can see

以禽鳥身上的傳染狀況而言

that pretty much the whole world has seen this virus

幾乎全世界都已經出現了這種病毒

except the Americas.

除了美洲地區

And I'll get into why we've so far been spared in a moment.

我待會兒會談到我們為何還沒被波及

In domestic birds, especially chickens,

對已馴化的禽鳥，尤其是雞而言

it's 100 percent lethal.

這種疾病的致死率高達100%

It's one of the most lethal things we've seen

可說是我們最近幾世紀

in circulation in the world

全世界流通的疾病之中

in any recent centuries.

致死率最高的疾病之一

And we've dealt with it by killing off lots and lots and lots of chickens,

我們靠大量屠殺受感染雞隻來應付此問題

and unfortunately often not reimbursing the peasant farmers

不幸的，雞農通常沒有得到補償

with the result that there's cover-up.

結果是雞農能夠掩藏就掩藏

It's also carried on migration patterns

這個病毒也會跟著季節性遷移的水鳥

of wild migratory aquatic birds.

隨著他們的遷徙路徑移動

There has been this centralized event

中國境內的程海

in a place called Lake Chenghai, China.

就曾經發生過一次集體感染事件

Two years ago the migrating birds

兩年前在此處聚集了許多水鳥

had a multiple event

適逢病毒發生突變

where thousands died because of a mutation occurring

造成上千隻候鳥死亡

in the virus,

突變讓病毒產生戲劇性的變化

which made the species range broaden dramatically.

結果是遠赴西伯利亞、歐洲、

So that birds going to Siberia, to Europe, and to Africa

和非洲的候鳥身上都帶著這個病毒

carried the virus, which had not previously been possible.

在這之前，這隻病毒未曾到過這些地方

We're now seeing outbreaks in human populations --

目前我們已看到人類發病的案例

so far, fortunately, small events,

所幸都是小規模的

tiny outbreaks, occasional clusters.

偶發的事件

The virus has mutated dramatically in the last two years

不過這個病毒最近兩年已發生非常劇烈的突變

to form two distinct families, if you will,

因此在H5N1病毒的演化樹上

of the H5N1 viral tree

產生了兩個很不同的群組

with branches in them,

而這兩組病毒型式

and with different attributes that are worrying.

各有令人擔憂的特性

So what's concerning us? Well, first of all,

所以我們究竟在擔心什麼？

at no time in history have we succeeded in making

首先，我們從來就沒有成功的

in a timely fashion, a specific vaccine

在短時間內，為兩億六千萬人

for more than 260 million people.

製作某一種疫苗的紀錄

It's not going to do us very much good in a global pandemic.

一旦面臨全球性大流行，我們會非常危險

You've heard about the vaccine we're stockpiling.

你們或許已經聽說我們正在囤積疫苗

But nobody believes it will actually be particularly effective

但沒有人相信，一旦面臨真正的大爆發

if we have a real outbreak.

這點疫苗會有什麼用

So one thought is:

曾經有人想過

after 9/11, when the airports closed,

說911事件之後機場關閉

our flu season was delayed by two weeks.

使得流感季節延後了兩週

So the thought is, hey, maybe what we should do is just

所以這個想法就是說，或許我們應該

immediately -- we hear there is H5N1 spreading from human to human,

在知道H5N1在人與人間傳染開來

the virus has mutated to be a human-to-human transmitter --

即病毒已突變成人對人傳染的型式時

let's shut down the airports.

乾脆就直接把機場關閉

However, huge supercomputer analyses,

不過，依據超級電腦的分析

done of the likely effectiveness of this,

這樣作的效益不大

show that it won't buy us much time at all.

只能將爆發的時間延後一些些

And of course it will be hugely disruptive in preparation plans.

而且還會阻礙我們的準備工作

For example, all masks are made in China.

舉例而言，所有的面罩都在中國製造

How do you get them mobilized around the world

一旦關閉了所有的機場

if you've shut all the airports down?

我們要如何把這些面罩送到世界各地？

How do you get the vaccines moved around the world

我們要如何將疫苗運送到世界各地？

and the drugs moved, and whatever may or not be available that would work.

藥品及其他防疫物資也會有同樣問題

So it turns out that shutting down the airports is counterproductive.

因此，關閉機場只有反效果

We're worried because this virus, unlike any other flu

我們很擔心，因為此病毒跟其他已知

we've ever studied, can be transmitted by eating raw meat

流感病毒不同，可以透過食用受到感染的動物

of the infected animals.

未煮熟的肉品而感染到病毒

We've seen transmission to wild cats and domestic cats,

因此我們已見到病毒以此方式傳染給野貓、

and now also domestic pet dogs.

家貓、還有家犬

And in experimental feedings to rodents and ferrets,

在囓齒類與貂科動物的餵食實驗中

we found that the animals exhibit symptoms never seen with flu:

我們發現這些動物出現一些一般流感未出現的症狀

seizures, central nervous system disorders, partial paralysis.

例如痙攣、中央神經系統障礙、局部麻痺等

This is not your normal garden-variety flu.

總之，這絕非我們一般所熟悉的流感

It mimics what we now understand

這個禽流感跟我們

about reconstructing the 1918 flu virus,

重建出的1918年流感傳染模式

the last great pandemic,

即上次的全球大流行非常類似

in that it also jumped directly from birds to people.

它也是直接從禽鳥傳染給人

We had evolution over time,

隨著時間演化

and this unbelievable mortality rate in human beings:

出現了令人難以置信的死亡率

55 percent of people who have become infected

被H5N1感染的人之中

with H5N1 have, in fact, succumbed.

事實上有55%已經死亡

And we don't have a huge number of people

而且被感染的人之中

who got infected and never developed disease.

大部分都會發病

In experimental feeding in monkeys

在猴子的餵食實驗中

you can see that it actually downregulates

我們發現這個疾病會

a specific immune system modulator.

減低某種特定的免疫系統調節物質

The result is that what kills you

因此，導致死亡的其實不是病毒

is not the virus directly, but your own immune system overreacting, saying,

而是免疫系統的過度反應，抗議：

"Whatever this is so foreign I'm going berserk."

「這東西太詭異，我要抓狂了。」

The result: most of the deaths

因此死亡者大部分

have been in people under 30 years of age,

是年齡不到30歲的人

robustly healthy young adults.

非常健康的年輕成年人

We have seen human-to-human transmission

我們見過的人對人傳染

in at least three clusters --

已經至少有三群

fortunately involving very intimate contact,

所幸都是因極親密的接觸而感染

still not putting the world at large at any kind of risk.

因此還不會對世界造成立即的危險

Alright, so I've got you nervous.

各位應該開始緊張了吧

Now you probably assume, well the governments are going to do something.

各位可能會認為政府應該會有所作為

And we have spent a lot of money.

我們也確實花費了許多金錢

Most of the spending in the Bush administration

不過布希政府到目前為止的花費

has actually been more related to the anthrax results

大部分針對炭疽病

and bio-terrorism threat.

和恐怖份子生物攻擊威脅的相關研究

But a lot of money has been thrown out at the local level and at the federal level

聯邦政府跟地方政府也花費很多經費

to look at infectious diseases.

探討傳染性疾病

End result: only 15 states

但結果是只有15個州

have been certified to be able to do mass distribution

被判定有能力在大流行時

of vaccine and drugs in a pandemic.

大量的分送疫苗和藥品

Half the states would run out of hospital beds

在第一個或第二個禮拜之內

in the first week, maybe two weeks.

約有一半的州就會發生病床不足的問題

And 40 states already have an acute nursing shortage.

40個州已經有護理人員嚴重短缺的問題

Add on pandemic threat, you're in big trouble.

加上大流行的威脅，問題就更嚴重了

So what have people been doing with this money?

所以到底錢用到哪裡去了？

Exercises, drills, all over the world.

全世界到處都在辦理各種演習

Let's pretend there's a pandemic.

讓我們假裝現在正在發生全球大流行

Let's everybody run around and play your role.

所以大家要趕快去做該做的事

Main result is that there is tremendous confusion.

結果就是會非常的混亂

Most of these people don't actually know what their job will be.

因為大部分的人不太清楚自己究竟該作什麼

And the bottom line, major thing that has come through

追根究底來說，我們沒有重大進展

in every single drill: nobody knows who's in charge.

每次演習，沒人知道誰是總指揮

Nobody knows the chain of command.

沒人知道指揮系統到底是怎樣

If it were Los Angeles, is it the mayor, the governor,

若流感發生在洛杉磯，總指揮到底是市長、州長、

the President of the United States, the head of Homeland Security?

美國總統、還是國土安全部部長？

In fact, the federal government says it's a guy called

其實，聯邦政府說指揮官是

the Principle Federal Officer,

一位「首席聯邦官員」

who happens to be with TSA.

而他隸屬「運輸安全管理部」

The government says

政府的說法是

the federal responsibility will basically be

聯邦政府的責任基本上是要把

about trying to keep the virus out, which we all know is impossible,

病毒屏除在境外，我們都知道這是不可能的

and then to mitigate the impact

還有就是去減緩大流行

primarily on our economy.

對我國的衝擊，尤其是對經濟

The rest is up to your local community.

剩下來的全部都要靠你的社區自己想辦法

Everything is about your town, where you live.

所以要回歸到你所居住的城鎮

Well how good a city council you have,

你的地方議會能不能幹

how good a mayor you have -- that's who's going to be in charge.

你的市長能不能幹─因為他要負責當指揮官

Most local facilities would all be competing

所有的地方政府將互相競爭

to try and get their hands on their piece

設法從聯邦政府庫存中取得

of the federal stockpile of a drug called Tamiflu,

一種叫作「克流感」的藥物

which may or may not be helpful -- I'll get into that --

這種藥物可能有用但也可能沒用─這個待會會談─

of available vaccines, and any other treatments,

還有取得疫苗或是其他任何的醫療物資

and masks, and anything that's been stockpiled.

還有口罩，和所有聯邦庫存的防治物資

And you'll have massive competition.

想想看所有地方政府在搶，這競爭有多激烈

Now we did purchase a vaccine, you've probably all heard about it,

我們確實有購買一種疫苗，你們也大概都聽過

made by Sanofi-Aventis.

是由賽諾菲安萬特（Sanofi-Aventis）藥廠製造的

Unfortunately it's made against the current form of H5N1.

很不幸的它是針對現在的H5N1病毒製造

We know the virus will mutate. It will be a different virus.

我們都知道病毒會突變，突變後就會完全不同

The vaccine will probably be useless.

因此這個疫苗可能會完全無效

So here's where the decisions come in.

所以決策過程就要處理這些問題

You're the mayor of your local town.

你是你們鎮的鎮長

Let's see, should we order that all pets be kept indoors?

我們該不該規定鎮民要將所有的寵物關在室內?

Germany did that when H5N1 appeared in Germany last year,

去年德國出現H5N1時就這麼作了

in order to minimize the spread

目的是要減少家戶之間因為

between households by household cats, dogs and so on.

家貓家犬等寵物造成的病毒散播

What do we do when we don't have any containment rooms

當我們沒有隔離病房時我們該怎麼辦

with reverse air that will allow the healthcare workers

醫護人員如果沒有這種負壓病房的保護

to take care of patients?

該如何去照顧病人

These are in Hong Kong; we have nothing like that here.

這些負壓病房在香港，我們這裡沒有這種東西

What about quarantine?

隔離措施呢？

During the SARS epidemic in Beijing quarantine did seem to help.

SARS流行期間北京實施的隔離政策好像有些效果

We have no uniform policies

在美國不但沒有

regarding quarantine across the United States.

全國統一的隔離政策

And some states have differential policies, county by county.

而且各州各郡之間也可能有不同政策

But what about the no-brainer things? Should we close all the schools?

最簡單的決定呢？我們該不該停課？

Well then what about all the workers? They won't go to work

如果停課是否要一起停班？小孩不上課

if their kids aren't in school.

家長也不會來上班

Encouraging telecommuting? What works?

鼓勵通訊上班如何？有效嗎？

Well the British government did a model of telecommuting.

英國政府曾經作過通訊上班的實驗

Six weeks they had all people in the banking industry

六週內，他們要求銀行業者

pretend a pandemic was underway.

假裝有大流行，只用通訊的方式上班

What they found was, the core functions --

發現有些核心業務無法進行

you know you still sort of had banks,

例如還有很多銀行

but you couldn't get people to put money in the ATM machines.

還未提供ATM自動存款服務

Nobody was processing the credit cards.

沒有人處理信用卡的資訊

Your insurance payments didn't go through.

沒有行員處理保險付款以致未能按時支付

And basically the economy would be in a disaster state of affairs.

總而言之就是經濟活動會癱瘓

And that's just office workers, bankers.

而且這銀行行員只是在室內辦公的人

We don't know how important hand washing is for flu --

我們也不知道洗手對流感的防治到底效用如何

shocking. One assumes it's a good idea to wash your hands a lot.

很驚人。我們都以為常洗手是好事

But actually in scientific community there is great debate

但事實上在科學界這還是個很大的爭議

about what percentage of flu transmission between people

到底人與人間的流感有多少比例

is from sneezing and coughing

藉著打噴嚏和咳嗽傳染

and what percentage is on your hands.

而經手傳染的比例又是如何

The Institute of Medicine tried to look at the masking question.

醫學研究中心也曾研究口罩的問題

Can we figure out a way, since we know we won't have enough masks

既然無法提供足夠的口罩，有無其他方法？

because we don't make them in America anymore,

因為美國已經不製造口罩

they're all made in China --

所有的口罩都在中國製造

do we need N95? A state-of-the-art, top-of-the-line,

我們是不是一定要用N95？這種最新科技、最高品質

must-be-fitted-to-your-face mask?

能完全貼合臉部配戴的口罩

Or can we get away with some different kinds of masks?

還是我們可用其他的口罩？

In the SARS epidemic, we learned in Hong Kong

在SARS流行期間，我們從香港的經驗得知

that most of transmission was because

大部分的感染是因為

people were removing their masks improperly.

人們摘除口罩的方式不對

And their hand got contaminated with the outside of the mask,

手被口罩外側汙染

and then they rubbed their nose. Bingo! They got SARS.

就去揉鼻子，結果就中獎，得到SARS

It wasn't flying microbes.

病毒並不是到處飛散的微生物

If you go online right now, you'll get so much phony-baloney information.

如果你現在上網查詢可以找到非常多胡扯的訊息

You'll end up buying -- this is called an N95 mask. Ridiculous.

你就會去買這個N95口罩。真的是太荒謬了

We don't actually have a standard

我們事實上並未替

for what should be the protective gear for the first responders,

第一線的工作者

the people who will actually be there on the front lines.

訂定保護裝置的標準

And Tamiflu. You've probably heard of this drug,

還有你們可能聽過「克流感」這種藥物

made by Hoffmann-La Roche, patented drug.

它是由 Hoffmann - La Roche 製造的專利藥品

There is some indication

有一些證據顯示

that it may buy you some time in the midst of an outbreak.

在流感爆發時這個藥物可能可以拖延一點時間

Should you take Tamiflu for a long period of time,

但是如果長期使用克流感

well, one of the side effects is suicidal ideations.

它的副作用之一是產生自殺的意念

A public health survey analyzed the effect

曾有一個公共衛生的調查研究

that large-scale Tamiflu use would have,

大規模使用克流感的效應

actually shows it counteractive

結果顯示克流感對公共衛生政策

to public health measures, making matters worse.

造成反作用，讓情況更糟

And here is the other interesting thing:

還有另一件有趣的事情：

when a human being ingests Tamiflu, only 20 percent

人服用克流感之後，只有20%

is metabolized appropriately

會被妥善代謝

to be an active compound in the human being.

轉化成人體內有效的成分

The rest turns into a stable compound,

其餘的會轉化成一個穩定的化合物

which survives filtration into the water systems,

通過各種過濾系統進入環境中的水

thereby exposing the very aquatic birds that would carry flu

因此有機會進入帶原的水鳥體內

and providing them a chance

提供這些病毒

to breed resistant strains.

產生抗藥性的機會

And we now have seen Tamiflu-resistant strains

我們已經在越南及埃及的

in both Vietnam in person-to-person transmission,

人對人傳染案例中觀察到

and in Egypt in person-to-person transmission.

對克流感產生抗藥性的病毒

So I personally think that our life expectancy

因此我個人認為克流感

for Tamiflu as an effective drug

能對抗流感的期限

is very limited -- very limited indeed.

應該是非常非常的短暫

Nevertheless most of the governments

不過大部分的政府

have based their whole flu policies

都是把整個抗流感的政策

on building stockpiles of Tamiflu.

建立在大量儲存克流感上

Russia has actually stockpiled enough

俄國就已經儲存了足以

for 95 percent of all Russians.

供應95%俄國人的藥品

We've stockpiled enough for 30 percent.

美國已經儲存足夠供應30%人口的藥量

When I say enough, that's two weeks worth.

足夠指的是兩個禮拜的藥量

And then you're on your own because

之後就要自己想辦法

the pandemic is going to last for 18 to 24 months.

因為全球大流行至少會延續18到24個月

Some of the poorer countries

一些經歷過H5N1流行

that have had the most experience with H5N1 have built up stockpiles;

卻較貧困的國家，他們所囤積的藥品

they're already expired. They are already out of date.

已經超過保存期限, 過期了

What do we know from 1918,

我們從1918年大流感

the last great pandemic?

得到的教訓是什麼？

The federal government abdicated most responsibility.

聯邦政府會推託大部份的責任

And so we ended up with this wild patchwork of regulations

因此我們只有美國各地法規的

all over America.

拼湊物

Every city, county, state did their own thing.

每個市、郡、州各自為政

And the rules

各地採用的規範

and the belief systems were wildly disparate.

和遵循的原則都大不相同

In some cases all schools, all churches,

有些地方是關閉所有的學校、教堂、

all public venues were closed.

和所有公共場所

The pandemic circulated three times in 18 months

1918年大流感在18個月內出現三波大流行

in the absence of commercial air travel.

而且還是在缺乏商用客機的時代背景下

The second wave was the mutated, super-killer wave.

其中第二波是突變造成的超級殺手浪潮

And in the first wave we had enough healthcare workers.

第一波大流行時我們還有足夠的醫護人員

But by the time the second wave hit

但是第二波大流行襲擊時

it took such a toll among the healthcare workers

造成醫護人員大量的傷亡

that we lost most of our doctors and nurses that were on the front lines.

讓我們失去了大部分的第一線醫師和護士

Overall we lost 700,000 people.

在美國共造成70萬人死亡

The virus was 100 percent lethal to pregnant women

那隻病毒對於懷孕婦女100%致命

and we don't actually know why.

我們至今仍不知道原因

Most of the death toll was 15 to 40 year-olds --

大部分的死者是15到40歲的人

robustly healthy young adults.

也就是非常健康的年輕成人

It was likened to the plague.

它的嚴重性可跟鼠疫相提並論

We don't actually know how many people died.

我們並不清楚全球到底死了多少人

The low-ball estimate is 35 million.

估計至少有3500萬人

This was based on European and North American data.

這是依據歐洲跟北美的資料估算的

A new study by Chris Murray at Harvard

哈佛大學的Chris Murray所作的最新研究顯示

shows that if you look at the databases that were kept

如果利用英國人在印度

by the Brits in India,

所建立的資料來看

there was a 31-fold greater death rate among the Indians.

印度人的死亡率是其他地區的31倍

So there is a strong belief that in places of poverty

因此有人強烈相信較貧困的地區

the death toll was far higher.

死亡人數應該會多出很多

And that a more likely toll

因此較可能的死亡人數

is somewhere in the neighborhood of 80 to 100 million people

應該是在八千萬到一億人之間

before we had commercial air travel.

而且是在還沒有商用航空的狀況下

So are we ready?

所以我們準備好了嗎?

As a nation, no we're not.

以美國來說，我們還沒準備好

And I think even those in the leadership

而且我想即使是領導階層的人

would say that is the case,

也會同意我的說法

that we still have a long ways to go.

說我們還有很大的進步空間

So what does that mean for you? Well the first thing is,

所以你們該怎麼辦？第一件事：

I wouldn't start building up personal stockpiles of anything --

我不會開始囤積任何東西

for yourself, your family, or your employees --

不管是為你自己、你的家人、或是你的員工

unless you've really done your homework.

除非你真正作好了你的功課

What mask works, what mask doesn't work.

哪幾種口罩有用？ 哪幾種沒有用？

How many masks do you need?

你需要多少口罩？

The Institute of Medicine study felt that

醫學研究中心的研究結果顯示

you could not recycle masks.

你不可以回收口罩再利用

Well if you think it's going to last 18 months,

所以如果你想要撐過18個月

are you going to buy 18 months worth of masks

你得為家裡的每一份子

for every single person in your family?

購買足夠18個月用的口罩嗎？

We don't know -- again with Tamiflu,

我們不知道。克流感呢？

the number one side effect of Tamiflu is

克流感最主要的副作用

flu-like symptoms.

是類流感症狀

So then how can you tell

所以如果你們全家

who in your family has the flu

都在服用克流感

if everybody is taking Tamiflu?

你該如何分辨到底是誰真正得了流感？

If you expand that out to think of a whole community,

如果你把這個概念延伸到整個社區

or all your employees in your company,

或是公司裡的所有員工

you begin to realize how limited

你會了解克流感的效用

the Tamiflu option might be.

真的很有限

Everybody has come up to me and said,

很多人會跟我說

well I'll stockpile water or, I'll stockpile food, or what have you.

那我就儲存水、食物或是其他物資好了

But really? Do you really have a place

真的嗎？你真的有空間

to stockpile 18 months worth of food? Twenty-four months worth of food?

儲存18個月或是24個月的食物嗎？

Do you want to view the pandemic threat

你真的要用1950年代

the way back in the 1950s

人們看待民防的方式

people viewed the civil defense issue,

看待這個全球大流行嗎？

and build your own little bomb shelter for pandemic flu?

真的要為大流感幫自己蓋一間防空洞嗎？

I don't think that's rational.

我不認為那叫理性

I think it's about having to be prepared

我認為重點不是以個人為單位作準備

as communities, not as individuals --

而是要以整個社區

being prepared as nation,

整個國家

being prepared as state, being prepared as town.

整個州、整個城鎮為單位作準備

And right now most of the preparedness

目前大部分的準備

is deeply flawed.

都有很大的缺陷

And I hope I've convinced you of that,

我希望我已經說服各位

which means that the real job is go out and

真正重要的工作是

say to your local leaders,

去問各位的地方主管

and your national leaders,

去問國家領導人

"Why haven't you solved these problems?

「為什麼還沒有解決這些問題？」

Why are you still thinking that

「你們為何還認為，」

the lessons of Katrina do not apply to flu?"

「卡崔娜颶風的教訓並不適用於流感的防治？」

And put the pressure where the pressure needs to be put.

請在該施壓的地方施壓

But I guess the other thing to add is,

還有，如果你擁有一個公司

if you do have employees, and you do have a company,

有一些員工

I think you have certain responsibilities

我認為你有責任

to demonstrate that you are thinking ahead for them,

表現出你比他們有遠見

and you are trying to plan.

你有在計畫

At a minimum the British banking plan showed that

至少英國的銀行實驗顯示

telecommuting can be helpful.

遠距通訊有一些幫助

It probably does reduce exposure

或許可以減少疾病的暴露

because people are not coming into the office and coughing on each other,

因為人們不用到辦公室對彼此咳嗽

or touching common objects

或是碰觸共通的物品

and sharing things via their hands.

經由接觸造成病毒傳播

But can you sustain your company that way?

但是你的公司能否以這種方式持續經營一段時間？

Well if you have a dot-com, maybe you can.

如果你有個網站，或許你能

Otherwise you're in trouble.

不然你的麻煩就大了

Happy to take your questions.

我很樂於回答問題

(Applause)

（掌聲）

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

問：哪些因素會決定全球大流行的時程長短？

Laurie Garret: What factors determine the duration of a pandemic, we don't really know.

答：哪些因素決定全球大流行的時程，我們不太清楚

I could give you a bunch of flip, this, that, and the other.

我列舉出一堆猜測的因素

But I would say that honestly we don't know.

但我寧願老實說我們並不清楚

Clearly the bottom line is

很顯然的，到最後

the virus eventually attenuates,

病毒的效力終將減弱

and ceases to be a lethal virus to humanity,

不再是會致人於死的病毒

and finds other hosts.

然後去找別的宿主

But we don't really know how and why that happens.

但我們不太清楚那如何發生或為什麼會發生

It's a very complicated ecology.

那是個非常複雜的生態

Audience member: What kind of triggers are you looking for?

問：你的警告指標是什麼？

You know way more than any of us.

你在這方面比我們都懂得多很多

To say ahh, if this happens then we are going to have a pandemic?

你認為發生了什麼情況，就會有大流行？

LG: The moment that you see any evidence

答：如果你看到嚴重的

of serious human-to-human to transmission.

人對人傳染的證據

Not just intimately between family members

也就是不只是互動親密的家人

who took care of an ailing sister or brother,

因為照顧生病者而受到感染

but a community infected --

而是社區感染

spread within a school,

像是學校中的感染

spread within a dormitory, something of that nature.

宿舍中的感染，等等類似的狀況

Then I think that there is universal agreement

如果有這種情況發生

now, at WHO all the way down:

世界衛生組織從上到下都會同意

Send out the alert.

發布警告

Audience member: Some research has indicated that statins can be helpful.

問：有些研究顯示藥物statins可能有幫助

Can you talk about that?

你能不能談一下？

LG: Yeah. There is some evidence that taking Lipitor

答：是的，是有一些證據顯示服用立普妥（Lipitor）

and other common statins for cholesterol control

還有其它控制膽固醇用的statins類藥品

may decrease your vulnerability

可能可降低流感病毒

to influenza.

對你的感染性

But we do not completely understand why.

但是我們並不完全了解為什麼

The mechanism isn't clear.

它的機制還並不清楚

And I don't know that there is any way

我也不知道有無方法

responsibly for someone to start

能讓人負責任地

medicating their children

將自己的Lipitor

with their personal supply of Lipitor or something of that nature.

或同類藥物給自己的小孩服用

We have absolutely no idea what that would do.

我們完全不知道會造成什麼效果

You might be causing some very dangerous outcomes

有可能會因為讓小孩服用這個藥物

in your children, doing such a thing.

造成非常危險的結果

Audience member: How far along are we in being able to determine

問：我們到目前為止有沒有辦法

whether someone is actually carrying, whether somebody has this

在一個人的症狀完全顯現之前

before the symptoms are full-blown?

就知道一個人已經感染或是帶原？

LG: Right. So I have for a long time said

答；好的，所以我一直都在倡導

that what we really needed was a rapid diagnostic.

說我們真正需要的是快速診斷的方法

And our Centers for Disease Control

美國的疾病管制局

has labeled a test they developed

將他們發展出來的一種檢測法

a rapid diagnostic.

視為快速檢測

It takes 24 hours in a very highly developed laboratory,

但得在高階的實驗室裡，由充分訓練的研究人員

in highly skilled hands.

進行24小時的分析

I'm thinking dipstick.

而我想要的是像試紙這麼簡單的東西

You could do it to your own kid. It changes color.

你可以在家裡檢查自己的小孩：如果變色

It tells you if you have H5N1.

就表示得了H5N1

In terms of where we are in science

以我們目前在科學方面的進展

with DNA identification capacities and so on,

目前DNA檢定的能力等等

it's not that far off.

作到這麼方便的篩檢並不難

But we're not there. And there hasn't been the kind of investment to get us there.

但是我們沒有，也沒有投資這種篩檢的發展

Audience member: In the 1918 flu I understand that

問：1918年的流感大流行

they theorized that there was some attenuation

我聽說有一個理論是病毒在

of the virus when it made the leap into humans.

傳給人體時毒性衰減

Is that likely, do you think, here?

這次也會發生類似的情形嗎？

I mean 100 percent death rate

我的意思是說100%死亡率

is pretty severe.

相當嚴重呢

LG: Um yeah. So we don't actually know

答：嗯，其實我們並不清楚

what the lethality was

1918年的病毒株在野鳥體內

of the 1918 strain to wild birds

還沒傳染給人時

before it jumped from birds to humans.

對鳥類的致死率如何

It's curious that there is no evidence

奇怪的是，在流感大流行之前

of mass die-offs of chickens

在美國找不到

or household birds across America

大量雞隻死亡

before the human pandemic happened.

或是其他家禽大量死亡的證據

That may be because those events

也許是因為這些事件

were occurring on the other side of the world

發生在世界其他地方

where nobody was paying attention.

而這些地方沒有人注意

But the virus clearly

不過病毒很明顯的

went through one round around the world

以一種非常溫和的病毒型式

in a mild enough form

在世界上繞了一圈

that the British army in World War I

以至於第一次世界大戰時，英國陸軍

actually certified that it was not a threat

認定它不是一個威脅

and would not affect the outcome of the war.

不足以影響戰爭的結果

And after circulating around the world

但是在它繞行地球一周之後

came back in a form that was tremendously lethal.

變成非常致命的品種

What percentage of infected people were killed by it?

受到感染的人中有多少百分比因此喪命？

Again we don't really know for sure.

我們真的不清楚

It's clear that if you were malnourished to begin with,

我們只知道如果你原本就營養不良

you had a weakened immune system,

如果你的免疫系統減弱

you lived in poverty in India or Africa,

如果你住在印度或非洲的貧民區

your likelihood of dying was far greater.

你死亡的機率就大許多

But we don't really know.

但是其他的我們真的不清楚

Audience member: One of the things I've heard is that

問：我曾經聽說

the real death cause when you get a flu is the associated pneumonia,

流感真正致命的是併發的肺炎

and that a pneumonia vaccine

而注射肺炎疫苗

may offer you 50 percent better chance of survival.

可以增進50%的存活率

LG: For a long time, researchers in emerging diseases

答：新興疾病的研究人員長期以來

were kind of dismissive of the pandemic flu threat

都對全球大流感這種想法

on the grounds that

不以為然，因為

back in 1918 they didn't have antibiotics.

1918年我們還沒有抗生素

And that most people who die of regular flu --

而且在一般流感流行期間

which in regular flu years

死亡的人

is about 360,000 people worldwide,

全球大約是36萬人

most of them senior citizens --

大部分都是老年人

and they die not of the flu but because the flu gives an assault to their immune system.

這些人並不是死於流感，而是因為流感減弱了他們的免疫系統

And along comes pneumococcus

於是他們感染肺炎雙球菌

or another bacteria, streptococcus

或是其他細菌，如鏈球菌

and boom, they get a bacterial pneumonia.

得到細菌性肺炎

But it turns out that in 1918 that was not the case at all.

但是1918年那次並非如此

And so far in the H5N1 cases in people,

到目前為止H5N1的人類病例中

similarly bacterial infection

類似的細菌性感染

has not been an issue at all.

根本就微不足道

It's this absolutely phenomenal disruption of the immune system

這個病毒的主要致死原因

that is the key to why people die of this virus.

是因為免疫系統的嚴重錯亂

And I would just add

我還要補充一下

we saw the same thing with SARS.

SARS的情況跟H5N1一模一樣

So what's going on here is your body says,

都是身體裡頭

your immune system sends out all its sentinels and says,

免疫系統將所有的哨兵派遣出去，說

"I don't know what the heck this is.

「我不知道這是什麼鬼東西，」

We've never seen anything even remotely like this before."

「我們從來沒有見過這種樣子的東西。」

It won't do any good to bring in the sharpshooters

派出狙擊手沒有用

because those antibodies aren't here.

因為根本就沒有適用的抗體

And it won't do any good to bring in the tanks and the artillery

然後派出坦克車跟砲兵也沒有用

because those T-cells don't recognize it either.

因為那些T細胞也不認得它

So we're going to have to go all-out thermonuclear response,

所以只好動用熱核能武器

stimulate the total cytokine cascade.

刺激細胞激素連鎖反應

The whole immune system swarms into the lungs.

結果整個免疫系統湧入肺部

And yes they die, drowning in their own fluids, of pneumonia.

患者淹沒於體液中，死於肺炎

But it's not bacterial pneumonia.

但是這不是細菌性肺炎

And it's not a pneumonia that would respond to a vaccine.

不是會對疫苗有反應的肺炎

And I think my time is up. I thank you all for your attention.

我想我的時間到了，謝謝各位

(Applause)

（掌聲）