How to quickly scale up contact tracing across the US | Joia Mukherjee

譯者: Bruce Sung 審譯者: Helen Chang

Chris Anderson: Joia, both you and Partners In Health

克里斯．安德森（CA）： 久雅 你和你們「健康夥伴」組織

have spent decades in various battlegrounds,

數十年來已經在各個不同的戰場上

battling epidemics.

對抗流行病

Perhaps, for context, you could give us a couple examples of that work.

也許你可以舉一兩個例子 讓我們了解一下這個背景

Joia Mukherjee: Yeah, so Partners In Health

久雅．木克吉（JM）： 好的。「健康夥伴」

is a global nonprofit that is more than 30 years old.

是個創立已經 30 多年的 全球性非營利組織

We started famously in Haiti in a squatter settlement,

眾所周知，我們是在 海地的違章建築區起步的

people who were displaced.

那裡都是些流離失所的人

And when we talked to them,

我們探訪後得知

they wanted health care and education,

他們要的是醫療、教育

houses, jobs.

居所，和工作

And that has informed our work,

這些資訊有利於我們的工作

that proximity to people who are suffering.

去接近這些受苦的人

When you think about health care and the poor,

想到醫療和低收入者

there is always disproportionate suffering

受苦最多的

for people who have been historically marginalized,

總是那些傳統上被邊緣化的人

like our communities that we serve in Haiti.

正如我們在海地所服務的社區一般

And so we've always tried to provide health care

因此我們總是盡量提供醫療服務

for the poorest people on earth.

給世界上最貧苦的人

And we were launched into an international dialogue

我們也投入國際間的對話

about whether that was possible

關於是否可能提供醫療給

for drug-resistant tuberculosis, for HIV.

抗藥性結核病患、HIV 病患

Indeed, for surgery, for cancer,

還有手術、癌症

for mental health,

心理衛生

for noncommunicable diseases.

以及非傳染性疾病等

And we believe it's possible,

我們相信這做得到

and it is part of the basic human right to care.

而且這些醫療照護是 最基本人權的一部分

So when COVID started, we saw this immediately as a threat

因此 COVID 一開始

我們就立即看出它威脅到貧民的健康

to the health of people who were the poorest.

And Partners In Health now works in 11 countries,

「健康夥伴」現正於 11 個國家服務

five on the African continent,

5 個在非洲大陸

Latin America and the Caribbean,

還有拉丁美洲和加勒比海地區

as well as the former Soviet Union.

以及前蘇聯國家

And we immediately prepared to scale up testing,

我們立即著手準備擴充檢測

contact tracing, treatment, care,

接觸者追蹤、治療以及照護的能量

and then saw that it wasn't being done in the United States in that way.

而且注意到美國國內 並沒有做同樣的事

And in fact, we were just sitting, passively waiting for people to get sick

事實上我們只是坐著 被動地等有人患病

and treat them in hospital.

然後在醫院裡治療他們

And that message got to the governor of Massachusetts,

麻薩諸塞州州長得到訊息後

and we started supporting the state to do contact tracing for COVID,

我們便開始支援他們做 COVID 的接觸者追蹤

with the very idea that this would help us identify and resource

因為這樣可以幫我們 找出並提供資源給

the communities that were most vulnerable.

最脆弱的社區

CA: So it's really quite ironic that these decades of experience

CA：這真的相當諷刺

從發展中地區和別處 學來的數十年經驗

in the developing world and elsewhere,

that that has now really been seen as a crucial need to bring to the US.

現在成了迫切需要帶回美國的

And especially to bring your expertise around contact tracing.

尤其需要帶回你們接觸者追蹤的經驗

So, talk a bit about contact tracing,

因此，來說一說接觸者追蹤

why does it matter so much,

它為何這麼必要

and what would, I don't know,

還有，一個完美的接觸者追蹤系統

a perfect contact tracing setup look like?

設置起來是什麼樣的？

JM: Well, first I want to say that you want to, always,

JM：我首先要說不管什麼疾病

in any type of illness,

我們總是要

you want to do prevention,

從預防

and diagnosis and treatment and care.

到診斷、治療，以及照護

That is what comprehensive approaches look like,

那才是全方位的做法

and that "care" piece, to us,

而「照護」的部分，對我們而言

is about the provision of social support and material support

是提供社會支援及實物支援

to allow people to get the care they need.

使人能夠得到他們所需要的照顧

So that might be transportation, it might be food.

提供的可能是交通運輸 也可能是食物

So when you look at that comprehensive approach,

因此在一個全方位的做法中

for an infectious disease,

針對傳染病

part of prevention is knowing where the disease is spreading

預防包括了要知道疾病在何處傳播

and how it's spreading and in whom it's spreading,

如何傳播，和在哪些人群中傳播

so that resources can be disproportionately put

如此我們才可以將更多的資源

注入高風險的區域

to the highest-risk areas.

So contact tracing is a staple of public health

因此接觸者追蹤是公共衛生的要務

and what it means is that every time a new person is diagnosed

意思就是每當有新的

with COVID or any infectious disease,

COVID 或任何傳染病的確診者

then you investigate and innumerate the people they've been in contacts with,

你就要去調查並且列出 他們接觸過的人

and call those contacts and say, "You've been exposed,"

並且電話通知這些接觸者： 「你曾在有病毒的環境中。」

or talk to them, "You've been exposed,

或者和他們談： 「你曾在有病毒的環境中，

these are the things you need to know.

以下是你該知道的事情。

First of all, how are you?

首先，你好嗎？

Do you need care yourself?"

你需要去就醫嗎 ?」

And facilitating that.

需要就幫他們安排。

"Second of all, these are the information you need to know to keep yourself safe.

「其次，你要知道這些可以 確保你本身安全的資訊。

About quarantine, about prevention."

一些關於隔離以及預防的資訊。」

And again, this would be with any infectious disease,

如前面所說，這適用於任何傳染病

from Ebola, to cholera, to a sexually transmitted disease like HIV.

從伊波拉病毒，到霍亂 到 HIV 之類的性病都是

And then we say,

接著問他們 ：

"OK, knowing what you know,

「這些你都知道了

do you have the means to protect yourself?"

那你有辦法自我保護嗎？」

Because often the most vulnerable

因為這些高危險群

do not have the means to protect themselves.

通常也沒辦法保護自己

So that is also where this resource component comes in

接著上場的是資源這個要素

and where equity is so critical

這時公平分配極度重要

to making this disease stop

如此才能阻止疫情

and also getting the information and the resources

才能將資訊和資源

to people who need them the most.

送到最需要的人手上

CA: And in a pandemic, the people who need them the most,

CA：在全球大流行的時候，最需要的人

the most vulnerable, as you say,

那些高危險群，如你所說

are probably also --

大概也正是在

That's where the disease is spreading a lot.

疾病流行最嚴重的地區

It's in everyone's interest to do this.

這麼做符合所有人的利益

You're not just making this sort of, wonderful, equity moral point

你並不只是主張良善平等的道德觀點

that we've got to help these people.

才說我們必須幫助這些人

It's actually in all of our interest, right?

這麼做其實是符合我們 所有人的利益的，對不對 ？

JM: Yes.

JM：是的

Yes, we are one humanity,

我們同屬人類

and any disease, any infectious disease that is spreading

任何疾病、任何正在傳播的流行病

is a threat to all of us.

威脅到我們每個人

And that is one of the pieces, there's the moral imperative,

那是其中一項要件，有道德要件

there is the epidemiologic imperative,

也有流行病學要件

that if you can't control these diseases everywhere,

如果不能在每個地方 都將這個疾病控制住

that it's a threat anywhere.

那它對任何一個地方都會造成威脅

And so as we look to the kind of society we want to live in,

看看我們想住的是什麼樣的社會

good health is something that gives us all so much return on our investment.

對於健康的投資，會給 全部的人帶來巨大的報酬

CA: Now, some countries were able to use contact tracing

CA：有些國家利用接觸者追蹤

almost to shut down the pandemic before it took off in that country.

幾乎在國內大流行之前便擋住了疫情

The US was unable to do that,

美國卻沒做到

and some people have taken the view

有些人所採的觀點是

that therefore, contact tracing became irrelevant,

既然如此，接觸者追蹤已經沒必要

that the strategy was mitigation, shut everything down.

而要採用減緩的策略，關閉一切

You've argued against that,

你持反對意見

that even in a process of lockdown

認為即使在閉關之下

that actually contact tracing plays a key role.

接觸者追蹤仍有其關鍵的角色

Help us understand the scale,

跟我們解說一下需要的規模

when there's a lot of cases,

當確診案例很多的時候

the scale of tracing, both cases

同時要追蹤那些案例

and everyone they may have been in contact with

以及他們接觸到的人

and their contacts.

還有那些人又接觸到的人

It quickly gets to a huge problem.

很快就成了大規模的問題

JM: It's massive.

JM：超大的

CA：在當今美國的 情況之下，要能夠有效

CA: What sort of workforce do you need to make a difference

at this moment, where the US is at?

你需要多少人力？

JM: It's massive.

JM：超大的

I mean, the scale is massive,

我是說，需要的規模超大的

and we should not take that lightly.

我們不能掉以輕心

And we don't, at Partners In Health.

在「健康夥伴」我們從不掉以輕心

I mean, we are willing to try to figure this out,

我是說，我們願意找出解決方案

and I always feel that if we could stop Ebola

而且我總覺得

如果我們在世界上最窮的地區 能夠阻止伊波拉病毒

in some of the poorest countries in the world,

of course we ought to do it here,

當然在這裡也應該這麼做

and was it too late when there were 28,000 deaths in Ebola?

已經有 28,000 人死於伊波拉 病毒，我們是不是太慢了？

Sure, it's always too late.

是啊，總是太慢

We should have started earlier,

我們是應該早點開始

但現在開始也還不遲

but it's not too late to have an impact.

And so there's three aspects of timing and scale.

關於時機和規模可以從三方面來看

First is, the earlier you start,

第一，越早開始

the better, right?

就越好，對不對 ？

And that's what we saw in Rwanda.

盧安達便是如此

They went from early testing and contact tracing,

他們做早期篩檢和接觸者追蹤

the first two cases entered into the country on March 15,

最初兩個案例 3 月 15 日入境

and in one month,

一個月的工夫

because of contact tracing, isolation and plenty of testing,

由於追蹤接觸者、隔離，及多做檢測

they had held that case rate to 134 people.

他們將確診人數控制在 134 人

It's remarkable, it's remarkable.

很棒 ，很棒

In the state of Georgia, where is home to the CDC,

疾管局所在的喬治亞州

similar population size, about 12 million,

人口數和他們差不多 大約一千二百萬

from the first two cases in the first month,

從最初兩個案例，一個月內

those cases became 4,400 cases.

便達到 4,400 例

And in the country of Belgium,

再看看比利時

a similar population,

人口也是差不多

those two cases became 7,400.

從兩例一下成為 7,400

So you do have to make scale to stop this.

的確需要投入大量人力來控制

But the earlier you do it,

但越早開始做

the more benefits there are to your society

就能為社區帶來越多好處

and also to the other people who need medical services --

而這也有利於其他 需要醫療服務的人——

women who are pregnant,

如懷孕的女性

people who need their fracture repaired,

或骨折需要處理的

because services themselves in the United States

因為在美國這些醫療服務

have been, you know, really hampered by this huge amount of COVID.

都已經因為有太多 COVID 病例而受到影響

So the first point is,

因此，第一點就是

it's always late, but it's never too late.

永遠都是太晚，但還是來得及

Why?

為什麼？

Because vulnerable populations are sitting ducks,

因為高危險群是易受攻擊的目標

and so imagine if one of your contacts was a nursing assistant

想像如果一位接觸者是助理護士

who worked in a nursing home.

在療養院工作

We know that one nursing assistant can spread it throughout a nursing home.

我們知道一位助理護士 可以感染整個療養院

And is it important to identify that person as a contact

因此找出接觸者

and assure that he or she is able to remain quarantined?

並且確保他們保持隔離十分重要吧？

That is critical.

這是非常關鍵的

And so it's hard to say,

所以不能輕易地說：

"Well, it's not worth it if it's just one person, two persons."

「喔，那只是一兩個人 不值得大費周章。」

Every life matters,

每一條命都很重要

and all of their contacts in the community of that person matters as well.

而且那個人在社區裡 接觸到的每個人也都很重要

So that's one thing.

這是第一點

The second about scale is people need jobs right now.

關於規模的第二點是 大家需要去就業工作

And they want to be part of a solution,

大家都希望為解決方案做出貢獻

and some of the frustration we see,

我們看到的一些挫敗感

the antilockdown movement,

那些反封鎖的運動

is really out of anger and frustration

實際上是來自憤怒與挫折

and feeling, "What can we do?"

以及無力感： 「我們到底能做什麼？」

And so this gives people this feeling that they're part of a solution

做接觸者追蹤可以讓大家 感覺自己為解決方案出了力

and can provide thousands of jobs.

而且可以造就成千上萬的就業機會

And then third, I would say, for us to reopen our schools,

然後第三點我要指出的是

要重開學校

our churches, our workplaces,

教堂、工作場所

we have to know where the virus is spreading

我們必須知道究竟疫情在哪裡傳播

so that we don't just continue on this path.

如此才不會一再重蹈覆轍

And so contact tracing provides the platform to control,

因此感染者追蹤是一個控制的平台

but also to see outbreaks in real time popping up,

也讓我們即時看到疫情的發生

and then respond promptly.

而能夠做快速的反應

So there are many reasons that we have to bring this to scale now.

因此我們有太多理由 必須做大量的接觸者追蹤

Even though it is tardy.

儘管現在已經慢了一步

CA: So especially as we have this pressure to go back to work,

CA：尤其當我們 現在面臨復工的壓力

like, contact tracing has to be part of that strategy,

接觸者追蹤必須是策略的一部分

or we're just inviting another disaster in a few weeks' time.

否則我們幾週內又會迎來一場災難

Whatever you make of what's happened during this mitigation process.

不管你對目前疫情控制的看法如何

JM: Exactly, exactly.

JM：沒錯，沒錯

Exactly, and so that's such an important part, Chris,

一點都沒錯，克里斯 那是非常重要的一部分

and something that we are just really keen

而且我們非常渴望

to look at the United States in a different way.

能夠換個角度來看美國

What are the long-term public health infrastructures

要有什麼樣的長期公共衛生基礎設施

that we need to protect us for the second wave, the third wave

才能在第二波、第三波 以及未來的大流行病

and in the future, for future pandemics?

到來的時候保衛我們？

CA: Whitney.

CA：惠特妮

Whitney Pennington Rodgers: You know, to that point,

惠特妮．潘寧頓．羅傑斯（WPR）： 關於那一點，我們有個問題

there is a question out there from one of our anonymous

來自一位不具名的社區人士

community members,

about why contact tracing isn't already part of our public health system.

為何我們的公共衛生系統 不是原本就有接觸者追蹤

It seems like it does make a lot of sense

似乎那樣才有道理

its a way to mitigate the spread of disease.

畢竟它是用來控制 疾病傳播的一種方法

你可以就這一點再講一些嗎？

Could you speak a little bit to that?

JM: I think many people have said --

JM：我想很多人已經說過——

and I am not a politician --

先說我不是搞政治的——

that our American health care infrastructure

美國的醫療系統

is built on treatment and not prevention.

是建立在治療而不是預防上

It's built on procedures

它是建立在醫療程序上

and not keeping people well.

而不是在人的保健上

And some of that was driven by profit,

部分的原因是利益取向

and some of that was driven by need,

有一部分則是因為需求

but I think we need to rethink how we deliver care in this environment.

但我認為我們必須重新思考 在這個環境下要如何來做

WPR: "There is some fear and suspicion about privacy and contact tracing.

WPR：「有人會擔心和猜疑 追蹤接觸者涉及的隱私問題

How can we build trust in the process?"

要如何在這個過程中建立信任呢？」

JM: Yeah, that's a great question,

JM：好問題

and I think there's fear about privacy

我想大家會擔心隱私問題

and part of it comes from the idea of what contact tracing is.

部分是來自於對接觸者追蹤的觀感

And I think that's why we feel strongly,

我們堅信

is if you lead with the idea that it's care

如果一開頭就讓他們 知道這是一種醫療照顧

and it's trying to get resources and information

這個攸關獲取資源和資訊

and help to people,

是為了幫助人

it seems very different

就會給他們很不一樣的觀感

than just, oh, who's sick, and who's a threat.

而不是一來就告訴他們某人 得病了、某人可能會傳染

And so fundamentally --

所以這個基本上——

and that's why we're so pleased to be at this TED talk today --

順便提一下，我們非常高興 今天能夠上 TED Talk——

is it's about communication, right?

就是關於溝通，對不對？

It's not about surveillance,

這不是關於監控

it's about communication and care and support.

而是關於溝通、醫療和支援

That's one thing.

這是其中的一面

And we'll be hearing from our colleagues

晚一點我們的同儕也會來講

on the tech side.

關於科技的那一面

There's ways to add tech, even to care,

甚至醫療中也可以融入科技

that it can be a resource for caring and communication.

而成為一種醫療兼溝通的資源

But there are ways to protect people's privacy

有很多方法可以同時保護人的隱私

and also to provide care,

又提供醫療照顧

and public health has many laws attached to it.

公共衛生有很多這方面的法律

This is all done within the constructs of our state public health laws.

這些通常是在州的公共衛生法架構中

And so I think some of the communication around this is,

我想關於這個我們要溝通的就是

how do we take care of each other,

我們要如何照顧彼此

how do we take care of the most vulnerable.

如何照顧弱勢者

And if we frame contact tracing as care,

只要我們將接觸者追蹤 放在醫療的框架內

I think that starts a different kind of conversation.

我想就可以將對話帶入不同的方向

CA: Mm.

CA：嗯

So, Joia, can you just talk in a bit more detail

久雅，妳可不可以再多說一點細節

about what it is that you are advising Massachusetts to do

關於你給麻薩諸塞州的

in terms of contact tracing.

接觸者追蹤的建議

Give us a sense of the scale of it.

說一下規模有多大

JM: Yeah, so the scale -- thank you.

JM：好，關於規模大小—— 謝謝你的問題

You know, we are able now to make about 10,000 calls a day

我們目前每天可以打 大約 10,000 通電話

to contacts.

給接觸者

So every new case that comes in,

每有一個新病例

the case is investigated by someone on the phone,

會有人以電話先做調查

and then those investigations

這些調查裡

means writing down the names and the phone numbers of the persons

記錄下接觸過的人名和電話

you've been in contact with for the time you were sick

要追溯到發病

and a couple days before.

之前兩天起

And with those numbers then, the contact tracers --

隨著這些數字 負責追蹤接觸者的人

And that's what we really redoubled the workforce and really expanded,

我們真的再次將人數加倍 真的擴充了這些人力

more than doubled,

不只加倍

to support the department of public health

來支援公共衛生部門

to do that contact tracing.

做接觸者的追蹤

So we have 1,700 people employed full time, with benefits,

我們現在僱用 1,700 人 全職，有福利

to call those contacts and say, "Are you OK?

由他們負責打電話給 接觸者：「你好嗎？

This is the information you need,"

這是你應該知道的資訊……」

and then, and I think this is the critical piece,

然後，接下來是我認為最關鍵的部分

when someone doesn't have the information,

如果對方不知該怎麼做

then we have another cadre of people we call the resource care coordinators,

我們還有另外一整個 團隊的資源協調員

who help that person, that contact,

去幫那位接觸者

to do the things they need to do to protect themselves.

得到需要的保護與協助

It might be food delivery,

像是送食物上門

it might be filing for unemployment benefits,

申請失業福利

it might be trying to get them medical care or a test.

或者幫他們安排醫療和檢測

That piece is the care piece.

那是醫療的部分

And that is what turns social distancing from very regressive --

這樣把後退的保持社交距離——

look at me in my beautiful house, social distancing --

你看我在漂亮的家裡保持社交距離——

to something that's progressive

變為前進

and paying attention to those who need the resources.

並且關注到那些需要資源的人

So the scale is massive,

因此規模非常龐大

with 1,700 employees hired to do this,

雇用了 1,700 人來從事這項工作

but they are connected

他們和社區裡的食物銀行

with local community food banks and churches and facilities

教會、各個單位

and primary health care centers as well.

以及主要的醫療中心都有聯繫

CA: Thank you so much, Joia.

CA：久雅，非常感謝妳