The secret weapon against pandemics | Georges C. Benjamin

譯者: Crystal Tsang 審譯者: Helen Chang

David Biello: It's now my great honor and privilege

大衛 · 比爾羅（大）： 我很榮幸向大家介紹

to introduce Dr. Georges Benjamin,

喬治 · 本傑明博士，

who's the executive director of the American Public Health Association,

他是美國公共衛生協會的執行董事，

who has a long and distinguished career,

在醫療和公衛這兩個職業領域中

both as a medical professional and as a public health professional.

都有很長的經歷和卓越的職涯。

Please give a warm welcome to Dr. Georges Benjamin.

請歡迎喬治 · 本傑明博士。

Georges Benjamin: Hey, David, how are you?

喬治 · 本傑明（喬）： 嘿，大衛，你好嗎？

DB: I am good, how are you, Dr. Benjamin?

大：我很好。本傑明博士你好嗎？

GB: I'm here. (Laughs)

喬：我還在。（笑聲）

DB: Hanging in there. Good.

大：要撐住。很好。

GB: Hanging in.

喬：在撐著。

DB: We know that the theme of the moment is reopening, I would say.

大：我們知道目前的關注焦點 是重新開放，至少我會這麼說。

We just heard one possibility for that,

我們剛剛才聽到了可能會。

but obviously,

但很顯然，

a lot of countries have already reopened in one form or another,

很多國家已經以某種 形式開始開放了，

and I believe, as of today,

且我相信，目前為止，

all 50 states here in the US have reopened in one form or another.

美國這裡的五十州 都以某種形式開放了。

How do we do that smartly, how do we do that safely?

我們要如何以明智、 安全的方式做好重新開放？

GB: Yeah, we really do need to reopen safely and carefully,

喬：我們確實需要以明智、 安全的方式來重新開放，

and it means that we have not got to forget these public health measures

那就表示，首先我們不能忘記

that really brought down the curve to begin with.

把疫情曲線拉下來的那些公衛措施。

And that means thing such as

那些措施包括像是

covering up your nose and mouth when you cough or sneeze,

在咳嗽或打噴嚏時要遮住口鼻，

wearing a mask, washing your hands,

戴口罩、洗手、

physically distancing yourself to the extent possible from others.

和他人盡可能保持實體距離。

Thinking about everything we do,

想想看我們所做的一切，

you know, before we go to work in the morning,

早上我們出門工作之前所做的，

while we're at work.

在職場做的。

And being as careful as many of us have been

而且我們要一直十分小心

跟過去兩個月很多人一樣，

in the last two months,

as we go into the next three months,

在接下來的三個月也要延續，

because this thing is not over.

因為這疫情尚未結束。

DB: Right.

大：是的。

There is the chance of more waves, as Uri [Alon] mentioned.

有可能像烏里（艾隆）提到的， 會有更多波疫情。

It seems like it's kind of incumbent on all of us then

看起來，我們所有人都有責任

to take public health as kind of a second job.

要把公衛當作另一份工作。

Is that right?

對嗎？

GB: You know, I've been arguing a lot

喬：我時常主張，

that now that everybody really knows what public health is,

現在大家都真確知道公衛是什麼了，

that everybody should always recognize that their second job is public health,

那麼大家也應該持續將公衛 視為他們的另一份工作，

whether you're picking up the garbage or working in a grocery store,

不論你是收垃圾的人、 在雜貨店工作的人、

or you are a bus driver,

或者公車司機，

or you're, you know, like me, doing public health,

或者像我一樣， 從事公衛方面的工作，

a physician or a nurse,

比如醫生或護士，

everybody needs to put the public health mantle

大家都應該把公衛

融入到他們的日常生活當中。

into what they do each and every day.

DB: What do you think --

大：就你看來——

So we're all public health professionals now,

所以我們大家都是公衛專業人士，

what do you think the new normal we might expect,

就你看來，當國家重新開放，

as countries reopen?

我們要預期什麼樣的新常態？

What is that going to look like,

那會是怎樣的情況？

or what do you hope that looks like, as a public health professional?

或者，身為公衛專業人士， 你希望是怎樣的情況？

GB: If I could wave a magic wand,

喬：如果我能揮一揮魔杖，

I would clearly recognize

我會清楚認知

that people are going to be doing a lot more of the public health things,

大家會做更多公衛的事，

in terms of handwashing

比如洗手

and thinking about what they do around safety when they go out in public.

和思考在公共場所時 要怎麼做才安全。

You know, it was not too long ago

不久前，

when you got in your car and you didn't put your seat belt on.

你進到車內， 還沒有繫上安全帶的習慣。

現今大家都會繫，

Today we do it,

and we don't think anything about it.

且完全不假思索。

Most of us don't smoke,

我們大部分人不抽菸

because we know that that's bad for us.

是因為我們知道抽菸對我們不好。

Most of us look both ways before we cross a street.

我們大部分人在過馬路時 會先看左右兩邊。

Most of us, you know,

我們大部分人

do things in our house, that are -- fix trip hazards.

在我們的房子裡 會做防止摔倒的措施。

So as we go forward with this outbreak,

當我們在這疫情向前邁進時，

I'm hoping that people will pay a lot more attention

我希望大家會更加注意

to things that can cause us to get an infection.

可能會讓我們受到感染的事物。

So you know, cleaning things, disinfecting things.

所以，東西要清洗、要消毒。

More importantly, not coming to work if you're sick.

更重要的是，如果生病就不要去工作。

I'm hoping that employers will put in paid sick leave for everybody,

我希望僱主會提供所有人帶薪的病假，

so people can stay home.

大家才能夠待在家裡。

Yeah, it’s an additional cost,

是的，那是額外的成本，

but I can tell you that we've now learned

但我可以告訴各位， 我們現在已經學到

that the cost of not doing something like that

不這麼做的成本更高，

is billions and billions and billions of dollars.

是數十億，數十億，數十億美金。

Paid sick leave is pretty cheap when you do that.

相較之下有薪的病假就便宜多了。

DB: Yeah, we are, I think, envious in the United States

大：我想，在美國，我們很羨慕

of all the countries that perhaps have

所有那些健康照護系統

a more all-encompassing health care system than we do.

比我們更完整、全面的國家。

Would you agree that masks are kind of the symbol

你是否認同，戴口罩就是象徵了

of adopting that "public health professional as a second job" mindset?

「視公衛職業為另一份工作」的心態？

GB: Well, you know, it's funny.

喬：這很有趣。

Our colleagues in Asia have had a mask --

我們在亞洲的同事有口罩——

wearing masks as a culture for many, many years.

戴口罩是種多年的文化。

And you know, we've always kind of chuckled at that.

我們一直竊笑這件事。

When I went overseas,

當我到海外，

I would always kind of chuckle when I saw people wearing masks.

當我看到有人戴口罩，我總會竊笑。

And of course, when this first started,

當然，這次疫情剛開始時，

you know, we only promoted masks for people that were infected

我們呼籲的是，需要 戴口罩的是被感染的人，

or of course, health care workers,

當然還有健康照護工作者，

who we thought were in a higher-risk environment.

因為我們認為他們 身處在高風險環境中。

But I think that wearing masks

但我認為，戴口罩

is probably going to be part of our culture.

很可能會變成我們文化的一部分。

We've already seen it probably will not be part of our beach culture,

我們已經看到，它可能無法 成為我們海灘文化的一部分，

although it probably should be for now.

雖然現在應該要這麼做。

But I do think that we're going to see more and more people wearing masks

但我確實認為，我們會在各種地方

看到更多人戴口罩。

in a variety of settings.

And I think that makes sense.

我認為這是合理的。

DB: Yeah, wear your mask to show that you care about others.

大：是的，戴口罩表示你關心其他人，

And that you have this, kind of, public health spirit.

且你具有公衛的精神。

So speaking of Asia,

說到亞洲，

who has done well?

哪個國家做得很好？

Looking around the world, you've been doing this for a while

你已經觀察全世界

and communicated with your peers,

並和你的同儕交流好一陣子了，

who has done well

哪個國家做得好？

and what can we learn from those good examples?

我們能從這些好典範身上學到什麼？

GB: Yeah, South Korea in many ways is the role model.

喬：在許多層面上，南韓是個典範。

You know, China actually, at the end of the day,

其實到頭來，中國也做得很好。

did reasonably well.

But the secret to all of those countries

但所有這些發病率和死亡率

that have had less morbidity and mortality than we have,

比我們低的國家，都有個秘密，

is they did lots of testing very early on,

就是他們很早就做很多的檢測，

they did contact tracing and isolation and quarantine,

它們做接觸者追蹤、隔離、檢疫，

which by the way, is the bedrock of public health practice.

順道一提，這些都是公衛實做的基礎。

They did it early, they did a lot of it,

它們很早就做，且做了很多；

and by the way, even though they're reopening their society,

順道一提，雖然它們正在重新開放，

and they're beginning to see episodic surges,

且開始出現突如其來的激增，

they then go back to those basic public health practices

接又會回到基本的公衛實做：

of testing, isolation, contact tracing

檢測、隔離、接觸者追蹤，

and transparency to the public when they can,

以及在可能的範圍內 盡可能做到對大眾公開資訊，

because it's important for the public to understand how many cases there are,

因為很重要的是要讓大眾知道

有多少確診案例、在哪裡，

where the disease is,

if you're going to get compliance from the public.

這樣才能得到大眾的配合。

DB: So testing, contact tracing and isolation.

大：所以，檢測、 接觸者追蹤，以及隔離，

That doesn't seem like rocket science, to use that old cliché.

那些老方法都不需要複雜的技術。

Why has that been hard for some countries to implement?

為什麼有些國家卻很難實施？

What's holding us back,

是什麼在扯我們的後腿？

is it electronic medical records,

是電子醫療記錄？

is it some fancy doodad,

是某種新奇的小玩意兒？

or is it just maybe overconfidence,

或者只是也許因為過去 一百年來在公衛上的成果

based on maybe the public health successes of the last 100 years?

造成我們過於自信了？

GB: You know, we are very much a pill society.

喬：要知道，我們 可說是個藥丸社會。

We think there's a pill for everything.

我們認為什麼都有藥丸可以治。

If we can't give you a pill for it,

遇到藥丸無法解決的，

then we can give you surgery and fix it.

就用手術來搞定。

You know, prevention works.

預防性工作，

And we have totally underinvested in prevention.

我們在預防性工作上 所做的投資完全不足。

We've totally underinvested in a strong, robust

我們根本沒做足夠的投資，

去建個強大、穩固的公衛系統。

public health system.

If you look at the fact that in the America today,

看看現今在美國社會的真實情況，

you can very easily know

你非常容易就能知道

what's coming off the shelf of a grocery store,

雜貨店有什麼現貨，

Amazon knows everything there is to know about you,

亞馬遜知道你的各種資訊，

but your doctor does not have the same tools.

但你的醫生卻沒有同樣的工具。

At three o'clock in the morning,

凌晨三點時

it's still very difficult to get a hold of your electrocardiogram,

仍舊很難取得你的心電圖、

or your medical record, or your list of allergies

醫療記錄，或過敏清單，

if you can't tell the practitioner what you have.

若無法告訴醫生你有什麼，就會如此。

And we just haven't invested in robust systems.

我們沒投資建造穩固的系統。

One of the interesting things about this outbreak

關於這次疫情，很有趣的一點是

is that it has created an environment

它創造出了一種環境，

in which we're now dependent on telemedicine,

現在這環境得要仰賴視訊醫療，

which has been around for several years,

視訊醫療已經存在許多年了，

but we weren't quite into it.

但我們過去不怎麼用。

But now, it's probably going to be the new standard.

但現在它可能會變成新的標準。

DB: But it also seems --

大：但，還似乎——

So, obviously,

很顯然，

those countries with an incredibly robust health care system,

健康照護系統超級穩固的那些國家，

like Taiwan, have done well,

比如台灣就做得很好，

but it seems like even countries that perhaps would be considered

但，似乎就連健康照護系統 被認為沒那麼穩固的國家，

to have a less robust health care system, like a Ghana in Africa,

比如非洲的迦納，

have actually done well.

防疫也做得很好。

What has been the, I guess, the secret sauce

那些國家的秘方是什麼？

for those kinds of countries?

GB: Yeah, it's still pretty early in some of their exposures,

喬：它們的接觸狀況還在很初期，

and hopefully, they might not have a wave that comes later,

希望他們之後不會有一波疫情，

that's still a possibility,

仍然有可能。

but at the end of the day,

但到頭來，

I think, to the extent you have done good, sound public health practices,

就執行好、做完善公衛實做來說，

all of the countries that have done well

所有疫情控制很好的國家

have implemented that.

都做到了。

Now we're a big country, we're a complex country.

我們是個大國，是很複雜的國家。

And yes, we didn't get the testing right to begin with.

是的，一開始我們沒做好檢測。

But we should not repeat the mistakes that we had over the last three months,

但我們不應該再重犯 我們過去三個月犯過的錯誤，

because we've still got several months to go.

因為我們還要再熬幾個月。

And now that we know what we did wrong,

現在我們已經知道做錯了，

I'm encouraging us to do it right the next time.

我想鼓勵大家，下次要做對。

DB: That seems smart.

大：那很明智。

GB: And the next time is tomorrow.

喬：下次就是明天。

DB: That's right.

大：沒錯。

It's already started.

已經開始了。

I mean, it almost seems to me,

在我看來，

if I can use this metaphor,

讓我這樣比喻，

that some of these countries

一些國家的系統已經有了抗體，

already had the, kind of, antibodies in their system,

because they had experience with maybe Ebola or the first SARS.

因為它們經歷過像是 伊波拉或第一波的 SARS。

Is that the key, previous exposure

過去接觸過這類公衛危機，

to these kind of public health crises?

是否是個關鍵因子？

GB: Well, this is a very different virus.

喬：這次的病毒很不一樣。

And while there may be some early evidence

雖然有些早期的證據顯示

that MERS and SARS one,

對 MERS 和 SARS 冠狀病毒，

we may have some early protection from that,

我們或有一些早期的防護，

there's some early, early studies looking at that,

有些早先的研究探討這些，

that's not the solution.

那並不是解決方案。

The secret sauce here is good, solid public health practice.

這裡的關鍵秘方在於 優良、實在的公衛實做，

That's the secret sauce here.

那才是關鍵秘方所在。

We should not be looking for anything, any mysticism,

我們不該想去尋找什麼很玄的東西，

or anyone to come save us with a special pill.

或期待有種特別藥丸能拯救我們。

This is all about good, solid public health practice,

重點在於實實在在地實做公衛，

because, by the way, look,

因為，順道一提，

this one was a bad one,

這次是個險峻的大流行，

but it's not the last one.

但它不會是最後一次大流行。

And so we need to prepare for the next really big one.

我們得要為下次大流行做好準備。

We think this one was bad,

我們認為這次很慘，

imagine what would have happened had Ebola been aerosolized,

想像如果換成是 伊波拉能透過空氣傳染，

or MERS had been aerosolized.

或 MERS 能透過空氣傳染。

You know, pick a TV movie.

看看電視上的電影就知道了。

Even though this was a bad one,

雖然這次的狀況很慘，

we still dodged a really, really bad one this time.

我們這次仍然是躲過了 非常糟糕的慘狀。

DB: Yeah, Middle East Respiratory Syndrome is no joke,

大：是的，MERS 可不是開玩笑的，

and we should be thankful that it doesn't spread more easily,

謝天謝地它沒有像 SARS 冠狀病毒

like SARS-CoV.

那麼容易傳染。

Is this, though --

不過，這是——

So all these diseases are zoonotic,

這些疾病都是人畜共患病，

that means they jumped to us from the animals that are out there.

它們從動物身上跳到我們身上， 而那些動物外頭有的是。

Obviously, humanity is kind of encroaching on nature

很顯然，人類正在以一種

in an ever more, kind of, urgent way,

前所未有的急迫方式侵佔大自然，

whether that's climate change or going into the forests, what have you.

不論是氣候變遷或侵入森林。

Is this just the new normal,

這是否只是個新常態，

like, we should expect pandemics every so often?

我們應該預期 將來常會有疾病大流行嗎？

GB: Well, they do come periodically,

喬：的確定期會出現大流行，

so this is not, you know, the first pandemic, right?

所以這次並非第一次大流行。

We've had several,

我們遇過好幾次，

100 years ago, the 1918 influenza,

一百年前，1918 年的流感，

SARS was a significant infection,

SARS 是很嚴重的感染，

even though it didn't get this bad, SARS one.

雖然 SARS 冠狀病毒沒有到這麼慘。

And we had the avian flu,

我們也有過禽流感，

which was a challenge,

那是個困難的挑戰，

and the swine flu.

還有豬流感。

We had Zika.

我們過過茲卡病毒。

So no, we've had several new disease outbreaks.

我們已經經歷過數次新疾病大流行。

These emerging diseases happen a lot,

這些新出現的疾病常常發生，

and in many ways,

在許多層面上，

we've been fortunate

我們一直很幸運，

that we have been able to identify them early

因為我們能及早辨識它們，

and contain them.

將它們控制住。

But we're now in an environment

但現在我們身處新環境，

where people can, by the way, make some of these things up.

在這環境裡，人可以造出這些病毒。

Now, this one did not happen, as best we can tell, it's not man-made.

這次不是，

我們目前的最佳判斷是 這次病毒並非人造的。

It did not probably come out of a leak in the lab.

病毒並不像是從實驗室流出來的。

But we know that, when I was in school,

但在我讀書時，我們就已知道，

to grow a bug, you had to be pretty sophisticated.

培養病菌/病毒非常地複雜。

That's not the case today.

現今的狀況並非如此。

And we need to protect ourselves from both naturally occurring infections

我們必須要保護我們自己， 對抗天然產生的感染，

and from those that are created by humans.

也要對抗人類創造的感染。

DB: Plus we have other, kind of, threat multipliers,

大：此外，我們還有 其他會讓威脅加倍的因子，

like climate change,

比如氣候變遷，

that make pandemics like this that much worse.

會讓這類的疫情更糟糕。

GB: You know, I was saying climate change was the greatest threat human survival

喬：我才說過，在這次疫情之前，

在人類已度過的威脅中， 最大的就是氣候變遷。

before this one.

But this is rivaling climate change.

但，這是很難纏的氣候變遷。

But let me tell you,

讓我告訴各位，

the big challenge we have now

我們目前要面對的大挑戰

is that we have a pandemic,

就是我們遇到了疾病大流行，

which we have still not contained,

且我們尚未將它控制住，

as we enter hurricane season,

一旦進入颶風季，

and we have climate change,

還有氣候變遷，

which is exacerbating the ferocity of the hurricanes that we're having.

會讓颶風的猛烈度大增。

So, you know, we're in for an interesting summer.

因此我們可能會有個帶勁的夏天了。

DB: And here's Chris with, I think, a question from our audience.

大：克里斯帶來了一個觀眾的提問。

Chris Anderson: Many questions, actually.

克里斯 · 安德森（克）： 其實是很多提問。

People are very interested in what you're saying, Georges.

喬治，大家對你 所談的內容很感興趣。

Here we go, here's the first one from Jim Young:

開始了，第一個是 吉姆 · 楊問的問題：

"How do we deal with people who don't believe this is serious?"

「我們要如何處理 不相信疫情嚴重性的人？」

GB: You know, you just have to continue to communicate the truth to folks.

喬：你得要持續將真相傳達給大眾。

One of the things about this particular disease

這種疾病的其中一項特性就是

is that it does not spare anyone.

它不會放過任何人、

It does not recognize political parties,

不認得黨派，

it does not recognize geography,

也無視地理。

and we had lots of people, particularly in rural communities,

有很多人，特別是在鄉村社區，

that were not seeing it, because it had not yet come to them,

還不了解這些，

因為之前疾病還沒襲向他們，

and they didn't believe it was real.

他們不相信這疫情是真的。

And now many of those communities are being ravaged by this disease.

現在有很多這類社區 被這疾病給蹂躪。

And so we just have to --

我們只得——

You know, it's not appropriate to say "I told you so."

說「我早告訴過你了」並不妥當。

It is appropriate to say, "Look, now that you see it,

妥當的說法是： 「聽著，現在你了解了，

come on board and help us resolve these problems."

就加入我們，盡一份心力， 一起解決這些問題吧。」

But this is something that's going to be around for a while.

但這將會持續一陣子。

And if it becomes endemic,

如果變成地方性流行，

meaning that it occurs all the time at some low level,

意即，經常會有低度的流行發生，

everyone is going to have this experience.

那麼人人都會經歷到。

CA: Thank you.

克：謝謝你。

Here is one from Robert Perkowitz.

接著是勞勃 · 波克維茲的問題。

"We seem to have been ignoring and underfunding public health,

「我們似乎忽視了公衛， 且投入的資金不足，

and we were unprepared for this virus."

這病毒讓我們措手不及。」

Look if the question is going to pop up there,

若這問題顯示於畫面，可以看一下。

I think it should, by some magic.

應該有某種魔法讓它顯示出來。

"What should our priorities be now

「若要為下次的公衛危機做準備，

to prepare for the next public health crisis?"

我們現在最優先要做的是什麼？」

GB: Well, we now need to make sure that we've put in the funding,

喬：現在我們得要確保我們能規劃

投入資金、資源、訓練、人員。

resources, training, staffing on the table.

And by the way, our next public health crisis

順道一提，我們下一個公衛危機

is not 10 years from now, it's not 20 years from now,

並不是在十年、二十年後。

it's the potential co-occurrence

下一個潛在危機是與流感變成共病，

of influenza, which we know is going to happen this fall,

我們知道在今年秋天就會發生，

because it comes every year,

因為每年秋天都會有流感，

with either continued COVID or a spike in COVID.

會在新型冠狀病毒延續下去 或達到高峰時，成為共病。

And we're going to have a disease process

我們將會見到

特性非常相似的疾病過程呈現，

which presents very much the same,

and we're going to have to differentiate COVID from influenza.

我們得想辦法把新型冠狀病毒 和流感區別開來。

Because we have a vaccine for influenza,

因為我們有流感疫苗，

we don't yet have a vaccine for COVID.

但我們還沒有 新型冠狀病毒的疫苗。

We hope to have one in about a year.

希望疫苗在一年左右會出來。

But that still remains to be seen.

但這就要再看看了。

DB: So get your flu shots.

大：所以，要去打流感疫苗。

CA: Yeah.

克：是的。

Indeed, in fact, David Collins asked exactly that question.

的確，事實上，大衛 · 柯林斯 就問了這個問題。

"What is the likelihood of a vaccine before the next wave?"

「疫苗能在下一波疫情發生之前 推出的可能性有多高？」

GB: Well you know, the fastest vaccine that we've ever developed was measles,

喬：要知道，我們過去開發 最快的疫苗是麻疹疫苗，

and that took four years.

也花了四年。

Now, a lot of things are different, right?

現在很多條件都不同了，對吧？

We have started on a SARS-one vaccine.

我們從 SARS 冠狀病毒疫苗著手。

So it had gone to a lot of animal trials,

已經做過了許多動物實驗，

it had gone to some very, very early human trials.

已經開始非常早期的人體實驗。

As you know, we just got some announcement

各位都知道，不久前才宣佈，

that at least it does seem to work in monkeys, in rhesus monkeys,

這種疫苗在獼猴身上似乎有效，

and there's some evidence that at least it may be efficacious and safe

有些證據顯示，

至少在極少數的人身上，

這種疫苗似乎是有效且安全的。

in a very, very small number of people.

When I say very, very small number of people,

我說的是極少數的人，

handful of people.

非常少。

So now it's got to go to phase two and phase three trials.

現在要進入第二、第三階段實驗。

So, yeah, [David] held up two hands,

是的，大衛用兩隻手比出人數了，

so yeah, yeah, it's a small number of people.

是的，沒有幾個人。

What that tells you is either that those folks were very lucky,

這個結果告訴你的是， 若不是這些人很幸運，

or it works.

就是疫苗有效。

And we won't know until we put this into the arms of thousands of people.

在給數千人施打疫苗之前， 我們不會知道答案。

CA: Here's an important question from a TED Fellow.

克：接著是一位 TED 研究員 問的一個重要問題。

"How do we actually train people about what public health means?

「我們要如何訓練人民 了解公衛的意涵？

Especially in the context of folks

特別是當對象是不相信

who don't believe they have a responsibility to 'the public?'"

自己對「公眾」有責任的人？

GB: Well, you know, I remind folks

喬：我會提醒大家，

that when public health does its best job,

當公衛發揮得最好時，

nothing happens.

就是沒有事情發生。

And of course, when nothing happens, we don't get credit for it.

如果沒有事情發生， 當然我們就沒有功勞。

So the reason that everyone in this country

所以，在美國之所以不需要

does not have to get up every morning and boil their own water

每個人每天早上起來 還得自己燒開水，

is because of public health.

就是因為公衛。

The reason that, if you get into a car accident,

之所以，如果你發生車禍，

you know, get into an automobile collision,

發生撞車，

and you wear your seat belt, and you have airbags,

你有繫上安全帶， 車上有安全氣囊，

and you're not killed from that automobile collision,

你沒在車禍中身亡，

is because of public health.

就是因為公衛。

The reason that the air is safe to breathe,

空氣之所以夠安全可以呼吸，

the food is safe to eat,

食物夠安全可以食用，

is because of public health.

就是因為公衛。

The reason that your kids are not in clothing that ignites

你的孩子之所以沒穿著會著火的衣服，

is because we have fire-retardant clothing.

就是因為我們有抗火的布料。

And that is a requirement.

那是必要的。

The reason that you don't trip walking down the stairs

你之所以在下樓梯時不會絆倒，

is because we've actually looked at how to build the stair

就是因為我們真的研究過 如何建造樓梯，

so that people don't trip when they go up or down it.

讓上下樓梯的人不會絆倒。

That's actually a public health intervention.

那其實就是公衛介入的功勞。

So the built environment,

所以，建立好的環境、醫療，

medicines, all those kinds of things,

所有這類事物、疫苗，

vaccines, those are all public health,

這些都是公衛。

and that's why public health is there,

那就是為什麼公衛一直都在。

and you may not believe that it's that important,

你可能無法置信它有那麼重要，

but we couldn't live without it.

但我們生活裡不能沒有它。

CA: Maybe one day we can all envision a health care system in America

克：也許有一天我們能夠 一起構思個美國的醫療系統

that actually has some incentives

能夠真正激勵公衛系統，

that point towards public health.

That would be very nice.

那將會是件好事。

David, I've got to just keep going with some of these questions, if it's OK,

大衛，如果可以， 我需要一直繼續提問，

因為這邊不停的有提問。

because they're pouring in.

There's one here from Jacqueline Ashby.

這裡有一個來自 賈桂琳 · 阿士比的提問，

Important question for every parent.

一個對於每位家長 非常重要的問題：

"What are your recommendations about sending children back to school?"

「針對送孩子返校上課 您有什麼建議嗎？」

GB: Yeah, I'm struggling with this one, I've got three grandkids.

喬：這對我也是個難題， 我自己就有三個孫子。

And the good news is that my grandkids are more technically proficient than I am,

還好我的孫子們比我嫻熟得多。

and right now are getting their lessons remotely.

現在他們在遠程上課。

I think it's going to be a challenge

我認為這將是一個挑戰，

as we think about sending kids back to school.

考慮將孩子送回去上學。

We're going to really need to know how infectious kids are

我們真的要知道

孩子們的傳染性有多強，

and how well they do when they get infected.

以及倘若他們感染了，應對力如何。

Now, right now, it seems,

目前看來似乎

except for a very small number of children who get a very rare disease,

除了一小部分得罕見疾病的孩子，

that they tolerate this disease very well.

孩子相當能夠承受這個疾病。

But the central question is,

但中心問題卻是：

how many of these germs will these kids bring back to you

多少感染過的孩子 會把病菌帶給你，

and to grandma and grandpa.

或帶給爺爺奶奶。

So that's going to be important.

那很重要。

And you know, trying to tell an eight-year-old

你也曉得，嘗試去告訴一個八歲小孩

not to interact with their friends,

不要跟他的朋友互動

is a real challenge.

是個大挑戰。

By the way, trying to tell a 17-year-old not to interact with their friends

對了，不讓 17 歲的孩子跟朋友接觸

is going to be a real challenge.

是個更大的挑戰。

So, we've got to properly educate these kids,

所以，我們真要 好好地教育這些孩子，

we've got to figure out how we stagger their schedules.

必須想好如何錯開他們的行程。

Uri's idea for the workforce

烏里對於人力的想法

might be an interesting concept for schools,

對於學校可能是個有趣的概念，

because the idea is to try to decompress the number of kids in the classroom.

因為這想法減少課室裡學生的數量。

By the way, if you get smaller class size, you get better education, anyway.

還有，小班教學的質量也會提高，

So, we've got to have enough teachers, though.

前提得要有足夠數量的老師。

So that may be the rate limiting step.

因此那可能是限制感染率增長的一步。

CA: Alright, last question here for now from [Steven] Petranek.

克：好的，最後一個問題 來自史提芬 · 潘特奈克。

Masks. Advice on masks --

口罩，關於口罩的建議。

I switched that off, here we go.

我把那個關了。行了。

Advice on masks seems to have shifted.

關於口罩的建議似乎有所改變。

"Would most Americans who live and work in cities

「在城市中生活和工作的美國人

be better off wearing masks

戴上口罩會不會更好？

to also help reduce the air pollution particles

能有助於減少他們每天碰到的

they encounter every day?"

空氣污染顆粒？」

GB: It may help some, absolutely.

喬：當然這也許有幫助。

But let me tell you what I would prefer we stopped doing:

但是讓我告訴你， 我會更偏向於不做什麼：

burning fossil fuels.

不燒礦物燃料。

And doing all those terrible things

並且不再做那些可怕的事情，

that we are doing to destroy our climate.

那些正在毀掉我們氣候的事情。

You know, everyone's talking about the fact

知道嗎，大家都在講

that we've had this amazing reduction

我們現有的美妙改變：

in CO2 because we're not driving cars.

二氧化碳減少，因為我們不開車了。

I've got to tell you,

我一定要說，

that is the best evidence that climate change is man-made.

那是最好的證明， 證明氣候變化是人為導致的。

All those climate change skeptics

所有氣候變化的質疑者，

who don't think climate change is man-made,

那些不認為氣候變化是人為的人，

we have just had a worldwide demonstration

我們就剛有了一個全球的展示，

on what people do to create climate change.

展示了人類做了些什麼 造成氣候變化。

And so what we need to do is stop

因此我們需要停止，

and move to a green economy.

轉成環保的經濟。

DB: Here, here.

大：這裡，這裡。

CA: Thank you so much for those,

克：真的非常感謝你的貢獻。

I'll dip back in at the end with maybe a couple more.

我會在最後再回來， 也許再帶回一些問題。

Thank you for this.

感謝。

DB: So we're waving the flag for masks.

大：我們高舉戴口罩的大旗。

But also, one of the things

不過還有別的。

其中一樣也逐漸從中變得清晰，

that has become clear from this

is that COVID-19 is not the great leveler that maybe some had hoped it was.

就是新冠肺炎可能不是

某些人希望的那樣 能夠撥亂反正。

Some communities are experiencing much worse,

一些社區正在經歷 明顯比其它社區更糟糕的結果。

significantly worse outcomes than others.

Why is that?

為什麼呢？

GB: We're talking principally about the African American

喬：我們主要在討論

美國非洲裔和拉丁裔的社區

and Latino communities

that seem to be disproportionately impacted if they get the disease.

看起來是不成比例地被疫情影響到。

And it's because of exposure, primarily.

然而這主要是因為暴露程度，

Those populations have more public-facing jobs.

這些人大都有面向大眾群體的工作，

So, you know, bus drivers,

你也知道，像巴士司機、

grocery clerks,

雜貨店店員、

working in long-term care facilities,

長照或療養院的工作人員、

nursing homes,

in meatpacking facilities, chicken farms.

在包裝肉食工廠或養雞場工作的人。

So that's why they're much more -- going to be exposed to the disease.

這就是為什麼他們會 更容易接觸到這個疾病，

Susceptibility.

容易被感染。

Lots of chronic disease.

很多慢性疾病。

So we know that particularly African Americans

我們了解到特別是美國的非洲裔

have disproportionate amounts of diabetes, heart disease,

有不成比例的糖尿病、心臟病的案例，

lung disease,

還有肺病。

and because of those chronic diseases,

因為那些慢性疾病，

we found early on that that virus

我們早就發現這個病毒

is more detrimental to those populations that have those diseases.

對原患有那些疾病的群體危害更大。

And so that's the big issue here.

因此這是一個很大的問題。

That is what's causing those differentiations

這是造成不同的原因。

and it's really a challenge,

這也是一個真正的挑戰，

because in many ways,

因為在很多方面，

those are many of the people

這些人正是

that we have decided are essential employees

我們當作必要的基礎工作人員，

and have to go to work.

他們必須要上崗上班。

DB: That's right.

大衛：沒錯。

So what is, in your view, the public health intervention

在你看來，公衛的介入

to protect these essential workers,

來保護那些必要的工作人員，

if you have ideas on that front?

你對這有什麼見解嗎？

GB: I absolutely do.

喬：當然我有。

We started this by a testing strategy based on symptoms.

我們一開始嘗試的策略 是在症狀的基礎上。

And now that we have enough tests,

而現在有了夠多的測試，

we need to make sure that not only people get those tests for clinical reasons,

我們需要確保不僅測試

那些上醫療診所和有症狀的感染者，

and people who have symptoms,

but also begin to prioritize people who are public-facing,

還要優先重視那些面向大眾的人，

who are essential workers.

那些必要的工作人員。

So, certainly people working in nursing homes, hospitals, etc.,

這絕對包含那些在療養院、 醫院等地點工作的人，

but bus drivers, security guards,

還有巴士司機、保全人員、

grocery store clerks.

雜貨店店員。

They need to be tested,

他們都需要被檢測，

and they need to have testing with the periodicity

需要週期性檢測。

that will secure them, their families,

這會保護他們和他們的家庭，

and give everyone the trust

讓大家信任他們不會被感染，

that they're not going to be infected

and we're not going to infect them.

我們也不會感染他們。

People who work in meatpacking plants,

以在肉食包裝設施裡工作的人為例，

as an example.

我們已經目睹這真正的悲劇

And we've seen the real tragedy

of what's going on in the meatpacking plants,

在肉食包裝廠上演著，

because they are working in an environment where they're shoulder to shoulder.

因為他們在肩並肩的環境裡工作。

There are some other things they need to do

有些其他的事情需要去做，

in terms of figuring out how to give them physical distancing on the assembly line,

比如找到一個讓他們 在組裝線上相互隔離的方式，

這很重要。

that's going to be important.

But again, Uri's idea is not a bad idea

但是，尤里的主意 是個值得我國考慮的好主意，

for this nation to consider,

for many of those industries to think about.

值得很多工業去思考。

DB: Yeah, we have to make sure that these truly are folks

大：對，我們需要確保這些人，

who are treated as essential workers, not sacrificial workers, it seems to me.

這些被視為必要的工作人員不被犧牲。

And obviously, this is not just confined to the US.

也很明顯，這不僅限於美國。

GB: Oh, absolutely.

喬：當然。

We're seeing these disparities not just in the United States,

我們現在所見到的不平等不僅在美國，

but in other countries as well.

在其他國家也存在。

And they have a lot to do with race and class

並且他們都跟種族和階級大大相關，

and the types of jobs that you do,

和你的工作型態、行業相關。

the occupations that you do.

And quite frankly,

坦白來講，

we should have thought about this when we saw the first data

我們在看到第一批數據時 應該早就想到，

that showed that in China

數據顯示了在中國

people with chronic diseases were much more at risk

患有慢性病的人們 處於更大的危險，

and had worse health outcomes.

健康預後的情況更差。

We would have sped up our actions right away,

我們本應立馬開始迅速行動。

because, look, that's happened with every new disease

因為，你看，每有新疾病 來到國內就會這樣。

that's come into the country.

DB: So it seems like a lot of this goes back to that potential --

大：似乎很多事情能追溯到潛在——

it's not an oxymoron,

這不是矛盾，

public health is everybody's job,

公衛是每個人的職責，

and we need to adopt that.

我們必須採用。

What does, in your view,

在你的看法裡，

a robust public health infrastructure look like?

什麼看起來會是個 穩固強壯的醫療系統？

What would that look like?

這會是什麼樣的？

GB: Well, you know,

喬：好的，

anytime a new health threat enters our community,

每當新的健康威脅進到我們的社區，

我們應該要能夠立刻辨識它，

we ought to be able to rapidly identify it,

contain it,

不讓它擴散；

and if we can mitigate it, for sure, and eliminate it if possible,

如果辦得到的話，當然要削弱、消除它；

and then put in all the protective measures

實施我們之前所有的防護措施。

that we had before.

就是要有

So that means having a well-staffed,

人手充足、訓練有素的政府公衛部門，

well-trained governmental public health entity,

just like we have for police, fire, EMS.

就像我們在警察、消防、 急救等方面做的那樣。

It means that they've got to be well-paid,

這也意味著他們必得有好薪水、

it means that they've got to be well-resourced.

有充足的資源。

You know, we still have some of our contact tracers

我們還有些追蹤接觸的人員

out there using pen and pads.

在使用筆和平板，

And sending things to Excel Spreadsheets.

填 Excel 的表格發送信息。

No, we need the same kind of robust technology

不，我們需要強健的科技，

that the folks at, you know,

就像任何網店賣家在使用的，

any of the online retailers are using, whether it's Amazon, etc.

不論是亞馬遜還是其他。

We're still looking at data that's two years in the rear

我們還在看落後兩年的數據

to make data-driven decisions.

來做以數據為準的決定。

We need to be able to make immediate decisions.

我們需要能夠立刻做決定。

By the way, Taiwan,

對了，台灣。

you mentioned them earlier,

你剛剛提到了他們。

I remember being in Taiwan

我記得我在台灣的時候

watching data come from infectious diseases, real time,

看傳染病的實時數據，

from their electronic medical record system.

來源是他們的電子醫療記錄系統。

So, you know, we can do this, the technology exists.

所以我們做得到，已有這科技。

DB: Imagine that.

大：就想像一下。

Wow, real time health information,

哇，實時健康信息，

what a difference that would make.

這真能造成極大的差異。

Do you think that technology can help us here,

你覺得科技能幫到我們嗎？

whether that's the Google-Apple collaboration or whatever else?

不論是谷歌與蘋果合作，還是其他？

GB: Technology can help us,

喬：科技可以幫到我們，

but it's not going to replace us.

但是不能代替我們。

We're nowhere near where we can sit back

我們現在並不處於可以閒置的時間點，

and have our electronic avatar do our work for us.

也不能讓電子虛擬的人物 做我們的工作。

But the technology can outstrip our work.

但是科技可以減少我們的工作量；

It can give us situational awareness.

可以提供我們對情況的認知，

It can give us real time information.

可以給我們實時的信息，

It allows us to send information from point A to point B

讓我們能夠從一個地方 到另一個地方發送信息

for data analysis.

用來做數據分析；

It allows us to do second thinking,

讓我們可以做第二階段的思考。

so we're doing all this modeling,

我們在建造模型

it allows others to check our numbers right away.

以讓其他人能馬上檢查我們的數據，

So it could speed up research.

加速研究的進展。

But we have to invest in it,

但是我們必須要持續投資，

and we have to continue it,

because obsolescence is always the evil part of technology.

因為科技最惡名昭彰的就是過時了。

DB: And it looks like Chris is back with more questions.

大：看來克里斯回來 要提更多問題了。

CA: Yeah, I guess we're getting close to the end,

克：對的，我想我們已經 接近尾聲了，

but the questions keep coming in.

但是提問還是源源不斷。

There's one here from Neelay Bhatt.

這裡有一個來自尼蕾 · 巴哈特。

"What role do you see parks, trails and open space play

「在你看來，公園、道路和露天表演

在協助公衛目標中擔任什麼角色？」

in assisting larger public health goals?"

GB: You know, green space is absolutely essential,

喬：綠化的空間絕對必要。

and the ability to get out and walk and exercise,

還有，能夠出去走走、鍛鍊，

having sidewalks, so that you can have communities that are walkable,

有一些人行道，可以讓你 在社區裡也能徒步行走、騎單車，

bikeable and green for utilization of all ages,

還有適合所有年齡層的綠地，

it's good for our mental health, it's good for our physical health.

有助於我們的精神健康、身體健康。

And I always tell folks, you know,

我一直都告訴大家，

it's a great place to go when someone's gotten on your last nerve.

這是有人惹火你時的好去處。

CA: Indeed.

克：沒錯。

Here we have one anonymous question.

這邊有一個匿名的提問。

Where possible don't go anonymous,

請盡量不要匿名，

because we're all friends here when all said and done.

因為在所有層面上 我們這裡都是好朋友。

Probably someone ... Anyway.

但是有可能......不管啦。

Let's see, but it's a good question.

我們來看，這是個好問題。

"There are many who are highly suspicious of what the real experts are saying.

「還有很多人質疑 真正專家說的話。

What have you found to be effective in helping the highly suspicious

您有找到什麼有效的辦法 可以幫助這些質疑者

be less suspicious and more trusting?"

不那麼多疑嗎？」

GB: Tell the truth.

喬：其實說實話，

If you make a mistake, acknowledge it and correct it right away.

如果你犯了一個錯， 就承認，立馬改正它，

Be consistent.

做個一致的人。

And don't say stupid stuff.

不要胡言亂語，

And far too often that happens.

那已經太多了。

And you know, one of the interesting things,

而且有一件非常有趣的事就是......

we've already been through this with the mask discussion.

我們已經討論過了，談口罩的時候，

You know, traditional wisdom was that we only had people wear the mask

傳統的想法是

只在有傳染性時才需要戴口罩，

if they were infectious,

or you're in a health care environment

或者在一個醫療的環境下，

where there was a high risk of getting the disease.

那裡有非常高的感染風險。

And then we said,

然後我們說，

no, it's OK for everybody to wear a mask.

不，所有人都可以戴口罩，

And that's because we learned eventually,

這是因為我們終於學到了，

and became much more believable,

也更有證據顯示，

in the science that we had asymptomatic spreading.

根據科學，無症狀感染是存在的。

But we did not communicate it very well.

但是先前未好好地溝通，

We said, oh, no, no, we're changing our minds,

我們之前說，喔，不， 現在我們改口了，

everybody can wear a mask,

所有人都可以戴口罩。

after telling people not to wear a mask.

這是在告訴人們不要戴口罩之後，

And then we didn't spend enough time explaining to people why.

而現在我們沒花足夠時間解釋為什麼。

So we lost trust.

因此我們失去了信任。

So we need to do a better job of that.

所以我們需要在這方面加強。

And then our leaders

還有我們的領導人

need to be very careful what they say when you have a bullhorn.

需要非常小心言行。

And by the way, I've made mistakes,

並且，我犯了一個錯誤，

I've said things on TV that were just wrong,

我曾在電視上說了一些 現在錯誤的事情，

because I was wrong.

我錯了。

And I've tried very hard to try to correct those

我已經努力嘗試改正那些錯誤，

as quickly as I can.

在我所能之內。

All of us do that,

我們都會犯錯，

but you have to be strong enough

但是你要夠堅強，

and have a strong enough personality to say when you're wrong

有足夠堅韌的人格，承認你犯了錯，

and then correct it.

然後改正。

Because at the end of the day, once you've lost trust,

因為到最後，一旦你失去了信任，

you've lost everything.

你就失去一切。

CA: Well if I might say so,

克：好的，如果非要我講的話，

just the way in which you're communicating right now,

就是剛剛你溝通的方式，

I mean, to me, that is a means of communication

我想說，對我而言，

那是一種可以引發信任的溝通方式。

that engenders trust.

I don't know what magic sauce you have going there,

我不知道你用了什麼魔法秘方，

but it's very, very compelling listening to you.

但是你說的話是非常令人信服的。

Thank you so much for this.

非常感謝您的參與。

David, do you have any other last cues?

大衛，你有什麼最後的提示嗎？

GB: I've made lots of mistakes.

喬：我犯過很多的錯誤......

DB: Yeah, no, but it really has been a real pleasure

大：是的，但是......

真榮幸有你的參與。感謝你。

to have you join us, and thank you for that.

Just one final question if I may.

如果可以的話，就問最後一個問題。

You've been doing this for a while,

你已經做這做一陣子了，

what gives you hope looking forward?

是什麼給予你向前看的希望？

GB: You know, let me tell you something.

喬：讓我告訴你，

The one thing that gives me hope

給我希望的是

is when I see people taking care of their friends and family members.

當我看到人們照顧家人和朋友時，

I mean, drive-by birthday parties.

像是生日派對——

I saw that on the news today.

我今天在新聞上看到——

People who are calling their friends.

人們跟好友通話——

I've heard from people that I haven't talked to in years,

好久不見的老友來電聯繫，告訴我：

who are just calling me to say,

「我好久沒有聯繫你了。 你還好嗎？」

"I haven't talked to you for a long time. Are you OK?"

So do more of that.

讓我們多多聯繫。

And the trust we've had in one another,

還有我們相互之間的信任，

and the love we've shown, it's just been absolutely amazing,

和我們表達的愛，絕對美妙。

它們都給我希望。

so that gives me hope.

DB: Humanity for the win in the end.

大：人性是最後的贏家。

GB: Yeah.

喬：對。

DB: Well, thank you so much, Dr. Benjamin,

大：好，本傑明博士，太感謝您了，

for joining us and for sharing your wisdom.

感謝您能參與，和我們分享智慧。

GB: Glad to be here.

喬：很榮幸在這裡。

CA: Yes, thank you.

克：感謝。

GB: You guys be safe.

喬：祝您們平安，

Your families be safe.

家人也平安。

DB: Thank you, you too.

大：謝謝，你也是。