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TSS特别报道:一个流行病时代:为何?

TSS EXCLUSIVE – An Age of Epidemics: Why?

by Vittorio Bollo

“While we don’t know when or where the next pandemic will occur, we know one is coming.” So said Rebecca Martin, director of the Center for Global Health at the Centers for Disease Control and Prevention (CDC), back in July 2018. Those were prescient words by Martin: It was a mere 18 months later when the COVID-19 pandemic swept the entire world.

“虽然我们不知道下一次大流行将在何时何地发生,但我们知道它即将来临。”——这是美国疾病控制与预防中心(CDC)全球健康中心主任丽贝卡·马丁(Rebecca Martin)在2018年7月说;马丁的这些话很有先见之明——仅仅18个月后,COVID-19便开始了大流行席卷整个世界。

Coronavirus arguably shook up the world like no pandemic since the Spanish Flu of 1918. After all, who of us were ever in near-global lock-down because of a virus before this? Ed Young even called COVD-19 “a truly modern epidemic” in The Atlantic in February 2020.

冠状病毒可以说是自1918年西班牙流感以来第二次席卷全球。毕竟,在此之前我们当中有谁曾因为一种病毒而被全球封锁?然而在2020年2月,Ed Young甚至称COVD-19为“一种真正的现代流行病”。

But are we actually living in an ‘age of epidemics’? Is there any evidence that there has been a surge in global or near-global epidemics in recent years? And if so, why?

但我们真的生活在一个“流行病时代”吗?那么是否有证据表明,近年来全球或近全球的流行病出现了增长? 如果回答是的话,那为什么?

Is This An Age of Epidemics?

这是一个流行病的时代吗?

In short, the answer appears to be yes, this is an age of epidemics. Consider that the Geneva-based World Health Organization (WHO) declared COVID-19 a “public-health emergency of international concern” (PHEIC) on January 30th, 2020. It is a designation that the WHO has used five times before: for H1N1 swine flu, polio, Zika, and twice for Ebola.

简而言之,答案似乎是肯定的——这是一个流行的时代;想想看,总部设在日内瓦的世界卫生组织(WHO)于2020年1月30日宣布COVID-19为“国际关注的突发公共卫生事件”(PHEIC);世界卫生组织之前曾五次使用这个名称:H1N1猪流感、脊髓灰质炎、寨卡病毒,以及两次埃博拉病毒。

What’s telling is that COVID-19 is the sixth such designation by the WHO in just over a decade. No other like period in the last 100 years has had so many epidemics on a potentially global scale. And that’s not to mention outbreaks in the last 20 years of serious diseases including Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS), Zika virus, Nipah virus, yellow fever, and Lassa fever.

说明问题的是COVID-19是世界卫生组织十多年来第六次将其列入此类名单;在过去的100年里,没有任何一个类似的时期在全球范围内发生过如此多的流行病,更不用说过去20年里爆发的严重疾病,包括严重急性呼吸道综合征(SARS)、中东呼吸综合征(MERS)、寨卡病毒、尼帕病毒、黄热病和拉沙热。

There of course have been pandemics with devastating losses of life throughout human history, many of them in ancient times. These ranged from the Plague of Athens in 430 B.C. that killed 100,000 people, to the Antonine Plague that ravaged the Roman Empire and killed over 5-million people from 165-180A.D. There was the bubonic plague or Black Death that is thought to have killed half of Europe’s population from 1346 to 1353. And of course the Spanish Flu that killed up to 100 million people worldwide from 1918-20.

当然,在人类历史上也曾发生过大规模流行病,造成了毁灭性的生命损失,其中许多是在古代。从公元前430年造成10万人死亡的雅典大瘟疫,到公元165-180年肆虐罗马帝国造成500多万人死亡的安东尼瘟疫;从1346年到1353年,欧洲有一半的人口死于黑死病;另外还有1918年至1920年期间,西班牙流感在世界范围内夺去了1亿人的生命。

Nevertheless, WHO-designated PHEICs do seem to be on the increase. There must be reasons for this. Why is our current era so conducive to epidemics? What factors have made this an age of epidemics?

然而,世卫组织指定的紧急事件似乎确实在增加,这肯定是有原因;那么为什么我们现在所处的时代如此有利于流行病?是什么因素使其流行起来

Modern Factors for Epidemics

流行病的现代因素

There are a number of factors that seem to be enabling the rising incidence of pandemics with global potential. Each one of these factors is ‘uniquely modern’ in that they are a mirror to the contemporary state of human society, including our relationship with the natural environment.

有许多因素似乎使具有全球潜力的流行病发病率不断上升,这些因素中的每一个都是“独特的现象”,因为它们反映了人类社会的当前状态,以及包括我们与自然环境的关系。

Burgeoning Populations

迅速增长的人口

The world’s population continues to grow at a rapid rate. It’s logical that as the world’s population expands, so the number of those who can get infected will grow too. The World Economic Forum (WEF) in March 2020 quoted a study that stated: “The number of outbreaks, like the number of emerging infectious diseases, appears to be increasing with time in the human population both in total number and richness of causal diseases”.

世界人口继续快速增长。随着世界人口的增长,感染艾滋病的人数也会增加,这是合乎逻辑的;世界经济论坛(WEF)在2020年3月引用了一项研究,该研究指出:“在人类人口中世界人口继续快速增长。随着世界人口的增长,感染艾滋病的人数也会增加,这是合乎逻辑的;世界经济论坛(WEF)在2020年3月引用了一项研究,该研究指出:“在人类人口中,疾病暴发的数量就像新出现的传染病的数量一样,在疾病的总数和数量上都随着时间而增加。”

Urbanization won’t help either. Today, roughly 55% of the world’s population lives in urban areas. That percentage is projected to increase to 68% by 2050, according to the UN’s Department of Social and Economic Affairs. A significant portion of this high-density living will be in impoverished neighborhoods, often with people living in extremely close quarters and in unhygienic conditions. These urban factors will greatly promote the spread of infectious diseases.

城市化也仍旧无济于事;今天,大约55%的世界人口居住在城市地区;据联合国社会和经济事务部预计:到2050年这一比例将上升到68%,这种高密度生活的很大一部分将在贫困社区,人们往往生活在非常接近的空间和不卫生的条件,这些城市因素将极大地促进传染病的传播。

Travel, Travel, Travel

行进,漫游以及游荡

Humans have never criss-crossed the planet as much as they do today, whether for business or leisure. According to the World Bank, there were 4.2 billion passenger journeys by air in 2018, compared to 310 million journeys in 1970. The International Air Transport Association (IATA) forecast that this would almost double to 8.2 billion airplane journeys by 2037. That’s a lot of mobility on a global scale – a perfect conduit by which any pathogen can spread.

人类从未像今天这样频繁地在地球上穿梭,无论是为了工作还是休闲的时候;根据世界银行(World Bank)的数据,2018年乘飞机出行的乘客数量为42亿人次,而1970年为3.1亿人次;国际航空运输协会(IATA)预测,到2037年,这一数字将翻一番,达到82亿人次;在全球范围内,这是一个很大的流动性——任何病原体都可以通过这个完美的管道传播。

There has also been a huge increase in those floating petri dishes known as cruise ships. The cruise industry was until 2017 the fastest-growing sector in the leisure travel industry, with annual growths of nearly 7% and a 62% increase in passengers between 2005 and 2015.

被称为游船的漂浮培养皿也有了巨大的增长。直到2017年,邮轮行业一直是休闲旅游行业增长最快的行业,2005年至2015年间 邮轮行业的年增长率接近7%、客运量增长62%。

Climate Change

气候变化

For years now, scientists have predicted that one of the impacts resulting from climate change will be an increase in infectious diseases and global pandemics, as reported by the WHO and Columbia University, among many others. Changing climate should result in the spread of vectors such as mosquitoes. The Zika virus that suddenly emerged in 2015 was able to spread from Brazil to the rest of South due to the El Niño effect, itself exacerbated in recent times by climate change, according to climatologists.

多年来,科学家们一直预测气候变化造成的影响之一,传染病和全球流行病的增加——世界卫生组织(WHO)和哥伦比亚大学(Columbia University)等机构报告了这一预测;气候变化应导致传播媒介,如蚊子的传播;气候学家表示,由于厄尔尼诺效应,2015年突然出现的寨卡病毒能够从巴西传播到南方的其他地方,而厄尔尼诺效应近年来又因气候变化而加剧。

Environmental Devastation

环境破坏

There is no denying that the natural environment is under siege worldwide. Deforestation and loss of species and biodiversity are increasingly rapidly, examples of what the United Nations declared as being the “unprecedented” decline of nature in 2019. This assault on the natural environment has health-related repercussions.

不可否认的是全世界的自然环境都受到了威胁;森林砍伐、物种灭绝和生物多样性丧失的速度越来越快,这是联合国在2019年宣布的“前所未有”的自然衰退的例子;这种对自然环境的破坏产生了与健康有关的影响。

For example, National Geographic wrote in November 2019 that there is a direct correlation between deforestation and the spread of infectious diseases. The National Geographic article cited the first outbreak of deadly Nipah virus in 1997 caused by displaced bats due to jungle clearings for agriculture in Indonesia. Research by the EcoHealth Alliance showed that 31% of outbreaks of new and emerging diseases were directly linked to deforestation.

例如,《国家地理》杂志在2019年11月写道,森林砍伐和传染病传播之间存在直接的相关性;《国家地理》杂志的文章引用了1997年第一次爆发的致命尼帕病毒,其起因是印度尼西亚为了农业而清除丛林中的蝙蝠;生态健康联盟(EcoHealth Alliance)的研究表明,31%的新出现疾病的爆发与森林砍伐直接相关。

It’s not that the viruses and other pathogens are ‘new’ – rather, it’s that we are now in ever-greater contact with them due to environmental factors. As Dr. Mike Ryan, the assistant director-general for emergency preparedness and response at the WHO, told the Huffington Post in 2018: “What’s shifting and changing is not the bugs ― it’s the humans. What’s changed is our relationship with those viruses, our relationship with the rainforests.”

但这并不是说这些病毒和其他病原体是“新”的,而是由于环境因素,我们现在与它们的接触越来越频繁;正如世界卫生组织负责应急准备和反应的助理总干事麦克·瑞安(Mike Ryan)博士在2018年对《赫芬顿邮报》所说:“改变和改变的不是细菌,而是人类。” 改变的是我们与这些病毒的关系,以及与雨林的关系。”

More Disease, Greater Probabilities

更多的疾病,更大的概率

Not only are we living in an era of more epidemics, but we’re also living in an era of more outbreaks of disease that have the potential to become global pandemics. An international benchmark is the WHO’s Blueprint priority diseases list that contains eight categories of disease, any one of which has the potential to spread globally and cause widespread mortality and economic upheaval. The more outbreaks of the listed diseases, the greater the risk for an eventual global pandemic.

我们不仅生活在一个有更多流行病的时代,而且我们也生活在一个有更多可能成为全球性流行病的疾病暴发的时代;一个国际基准是世卫组织的《蓝图》优先疾病清单,该清单包含八类疾病,其中任何一种都有可能在全球传播并造成广泛的死亡和经济动荡;所列疾病的暴发次数越多,最终发生全球大流行的风险就越大。

This reality was revealed in June 2018, when it was reported that, for the first time ever, the world was having to contend with six of the eight categories listed in the WHO’s Blueprint. The ‘Deadly Six’ were ebola, Lassa, Nipah, MERS, Rift Valley fever, and Zika, all of which were active outbreaks during that month of 2018. The only two WHO-designated diseases ‘missing’ as outbreaks in June 2018 were Crimean-Congo haemorrhagic fever (CCHF) and, very ominously, the one designated by the WHO as ‘Disease X’.

这一现实在2018年6月被揭露出来,当时有报道称世界有史以来第一次不得不与世卫组织蓝图中列出的8个类别中的6个竞争;“致命的六例”是埃博拉病毒、拉沙病毒、尼帕病毒、中东呼吸综合征、裂谷热和寨卡病毒,所有这些都是2018年那个月的活跃爆发;世卫组织指定的2018年6月疫情中仅有两种“缺失”的疾病,即克里米亚-刚果出血热(CCHF)和世卫组织指定的“X病毒”。

Fair to say that COVID-19 is that ‘Disease X’?

那么可以说COVID-19是“X病毒”吗

Final Thoughts

最终想法

Bill Gates says we should prepare for a deadly outbreak as we do for war. He makes a very valid point. The potential devastation to human life and to the economy that a pandemic can cause is certainly akin to that of being at war.

比尔·盖茨说:”我们应该像备战战争一样,为致命的疾病爆发做好准备”,他的观点很有道理,大流行对人类生活和经济造成的潜在破坏,肯定类似于处于战争状态。

Unfortunately, the response to the COVID-19 pandemic has been, for the most part, haphazard, confused, and inefficient. The world needs to be better prepared for the next one, which is surely just down the road.

不幸的是对第19届脊髓灰质炎大流行的反应在很大程度上是随意的、混乱的和低效的;世界需要为下一次危机做更好的准备,它肯定就在前方。

It should be cautioned that what we have experienced with COVID-19 is not unique in human history in terms of morbidity rates; after all, the Athens and Antonine plagues had huge infection rates at a time when populations were far smaller than today.

值得注意的是就发病率而言,我们对COVID-19的经历在人类历史上并不是独一无二的,毕竟雅典和安东尼瘟疫的感染率很高,但当时的人口比现在少得多。

Even COVID-19’s global scale isn’t novel, as seen with the Spanish Flu a century ago. There was a lot less mobility in the 14th century than there is today, yet the Black Death wiped out half of Europe in just a few years.

就像一个世纪前的西班牙流感一样,COVID-19的全球规模也并不新奇;14世纪的人口流动性比现在小得多,但黑死病在短短几年内就席卷了欧洲的一半地区。

But perhaps we do well to heed the fact that this is the sixth WHO-designated PHEIC since 2004. Perhaps there’s something to the opinion that this a truly modern epidemic. Only when we acknowledge the modernity of how we spread disease can we then put in place the measures needed to ensure more effective, rapid responses to epidemics now and in the future.

但也许我们应该注意到,这是自2004年以来世卫组织指定的第六个PHEIC,也许有人认为这是一种真正的现代流行病;只有承认我们传播疾病的方式具有现代性,我们才能采取必要措施,确保在现在和将来对流行病作出更有效、更迅速的反应。

翻译:SGCS翻译组

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