【纽约时报】：新冠病毒最致命的阶段可能即将到来 （双语）
《纽约时报》：新冠病毒最致命时期可能很快就要到来
If world leaders don’t act now, the end of the Covid pandemic may come with a horrible form of herd immunity, as more transmissible variants that are taking hold around the world kill millions.
如果世界领导人现在不采取行动，随着传播力更强的变种扩散至全世界，导致数百万人死亡，新冠大流行可能会以一种可怕的群体免疫形式结束。
There’s troubling new evidence that the B.1.617.2 variant, first identified in India, could be far more transmissible than even the B.1.1.7 variant, first identified in Britain, which contributed to some of the deadliest surges around the world.
令人不安的新证据表明，在印度最先发现的B.1.617.2变种可能比在英国最先发现的B.1.1.7变种更容易传播，后者导致了世界上一些最致命的病例激增。
In countries with widespread vaccination, like the United States and Britain, we can expect that Covid cases, hospitalizations and deaths will continue to decline or stay low, especially because lab tests and real world experience show that vaccines appear to defend recipients well against the severe effects of both variants.
在美国和英国等广泛接种疫苗的国家，我们可以预期新冠病毒病例、住院和死亡人数将继续下降，或保持在较低水平，特别是因为实验室检测和真实世界经验表明，疫苗似乎可以很好地保护接种者免受两种变体带来的严重症状。
For much of the rest of the world, though, this even more transmissible new variant could be catastrophic.
然而，对于世界其他大部分地区来说，这种更具传播性的新变种可能是灾难性的。
The evidence is not yet conclusive because the data is preliminary and figuring out if a variant is more transmissible isn’t easy. It could be spreading rapidly in an area because of chance. Maybe it got there before other variants and found a susceptible population, or got lucky and seeded a mega-cluster. If a variant is seen more frequently in a country’s genomic databases it could just be because travelers, who are often tested more routinely, are bringing it in from another country where it is already dominant.
证据尚无定论，因为只有初步数据，而且确定变体是否更具传播性并非易事。它在一个地区的迅速传播可能只是出于偶然。也许它到达那里早于其他变种，并发现了易感人群，或者正巧传播给了一个大型集群。如果一个变体在一个国家的基因组数据库中更频繁地出现，那可能只是因为常常定期接受测试的旅行者将变体从另一个国家带来，而该变体在那个国家已经形成支配优势。
Onekey measure that’s been used in previous outbreaks to figure out if a variantwas more transmissible was to look at “secondary attack rates” in non-travelsettings — how many people who come into close contact with an infected personget the virus themselves. The greater the number of these contacts getting thevirus, on average, the greater the likelihood that a variant’s transmissibilityis greater.
在之前的暴发中，用来确定变体是否更具传播性的一项关键措施是查看非旅行环境中的“二代发病率”——有多少感染密接者感染了该病毒。这些密接者感染病毒的平均人数越多，变体的传播力就越大。
Dataon secondary attack rates released on Saturday by a British public healthagency similar to our own Centers for Disease Control and Prevention suggeststhat this variant first seen in India may be substantially more transmissible amongclose contacts than even the already highly transmissible B.1.1.7. A reportpublished by the same agency on Thursday further supports last week’s findings.It was just such early data that raised alarms about B.1.1.7, with laterinformation confirming those early fears.
一家相当于我们疾病预防与控制中心的英国公共卫生机构周六发布的二代发病率数据表明，这种在印度最先出现的变种可能比已经广泛传播的B.1.1.7更容易在密接者中传播。该机构周四发布的一份报告进一步支持了上周的调查结果。正是这样的早期数据引起了关于B.1.1.7的警报，后来的信息证实了那些早期的担忧。
AdamKucharski, an epidemiologist with the London School of Hygiene and TropicalMedicine, also told me that the faster spread in areas of Britain with higherlevels of the variant suggests it has higher transmissibility. This point seemsto be backed up by the terrible outbreaks in India and neighboring Nepal, whereit is also widespread. Given how limited genetic identification is in thosecountries, the data from Britain is particularly useful for assessing the risk.
伦敦卫生与热带医学院(London School of Hygieneand Tropical Medicine)的流行病学家亚当·库查斯基(Adam Kucharski)还告诉我，在英国的一些地区，变体出现率较高的区域的传播速度也较快，这表明它具有较高的传染性。这一点似乎也反映在印度和邻国尼泊尔可怕的疫情中，它在那里也很普遍。鉴于这些国家的基因鉴定有限，来自英国的数据对于评估风险尤其有用。
Avariant with higher transmissibility is a huge danger to people withoutimmunity either from vaccination or prior infection, even if the variant is nomore deadly than previous versions of the virus. Residents of countries likeTaiwan or Vietnam that had almost completely kept out the pandemic, andcountries like India and Nepal that had fared relatively well until recently,have fairly little immunity, and are largely unvaccinated. A more transmissiblevariant can burn through such an immunologically naïve population very fast.
具有更高传染性的变体对于没有通过接种或先前感染得到免疫力的人来说是一个巨大的危险，即使该变体并不比先前的病毒更致命。台湾或越南等几乎完全避免了大流行的国家，以及印度和尼泊尔等直到最近以前都表现相对良好的国家的居民，几乎没有免疫力，而且基本上没有接种疫苗。一种更具传染性的变种可以非常快地在这群未产生过免疫的人群中传播。
Increasedtransmissibility is an exponential threat. If a virus that could previouslyinfect three people on average can now infect four, it looks like a smallincrease. Yet if you start with just two infected people in both scenarios,just 10 iterations later, the former will have caused about 40,000 cases whilethe latter will be more than 524,000, a nearly 13-fold difference.
由升高的传播性带来的威胁是指数级别的。如果一种病毒以前平均可以感染3人，而现在可以感染4人，这看起来只是增长了一点。然而，如果你在两种情况下都只从两个感染者开始，仅仅10代感染后，前者将导致大约4万个病例，而后者将超过52.4万，相差近13倍。
Morallyand practically, this emergency demands immediate action: widespreadvaccination of those most vulnerable where the threat is greatest.
无论从道义还是实际角度，这种紧急情况都需要立即采取行动：在威胁最大的地方对最脆弱的人进行广泛的疫苗接种。
Waivingvaccine patents is fine, but unless it’s tied to a process that actuallyincreases the supply of vaccines, it’s a little bit more than expressingthoughts and prayers after a tragedy. Officials from all nations that producevaccines need to gather for an emergency meeting immediately to decide how tocommandeer whatever excess capacity they have to produce more, through whatevermeans necessary. Because of the threat of increased transmissibility, and sincethe evidence at hand indicates that all of the vaccines, even the Chinese andRussian versions, appear to be highly effective against severe disease orworse, the focus should be on manufacturing and distributing the highest numberof doses possible as fast as possible.
豁免疫苗专利很好，但除非它与实际增加疫苗供应的过程相关联，否则它只是在悲剧发生后表达慰问和祈祷。所有生产疫苗的国家的官员需要立即召开紧急会议，以决定如何通过任何必要的手段征用他们现有的过剩产能以制造更多疫苗。由于存在传染性增加的威胁，而且手头的证据表明，所有疫苗，即使是中国和俄罗斯版本，似乎对重症或危重症都非常有效，因此重点应该放在如何以最快的方式制造和分发最多的疫苗。
Ifthe choice is between no vaccine and any vaccine, the precedence should go towhatever can be manufactured fastest, regardless of patents, nation of origin,or countries prioritizing their allies or wannabe allies.
如果任何疫苗都可以的话，那么应优先考虑生产得最快的那一种，而不考虑专利、原产国，或优先考虑盟友或想要成为盟友的国家的疫苗。
Vaccinesupplies need to be diverted now to where the crisis is the worst, if necessaryaway from the wealthy countries that have purchased most of the supply. It is,of course, understandable that every nation wants to vaccinate its own first,but a country with high levels of vaccination, especially among its morevulnerable populations, can hold things off, especially if they also had bigoutbreaks before. In addition, excess stockpiles can go where they are neededwithout even slowing down existing vaccination programs.
疫苗供应现在需要转移到危机最严重的地方，如有必要，可以从那些已经购买了大部分供应的富裕国家转移。当然，每个国家都想先为自己的居民接种疫苗是可以理解的，但是如果一个国家的疫苗接种水平高——尤其是在其较脆弱的人群中，可以先暂停，尤其是如果他们之前也曾暴发过大规模疫情。此外，多余的库存可以用于需要的地方，这甚至不会减慢现有的疫苗接种计划。
Rightnow, Covax, the global alliance for vaccine equity, does not have enoughvaccines to distribute, and what supply it does get is allocated according tonational population, not the seriousness of outbreaks. This needs to change.Our fire department needs more water, and should direct it to where the fire isburning, not to every house on the street.
目前，致力于疫苗公平的全球联盟Covax没有足够的疫苗可以分发，而它能得到的供应量是根据国家人口而不是疫情严重程度分配的。这需要改变。我们的消防队需要更多的水来灭火，而且应该把它送到着火的地方，而不是送到街上的每一个房子。
Theresponses could vary. The elderly and health care workers could be prioritizedwherever a crisis is worst. Dose-sparing strategies could be applied — delayingboosters has been successful in Britain and Canada when they faced surges. Thedetails can be decided by the global health authorities.
应对措施可能会有所不同。在危机最严重的地方，可以优先考虑老年人和医护人员。可以应用剂量节省策略——当英国和加拿大面临病例激增时，延迟第二剂的策略已经取得了成功。具体细节可由全球卫生当局决定。
Ifthere is a reasonable possibility that the world faces a mounting threat, it’sbest to intervene as early and aggressively as possible, because even a few weeksof delay could make a huge difference. Waiting for definitive evidence oftransmissibility could allow the variant to rampage — besides, if fears proveunfounded then the world would still be better off for being more vaccinated.And any solution, even if imperfect, is better than waiting for the perfectsetup or the most conclusive evidence.
如果世界面临日益严峻的威胁的可能性是合理存在的，尽早并积极地进行干预是最好的办法，因为即便只是几周的延迟也会产生巨大的影响。等待可传播性的确切证据发布可能会给变种的肆虐留出时间——此外，如果证明这样的担忧是没有必要的，那么世界仍然会因更多人接种了疫苗而变得更好。任何解决方案，即使不完美，也比等待完美的方案或最确凿的证据要好。
AsDr. Kucharski told me, it’s now entirely possible that most Covid deaths couldoccur after there are enough vaccines to protect those most at risk globally.Britain had more daily Covid-related deaths during the surge involving B.1.1.7than in the first wave, when there was less understanding of how to treat thedisease and far fewer therapeutics that later helped cut mortality rates. Evenafter the vaccination campaign began, B.1.1.7 kept spreading rapidly among theunvaccinated. A similar pattern was observed in much of Eastern Europe as well.
库查斯基告诉我，最多的新冠病毒死亡现在完全有可能发生在有足够的疫苗来保护全球最危险的人群之后。在B.1.1.7变种病例激增期间，英国日增新冠死亡人数比第一波疫情还要多，而在第一波疫情中，人们对如何治疗这种疾病的了解较少，对那些后来有助于降低死亡率的疗法的了解也少得多。即使在疫苗接种开始后，B.1.1.7仍在未接种人群中迅速传播。在东欧的大部分地区也观察到类似的模式。
Evenif it is determined the transmissibility of B.1.617.2 isn’t as bad as feared,the emergency is still there.
即使确定B.1.617.2的传播性没有人们担心的那么糟糕，紧急情况仍然存在。
Thekind of catastrophic outbreak like the one in India can cause many moreneedless deaths simply by overwhelming our resources. Already, there arereports that countries ranging from Nepal to the Philippines to South Africa toNigeria may face supplemental oxygen shortages of the kind seen in India. Thispathogen has one fatality rate when oxygen is available as a therapy and one whenit is not, and it would be an unspeakable tragedy to suffer the latter in thesecond year of the pandemic.
像印度那样的灾难性暴发可能会导致我们的资源不堪重负，从而造成更多不必要的死亡。已经有报道称，从尼泊尔到菲律宾、南非到尼日利亚等国家可能面临印度发生的那种辅助氧气短缺的情况。在治疗中是否有氧气，直接决定了这种病的致死率，在大流行的第二年还要面对没有氧气的局面，将是一场无法形容的悲剧。
Likeall pandemics, this one will end either with millions — maybe billions — beinginfected or being vaccinated. This time, world leaders have a choice, butlittle time to make that choice before it is made for them.
与所有大流行一样，这场大流行将以数百万人——甚至数十亿人——被感染或接种疫苗而告终。这一次，世界领导人有一个选择，但留给他们做决定的时间不多了。
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