何时新冠如流感？美国抗疫是躺平？
本来在聊其他话题，不知不觉又回到疫情，也许，这是碰巧出现在我们这个时代的人，最为共同的语言。
从武汉到西安，没错，看到了很多极端事件，也很多愤怒，然后，愤怒会随着时间消退，那些具体的人，也会随着时间离我们远去。
如果去除这些极端景象和荒诞执法，如此这般的严防死守是不是更好的选择？
那么多国家每天真的都在死人，美国，Covid19。1月1日563，1月2日505，1月3日884，1月4日1847。截止到2022年1月4日,美国Covid19死亡人数851,475。美国的851,475，相当于14亿的390万。
每天除了公共室内空间戴口罩，部分情况下被查疫苗或核酸证明，人们正常上班、正常上学、正常购物、正常旅游。一边每天都有Covid19死亡数字，一边却说正常生活，这就是正常，这正常吗？
说到2020，不同的州，防疫措施不同，最严厉的措施之下，次生灾害也很突出，超过常数的脑卒中、糖尿病等等不治，相关的对比研究，或许在不远的将来可以看到，会包括人口结构、医护条件，组别分类、病因分析……，以及我们这种小白想不出的种种专业角度。
关于美国的Covid19死亡统计标准，说了快二年，只要感染都算数，包括但不仅限于Covid19是其直接或间接死因。
而超量死亡，说到2020年和2021年，人们自然首先联想疫情，其实，远远不是如此简单，直接、间接、无关以及次生灾害。耐人寻味的是日本和台湾，2020年的超量死亡人数，均为负。
如同是药三分毒，任何防控措施都有负作用，非甲类传染病用甲类传染病的方法，如同猛药治小疾，而SARS-CoV-2在初期之所以伤害那么大，就是因为人体免疫系统的过激反应，自己把自己打垮。
2020年初的武汉，如果可以认定为甲等，2021到2022的西安呢？经过了二年，有疫苗、有药物、有抗体。为什么西安做出如此严重的反应，是真的甲等，还是小题大做？
有人说，远不到比较成败的时候，当然，防疫面前没有成功没有胜利，只有损失多、少。
有人说，从不同地区的措施和人们的态度，也许应该重新认识生命与生活，清零与共处。
1889-1890年
大流感造成全球约一百万人死亡，当时全球人口15亿。后世研究认为，最可能H3N8，也怀疑冠状病毒。
918-1920年
H1N1西班牙大流感，估计先后感染了全球1/3的人口（全球人口17亿），夺去数千万生命。
我们能否想象流感疫情最早袭来时候人们的恐惧？会不会超过当今人们面对当前的Covid？当时的人们又有多想清零？然后，从哪个时间点，意识到要和这只不曾有过的病毒共处？因为，显然无法清洗全部空气。
本来不完美的世界增加了一重凶险，人们不得不继续，该种地的种地，该赶集的赶集。
1957-1958年
H2N2亚洲流感，全球110万人死亡。全球人口29亿。
1968-1969年
H3N2香港流感，全球400万人丧生，H2N2的变异。全球人口35亿。
1977年
H1N1俄罗斯流感，全球死亡70万。全球人口42亿。
医生说，去年打的流感疫苗里，还包括针对1958年那只的成分，因为病毒仍在。
SARS-CoV-2
已使547万人丧生，人类从未和大流行的灾难分离。
为什么提到流感？
今天的Covid，如同昨天的流感，今天的流感，也许就是明天的新冠。
好的，回到Covid19，其实，不是远远不到论定的时候，而是可能永无结果。
1918年出生的，如今只剩下零星的百岁老人，而一百多年，流感未曾停过，Covid-19，不仅是现世的恐惧，也是未来的危险。
数字，我们能计算去年、前年，今年、明年，我们还能计算多少年？
人类一次次走出来，依靠的不是围堵，而是疏通，不是清零，而是相互适应。
一个本来就不完美的世界，又多了一重凶险。
我们，不得不，回归，正常生活。
带着多一重防护，
卫生习惯、疫苗和药物。
没错，每个国家都有不足和失误，政策松紧失当，有很多批评和抗争。
但看待防疫措施和“疫情结束”，需要换一种思路，从紧急应对匆忙上马，已同时开始为“防疫常态化”积累铺垫，这当然不是“躺平”，而是务实的理性。
*感谢Clubhouse讨论并给予知识普及、启发思路的医生和各位朋友。
中国疾控中心关于流感疫苗接种指南（包括中国的流感病毒致病现状和数据）
http://www.chinaivdc.cn/cnic/fascc/201912/P020191220449614636907.pdf
中华医学杂志《2016-2019中国季节性流感负担估计》
http://rs.yiigle.com/CN112137202108/1311093.htm
中国疾控中心资讯《全球每年死亡65万人！流感危害被严重低估，医务人员应加强流感认识》
https://www.chinacdc.cn/gwxx/201908/t20190821_204896.html
中华医学杂志《新型流行性感冒疫苗的应用及研究进展》
http://rs.yiigle.com/m/CN112137202138/1339517.htm
世卫关于流感疫苗
https://www.who.int/immunization/Pandemic_influenza_Chinese.pdf?ua=1
流感疫苗的历史（摘自维基百科）：
Origins and development
In the worldwide Spanish flu pandemic of 1918, "Pharmacists tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and serums (chiefly against what we now call Hemophilus influenzae – a name derived from the fact that it was originally considered the etiological agent – and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success."[24]
In 1931, viral growth in embryonated hens' eggs was reported by Ernest William Goodpasture and colleagues at Vanderbilt University. The work was extended to growth of influenza virus by several workers, including Thomas Francis, Jonas Salk, Wilson Smith and Macfarlane Burnet, leading to the first experimental influenza vaccines.[25] In the 1940s, the US military developed the first approved inactivated vaccines for influenza, which were used in the Second World War.[26] Hen's eggs continued to be used to produce virus used in influenza vaccines, but manufacturers made improvements in the purity of the virus by developing improved processes to remove egg proteins and to reduce systemic reactivity of the vaccine.[27] In 2012, the US Food and Drug Administration (FDA) approved influenza vaccines made by growing virus in cell cultures[28][29][30] and influenza vaccines made from recombinant proteins[31] have been approved, with plant-based influenza vaccines being tested[when?] in clinical trials.[32]
Acceptance
The egg-based technology for producing influenza vaccine was created in the 1950s.[33] In the US swine flu scare of 1976, President Gerald Ford was confronted with a potential swine flu pandemic. The vaccination program was rushed, yet plagued by delays and public relations problems. Meanwhile, maximum military containment efforts succeeded unexpectedly in confining the new strain to the single army base where it had originated. On that base, a number of soldiers fell severely ill, but only one died. The program was canceled after about 24% of the population had received vaccinations. An excess in deaths of twenty-five over normal annual levels as well as four hundred excess hospitalizations, both from Guillain–Barré syndrome, were estimated to have occurred from the vaccination program itself, demonstrating that the vaccine itself is not free of risks. The result can be cited to support lingering doubts about vaccination as well as to counter ungrounded claims about the safety of vaccination.[34] In the end, however, even the maligned 1976 vaccine may have saved lives. A 2010 study found a significantly enhanced immune response against the 2009 pandemic H1N1 in study participants who had received vaccination against the swine flu in 1976.[35]
Quadrivalent vaccines for seasonal flu
quadrivalent flu vaccine administered by nasal mist was approved by the FDA in March 2012.[36][37] Fluarix Quadrivalent was approved by the FDA in December 2012.[38]
In 2014, the Canadian National Advisory Committee on Immunization (NACI) published a review of quadrivalent influenza vaccines.[39]
Starting with the 2018-2019 influenza season most of the regular-dose egg-based flu shots and all the recombinant and cell-grown flu vaccines in the United States are quadrivalent.[40] In the 2019–2020 influenza season all regular-dose flu shots and all recombinant influenza vaccine in the United States are quadrivalent.[41]
In November 2019, the FDA approved Fluzone High-Dose Quadrivalent for use in the United States starting with the 2020-2021 influenza season.[42][43]
In February 2020, the FDA approved Fluad Quadrivalent for use in the United States.[44][45] In July 2020, the FDA approved both Fluad and Fluad Quadrivalent for use in the United States for the 2020–2021 influenza season.[44][46]