音频 | 中国病毒治理给世界的启示 | Epidemics & Pandemics 辨析
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世界卫生组织对pandemic的定义是：A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. 从这个定义当中我们可以看到，pandemic是epidemic的一种，但是它的范围一定要非常大，至少要跨越国界甚至是洲际，并能影响大量的人口。
视频：传染病epidemic与 全球性传染病）pandemic
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With constant media coverage of diseases like the Ebola, Zika virus, H1N1, COVID19 and the yearly flu, we always hear about the threat of pandemics and epidemics, but what do these really mean when it comes to disease emergence and spread?The endemic level or baseline of a disease is the amount that is usually present in a given community. An epidemic is a sharp increase in the number of people infected with that disease in that same community. A pandemic is, therefore, an epidemic that has spread to several countries and continents, affecting a large number of people.
What can cause an epidemic?Epidemics can be caused by a couple of different factors, including:· An increase in the amount of a disease or its virulence· Its appearance in a new location· An enhanced mode of transmission· A change in the susceptibility of the organism to being infected, and· Increased host exposure or a new method of host infection.
Three common ways epidemics can be spread are:
· From a common source, where a group of people are all exposed to a toxin or infectious agent from the same source· By propagated outbreak, with transmission from one individual to another, or· Using a carrier (vector) like mosquitoes that interact with a human being and consequently transmits the disease.
Viruses are most often responsible for pandemics and epidemics. Research has shown that viruses adopt a technique called ‘Cell Surfing, ’ which allows them to spread much faster from person to person. Studies prove that viruses replicate much faster than bacteria. Due to this increased infectivity, viruses can spread more quickly throughout a town or city. Viruses such as Influenza also mutate often so it is difficult for researchers to find a treatment.
Of course, other types of pathogens such as bacteria shouldn’t be underestimated. Bacterial infections like Cholera can infect and kill thousands, as demonstrated throughout Africa. Also, bacteria that are resistant to antibiotics pose a massive threat to humanity and already kill millions every year. Both viruses and bacteria can cause large outbreaks, so neither should be prioritized nor dismissed.
To classify the spread of disease as a pandemic, there needs to be community-level outbreak epidemics in one other country in a different world health organization defined region, which signifies that the disease is beginning to spread around the world. By this time the respective governments of outbreak-stricken countries are meant to take action to halt disease progression and implement national health strategies.
So, the next time you hear about epidemics and pandemics on the news, you don’t need to prepare to flee to Antarctica. Take some time to know more about the disease, how it is spread and where it is prevalent, to keep yourself safe.
文章导读：
The pandemic
The virus is coming
Governments have an enormous amount of work to do.
In public health, honesty is worth a lot more than hope. It has become clear in the past week that the new viral disease, covid-19, which struck China at the start of December will spread around the world. Many governments have been signalling that they will stop the disease. Instead, they need to start preparing people for the onslaught.
Officials will have to act when they do not have all the facts, because much about the virus is unknown. A broad guess is that 25-70% of the population of any infected country may catch the disease. China’s experience suggests that, of the cases that are detected, roughly 80% will be mild, 15% will need treatment in hospital and 5% will require intensive care. Experts say that the virus may be five to ten times as lethal as seasonal flu, which, with a fatality rate of 0.1%, kills 60,000 Americans in a bad year. Across the world, the death toll could be in the millions.
If the pandemic is like a very severe flu, models point to global economic growth being two percentage points lower over 12 months, at around 1%; if it is worse still, the world economy could shrink. As that prospect sank in during the week, the S&P 500 fell by 8%.
Yet all those outcomes depend greatly on what governments choose to do, as China shows. Hubei province, the origin of the epidemic, has a population of 59m. It has seen more than 65,000 cases and a fatality rate of 2.9%. By contrast, the rest of China, which contains 1.3bn people, has suffered fewer than 13,000 cases with a fatality rate of just 0.4%. Chinese officials at first suppressed news of the disease, a grave error that allowed the virus to take hold. But even before it had spread much outside Hubei, they imposed the largest and most draconian quarantine in history. Factories shut, public transport stopped and people were ordered indoors. This raised awareness and changed behaviour. Without it, China would by now have registered many millions of cases and tens of thousands of deaths.
The World Health Organisation was this week full of praise for China’s approach. That does not, however, mean it is a model for the rest of the world. All quarantines carry a cost—not just in lost output, but also in the suffering of those locked away, some of whom forgo medical treatment for other conditions. It is still too soon to tell whether this price was worth the gains. As China seeks to revive its economy by relaxing the quarantine, it could well be hit by a second wave of infections. Given that uncertainty, few democracies would be willing to trample over individuals to the extent China has. And, as the chaotic epidemic in Iran shows, not all authoritarian governments are capable of it.
Yet even if many countries could not, or should not, exactly copy China, its experience holds three important lessons—to talk to the public, to slow the transmission of the disease and to prepare health systems for a spike in demand.
A good example of communication is America’s Centres for Disease Control, which issued a clear, unambiguous warning on February 25th. A bad one is Iran’s deputy health minister, who succumbed to the virus during a press conference designed to show that the government is on top of the epidemic.
Even well-meaning attempts to sugarcoat the truth are self-defeating, because they spread mistrust, rumours and, ultimately, fear. The signal that the disease must be stopped at any cost, or that it is too terrifying to talk about, frustrates efforts to prepare for the virus’s inevitable arrival. As governments dither, conspiracy theories coming out of Russia are already sowing doubt, perhaps to hinder and discredit the response of democracies.
The best time to inform people about the disease is before the epidemic. One message is that fatality is correlated with age. If you are over 80 or you have an underlying condition you are at high risk; if you are under 50 you are not. Now is the moment to persuade the future 80% of mild cases to stay at home and not rush to a hospital. People need to learn to wash their hands often and to avoid touching their face. Businesses need continuity plans, to let staff work from home and to ensure a stand-in can replace a vital employee who is ill or caring for a child or parent. The model is Singapore, which learned from SARS, another coronavirus, that clear, early communication limits panic.
China’s second lesson is that governments can slow the spread of the disease. Flattening the spike of the epidemic means that health systems are less overwhelmed, which saves lives. If, like flu, the virus turns out to be seasonal, some cases could be delayed until next winter, by which time doctors will understand better how to cope with it. By then, new vaccines and antiviral drugs may be available.
When countries have few cases, they can follow each one, tracing contacts and isolating them. But when the disease is spreading in the community, that becomes futile. Governments need to prepare for the moment when they will switch to social distancing, which may include cancelling public events, closing schools, staggering work hours and so on. Given the uncertainties, governments will have to choose how draconian they want to be. They should be guided by science. International travel bans look decisive, but they offer little protection because people find ways to move. They also signal that the problem is “them” infecting “us”, rather than limiting infections among “us”. Likewise, if the disease has spread widely, as in Italy and South Korea, “Wuhan-lite” quarantines of whole towns offer scant protection at a high cost.
Scrub up
The third lesson is to prepare health systems for what is to come. That entails painstaking logistical planning. Hospitals need supplies of gowns, masks, gloves, oxygen and drugs. They should already be conserving them. They will run short of equipment, including ventilators. They need a scheme for how to set aside wards and floors for covid-19 patients, for how to cope if staff fall ill, and for how to choose between patients if they are overwhelmed. By now, this work should have been done.
This virus has already exposed the strengths and weaknesses of China’s authoritarianism. It will test all the political systems with which it comes into contact, in both rich and developing countries. China has bought governments time to prepare for a pandemic. They should use it.
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