数据已经出炉—停止恐慌,结束完全孤立的局面

2020年4月28日10:19:04数据已经出炉—停止恐慌,结束完全孤立的局面已关闭评论 6587586字阅读25分17秒
摘要

新型冠状病毒肺炎大流行的悲剧似乎正在进入遏制阶段。成千上万的美国人死去,美国人现在迫切需要明智的政策制定者有勇气忽视恐慌,依靠事实。领导人必须检查所积累的数据,看看到底发生了什么,而不是继续强调假设性的预测;把经验证明和建立了几十年的生物学基本原理结合起来;然后深思熟虑地恢复国家的功能。

数据已经出炉—停止恐慌,结束完全孤立的局面

The tragedy of the COVID-19 pandemic appears to be entering the containment phase.Tens of thousands of Americans have died,and Americans are now desperate for sensible policymakers who have the courage to ignore the panic and rely on facts.Leaders must examine accumulated data to see what has actually happened,rather than keep emphasizing hypothetical projections;combine that empirical evidence with fundamental principles of biology established for decades;and then thoughtfully restore the country to function.

新型冠状病毒肺炎大流行的悲剧似乎正在进入遏制阶段。成千上万的美国人死去,美国人现在迫切需要明智的政策制定者有勇气忽视恐慌,依靠事实。领导人必须检查所积累的数据,看看到底发生了什么,而不是继续强调假设性的预测;把经验证明和建立了几十年的生物学基本原理结合起来;然后深思熟虑地恢复国家的功能。

Five key facts are being ignored by those calling for continuing the near-total lockdown.

那些呼吁继续近乎完全封锁的人忽视了五个关键事实。

Fact 1:The overwhelming majority of people do not have any significant risk of dying from COVID-19.

事实1:绝大多数人没有任何明显的死于新型冠状病毒肺炎的风险。

The recent Stanford University antibody study now estimates that the fatality rate if infected is likely 0.1 to 0.2 percent,a risk far lower than previous World Health Organization estimates that were 20 to 30 times higher and that motivated isolation policies.

最近斯坦福大学的抗体研究现在估计,如果感染,死亡率可能是0.1%0.2%,这一风险远低于世界卫生组织先前估计的2030倍,这促使了隔离政策的出台。

In New York City,an epicenter of the pandemic with more than one-third of all U.S.deaths,the rate of death for people 18 to 45 years old is 0.01 percent,or 10 per 100,000 in the population.On the other hand,people aged 75 and over have a death rate 80 times that.For people under 18 years old,the rate of death is zero per 100,000.

在纽约市,这个流行病的中心,超过全美死亡人数的三分之一,1845岁人群的死亡率为0.01%,即每10万人中有10人死亡。另一方面,75岁及以上的人的死亡率是这个数字的80倍。对于18岁以下的人来说,每10万人中的死亡率为零。

Of all fatal cases in New York state,two-thirds were in patients over 70 years of age;more than 95 percent were over 50 years of age;and about 90 percent of all fatal cases had an underlying illness.Of 6,570 confirmed COVID-19 deaths fully investigated for underlying conditions to date,6,520,or 99.2 percent,had an underlying illness.If you do not already have an underlying chronic condition,your chances of dying are small,regardless of age.And young adults and children in normal health have almost no risk of any serious illness from COVID-19.

在纽约州的所有致命病例中,三分之二是70岁以上的患者;95%以上是50岁以上的患者;90%的致命病例有潜在疾病。到目前为止,在6570例确诊的新型冠状病毒肺炎死亡病例中,有6520例,即99.2%,患有潜在疾病。如果你还没有潜在的慢性疾病,那么无论年龄大小,你的死亡几率都很小。健康状况正常的年轻人和儿童几乎没有患上任何严重疾病的新型冠状病毒肺炎。

Fact 2:Protecting older,at-risk people eliminates hospital overcrowding.

事实2:保护老年人,有风险的人消除了医院过度拥挤。

We can learn about hospital utilization from data from New York City,the hotbed of COVID-19 with more than 34,600 hospitalizations to date.For those under 18 years of age,hospitalization from the virus is 0.01 percent,or 11 per 100,000 people;for those 18 to 44 years old,hospitalization is 0.1 percent.Even for people ages 65 to 74,only 1.7 percent were hospitalized.Of 4,103 confirmed COVID-19 patients with symptoms bad enough to seek medical care,Dr.Leora Horwitz of NYU Medical Center concluded"age is far and away the strongest risk factor for hospitalization."Even early WHO reports noted that 80 percent of all cases were mild,and more recent studies show a far more widespread rate of infection and lower rate of serious illness.Half of all people testing positive for infection have no symptoms at all.The vast majority of younger,otherwise healthy people do not need significant medical care if they catch this infection.

我们可以从纽约市的数据中了解医院的利用情况,纽约市是新型冠状病毒肺炎的温床,到目前为止有超过34,600人住院。对于18岁以下的人,因病毒而住院的比例是0.01%,即每10万人中有11;对于1844岁的人,住院的比例是0.1%。即使是6574岁的人,也只有1.7%的人住院治疗。纽约大学医学中心的 Leora Horwitz 医生总结道:4103名确诊的新型冠状病毒肺炎患者中,年龄是住院治疗的最大危险因素
甚至早期世界卫生组织的报告也指出,80%的病例都是轻微的,最近的研究表明,感染的范围更广,严重疾病的发病率更低。所有感染阳性的人中有一半根本没有任何症状。绝大多数年轻人,否则健康的人不需要重大的医疗护理,如果他们感染了这种传染病。

Fact 3:Vital population immunity is prevented by total isolation policies,prolonging the problem.

事实3:完全隔离的政策阻止了至关重要的人口免疫,延长了问题。

We know from decades of medical science that infection itself allows people to generate an immune response—antibodies—so that the infection is controlled throughout the population by"herd immunity."Indeed,that is the main purpose of widespread immunization in other viral diseases—to assist with population immunity.In this virus,we know that medical care is not even necessary for the vast majority of people who are infected.It is so mild that half of infected people are asymptomatic,shown in early data from the Diamond Princess ship,and then in Iceland and Italy.That has been falsely portrayed as a problem requiring mass isolation.In fact,infected people without severe illness are the immediately available vehicle for establishing widespread immunity.By transmitting the virus to others in the low-risk group who then generate antibodies,they block the network of pathways toward the most vulnerable people,ultimately ending the threat.Extending whole-population isolation would directly prevent that widespread immunity from developing.

从几十年的医学研究中我们知道,感染本身可以使人产生免疫反应ーー抗体ーー从而通过"群体免疫"控制整个人群的感染——事实上,这正是其他病毒性疾病广泛免疫的主要目的ーー帮助提高人群的免疫力。在这种病毒中,我们知道绝大多数感染者甚至不需要医疗护理。它是如此的温和,以至于一半的感染者没有症状,钻石公主号船上的早期数据显示,然后在冰岛和意大利。这被错误地描述为一个需要大规模隔离的问题。事实上,没有严重疾病的感染者是建立广泛免疫力的直接途径。通过将病毒传播给低风险人群中的其他人,然后由他们产生抗体,他们阻断了通向最脆弱人群的路径网络,最终结束了威胁。扩大整个种群的隔离将直接阻止这种广泛的免疫性发展。

Fact 4:People are dying because other medical care is not getting done due to hypothetical projections.

事实4:人们正在死亡,因为其他医疗护理由于假设的推测而无法完成。

Critical health care for millions of Americans is being ignored and people are dying to accommodate"potential"COVID-19 patients and for fear of spreading the disease.Most states and many hospitals abruptly stopped"nonessential"procedures and surgery.That prevented diagnoses of life-threatening diseases,like cancer screening,biopsies of tumors now undiscovered and potentially deadly brain aneurysms.Treatments,including emergency care,for the most serious illnesses were also missed.Cancer patients deferred chemotherapy.An estimated 80 percent of brain surgery cases were skipped.Acute stroke and heart attack patients missed their only chances for treatment,some dying and many now facing permanent disability.

为数百万美国人提供的重要医疗保健被忽视,人们迫切希望接纳"潜在的"新型冠状病毒肺炎/艾滋病患者,并担心这种疾病的传播。大多数州和许多医院突然停止了"非必要"的程序和手术。这样就避免了危及生命的疾病的诊断,比如癌症筛查、未被发现的肿瘤活组织检查以及可能致命的脑动脉瘤。最严重疾病的治疗,包括紧急护理,也被错过了。癌症患者推迟化疗。据估计,80%的脑部手术病例被跳过。急性中风和心脏病发作的患者错过了他们唯一的治疗机会,一些人濒临死亡,许多人现在面临永久性残疾。

Fact 5:We have a clearly defined population at risk who can be protected with targeted measures.

事实5:我们有一个明确界定的风险人口,可以采取有针对性的措施保护他们。

The overwhelming evidence all over the world consistently shows that a clearly defined group—older people and others with underlying conditions—is more likely to have a serious illness requiring hospitalization and more likely to die from COVID-19.Knowing that,it is a commonsense,achievable goal to target isolation policy to that group,including strictly monitoring those who interact with them.Nursing home residents,the highest risk,should be the most straightforward to systematically protect from infected people,given that they already live in confined places with highly restricted entry.

世界各地的压倒性证据一致表明,一个明确界定的群体—老年人和其他有潜在疾病的人----更有可能患有需要住院治疗的严重疾病,更有可能死于新型冠状病毒肺炎。了解到这一点,针对该组制定隔离策略是一个常识性的、可实现的目标,包括严格监控与它们交互的人员。最高风险的养老院居民,应该是最直接系统地防止感染者的人,因为他们已经生活在高度限制进入的狭窄地方。

The appropriate policy,based on fundamental biology and the evidence already in hand,is to institute a more focused strategy like some outlined in the first place:Strictly protect the known vulnerable,self-isolate the mildly sick and open most workplaces and small businesses with some prudent large-group precautions.This would allow the essential socializing to generate immunity among those with minimal risk of serious consequence,while saving lives,preventing overcrowding of hospitals and limiting the enormous harms compounded by continued total isolation.Let's stop underemphasizing empirical evidence while instead doubling down on hypothetical models.Facts matter.

基于基本的生物学原理和已有的证据,适当的政策应该是制定一个更有针对性的策略,就像一开始概述的那样:严格保护已知的弱势群体,自我隔离那些病情轻微、开放的大多数工作场所和小企业,并采取一些谨慎的大群体预防措。这将使必不可少的社交活动能够在严重后果风险最小的人群中产生免疫力,同时拯救生命,防止医院过度拥挤,并限制因持续完全隔离而造成的巨大伤害。让我们停止不重视经验证明,而是在假设的模型上加倍下注。事实很重要。

Scott W.Atlas,MD,is the David and Joan Traitel Senior Fellow at Stanford University's Hoover Institution and the former chief of neuroradiology at Stanford University Medical Center.

医学博士 Scott w.Atlas 是胡佛协会的 David and Joan Traitel 高级研究员,斯坦福大学医学中心的神经放射学前主任。

来源:

https://thehill.com/opinion/healthcare/494034-the-data-are-in-stop-the-panic-and-end-the-total-isolation

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