The struggle to save lives and the economy is likely to present agonizing choices
在救助生命和拯救经济当中进行选择是一个残酷的选择
PLANET EARTH is shutting down. In the struggle to get a grip on covid-19, one country after another is demanding that its citizens shun society. As that sends economies reeling, desperate governments are trying to tide over companies and consumers by handing out trillions of dollars in aid and loan guarantees. Nobody can be sure how well these rescues will work.
整个蓝星都陷入停摆。为了抗击新冠肺炎疫情，多国政府加强对境内社会活动的限制。由于疫情给经济造成了巨大冲击，各国政府都出台了包括直接提供巨额的现金援助或者*款贷**等经济援助计划来帮助个人或者企业度过难关。这些举措的效果如何尚不可知。
But there is worse. Troubling new findings suggest that stopping the pandemic might require repeated shutdowns. And yet it is also now clear that such a strategy would condemn the world economy to grave—perhaps intolerable—harm. Some very hard choices lie ahead.
研究结果表明在取得抗击新冠肺炎疫情胜利前需要经历一个长期封闭-解封-封闭的过程。这种过程将对全球经济造成巨大的伤害。对于各国政府来说，未来将面临非常艰难的政策选择。
Barely 12 weeks after the first reports of people mysteriously falling ill in Wuhan, in central China, the world is beginning to grasp the pandemic’s true human and economic toll. As of March 18th SARS-CoV-2, the virus behind covid-19, had registered 134,000 infections outside China in 155 countries and territories. In just seven days that is an increase of almost 90,000 cases and 43 countries and territories. The real number of cases is thought to be at least an order of magnitude greater.
在武汉首次报告不明病例后的12周，全球的社会和经济都受到了此次疫情的冲击。3月18日中国以外的155个国家和地区新冠确诊病例达到13万4千人，而仅仅是7天后，疫情影响扩大到全球189个国家和地区，新增确诊病例9万人。有观点认为实际感染人数至少是目前确诊人数的10倍。
Spooked, governments are rushing to impose controls that would have been unimaginable only a few weeks ago. Scores of countries, including many in Africa and Latin America, have barred travelers from places where the virus is rife. Times Square is deserted, the City of London is dark and in France, Italy and Spain cafés, bars and restaurants have bolted their doors. Everywhere empty stadiums echo to absent crowds.
各国政府纷纷出台各种严厉手段防控疫情。包括非洲和拉美国家在内的许多国家开始禁止疫情严重地区的旅客入境。美国、英国、法国、意大利和西班牙等国都相继宣布关闭咖啡馆、酒吧、餐厅和体育场所。
It has become clear that the economy is taking a much worse battering than analysts had expected (see Briefing). Data for January and February show that industrial output in China, which had been forecast to fall by 3% compared with a year earlier, was down by 13.5%. Retail sales were not 4% lower, but 20.5%. Fixed-asset investment, which measures the spending on such things as machinery and infrastructure, declined by 24%, six times more than predicted. That has sent economic forecasters the world over scurrying to revise down their predictions. Faced with the most brutal recession in living memory, governments are setting out rescue packages on a scale that exceeds even the financial crisis of 2007-09 (see leader).
经济形势比分析师预计的还要糟糕。中国1-2月规模以上工业增加值同比下降13.5%，预期3%。社会消费品零售总额同比大幅下降20.5%,市场预期下降4%。1-2月全国固定资产投资下降24.5%，比期下降多了六倍。全球各大经济预测机构因而纷纷下调之前预测。面对这场空前严峻的疫情，各国政府纷纷出台一揽子救助计划，计划的规模将超过2008年金融危机的救助规模。
This is the backdrop for fundamental choices about how to manage the disease. Using an epidemiological model, a group from Imperial College in London this week set out a framework to help policymakers think about what lies ahead. It is bleak.
以上就是全球各国做出防控疫情决策时所面临的现实。上周，伦敦帝国理工学院的一个研究小组建立了一个基于流行病学的预测模型帮助决策者进行决策，该模型预测疫情防控前景很严峻。
One approach is mitigation, “flattening the curve” to make the pandemic less intense by, say, isolating cases and quarantining infected households. The other is to suppress it with a broader range of measures, including shutting in everybody, other than those who cannot work from home, and closing schools and universities. Mitigation curbs the pandemic; suppression aims to stop it in its tracks.
该研究团队分析了两种策略。有一种策略我们称之为“缓解策略”，通过隔离确诊病患和受感染家庭来控制病毒传播，延缓流行速度；另一种策略我们称之为“抑制策略”，通过更广泛的措施来阻断疫情传播包括要求所有人居家隔离（除了那些不能在家工作的人），以及关闭学校。第一种方法重在抑制疫情传播，而后一种方法则是要彻底阻断病毒传播。
The modelers found that, were the virus left to spread, it would cause around 2.2m deaths in America and 500,000 in Britain by the end of summer. In advanced economies, they concluded, three months of curve-flattening, including two-week quarantines of infected households, would at best prevent only about half of these. Moreover, peak demand for intensive care would still be eight times the surge capacity of Britain’s National Health Service, leading to many more deaths that the model did not attempt to compute. If that pattern holds in other parts of Europe, even its best-resourced health systems, including Germany’s, would be overwhelmed.
研究人员发现，如果不采取措施任由病毒肆意传播，那么到今夏结束时，美国和英国分别将有220万人和50万人死于该病毒。研究人员发现，在发达国家中，如果实行第一种方法（包括14天居家隔离），也仅能使得预计死亡人数减少一半。疫情高峰期对于重症监护的需求将是英国国家医疗服务体系（NHS）救治能力的八倍之多，这将使得死亡人数大大增加，而该模型尚未考虑这种情况。如果把这个模型放到欧洲其他地区，即便是在有着充裕医疗资源的德国也将会不堪重负。
No wonder governments are opting for the more stringent controls needed to suppress the pandemic. Suppression has the advantage that it has worked in China. On March 18th Italy added 4,207 new cases whereas Wuhan counted none at all. China has recorded a total of just over 80,000 cases in a population of 1.4bn people. For comparison, the Imperial group estimated that the virus left to itself would infect more than 80% of the population in Britain and America.
难怪各国政府更倾向选择“抑制策略”。中国取得的卓越防疫成就证明了该策略的优势。3月18日，意大利新增了4207例确诊患者，同一天武汉实现了零新增。中国有14亿人口，全部确诊病例仅8万。相比之下，按照帝国理工学院的模型预测，英美将有80%的人口被感染。
But that is why suppression has a sting in its tail. By keeping infection rates relatively low, it leaves many people susceptible to the virus. And since covid-19 is now so widespread, within countries and around the world, the Imperial model suggests that epidemics would return within a few weeks of the restrictions being lifted. To avoid this, countries must suppress the disease each time it resurfaces, spending at least half their time in lockdown. This on-off cycle must be repeated until either the disease has worked through the population or there is a vaccine which could be months away, if one works at all.
但这种“抑制策略”也留下了一些隐患。这种策略使得感染率保持在一个较低水平，也意味着很多人对病毒没有免疫。帝国理工学院的这支研究团队认为一旦放开管控措施，病毒将在几周之内重新爆发。为了避免这种情况的发生，各国政府需要在疫情复发时不断压制它，这将导致整个社会有一半的时间处于封闭状态。这种反复状态将会持续到群体免疫或者疫苗在数月内出现，前提是疫苗是有效的。
This is just a model, and models are just educated guesses based on the best evidence. Hence the importance of watching China to see if life there can return to normal without the disease breaking out again. The hope is that teams of epidemiologists can test on a massive scale so as to catch new cases early, trace their contacts and quarantine them without turning society upside down. Perhaps they will be helped by new drugs, such as a Japanese antiviral compound which China this week said was promising.
这只是一个理想模型，模型只是基于最佳证据下的合理猜测。关键还是要看中国在恢复社会常态后的疫情防控情况。现在寄希望于防疫专家们可以通过大规模的核酸检测，越早发现病例后，找到密切接触者后进行隔离，这将不会过多影响社会秩序。也许我们还可以寄希望于新药开发，本周中国政府称日本的一款抗病毒药物是有效的。
But this is just a hope, and hope is not a policy. The bitter truth is that mitigation costs too many lives and suppression may be economically unsustainable. After a few iterations’ governments might not have the capacity to carry businesses and consumers. Ordinary people might not tolerate the upheaval. The cost of repeated isolation, measured by mental well-being and the long-term health of the rest of the population, might not justify it.
但这仅仅是希望，希望不能代替政策。“缓解策略”需要付出巨大的生命代价，而“抑制策略”在经济上并不能长久。在经过数次疫情反复的状况后，政府将会无力承担社会经济损失。普通人也会无法忍受这种反复变化带来的冲击。反复隔离对于社会带来的身心伤害将是无可计量的。
In the real world there are trade-offs between the two strategies, though governments can make both more efficient. South Korea, China and Italy have shown that this starts with mass-testing. The more clearly you can identify who has the disease, the less you must depend upon indiscriminate restrictions. Tests for antibodies to the virus, picking up who has been infected and recovered, are needed to supplement today’s which are only valid just before and during the illness (see article). That will let immune people go about their business in the knowledge that they cannot be a source of further infections.
在现实世界中，在两种策略间会有平衡，但政府可以让两者都变得更高效。从韩国、中国和意大利的经验来看，可以进行大规模的核酸检测。越能清楚识别染病者，就越不必实施全面的无差异限制措施。现在的检测手段只能发现发病前和发病中的人，除此之外还需要大量核酸检测来找到那些已经获得免疫力的群体。让这些人知道自己不会再成为感染源，可以开展日常活动。
A second line of attack is to use technology to administer quarantines and social distancing. China is using apps to certify who is clear of the disease and who is not. Both it and South Korea are using big data and social media to trace infections, alert people to hotspots and round up contacts. South Korea changed the law to allow the state to gain access to medical records and share them without a warrant. In normal times many democracies might find that too intrusive. Times are not normal.
第二个就是科学防疫和社会隔离。中国通过使用防疫二维码来辨别人们的状态。中韩同时采用了大数据和社交媒体来追踪病例，警示人们远离疫情爆发点。韩国修改法律允许政府无需申请搜查令的情况下取得民众的医疗记录和发布民众的病例。在正常时期，这种行为往往被认为是侵犯隐私。但现在是非常时期。
Last, governments should invest in health care, even if their efforts take months to bear fruit and may never be needed. They should increase the surge capacity of intensive care. Countries like Britain and America are desperately short of beds, specialists and ventilators. They should define the best treatment protocols, develop vaccines and test new therapeutic drugs. All this would make mitigation less lethal and suppression cheaper.
最后，政府应该在医疗卫生事业上投入更多，即便这些投入可能耗时很久才有成效，甚至可能永远不会派上用场。政府应该大力发展重症科室的救治能力。英美两国极度缺乏病床、专科医师和呼吸机。政府应该制定合适的治疗方案，研发疫苗和测试新药。这些努力会使得“缓解策略”的死亡率降低，“抑制措施”的代价更小。
Be under no illusions. Such measures might still not prevent the pandemic from extracting a heavy toll. Today governments seem to be committed to suppression, whatever the cost. But if the disease is not conquered quickly, they will edge towards mitigation, even if that will result in many more deaths. Understandably, just now that is not a trade-off any government is willing to contemplate. They may soon have no choice.
但不要抱有幻想。上述措施仍无法阻止这场全球大流行病带来的惨痛损失。目前各国政府都在不计成本的防控疫情。如果疫情不能迅速结束，各国政府将逐渐转向缓解策略，即便这可能导致更多的人死亡。当下各国政府不愿意采取这种措施，但随着疫情的恶化，他们将别无选择。