国际医学顶级期刊批评特朗普政府：将新冠危机变成了悲剧

图源： NEJM

北京时间10月8日，权威医学期刊《新英格兰医学杂志》（NEJM）发表编辑部联名社论，谴责特朗普政府在此次新冠疫情中的表现，指其让一场公共卫生危机一步步演变成为一出“悲剧”。

新冠疫情对全球所有国家来说，都是一场难度巨大的挑战。在疫情面前，唯一能把握住的就是积极应对。而在美国，“我们一直以来都应对地极其糟糕”。社论表示，“我们基本上每一步都失败了”：

明明有足够的预警，但当疾病传播到美国时，却没有能力进行高效的检测；疾病在许多社区蔓延后，美国迟迟没有实施隔离措施； 在疾病得到充分控制之前，关于社交距离的规定也已经放松了限制；在美国大多数地区，人们根本不戴口罩，主要是因为特朗普政府明确表示，口罩只是政治工具，而非有效的防疫措施；在疫苗研发方面，虽然政府投入了大量资金，但其言论使得研发过程政治化，并招致公众的不信任。

社论进一步指出，无论从医疗技术、科研水平还是生产能力来说，美国都是享有巨大优势的。然而，在疫情应对上，美国政府没有好好利用这些优势，做出了种种错误决定：

联邦政府基本上将疾病防控的工作甩给了各州，然而各州州长却没有联邦政府拥有的各项条件和手段；美国国立卫生研究院（NIH）在疫苗研发中起了重要作用，却被排除在政府决策的大门之外；政府不依靠科学家和专业人员，反去求助于不了解情况的所谓“意见领袖”和假充内行的“门外汉”，而这些人通常掩盖事实真相并散布谎言。

社论最后呼吁民众通过投票改变如今的局面：“在我们这个时代最严重的公共卫生危机面前，我们的领导人表现出了引致危险的无能。我们不应该助纣为虐，不应该让这些德不称位的人继续尸位素餐，而令美国的死亡人数再多出成千上万人。”

值得一提的是，在过去的200多年中，《新英格兰医学杂志》作为在世界医疗领域享誉盛名的顶级学术期刊，从未涉足过政治领域或是表明过政治立场。

（钛媒体编辑萌萌整理）

以下为社论原文及译文，来自微信公号“NEJM医学前沿”：

Dying in a Leadership Vacuum

在领导力真空中死去

The Editors

N Engl J Med 2020; 383:1479-1480

Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

Covid-19造成了全球性危机。这场危机是对领导力的一场考验。由于并无对抗新型病原体的理想手段，因此各国被迫就如何应对做出艰难选择。而美国的领导人没有通过这场考验。他们把危机变成了悲剧。

The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.

此次失败触目惊心。根据约翰霍普金斯大学系统科学与工程中心（Johns Hopkins Center for Systems Science and Engineering）[1]数据，美国Covid-19患病人数和死亡人数都居于世界首位，远远超过中国等人口更多的国家。美国的病死率是加拿大的2倍多，比人口老龄化并因而拥有众多Covid-19高危人群的日本高出近50倍，甚至比越南等中低收入国家高出近2,000倍。Covid-19是一项巨大挑战，许多因素造成了其严峻程度。但如何应对是一个我们可以控制的因素，而美国的表现自疫情暴发就一直不佳。

We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.

我们知道我们原本可以做得更好。最早暴发疫情的中国经历最初的拖延后，选择了严格的隔离措施。这些措施虽然严厉但很有效，基本上在疫情暴发之初就遏制了传播。据报道，其病死率降低至每百万人中有3人死亡，而美国每百万人中有超过500人死亡。新加坡和韩国等与中国往来比较多的国家很早就加强了检测，同时还积极追踪接触者并采取适当隔离措施，因而疫情相对较轻。新西兰也采取了同样措施，加上该国的地理优势，他们几乎清除了Covid-19，因而可以缩短封锁时间，其社会基本上已经重新开放至疫情前水平。总的来说，许多民主国家不仅比美国做得好，而且比美国做的好得多。

Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.

为什么美国此次应对疫情表现如此糟糕？我们基本上每一步都失败了。我们得到了充分预警，但当疾病传播到美国时，我们没有能力进行有效检测，甚至无法为医护人员和公众提供最基本的个人防护设备。我们在检测能力方面仍然远远落后。虽然检测的绝对数量已大幅增加，但更有用的衡量指标是每检出一例感染的检测数量。就这一指标而言，我们在国际上的排名非常靠后，甚至落后于生物医学基础设施和生产能力不及我们的哈萨克斯坦、津巴布韦和埃塞俄比亚等国家[2]。此外，由于美国不重视提高检测能力，因此常需等待很长时间才能拿到结果，此时检测结果对于疾病控制已经毫无用处。

Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.

我们往往关注技术，而大多数成效显著的干预措施并不复杂。Covid-19在许多社区蔓延之后，美国才采取隔离措施，不仅为时已晚，政策不统一，而且并未严格执行这些措施。我们执行保持社交距离的规定，在许多地方充其量只能说是漫不经心，并且早在疾病得到充分控制之前就已放宽限制。在美国很多地方，人们根本就不戴口罩，很大程度上是因为我们的领导人已经明确表示，口罩只是政治工具，而不是有效的感染控制措施。政府在疫苗开发方面投入了大量资金，这是恰当的做法，但其言论却使疫苗开发过程政治化，导致公众的不信任日益加深。

The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

美国遭遇这场危机时拥有巨大优势。除了巨大的生产能力，我们还有全世界称羡的生物医学研究体系。我们在公共卫生、卫生政策和基础生物学方面拥有强大专业能力，并且一直能够将这些专业能力转化为新疗法和预防措施。这些专业能力很多来自政府机构，可我们的领导人却选择无视甚至诋毁专家。

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

国家领导人应对疫情的措施一直不够充分。联邦政府基本上已经将疾病控制工作甩给了各州。各州州长的应对各不相同，原因主要不是党派政治，而是能力。但不论他们能力如何，州长都不拥有在联邦政府控制下的各种应对手段。联邦政府没有应用这些手段，而是削弱了它们。美国疾病控制与预防中心曾是世界领先的疾病防控组织，如今却遭受重创，并且在检测和政策方面遭遇惨败。美国国立卫生研究院在疫苗开发方面发挥了关键作用，但却被排除在政府的许多关键决策之外。美国食品药品管理局已经被可耻地政治化了[3]，他们似乎屈从于政府压力，而不是遵循科学证据。我们的领导人破坏了人们对科学和政府的信任[4]，造成的损害肯定会比他们本人更长久。政府没有依赖专业知识，而是求助于无知的“意见领袖”和冒牌内行，他们掩盖真相，助长了彻头彻尾的谎言的传播。

Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.

我们要明确我们为连简单措施都不采取所付出的代价。此次令有色人种社区损失尤重的疫情加剧了与种族不平等相关的紧张关系。正处于社交和智力发展关键时期的许多儿童无法上学。医护人员将自己生命置于危险之中，辛勤工作，但他们的这些付出却未能得到妥善运用。我们本届领导人以经济为傲，可在全球大多数国家已经一定程度开放经济活动的情况下，美国Covid-19患病率仍然居高不下，许多行业无法重新开业，因而损失数千亿美元和数百万就业机会。而且，已经有超过20万美国人在此次疫情中丧生。我们无法完全避免Covid-19造成的患者死亡。但是，尽管无法准确预测美国政策不力和不当造成的额外死亡人数，但这一数字至少有数万之多，而且此次疫情造成的美国死亡人数已经超过了二战以来的任何一场冲突。

Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

假如有其他人如此毫无顾忌地糟蹋生命和金钱，他们一定会受到法律惩罚。我们的领导人却声称他们的行为享有豁免权。但是，即将到来的选举赋予了我们审判其行为的权力。理性的人当然会对候选人的许多政治立场持不同意见。但真相本身既不持自由派观点，也不持保守派观点。在我们这个时代最严重的公共卫生危机面前，我们的领导人表现出了危险的无能。我们不应该纵容他们，不应该让这些人继续尸位素餐，而令美国的死亡人数再多出成千上万人。

参考文献

1. Johns Hopkins University Coronavirus Resource Center. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (https://coronavirus.jhu.edu/map.html).

2. Total number of COVID-19 tests per confirmed case, September 14, 2020. Our World in Data (https://ourworldindata.org/grapher/number-of-covid-19-tests-per-confirmed-case).

3. McGinley L, Abutaleb L, Johnson CY. Inside Trump’s pressure campaign on federal scientists over a Covid-19 treatment. Washington Post. August 30, 2020 (https://www.washingtonpost.com/health/convalescent-plasma-treatment-covid19-fda/2020/08/29/e39a75ec-e935-11ea-bc79-834454439a44_story.html).

4. Haberman M. Trump admits downplaying the virus knowing it was ‘deadly stuff.’ New York Times. September 9, 2020 (https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-book-virus.html).

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