据《卫报》报道,在一批机构高调取消活动之后,面对来自公众和科学界的压力,英国政府将从下周末开始取消大型集会。
在政府宣布该决定之前,从英格兰足球超级联赛到英国女王,都接二连三地取消了比赛和官方活动,尽管根据政府公布的政策,取消活动无助于阻止感染,反而会严重干扰公共生活。
知名科学家和政界人士也纷纷批评鲍里斯·约翰逊政府公布的新型冠状病毒疫情防控举措。英国政府采取的策略与欧洲多数政府的防控措施截然不同,而且尽管政府宣布取消大型集会,但原定政策将继续有效。
科学家和政界人士的反对意见主要集中在获得对病毒的“群体免疫力”这条政策。该政策意味着让至少4000万英国人感染病毒,最终使全社会对这种疾病形成长期抵抗力。
英国政府首席科学顾问帕特里克·瓦兰斯上周五参加BBC广播四台《今日》栏目时表示:“我们的目的是尽量降低和压平峰值,而不是完全抑制高峰期到来。而且由于绝大多数人的症状较轻,能够获得一定程度的群体免疫力,从而使更多人对这种疾病免疫,就能减少病毒传播。”
英国政府称,需要约六成人口感染病毒,才能获得群体免疫。到那时,传播率会下降,足以保护剩余40%的英国人,使他们免于感染病毒。但这种策略还有重要的一点,即尽量控制被感染群体。在理想情况下,政府希望只有可能出现轻度症状的人群感染病毒。(英国政府此前曾经表示,在最糟糕的情况下,最终可能有80%的人口感染病毒,高于德国政府估计的70%。)
英国的疫情防控方法意味着在尽量降低死亡率的同时,国内许多健康人将不得不染上这种疾病。这个策略与其他许多国家努力防止人们感染的做法截然不同。
英国政府的方法基于一种假设,即COVID-19会像流感一样,成为一种重复出现的季节性病毒,而且只要感染过这种病毒就不会再次感染。如果确实如此(存在非常大的不确定性),从长远的角度来看,通常有两种方式可以防控病毒。第一种是通过疫苗,如果没有疫苗,第二种方式是让足够多的人感染病毒,在康复后产生免疫力避免重复感染,从而降低病毒的流行性,并减少易感染人群面临的风险。
但正如多位科学专家所说,问题在于这种方法依旧存在巨大的风险。
爱丁堡大学全球公共卫生项目主任德维·施利达在推文中写道:“我今天跟其他学术界人士、科学记者、私营公司和政府人员交流过,但我依旧很难理解政府的做法。政府似乎照搬了应对流感的策略。但COVID-19可不是流感,它比流感更难对付,造成的健康后果非常严重。”
同时,完全隔离易感染人群可能并不现实,甚至无法确定哪些人是易感染人群。实现群体免疫有很大难度;例如,对于麻疹,只能通过非常高的疫苗接种率才能维持群体免疫。
瓦兰斯、首席医学官克里斯·惠蒂和英国首相约翰逊在上周四晚上出席了新闻发布会。英国政府在发布会上宣布,英国将进入病毒防控的“延缓”阶段,通过压平病例曲线,将新型冠状病毒的高峰期延迟到温暖月份,从而减轻医疗系统的压力。呼吸道病毒在温暖月份的流行性通常较弱。
虽然政府的防控措施要求有轻度咳嗽和流感症状的人群留在家中,但却未采用欧洲多数国家和北美国家逐步采取的措施,如封闭大中学校等。
政府在上周四宣布,可能在未来某个时间点执行这些更严格的措施,但在没有绝对必要之前这样做还为时尚早,会干扰人们的日常生活。这些措施会让人们对于遵守隔离限制产生疲劳,而且根据英国政府提供的数据,当感染人数即将达到高峰时,人们反而会因为疲劳而忽视这些限制措施。
英国的疫情防控策略严重依赖数学模拟和一个绰号“助推小组”的政府行为洞察团队。该团队利用心理学理论,“助推”人们做出某种行为,如缴税或生病时留在家中等。
但英国政府公布的新措施没有其他国家那么严格,而且这些措施强调群体免疫,因此遭到了知名病毒学家和流行病学家以及保守党在内的政界人士的强烈批评。
在BBC电视台的《新闻之夜》栏目中,英国前卫生大臣和外交事务大臣、保守党议员杰里米·亨特称政府不取消大型集会的决定“令人意外和担忧”,他表示根据当前的预测,英国的感染率会在约四周内达到意大利目前的水平,因此英国应该采取更极端的措施做好准备。
与此同时,前保守党内阁大臣罗里·斯图尔特在接受CNN主持人克里斯汀·阿曼普采访时形容政府的决定是“非常反常的”策略,他表示英国政府的做法会带来病毒在全世界传播的风险,而且低估了病毒对本国卫生体系的影响。
斯图尔特说:“英国试图遵循群体免疫理论防控病毒。换言之,他们认为战胜这种病毒是不可能的,所以最终不得不放任它在民众当中传播。”
“这是非常非常重要的选择。但这根本不是科学选择,而是政治上的决定。他们判断人们准备容忍哪些限制,判断人们准备接受学校关闭多久,这些都是经济上的判断。”
斯图尔特补充说,他认为政府的判断是错误的,因为政府决策过程不透明,而且“如果公众了解到政府这种观点隐含的意思是,他们宁愿让一些人早死来阻止之后更多人的死亡,这时候人们会变得非常焦虑。”
杜克大学全球健康政策影响中心主任加文·亚梅发推文称:“真是令人难以理解。瓦兰斯怎么会知道新型冠状病毒会变成一种季节性的、地方性流行病毒呢?瓦兰斯怎么会知道最好的方法是有意识地希望大部分人感染病毒呢?这种风险极高的做法背后到底有什么证据??”
英国政府上周三公布的新疫情防控策略包括国家医疗服务体系将不再对医院以外的患者进行病毒检测,不再对轻症患者进行检测和确诊。这条新政策让政府更难确定人口达到群体免疫的具体时间,只能根据医院确诊新冠肺炎病例的死亡率向后推算。
贝尔法斯特女王大学实验医学中心呼吸道病毒感染专家林赛·布罗德本特指出,在新冠肺炎患者中轻症患者应该占绝大多数。如果对轻症病例不进行检测,还会导致英国的死亡率统计数据失真。
她在推文中写道:“对尽可能多的人进行检测非常重要。韩国就是很好的例子。英国政府宣布仅对更严重的患者进行检测,这会增加隔离感染患者的难度,并且产生英国死亡率很高的表象!”
根据世界卫生组织数据,截至3月16日,英国报告了1395例新型冠状病毒病例,死亡病例35例。(财富中文网)
翻译:刘进龙
审校:汪皓
据《卫报》报道,在一批机构高调取消活动之后,面对来自公众和科学界的压力,英国政府将从下周末开始取消大型集会。
在政府宣布该决定之前,从英格兰足球超级联赛到英国女王,都接二连三地取消了比赛和官方活动,尽管根据政府公布的政策,取消活动无助于阻止感染,反而会严重干扰公共生活。
知名科学家和政界人士也纷纷批评鲍里斯·约翰逊政府公布的新型冠状病毒疫情防控举措。英国政府采取的策略与欧洲多数政府的防控措施截然不同,而且尽管政府宣布取消大型集会,但原定政策将继续有效。
科学家和政界人士的反对意见主要集中在获得对病毒的“群体免疫力”这条政策。该政策意味着让至少4000万英国人感染病毒,最终使全社会对这种疾病形成长期抵抗力。
英国政府首席科学顾问帕特里克·瓦兰斯上周五参加BBC广播四台《今日》栏目时表示:“我们的目的是尽量降低和压平峰值,而不是完全抑制高峰期到来。而且由于绝大多数人的症状较轻,能够获得一定程度的群体免疫力,从而使更多人对这种疾病免疫,就能减少病毒传播。”
英国政府称,需要约六成人口感染病毒,才能获得群体免疫。到那时,传播率会下降,足以保护剩余40%的英国人,使他们免于感染病毒。但这种策略还有重要的一点,即尽量控制被感染群体。在理想情况下,政府希望只有可能出现轻度症状的人群感染病毒。(英国政府此前曾经表示,在最糟糕的情况下,最终可能有80%的人口感染病毒,高于德国政府估计的70%。)
英国的疫情防控方法意味着在尽量降低死亡率的同时,国内许多健康人将不得不染上这种疾病。这个策略与其他许多国家努力防止人们感染的做法截然不同。
英国政府的方法基于一种假设,即COVID-19会像流感一样,成为一种重复出现的季节性病毒,而且只要感染过这种病毒就不会再次感染。如果确实如此(存在非常大的不确定性),从长远的角度来看,通常有两种方式可以防控病毒。第一种是通过疫苗,如果没有疫苗,第二种方式是让足够多的人感染病毒,在康复后产生免疫力避免重复感染,从而降低病毒的流行性,并减少易感染人群面临的风险。
但正如多位科学专家所说,问题在于这种方法依旧存在巨大的风险。
爱丁堡大学全球公共卫生项目主任德维·施利达在推文中写道:“我今天跟其他学术界人士、科学记者、私营公司和政府人员交流过,但我依旧很难理解政府的做法。政府似乎照搬了应对流感的策略。但COVID-19可不是流感,它比流感更难对付,造成的健康后果非常严重。”
同时,完全隔离易感染人群可能并不现实,甚至无法确定哪些人是易感染人群。实现群体免疫有很大难度;例如,对于麻疹,只能通过非常高的疫苗接种率才能维持群体免疫。
瓦兰斯、首席医学官克里斯·惠蒂和英国首相约翰逊在上周四晚上出席了新闻发布会。英国政府在发布会上宣布,英国将进入病毒防控的“延缓”阶段,通过压平病例曲线,将新型冠状病毒的高峰期延迟到温暖月份,从而减轻医疗系统的压力。呼吸道病毒在温暖月份的流行性通常较弱。
虽然政府的防控措施要求有轻度咳嗽和流感症状的人群留在家中,但却未采用欧洲多数国家和北美国家逐步采取的措施,如封闭大中学校等。
政府在上周四宣布,可能在未来某个时间点执行这些更严格的措施,但在没有绝对必要之前这样做还为时尚早,会干扰人们的日常生活。这些措施会让人们对于遵守隔离限制产生疲劳,而且根据英国政府提供的数据,当感染人数即将达到高峰时,人们反而会因为疲劳而忽视这些限制措施。
英国的疫情防控策略严重依赖数学模拟和一个绰号“助推小组”的政府行为洞察团队。该团队利用心理学理论,“助推”人们做出某种行为,如缴税或生病时留在家中等。
但英国政府公布的新措施没有其他国家那么严格,而且这些措施强调群体免疫,因此遭到了知名病毒学家和流行病学家以及保守党在内的政界人士的强烈批评。
在BBC电视台的《新闻之夜》栏目中,英国前卫生大臣和外交事务大臣、保守党议员杰里米·亨特称政府不取消大型集会的决定“令人意外和担忧”,他表示根据当前的预测,英国的感染率会在约四周内达到意大利目前的水平,因此英国应该采取更极端的措施做好准备。
与此同时,前保守党内阁大臣罗里·斯图尔特在接受CNN主持人克里斯汀·阿曼普采访时形容政府的决定是“非常反常的”策略,他表示英国政府的做法会带来病毒在全世界传播的风险,而且低估了病毒对本国卫生体系的影响。
斯图尔特说:“英国试图遵循群体免疫理论防控病毒。换言之,他们认为战胜这种病毒是不可能的,所以最终不得不放任它在民众当中传播。”
“这是非常非常重要的选择。但这根本不是科学选择,而是政治上的决定。他们判断人们准备容忍哪些限制,判断人们准备接受学校关闭多久,这些都是经济上的判断。”
斯图尔特补充说,他认为政府的判断是错误的,因为政府决策过程不透明,而且“如果公众了解到政府这种观点隐含的意思是,他们宁愿让一些人早死来阻止之后更多人的死亡,这时候人们会变得非常焦虑。”
杜克大学全球健康政策影响中心主任加文·亚梅发推文称:“真是令人难以理解。瓦兰斯怎么会知道新型冠状病毒会变成一种季节性的、地方性流行病毒呢?瓦兰斯怎么会知道最好的方法是有意识地希望大部分人感染病毒呢?这种风险极高的做法背后到底有什么证据??”
英国政府上周三公布的新疫情防控策略包括国家医疗服务体系将不再对医院以外的患者进行病毒检测,不再对轻症患者进行检测和确诊。这条新政策让政府更难确定人口达到群体免疫的具体时间,只能根据医院确诊新冠肺炎病例的死亡率向后推算。
贝尔法斯特女王大学实验医学中心呼吸道病毒感染专家林赛·布罗德本特指出,在新冠肺炎患者中轻症患者应该占绝大多数。如果对轻症病例不进行检测,还会导致英国的死亡率统计数据失真。
她在推文中写道:“对尽可能多的人进行检测非常重要。韩国就是很好的例子。英国政府宣布仅对更严重的患者进行检测,这会增加隔离感染患者的难度,并且产生英国死亡率很高的表象!”
根据世界卫生组织数据,截至3月16日,英国报告了1395例新型冠状病毒病例,死亡病例35例。(财富中文网)
翻译:刘进龙
审校:汪皓
The U.K. will cancel mass gatherings beginning next weekend, The Guardian newspaper reported Friday night, after a wave of high-profile cancellations and pressure from the public and scientific community appeared to force the government's hand.
The announcement came after British institutions, from football's Premier League to the Queen, moved to cancel games and official engagements, despite official government policy that cancellations would do little to stem infections and would cause too large a disruption on public life.
It also followed statements from both well-known scientists and politicians criticizing Boris Johnson's government's strategy for fighting coronavirus, which takes a markedly different approach than most European governments and, despite Friday's announcement, remains in place.
At the heart of that outcry: a policy to push for "herd immunity" to the virus, which would involve allowing at least 40 million Britons to become infected in the hopes of building up a long-term, society-wide resistance to the disease.
"Our aim is to try and reduce the peak [of the infections], broaden the peak, not suppress it completely," Patrick Vallance, chief scientific advisor to the U.K. government, told BBC Radio 4's Today program on Friday. "Also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission."
For herd immunity to kick in, the U.K. government said that about 60% of the population would need to contract the virus. At that point, the rate of transmissions drops enough to protect the remaining 40% of the population from contracting the virus. But the strategy is also based around trying to manage which people are in that 60%—in an ideal scenario, the government would want only those most likely to experience a mild illness to get infected. (The government has previously said, that in a worst case scenario, 80% of the population might eventually contract the virus, above the German government's estimate of 70%.)
The U.K.'s approach means many healthy people in the country have to get the disease—while keeping the fatality rate as low as possible. It's a marked break with the approach in much of the rest of the world, which is to stop people from getting coronavirus, period.
It's also an approach that is based on the assumptions that COVID-19 will be a recurring, seasonal virus—like the flu—and that once you get the virus, you can't get it again. If that's the case—and those are very big ifs—there are usually two ways to manage a virus long-term. The first is through a vaccine, and if one doesn't exist, the second is through enough people catching the virus, recovering, and being immune to re-infection, therefore making the virus much less common, and less of a risk to those who are vulnerable.
The problem is that this approach is still extremely risky, as multiple scientific experts pointed out.
"I've been talking to other academics, science journalists, private companies, & gov't people all of today and still struggling to understand this," Devi Sridhar, Chair of Global Public Health at the University of Edinburgh tweeted. "The gov't seems to be following flu playbook strategy. But this is not the flu. COVID-19 is much worse & health outcomes are sobering."
In the mean time, it's likely impossible to completely sequester those who are vulnerable or know exactly who will be vulnerable in the first place. Herd immunity is difficult; in the case of measles, for example, it's is only preserved through very high vaccination rates.
During the press conference on Thursday evening with Vallance, chief medical officer Chris Whitty, and prime minister Johnson, the government announced the country was moving to the "delay" phase for managing the virus, which includes attempting to lessen the pressure on the health system by flattening out the curve of cases and pushing the peak of the virus out to the warmer months, when respiratory viruses are typically not as viral.
That approach includes asking people with even very mild cough and flu symptoms to stay home, but stopped short of the measures seen in most other European countries and increasingly in North America, including closing schools and colleges.
The government said Thursday that it may have to impose these more stringent measures at some point in the future, but that doing so now would be premature, disrupting daily life before it was absolutely necessary, and risking the public would grow tired of complying with the restrictions and begin to ignore them just when the peak number of infections might be expected, based on the data the U.K. government has crunched.
It's a strategy that relies heavily on mathematical modeling and a government behavioral insights team, known by the nickname the "nudge unit", for their use of a psychological theory to "nudge" people towards certain behaviors—like paying their taxes, or staying home when they feel sick.
But the announced new measures, which are far less strict than those other nations' have imposed, paired with the emphasis on herd immunity, also provoked staunch criticism from both well-known virologists and epidemiologists, and politicians, including Conservatives.
On the BBC's Newsnight program, Conservative MP Jeremy Hunt, a former health secretary and foreign secretary, called the decision not to cancel large gatherings "surprising and concerning," and said that given predictions the U.K. will reach Italy's current infection rates in roughly four weeks, more extreme measures should be taken to prepare.
Meanwhile Rory Stewart, a former Conservative cabinet minister, called it a "very eccentric" tactic in an interview with CNN's Christiane Amanpour, and said the government's approach risked spreading the virus to the rest of the world, while underestimating the impact of the virus on the country's own health system.
"Britain is trying to follow a theory of herd immunity. In other words they believe it’s impossible to get on top of this disease, and therefore you have to ultimately let it run through the population," Stewart said.
"That is a very, very big choice. It’s not a scientific choice, it’s fundamentally a political choice. These are judgements about what the population are prepared to put up with, these are judgements about how long people are prepared to have schools closed, these are judgements fundamentally about economics.”
Stewart added that he thought the government had made the wrong judgement by not being transparent, and said that "when the public understands that implicit in this argument is that they would rather that people died earlier to prevent more people dying later, the public will be very troubled.”
"It is baffling," tweeted Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University. "How does Vallance *know* that this is going to be an endemic seasonal virus? How does Vallance *know* that the best approach is to deliberately hope most people get infected? Where on earth is the evidence behind this very, very risky approach??"
The announcement of the government's new strategy on Wednesday included a new policy that the NHS will stop testing for the virus outside of hospitals, leaving mild cases untested and unconfirmed. That would make it more difficult to determine when the population had indeed reached herd immunity, other than by extrapolating backwards from the fatality rate of confirmed coronavirus cases in hospitals.
But the lack of testing for mild cases, which are believed to be the vast majority, was also likely to distort the country's fatality statistics, pointed out Lindsay Broadbent, an expert on respiratory virus infections at the Centre for Experimental Medicine at Queen’s University Belfast.
"Testing as many as possible is so important. South Korea are an excellent example of this," she tweeted. "With the U.K. gov announcing they will restrict testing to more severe patients this will make isolation of infected difficult and will look like we have a high fatality rate!"
On Friday afternoon, the U.K. had 798 reported cases of coronavirus, a jump of more than 35% from the previous day, with 10 fatalities.