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[德国新闻] 对付新冠,应从防守走向进攻,让我们有控制地群体免疫!

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    2016-10-12 21:50
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    发表于 2020-8-17 15:32 | 显示全部楼层 |阅读模式

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    全球感染数量正在增加,即使在基本没有新冠病毒的地区新西兰,地域偏远,人口密度极低,也一次次出现了个别感染爆发。想要消灭新冠病毒的政策已经被证实是徒劳。除瑞典外,几乎所有国家都在尝试消灭冠状病毒。群体免疫已经别无选择。

    在即将到来的秋冬近半年的时间,大家都非常担心冠状病毒感染可能会比过去几周更加严重。不过与大流行初期爆发相比,现在正在进行检测的数量要多得多。

    大流行一开始,灭绝策略就成为了理论首选,实际操作中它以失败告终。所谓灭绝策略是遵循100-0规则的原则,将冠状病毒彻底根除。否则,总会有新的爆发。


    防守型的根除病毒策略宣告失败

    任何对第二波或第三波感到震惊的人必须接受还会出现永久感染可能。所有人抗击感染和疾病方面做出的所有努力只是因为极少数人的不当行为而功亏一篑,打回原形。一切又要重新开始。从理论上讲是有可能彻底根除冠状病毒的,但是在实践中,相关的后续成本过高。自从今年年初爆发大流行以来,几乎没有哪个国家不实施数月之久的严格的商业和社会封锁,就可以让冠状病毒的传播得以缓解。

    事实证明,高度复杂交织的世界经济,活跃的跨境商品,商业和度假交通,根本无法实现国家灭绝战略。全球根本没有形成共同努力的战略。各国利益完全不同,对许多国家来说成本太高。显然,消灭冠状病毒的战略的100-0规则只有在经济和社会受到100%限制下才能实现。然而任何现实状态下也不会挑选这种荒谬的政策。

    经济即将崩溃。根除病毒的策略与新冠病毒本身对健康和预期寿命造成的损害要大得多,从一开始就失败了。它行不通!


    妥协下的变通选择

    现实情况下几乎总是要求妥协,而不是绝对100-0策略。几乎所有情况都证实了降低边际收益和增加边际成本的规律,这些规律指导着许多经济过程。最终实现目标的成本不断增加。如果将柠檬压榨到最后一滴,产量会降低很多。这就是为什么许多现实的人遵循80-20经验法则的原因。用少量的努力(大约是可能的20%)会产生较大的回报(大约是可能的80%)。对收获者来说,损失的那20%是投入80%的努力可以承受的。在没有最优选项的情况下,人们往往会选择次优方案。

    人们一旦承认根除新冠病毒的策略失败,那么群体免疫就会将会作为替代方案计上心头。等到大部分人口得到了免疫力,冠状病毒才会失去大流行性传染,其大规模的威胁才会自行消失。但是这可能需要很长时间。问题是当事实证明抗体受到时间限制只能在一定时间内产生保护。很明显群体免疫不是快速恢复正常生活的药方。


    抛弃过多的幻想

    疫苗是群体免疫的最简形式。这就是为什么全世界的人们都热衷于研发新冠疫苗,以及专门用于治疗新冠肺炎的药物。人们必须清醒地认识一个事实,新冠病毒无法根除,但是可以抑制其效果,最好让它的伤害减到最低。

    即使如此人们不该对快速成功获取免疫抱有过多幻想,即使有效疫苗获得审批上市,德国8300万人口都想获得疫苗也需要花很长时间。


    此外,关于疫苗对不同年龄组的保护作用,保护时间和副作用的研究仍很多。由于疫苗对长期(副作用)的不确定性越来越大,因此,出于增强群体免疫力在法律上强制接种疫苗还存在伦理上的思考。


    和新冠共存的生活

    其实对很多人来说已经越来越清晰:和新冠病毒共存生活还有很长一段路要走。对待新冠应该就像对待流感一样,告别消灭策略。这样一来,大家面对第二波疫情,第N波疫情不用那么激动紧张,聚集起来的政治力量也可以在其他方面更好的利用。现在所有政治力量都应集中在尽可能智慧和理智地实施群体免疫战略。

    在清醒,节制和手段之间平衡与新冠相关的健康,经济和社会风险非常重要:必须权衡新冠对健康的损害与旨在防止大流行性雪崩蔓延的政策的后续成本。这是找到符合80-20经验法则的折衷方案。因此,应该务实地接受越来越多的新感染,而不能走尝试过已告失败了的根除新冠的回头路。

    只要卫生系统不超负荷,并且有足够的能力,按照医院可以承受的强度来治疗所有重症患者,就不再需要采取紧急措施。放弃根除策略肯定是以产生新冠风险为代价的。放弃对基本权利的严格限制和全面冻结社会或经济活动肯定是有代价的。

    折衷方案当然不是不受限制和不受控制地群体免疫。重要的是要防止主观动态的加速作用,并防止出现会破坏医疗保健系统的危险。

    群体免疫和根除策略之间的最大区别是不再执行全国范围经济封锁和社会隔离的紧急措施,因此有可能造成新增感染进一步增加。现在要权衡因为新冠病例增加而造成的健康卫生后果。然后根据情况找出,如何在特定区域或某些行业中对特定人群和个体公司的限制是合理的措施。80-20的经验法则可以通过距离要求或口罩要求以相对较小的成本产生较大的效果。

    群体免疫是一种进攻策略。它一方面努力平衡冠状病毒的不同后果,另一方面努力与之抗争。与防守型的消灭策略不同,它寻求优化而不是最优。它并没有试图排除一些无法避免的事情,允许新的感染,对基本权利的限制只有在保持相称性以及健康,自由与繁荣之间的平衡的前提下才是合理的。它接受所有相关的风险,是权宜之计。同时也在保护高风险人群。

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    发表于 2020-8-17 15:51 来自手机 | 显示全部楼层
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    发表于 2020-8-18 02:28 | 显示全部楼层
    A new report from the Centers for Disease Control and Prevention confirmed that the coronavirus cases in New York City at the start of the pandemic were from Europe, prompting a new round of outrage from Governor Andrew Cuomo. "The virus came to New York, and Americans died, because of government failure," he said in call with journalists on Thursday afternoon. "These are the facts. They missed the science."

    The report, titled, "Detection and Genetic Characterization of Community-Based SARS-CoV-2 Infections — New York City, March 2020," notes, "The NYC Department of Health and Mental Hygiene conducted sentinel surveillance of influenza-like symptoms (ILS) and genetic sequencing to characterize community transmission and determine the geographic origin of SARS-CoV-2 infections. Among 544 specimens tested from persons with ILS and negative influenza test results, 36 (6.6%) were positive. Genetically sequenced positive specimens most closely resembled sequences circulating in Europe."

    The CDC also noted that while domestic airport screening and bans "on foreign nationals traveling from China" were put in place on February 2nd, "similar travel restrictions from the Schengen Area in Europe were only implemented March 13th," when the virus was already in New York. "Although travel restrictions are an important mitigation strategy, by the time the European restrictions were implemented, importation and community transmission of SARS-CoV-2 had already occurred in NYC."

    Cuomo reiterated the point about the European travel ban being too late, "The president likes to talk about the travel ban [on Chinese flights] that was effective... his own CDC says the travel ban was too late." He pointed out how there were thousands of flights from Europe landing at JFK and Newark Airports in early March.

    The CDC report also bolsters Mount Sinai's findings, published in April, that said the genome associated with COVID-19 patients in NYC resembles a strain of the virus from Europe.

    A frustrated Cuomo warned, "There will be a second wave, [but] it's not going to be a mutated virus... it's going to be a rebound of COVID from other states that got infected, transmitting it back to New York."

    The governor said this would be a "double-barreled shotgun of federal incompetence," and urged, "Follow the science, Mr. President. Open your eyes. Listen to the federal health officials."

    NYC's Phase 4 Won't Include Additional Indoor Activity, Cuomo Says
    1:30 p.m. New York City's Phase 4 won't include additional indoor activity like malls and cultural institutions once the city moves into the final COVID-19 reopening phase, Governor Andrew Cuomo announced during a press call on Thursday.

    NYC is on track to go into Phase 4 on Monday, but Cuomo said a final decision won't be announced until 4 p.m. Friday.

    All other regions in New York have entered Phase 4, which includes low-risk outdoor and indoor activities like zoos, gardens, historical sites, malls and museums. It also includes schools and sports competitions without fans.

    Cuomo didn't say when those indoor activities could reopen in the city.

    On Wednesday, 14 New Yorkers died from the coronavirus, Cuomo said. Hospitalizations dropped by 18 to 813 in the state. The positivity rate was about 1 percent—769 of the 72,685 COVID-19 tests came back positive.

    Though the infection rate remains steady, the governor emphasized infection increases elsewhere in the country could come back to hurt New York and doubled down on compliance of social distancing rules at bars and restaurants.

    “That’s one of the things we’re worried about in New York is the virus coming from the states with the high infection rates. It’s our pleasure to help Houston, to help Atlanta, to help states across the nation deal with it," he said on the press call, joined by Houston's Mayor Sylvester Turner. "It’s the right thing to do as Americans. It’s also in our self-interest because we are all in this together.”

    A new rule will now allow officials to shutter an establishment after three violations of social distancing regulations. Previously, officials could revoke a business's liquor license.

    "If we do not enforce compliance, the virus will spread," Cuomo said. "It is that simple. If you eat a piece of cheesecake, you will see it on the scale tomorrow. Our actions create the response of the virus."

    Cuomo said the state’s mandated 14-day quarantine rules for out-of-state travelers saw a 92 percent compliance rate, which refers to travelers who fill out forms before they leave an airport. State officials do random checks on those who fill out the airport forms, though he didn't say how many people were checked. An upstate county saw its infection rate rise after New Yorkers returned on a flight from Atlanta last week.

    “It’s like any other law. You can speed, yeah, but if you get caught, you get the ticket,” Cuomo said. “This is a totally new function for state government. We have no border control. It’s not what the state does.”
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