比尔·盖茨：美国错失了遏制病毒蔓延的最佳时机 但时间窗口尚未关闭

There’s no question the United States missed the OPPOrtunity to get ahead of the novel coronavirus. But the window for making important decisions hasn’t closed. The choices we and our leaders make now will have an enormous impact on how soon case numbers start to go down, how long the economy remains shut down and how many Americans will have to bury a loved one because of covid-19.

Our foundation has been working to slow the outbreak for several months. To date, we’ve invested $105 million in efforts to create new therapeutics, expand access to testing, and limit the virus’s impact here in Seattle.

我们的基金会几个月来一直致力于减缓疫情发展。截至目前，我们已经投入1.05亿美元，用于开发新的治疗方案、提高检测的可及性和在西雅图限制病毒传播的影响。

As a result of this work, I’ve spoken with experts and leaders in Washington and across the country. It’s become clear to me that we must take three steps.

由于这些工作，我得以与华盛顿和全国的专家和领导人进行沟通。我很清楚，现在我们必须采取三个行动。

First, we need a consistent nationwide approach to shutting down. Despite urging from public health experts, some states and counties haven’t shut down completely. In some states, beaches are still open; in others, restaurants still serve sit-down meals.

首先，我们需要采取全国统一的闭关措施。尽管公共卫生专家极力敦促，一些州县还是没有完全关闭。在一些州，海滩仍旧开放；而在另一些州，餐馆仍然提供堂食服务。

This is a recipe for disaster. Because people can travel freely across state lines, so can the virus. The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown. Any confusion about this point will only extend the economic pain, raise the odds that the virus will return, and cause more deaths.

这是做后患无穷。由于人们可以自由地穿越州界，病毒也同样可以。这个国家的领导人需要明确：闭关意味着关闭所有公共场所。没人能继续照常活动或放松闭关管控，直到全美病例数开始下降，而这将需要10周甚至更长的时间。做不到这一点会延长经济阵痛、增加疫情回弹的可能性，以及导致更多的死亡。

Second, the federal government needs to step up on testing. Far more tests should be made available. We should also aggregate the results so we can quickly identify potential volunteers for clinical trials and know with confidence when it’s time to return to normal. There are good examples to follow: New York state recently expanded its capacity to up to more than 25,000 tests per day.

其次，联邦政府需要加强检测。人们应该获得更多的检测机会。我们还应汇总测试结果，以便快速甄别出可以进行临床试验的志愿者，并且明确何时才能恢复正常。我们可以效仿一些不错的例子：纽约州最近将其检测能力提高到每天2.5万次以上。

There’s also been some progress on more efficient testing methods, such as the self-swab developed by the Seattle Coronavirus Assessment Network, which allows patients to take a sample themselves without possibly exposing a health worker. I hope this and other innovations in testing are scaled up across the country soon.

我们在开发更高效的检测方式上也取得了一些进展，例如由“西雅图冠状病毒评估网络”开发的自检拭子，病人可以在没有医务人员在场的情况下自行采样。我希望这项技术和其他检测方面的创新可以尽快在全国大规模推广。

Even so, demand for tests will probably exceed the supply for some time, and right now, there’s little rhyme or reason to who gets the few that are available. As a result, we don’t have a good handle on how many cases there are or where the virus is likely headed next, and it will be hard to know if it rebounds later. And because of the backlog of samples, it can take seven days for results to arrive when we need them within 24 hours.

即便如此，检测在一定时间内可能供不应求，而眼下谁应该获得这些稀缺的检测资源也没有规矩可循。正因如此，我们并没有完全掌握到底有多少病例，或者病毒接下来会蔓延到哪里，也很难知道疫情之后是否会反弹。此外，由于检测样本的积压，我们需要在24小时内就得到的结果，可能会花费七天才能得到。

This is why the country needs clear priorities for who is tested. First on the list should be people in essential roles such as health-care workers and first responders, followed by highly symptomatic people who are most at risk of becoming seriously ill and those who are likely to have been exposed.

这就是为什么这个国家需要明确哪些人有检测的优先权。在这个名单上，首先应该是那些重要岗位上的人，例如医护工作者和急救人员，其次是症状明显并有可能发展成重症的人，以及可能已经发生病毒暴露的人。

The same goes for masks and ventilators. Forcing 50 governors to compete for lifesaving equipment — and hospitals to pay exorbitant prices for it — only makes matters worse.

对于口罩和呼吸机同样如此。让50个州长被迫争抢救命的设备，并让医院为此支付高昂的价格，这只会让情况变得更糟。

Finally, we need a data-based approach to developing treatments and a vaccine. Scientists are working full speed on both; in the meantime, leaders can help by not stoking rumors or panic buying. Long before the drug hydroxychloroquine was approved as an emergency treatment for covid-19, people started hoarding it, making it hard to find for lupus patients who need it to survive.

最后，我们需要一个基于数据的方法来开发治疗方案和疫苗。科学家正在这两方面全速攻关。与此同时，领导人不要煽动谣言或引发恐慌性抢购。早在羟氯喹被批准用于新冠肺炎紧急治疗之前，人们就开始抢购，这让狼疮患者很难找到赖以生存的药物。

We should stick with the process that works: Run rapid trials involving various candidates and inform the public when the results are in. Once we have a safe and effective treatment, we’ll need to ensure that the first doses go to the people who need them most.

我们应该坚定贯彻有效的流程：例如对多种候选药物进行快速试验，并在得到结果的第一时间告知公众。一旦我们有了安全、有效的治疗方案，就要确保最先给最需要的人使用。

To bring the disease to an end, we’ll need a safe and effective vaccine. If we do everything right, we could have one in less than 18 months — about the fastest a vaccine has ever been developed. But creating a vaccine is only half the battle. To protect Americans and people around the world, we’ll need to manufacture billions of doses.

为了消灭这种疾病，我们需要安全有效的疫苗。如果我们每件事都做对了，我们就能在18个月内得到它——这将是有史以来最快被开发出来的疫苗。然而，开发疫苗只是战役的一半。为了保护美国和全世界的人，我们将需要生产数十亿剂疫苗。

Without a vaccine, developing countries are at even greater risk than wealthy ones, because it’s even harder for them to do physical distancing and shutdowns. The further down the income ladder people live, the more important it is that they go to work every day just to feed their family.

如果没有疫苗，发展中国家会比富裕国家面临更高风险，因为它们更难实施社交隔离和闭关措施。处于收入阶梯越底端的人，越需要靠每天工作来养家糊口。

If they live in the poorest parts of sub-Saharan Africa or India, staying home simply isn’t an option. Even if they do stay home, they can’t just wall themselves off from their neighbors; in slums, the houses are packed together so closely that there’s no way to keep your distance. All the work that rich countries are doing now to develop vaccines will save lives in those places, too.

如果他们生活在撒哈拉以南非洲或印度最贫困的地区，呆在家里根本就不是个办法。即便呆在家里，他们也无法将自己与邻居隔离开来：在贫民窟，房屋彼此挨得太紧，以至于人们很难与其他人保持距离。富裕国家正在开发疫苗，这些工作也将帮助在贫困地区挽救生命。

We can get a head start on manufacturing all of the doses we’ll need now by building the facilities where these vaccines will be made. Because many of the top candidates are made using unique equipment, we’ll have to build facilities for each of them, knowing that some won’t get used. Private companies can’t take that kind of risk, but the federal government can. It’s a great sign that the administration made deals this week with at least two companies to prepare for vaccine manufacturing. I hope more deals will follow.

我们现在就可以从建设疫苗生产场所开始行动。因为最佳候选疫苗中有许多需要特殊生产设备，我们必须为每一种分别建设生产设施，虽然我们知道有些可能不会被用到。私营企业无法承担这样的风险，但联邦政府可以。政府本周与至少两家公司签订了协议，为疫苗生产做准备，这是一个很好的迹象。我希望之后会有更多这样的合作。

In 2015, I urged world leaders in a TED talk to prepare for a pandemic the same way they prepare for war — by running simulations to find the cracks in the system. As we’ve seen this year, we have a long way to go. But I still believe that if we make the right decisions now, informed by science, data and the experience of medical professionals, we can save lives and get the country back to work.

2015年，我在一次TED演讲中呼吁世界领导人做好应对全球大流行病的准备，就像他们为战争做准备那样，通过模拟演练发现系统里的漏洞。正如我们今年所看到的，我们还有很长的路要走。但我仍旧相信，如果我们能在科学、数据和医疗专家经验的指导下做出正确的决定，我们就能挽救生命，并且让整个国家恢复正常运转。