哈佛大学教授:十二条被遗忘的公共卫生准则
发布于 2021-10-10 19:18
翻译 | 李长青
《大巴灵顿宣言》作者之一，美国哈佛大学流行病学教授马丁-库尔多夫（Martin Kulldorff）最新发推，列举了新冠疫情时期12条被遗忘的公共卫生准则。
第一，公共卫生关乎所有健康结果，而不仅仅是像新冠这样的单一病种。考虑公共卫生措施的危害也很重要。
#1 Public health is about all health outcomes, not just a single disease like #COVID19. It is important to also consider harms from public health measures.
第二，公共卫生关乎长期而非短期。春季的新冠封锁只是将大流行延缓和推迟到了秋季。
#2 Public health is about the long term rather than the short term. Spring #COVID19 #lockdowns simply delayed and postponed the pandemic to the fall.
第三，公共卫生关乎每一个人。而不应该被用于将疾病重负从富裕人群转移到不太富裕的人群，就像新冠封锁所做的那样。
#3 Public health is about everyone. It should not be used to shift the burden of disease from the affluent to the less affluent, as the #COVID19 #lockdowns have done.
第四，公共卫生是全球性的。公共卫生科学家需要考虑他们的建议的全球影响。
#4 Pubic health is global. Public health scientists need to consider the global impact of their recommendations.
第五，风险和危害无法完全消除，但可以减少。消除和零新冠策略适得其反，把事情变得更糟。
#5 Risks and harms cannot be completely eliminated, but they can be reduced. Elimination and zero-COVID strategies backfire, making things worse.
#6 Public health should focus on high-risk populations. For #COVID19, many standard public health measures were never used to protect high-risk older people, leading to unnecessary deaths.
科普事业，因你而不同！
第七，虽然接触者追踪和隔离对于某些传染病至关重要，但对于流感和新冠等普通感染来说徒劳且适得其反。
#7 While contact tracing and isolation is critically important for some infectious diseases, it is futile and counterproductive for common infections such as influenza and #COVID19.
第八，病例只应是患者，对无症状个体进行大规模检测有害公众健康。
#8 A case is only a case if a person is sick. Mass testing asymptomatic individuals is harmful to public health.
第九，公共卫生关乎信任。为获取公众信任，公共卫生官员和媒体必须诚实并信任公众，不应在大流行中使用羞辱和恐惧。
#9 Public health is about trust. To gain the trust of the public, public health officials and the media must be honest and trust the public. Shaming and fear should never be used in a pandemic.
第十，公共卫生科学家和官员必须对未知的事情诚实。例如，流行病模型应该在全部的合理输入参数范围内运行。
#10 Public health scientists and officials must be honest with what is not known. For example, epidemic models should be run with the whole range of plausible input parameters.
第十一，在公共卫生领域，公开的文明辩论非常重要。审查、噤声和诽谤会导致害怕讲话、从众思考和不信任。
#11 In public health, open civilized debate is profoundly critical. Censoring, silencing and smearing leads to fear of speaking, herd thinking and distrust.
第十二，对于公共卫生科学家和官员来说，听取公众的意见很重要，他们正在承受公共卫生的后果。这次大流行已经表明，许多非流行病学家比一些流行病学家更了解公共卫生。
#12 It is important for public health scientists and officials to listen to the public, who are living the public health consequences. This pandemic has proved that many non-epidemiologists understand public health better than some epidemiologists.
延伸阅读
大巴灵顿宣言 The Great Barrington Declaration
As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.
我们来自世界各地和左右派阵营，我们奉献自己的职业生涯来保护人民。目前的封锁政策对公众健康正产生短期和长期破坏性的影响。其后果（仅举几例）包括：儿童疫苗接种率降低、心血管疾病管理恶化、癌症筛查减少和精神健康恶化。这些会导致未来几年死亡率猛增，而工薪阶层和年轻人的负担最重。让学生不能返校上学，是一种巨大的不公。
Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.
在疫苗问世之前继续采取封锁措施将造成不可挽回的损失，而首当其冲的是弱势群体。
Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
幸运的是，我们对新冠病毒的认识在不断加深。我们知道年老体弱者感染新冠病毒死亡的几率比年轻人高一千多倍。事实上，对于儿童来说，新冠病毒的危险性要低于包括流感在内的许多其它危害。
Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
随着人群中免疫力的增强，包括年老体弱者在内的所有人被感染的风险都会降低。我们知道，人群最终会达到群体免疫，即新的感染率稳定下来。这可以借助疫苗来实现（但不依赖于疫苗）。因此，我们的目标应该是最大限度地降低死亡率和社会危害，直至达到群体免疫。
As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
在达到群体免疫前，最具同情心并权衡利弊的办法，是让那些死亡风险最小的人过正常的生活。让他们通过自然感染，建立对病毒的免疫力。同时，更好地保护那些风险最高的人。我们称之为重点“针对性保护”。
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
采取措施保护年老体弱者，应该是公共卫生部门应对新冠疫情的核心目标。例如，养老院应该用已获免疫力的工作人员，并对其他工作人员和所有来访者进行频繁的PCR检测。应尽量减少工作人员的轮换。居住在家的退休人员，应让人将食品和其它必需品送至家中。若情况许可，他们应该在室外而非室内与亲人会面。全面而详细的措施清单，包括针对多代家庭的办法，是可以实施的，而且完全在公共卫生专业人员的范围和能力之内。
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
不易受新冠病毒伤害的人，应立即让他们恢复正常生活。每个人都应实行简单的卫生措施，如洗手和生病时呆在家里，以降低群体免疫的门槛。学校和大学，应该开放面授，恢复体育等课外活动。低风险的年轻人，应该正常工作，而不是在家工作。餐馆和其它行业，应该开门营业。艺术、音乐、体育和其它文化活动，应当恢复。风险较大的人，如果他们自己愿意，也可以参加这些活动，而整个社会则可以享受到建立了群体免疫的人对易感者的保护。
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.
2020年10月4日，本宣言由以下人员在美国大巴灵顿起草并签署：
Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations.
Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.
Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.
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