疫情恶化谁之责？唯有总统特朗普

美国学者James A. Wiley近期撰文指出美国总统特朗普需为新冠肺炎疫情在美国的恶化负责。原文标题为“Trump and the COVID-19 Epidemic in the US”，文章为作者授权发布。

——编者按

显然，美国一直没有足够的病毒检测工具来追踪新冠病毒的大流行。然而，为什么在新加坡、韩国、澳大利亚等国都迅速开发并广泛部署了检测试剂之后，美国仍然会严重滞后呢？美国的问题出在哪?

一些基本事实是众所周知的:

· 中国很早就报告了新冠病毒的基因序列并且提供给了全世界。之后美国疾病预防与控制中心决定开发自己的检测试剂，并控制了将试剂应用于检测新冠肺炎（COVID-19）的审批权。然而最早开发的检测试剂却是有缺陷的。

· 美国疾病预防与控制中心不愿批准使用他国的检测试剂，还动员各公共和私营部门自己开发检测试剂，这样耽误了更多的时间。

· 由于缺乏检测试剂盒，人们的检测请求还需等待集中审批，这就进一步阻碍了地方政府对病毒传播的追踪，以及对受感染者的隔离工作的推进。

如今，美国控制新冠疫情的唯一选择，只剩下大规模地、代价高昂地封锁整个社会。未来出现“我们要共同面对”和“现在不是相互指责的时候”的呼声是可以预见的。是的，我们需要以一种彼此合作和慷慨互助的精神与病毒做斗争。然而，有些人却要被指责。作为领导者，本可以避免迫在眉睫的灾难却没有采取行动，他们需要为自己的行为负责。图中本土新增加确诊和死亡病例的变化趋势体现了美国阻止此场疫情行动的失败，但是从数字以外的角度来分析具体情况是更有意义的事。下面的图表标注了两条曲线。

· 蓝线表示的是从1月20日（美国报告第一例新冠病例之前的两天）开始的每天确诊的新发病例数。

· 红线是对每天与感染者发生接触的人数的保守估计。

例如，在2月3日新确诊了3例新冠病毒阳性病例，我们就计算在此之前的5天时间里，这3个人所接触过的健康人口数（图中用红线标注）。绘图时我们假设这3人在检测出病毒阳性后，不再继续传播给其他未受感染者。同时在没有常规检测的情况下，感染者传播病毒的时间可能会再长一些；因为根据目前的情况估计，新冠病毒感染者的无症状期为1至14天。此外，我们还不计算那些仅有轻微症状而从未接受过检测的人，即使他们可以传播病毒。因此，图中红线显示的其实是被严重低估的数值。到3月16日，红色曲线攀升到24158，即每日通过接触病毒感染者而感染的最低人数为24158人，图表中的隐形传播曲线可为新发病例提供参考指导，曲线的攀升趋势反映了早期常规病毒检测手段缺失的后果。根据发表在《旅行医学杂志》(Journal of Travel Medicine) 2020年2月刊上的一篇综述，目前估计单个病毒感染者平均传染人数的范围为1.4至6.49人。

为什么美国不动员起来开发并部署对COVID-19的检测呢？造成行动延迟的一个最基本的原因，是美国高层领导的彻底失败。

《华盛顿邮报》(The Washington Post) 制作了一份特朗普关于冠状病毒疫情发表声明的时间表。在附录中，我把声明和声明发布当天美国冠状病毒确诊的病例数进行了匹配。新确诊病例起初增长缓慢，之后快速增长；与此同时，一直对世界其他地区疫情发展进行观察的公共卫生专家们，也针对恶化的疫情发出了警告。然而特朗普总统却竭尽所能地淡化疫情的威胁，声称一切尽在掌控中，宣称他关闭边境的举措已经控制了感染，强调中国是病毒的来源 (“China Virus”)，指责民主党和媒体的“假新闻”夸大了疫情的威胁，还将新冠疫情与流感作比较，特意指出每年有许多人死于流感但并没有因流感封锁社会。

不过近来，他终于承认了我们存在一个问题，并以一种将军的姿态领导着公共卫生部队击败这个外来病毒。他承诺美国食品和药物管理局（FDA）将为数百万人提供检测，然而根据《大西洋月刊》(The Atlantic) 对美国卫生部门进行的一项调查，到3月初实际检测的数量还不到2000例。

我不知道新冠病毒检测在中国的疫情控制中究竟发挥了多大的作用，但我听说在中国这种检测很容易获得。如果要确证它的有效性，我们可以观察新加坡、韩国和澳大利亚的防控经验。广泛的检测是有效的，尤其是在疫情爆发之初。可以肯定的是，由于美国早期病毒检测的缺失导致死亡人数增多、病例数增加、社会生活中断、经济损失更严重，给美国医疗体系带来严峻的考验。

谁该为此负责？唯有总统特朗普。他总说这种疾病并不严重，他总是竭力控制任何有可能损害他连任前景的信息，他以惩罚那些在他的政府里进进出出的人而闻名，这无疑会让那些更懂行的人选择沉默。美国疾病预防与控制中心和公共卫生界的许多有能力的人都发表了看法，但没有人听得进这些声音。大多数共和党人仅仅附和特朗普的观点，而等到民主党人发言的时候，已经太晚了。

让我们停止称新型冠状病毒为中国病毒。它其实是一场“特朗普灾难”。■

作者简介：

James A. Wiley 博士
美国加州大学旧金山分校(UCSF)医学院卫生政策研究所客座教授

译者简介：

周雯娟 中南大学文学与新闻传播学院副教授

文稿编辑 | 牛秀丽

网络编辑 | 周泓 戴斌

内容审核 | 易龙

附：英文原文

Trump and the COVID-19 Epidemic in the US

That we don’t have enough test kits to track the epidemic is apparent. Why does the United States lag so far behind Singapore, South Korea, and Australia, where tests were developed quickly and widely deployed. What happened?

Some basic facts are known:

· The genetic code of the virus was known very early and given to world by China. CDC was determined to develop its own test and to take control of the approval of using it to test for COVID-19. But the first versions of the test were flawed.

· CDCs reluctance to approve other tests and to mobilize the public and private sectors to develop tests created more delays.

· The lack of such kits and requirements of centralized approval of testing prevented and continues to prevent localities from tracking the spread of the virus and quarantining infected people.

Now the only alternative to control the epidemic is through massive and costly lockdown of the whole society. There are the predictable calls for national unity. “We are all in this together” and “This is no time for finger pointing”. Yes, we need to fight this with a spirit of cooperation and generosity for each other. But fingers need to be pointed. The persons in charge should be held responsible for actions not taken that could have averted the looming catastrophe.

Our failure to prevent a disaster is already reflected in the trend of new cases and deaths. But it is useful to look beyond the numbers to understand how it might have been otherwise. The chart shows below shows two lines.

· The blue line shows the number of new cases in each day, starting on January 20, two days before the first case was reported in the US.

· The red line is a conservative estimate of the number of infected people circulating on each date.

If three new cases were detected on February 3, we count those three people as circulating infected persons for each of five days before they got a positive test. After they test positive we assume they no longer transmit the virus to uninfected persons. Circulation may be quite a bit longer in the absence of routine testing because no symptoms appear for 1 to 14 days according to current estimates. In addition we don’t count persons who are never tested and therefore don’t show up as cases because they had mild symptoms, even though they can likely transmit the virus. So the red line is a gross underestimate. By March 16, this curve rose to a daily minimum number of 24,158 circulating infected persons. This is the shadow epidemic that feeds an exponential curve of new cases and its path reflects the absence of early and routine testing. Current estimates of the average number of persons infected by a single infected person range from 1.4 to 6.49, based on a review published in the February 2020 issue of Journal of Travel Medicine.

Why didn’t the US mobilize to develop and deploy testing for COVID-19? The single most basic cause of delay was an utter failure of leadership at the top.

The Washington Post created a timeline of Trump statements about the corona virus epidemic. In an appendix, I’ve matched them with the number of corona virus cases reported the day Trump made the statement. While new cases were increasing, slowly at first, then more rapidly, there were warnings from public health experts watching developments elsewhere. Trump minimized the threat of epidemic, asserting that all was under control, claimed credit for controlling infection by closing our borders, emphasized that the virus came from China (“China Virus”), blamed the Democrats and the media for “fake news” exaggerating the threat, and compared corona virus to the flu noting that many die each year from flu without shutting down the society.

He has now admitted we have a problem and adopted the posture of a general leading the army of public health to defeat the foreign virus. He promises that FDA will make millions of tests available but the actual number tested by early March was less than 2,000 according to a survey of health departments done by Atlantic magazine.

I don’t know how much of a role testing played during China’s crisis, but I have heard that testing was widely available. To determine its effectiveness, we should watch the experiences of Singapore, South Korea, and Australia. We can say widespread testing works, especially at the beginning of an outbreak. And we can be sure that the absence of early testing in the US caused deaths, increased illness and disruption of social life, economic damage, and a serious stress test of our medical care system.

Who is responsible? In a single word Trump. He dismissed the epidemic as minor. He tried to control any information that would damage his re-election prospects. His reputation for punishing people who speak out, in and out of his administration, no doubt kept those who knew better silent. Many competent people at CDC and elsewhere in the public health community spoke but were not heard. Most Republicans simply repeated his messages. And by the time the Democrats spoke up, it was too late.

Let’s stop calling it the China virus. It’s the Trump Catastrophe.■

James A. Wiley, PhD

Adjunct Professor

Institute for Health Policy Studies

School of Medicine

University of California, San Francisco