冠状病毒是否比疾病更严重?

冠状病毒是否比疾病更严重?
安全,但是要付出什么代价?
Solarisys /快门

1968年,在上一次重大流感大流行的高峰期,全世界至少有XNUMX万人死亡, 包括十万美国人。 That year AMM Payne, a professor of epidemiology at Yale University,那年,耶鲁大学流行病学教授AMM Payne :

在征服珠穆朗玛峰的过程中,成功不到100%就是失败,但是在大多数传染性疾病中,我们没有面临达到如此绝对目标的挑战,而是试图在尽可能快的时间内将问题减少到可容忍的水平可用资源的限制...

该信息值得重复,因为寻求“绝对目标”与寻求“容许水平21年2020月XNUMX日,BMJ 报道 对于集中于保护面临严重COVID风险最大的人,还是对所有人实施封锁,英国科学家之间的意见分歧。

一组40位科学家写道 英国首席医学官的建议,他们的目标应该是“在整个人群中抑制病毒”。

In 另一封信,由28位科学家组成的小组建议,“随着年龄和健康状况的不同,风险的巨大差异表明,统一政策(适用于所有人)所造成的危害将超过其收益”。 Instead, they called for a “targeted and evidence-based approach to the COVID-19 policy response”.相反,他们呼吁“对COVID-XNUMX政策做出有针对性的,循证的方法”。

一周后,科学作家 斯蒂芬·布兰尼 wrote a piece for the Guardian arguing that the positions in the letter with 28 authors represent those of a small minority of scientists.为《卫报》写了一篇文章,论证信中有XNUMX位作者的位置代表了少数科学家的位置。 “The overwhelming scientific consensus still lies with a general lockdown,” he claimed.他声称:“压倒性的科学共识仍然与总体封锁有关。”

几天后,超过60位医生写了 另一封信 他说:“由于越来越多的数据和现实世界的经验,我们担心单轨回应对生命和生计的威胁要比挽救Covid的生命多。”


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这场 来来回回 毫无疑问,这一过程将持续一段时间,尽管有关人士希望将反对的科学观点和见解视为一种礼物,并成为一种怀疑和学习的机会,而不是一个“竞争阵营”。

科学共识需要时间

There are issues, such as global warming, where there is scientific consensus.在诸如科学的共识等全球变暖等问题上。 But consensuses take decades, and COVID-19 is a new disease.但是共识需要数十年的时间,而COVID-XNUMX是一种新疾病。 Uncontrolled experiments in lockdown are still ongoing, and the long-term costs and benefits are not yet known.锁定中不受控制的实验仍在进行中,长期成本和收益尚不清楚。 I very much doubt that most scientists in the UK have a settled view on whether pub gardens or universities campuses should be closed or not.我非常怀疑英国的大多数科学家对是否应关闭酒馆花园或大学校园没有定论。 People I talk to have a range of opinions: from those who accept that the disease is now endemic, to those who wonder if it can still be eradicated.我所交谈的人有各种各样的意见:从那些认为这种疾病现在是地方病的人,到那些想知道是否仍可以根除的人。

一些人认为,任何不涉足特定流行病学的流行病学家都怀疑或做得不够。 造型 and that their views should not carry much weight.并且他们的观点不应该太重要。 They go on to dismiss the views of other scientists and non-scientist academics as irrelevant.他们继续否认其他科学家和非科学学者的观点无关紧要。 But science is not a dogma, and views often need to be modified in the light of increasing knowledge and experience.但是,科学不是教条,常常需要根据不断增长的知识和经验来修改观点。 I am a geographer, so I am used to seeing such games of academic hierarchy played above me, but I do worry when people resort to insulting their colleagues rather than admit that knowledge and circumstance have changed and reappraisal is necessary.我是一个地理学家,所以我习惯于在我上面玩这种学术等级的游戏,但是当人们诉诸侮辱同事而不是承认知识和情况已经改变并且需要重新评估时,我确实担心。

严峻的演算

Is the cure worse than the disease?治愈比疾病还差吗? This is the question that currently divides us, so it is worth considering how it might be answered.这是当前使我们分裂的问题,因此值得考虑如何回答。 We would have to know how many people would die of other causes, for example, of suicide (including我们将不得不知道有多少人死于其他原因,例如自杀(包括 儿童自杀),否则就不会发生这种情况,或者是由于饮酒量增加引起的肝病,没有得到诊断或治疗的癌症,从而确定了特定政策挽救生命的时间点。 And then what value should you put on those lost or damaged lives against the economic consequences?然后,您应为那些因经济后果而丧生或受损的人赋予什么价值呢?

We do not live in a perfect world with perfect data.我们不会生活在拥有完美数据的完美世界中。 For children, for whom the risk of death from COVID is almost zero and the risks of long-term effects are thought to be very low, it is easier to weigh up the negative effects of not going to school or of being trapped in households with rising domestic abuse.对于因COVID死亡的风险几乎为零且长期影响的风险被认为非常低的儿童,更容易权衡不上学或被困在家庭中的负面影响家庭虐待上升。

For university students, who are mostly young, a similar set of calculations could be made, including estimating the “cost” of having the infection now, versus the cost of having it later, possibly when the student is with their older relatives at Christmas.对于大多是年轻的大学生,可以进行类似的计算,包括估计现在感染的“成本”与以后感染的成本(可能是当学生在圣诞节与年长的亲戚在一起时)。 With older people, though, the calculus – even in a perfect world – would become increasingly complex.但是,对于老年人来说,即使在理想的世界中,演算也会变得越来越复杂。 When you are very old and have very little time left, what risks would you be willing to take?当您年纪大,几乎没有时间时,您愿意承担什么风险? One elderly man famously一位老人着名 声称:“在滨海韦斯顿的一处老年住宅中,要再呆两年,没有任何值得放弃的乐趣。”

最近的一篇论文 发表在Nature上,这表明即使在香港,自98月以来戴口罩的比例超过XNUMX%,也无法在本地消除COVID。 If it is not possible there, it may not be possible anywhere.如果那里不可能,那么在任何地方都不可能。

On the brighter side, elsewhere, elderly people have been protected even when transmission rates are high and overall resources are low.从好的方面来看,即使在高传播率和低资源的情况下,老年人也受到了保护。 In India,在印度, 最近的一项研究 发现“有理由相信,印度老年人的严格在家中待命,再加上通过社会福利计划和社区卫生工作者的定期交往必需品,有助于降低该年龄组在泰米尔纳德邦和安得拉的感染率邦。”

However, minimising mortality is not the only goal.但是,降低死亡率并不是唯一的目标。 For those who don't die, the outcome对于那些不死的人,结果 仍然可以 1970年,就在他成为伦敦卫生与热带医学学院院长之前不久,CE戈登·史密斯(CE Gordon Smith) :

The essential prerequisite of all good public health measures is that careful estimates should be made of their advantages and disadvantages, for both the individual and the community, and that they should be implemented only when there is a significant balance of advantage.所有良好的公共卫生措施的基本前提是,应仔细评估其对个人和社区的利弊,并且只有在利益之间取得重大平衡时才应实施这些措施。 In general, this ethic has been a sound basis for decision in most past situations in the developed world although, as we contemplate the control of milder diseases, quite different considerations such as the convenience or productivity of industry are being brought into these assessments.总体而言,尽管在我们考虑控制轻度疾病的过程中,这些道德标准已成为发达国家过去大多数情况下决策的可靠基础,但在这些评估中却考虑了完全不同的考虑因素,例如工业的便利性或生产率。

“竞争阵营”的言论需要结束。 No individual or small group represents the view of the majority.没有任何个人或小组代表多数人的观点。谈话

关于作者

Danny Dorling,Halford Mackinder地理学教授, 牛津大学

本文重新发表 谈话 根据知识共享许可。 阅读 原创文章.

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