I want to lead here by talking a little bit about my credentials to bring this up with you, because, quite honestly, you really, really should not listen to any old person with an opinion about COVID-19.
(Laughter)
So I’ve been working in global health for about 20 years, and my specific technical specialty is in health systems and what happens when health systems experience severe shocks. I’ve also worked in global health journalism; I’ve written about global health and biosecurity for newspapers and web outlets, and I published a book a few years back about the major global health threats facing us as a planet. I have supported and led epidemiology efforts that range from evaluating Ebola treatment centers to looking at transmission of tuberculosis in health facilities and doing avian influenza preparedness. I have a master’s degree in International Health. I’m not a physician. I’m not a nurse. My specialty isn’t patient care or taking care of individual people. My specialty is looking at populations and health systems, what happens when diseases move on the large level. If we’re ranking sources of global health expertise on a scale of one to 10, one is some random person ranting on Facebook and 10 is the World Health Organization, I’d say you can probably put me at like a seven or an eight. So keep that in mind as I talk to you.
I’ll start with the basics here, because I think that’s gotten lost in some of the media noise around COVID-19. So, COVID-19 is a coronavirus. Coronaviruses are a specific subset of virus, and they have some unique characteristics as viruses. They use RNA instead of DNA as their genetic material, and they’re covered in spikes on the surface of the virus. They use those spikes to invade cells. Those spikes are the corona in coronavirus. COVID-19 is known as a novel coronavirus because, until December, we’d only heard of six coronaviruses. COVID-19 is the seventh. It’s new to us. It just had its gene sequencing, it just got its name. That’s why it’s novel.
If you remember SARS, Severe Acute Respiratory Syndrome, or MERS, Middle Eastern Respiratory Syndrome, those were coronaviruses. And they’re both called respiratory syndromes, because that’s what coronaviruses do – they go for your lungs. They don’t make you puke, they don’t make you bleed from the eyeballs, they don’t make you hemorrhage. They head for your lungs.
COVID-19 is no different. It causes a range of respiratory symptoms that go from stuff like a dry cough and a fever all the way out to fatal viral pneumonia. And that range of symptoms is one of the reasons it’s actually been so hard to track this outbreak. Plenty of people get COVID-19 but so gently, their symptoms are so mild, they don’t even go to a health care provider. They don’t register in the system. Children, in particular, have it very easy with COVID-19, which is something we should all be grateful for.
Coronaviruses are zoonotic, which means that they transmit from animals to people. Some coronaviruses, like COVID-19, also transmit person to person. The person-to-person ones travel faster and travel farther, just like COVID-19. Zoonotic illnesses are really hard to get rid of, because they have an animal reservoir. One example is avian influenza, where we can abolish it in farmed animals, in turkeys, in ducks, but it keeps coming back every year because it’s brought to us by wild birds. You don’t hear a lot about it because avian influenza doesn’t transmit person-to-person, but we have outbreaks in poultry farms every year all over the world. COVID-19 most likely skipped from animals into people at a wild animal market in Wuhan, China.
Now for the less basic parts. This is not the last major outbreak we’re ever going to see. There’s going to be more outbreaks, and there’s going to be more epidemics. That’s not a maybe. That’s a given. And it’s a result of the way that we, as human beings, are interacting with our planet. Human choices are driving us into a position where we’re going to see more outbreaks. Part of that is about climate change and the way a warming climate makes the world more hospitable to viruses and bacteria. But it’s also about the way we’re pushing into the last wild spaces on our planet.
When we burn and plow the Amazon rain forest so that we can have cheap land for ranching, when the last of the African bush gets converted to farms, when wild animals in China are hunted to extinction, human beings come into contact with wildlife populations that they’ve never come into contact with before, and those populations have new kinds of diseases: bacteria, viruses, stuff we’re not ready for. Bats, in particular, have a knack for hosting illnesses that can infect people, but they’re not the only animals that do it. So as long as we keep making our remote places less remote, the outbreaks are going to keep coming.
We can’t stop the outbreaks with quarantine or travel restrictions. That’s everybody’s first impulse: “Let’s stop the people from moving. Let’s stop this outbreak from happening.” But the fact is, it’s really hard to get a good quarantine in place. It’s really hard to set up travel restrictions. Even the countries that have made serious investments in public health, like the US and South Korea, can’t get that kind of restriction in place fast enough to actually stop an outbreak instantly. There’s logistical reasons for that, and there’s medical reasons. If you look at COVID-19 right now, it seems like it could have a period where you’re infected and show no symptoms that’s as long as 24 days. So people are walking around with this virus showing no signs. They’re not going to get quarantined. Nobody knows they need quarantining.
There’s also some real costs to quarantine and to travel restrictions. Humans are social animals, and they resist when you try to hold them into place and when you try to separate them. We saw in the Ebola outbreak that as soon as you put a quarantine in place, people start trying to evade it. Individual patients, if they know there’s a strict quarantine protocol, may not go for health care, because they’re afraid of the medical system or they can’t afford care and they don’t want to be separated from their family and friends. Politicians, government officials, when they know that they’re going to get quarantined if they talk about outbreaks and cases, may conceal real information for fear of triggering a quarantine protocol. And, of course, these kinds of evasions and dishonesty are exactly what makes it so difficult to track a disease outbreak. We can get better at quarantines and travel restrictions, and we should, but they’re not our only option, and they’re not our best option for dealing with these situations.
The real way for the long haul to make outbreaks less serious is to build the global health system to support core health care functions in every country in the world so that all countries, even poor ones, are able to rapidly identify and treat new infectious diseases as they emerge. China’s taken a lot of criticism for its response to COVID-19. But the fact is, what if COVID-19 had emerged in Chad, which has three and a half doctors for every hundred thousand people? What if it had emerged in the Democratic Republic of the Congo, which just released its last Ebola patient from treatment? The truth is, countries like this don’t have the resources to respond to an infectious disease – not to treat people and not to report on it fast enough to help the rest of the world.
I led an evaluation of Ebola treatment centers in Sierra Leone, and the fact is that local doctors in Sierra Leone identified the Ebola crisis very quickly, first as a dangerous, contagious hemorrhagic virus and then as Ebola itself. But, having identified it, they didn’t have the resources to respond. They didn’t have enough doctors, they didn’t have enough hospital beds and they didn’t have enough information about how to treat Ebola or how to implement infection control. Eleven doctors died in Sierra Leone of Ebola. The country only had 120 when the crisis started. By way of contrast, Dallas Baylor Medical Center has more than a thousand physicians on staff.
These are the kinds of inequities that kill people. First, they kill the poor people when the outbreaks start, and then they kill people all over the world when the outbreaks spread. If we really want to slow down these outbreaks and minimize their impact, we need to make sure that every country in the world has the capacity to identify new diseases, treat them and report about them so they can share information.
COVID-19 is going to be a huge burden on health systems. COVID-19 has also revealed some real weaknesses in our global health supply chains. Just-in-time-ordering, lean systems are great when things are going well, but in a time of crisis, what it means is we don’t have any reserves. If a hospital – or a country – runs out of face masks or personal protective equipment, there’s no big warehouse full of boxes that we can go to to get more. You have to order more from the supplier, you have to wait for them to produce it and you have to wait for them to ship it, generally from China. That’s a time lag at a time when it’s most important to move quickly.
If we’d been perfectly prepared for COVID-19, China would have identified the outbreak faster. They would have been ready to provide care to infected people without having to build new buildings. They would have shared honest information with citizens so that we didn’t see these crazy rumors spreading on social media in China. And they would have shared information with global health authorities so that they could start reporting to national health systems and getting ready for when the virus spread. National health systems would then have been able to stockpile the protective equipment they needed and train health care providers on treatment and infection control. We’d have science-based protocols for what to do when things happen, like cruise ships have infected patients. And we’d have real information going out to people everywhere, so we wouldn’t see embarrassing, shameful incidents of xenophobia, like Asian-looking people getting attacked on the street in Philadelphia. But even with all of that in place, we would still have outbreaks. The choices we’re making about how we occupy this planet make that inevitable.
As far as we have an expert consensus on COVID-19, it’s this: here in the US, and globally, it’s going to get worse before it gets better. We’re seeing cases of human transmission that aren’t from returning travel, that are just happening in the community, and we’re seeing people infected with COVID-19 when we don’t even know where the infection came from. Those are signs of an outbreak that’s getting worse, not an outbreak that’s under control.
It’s depressing, but it’s not surprising. Global health experts, when they talk about the scenario of new viruses, this is one of the scenarios that they look at. We all hoped we’d get off easy, but when experts talk about viral planning, this is the kind of situation and the way they expect the virus to move.
I want to close here with some personal advice. Wash your hands. Wash your hands a lot. I know you already wash your hands a lot because you’re not disgusting, but wash your hands even more. Set up cues and routines in your life to get you to wash your hands. Wash your hands every time you enter and leave a building. Wash your hands when you go into a meeting and when you come out of a meeting. Get rituals that are based around handwashing.
Sanitize your phone. You touch that phone with your dirty, unwashed hands all the time. I know you take it into the bathroom with you.
(Laughter)
So sanitize your phone and consider not using it as often in public. Maybe TikTok and Instagram can be home things only.
Don’t touch your face. Don’t rub your eyes. Don’t bite your fingernails. Don’t wipe your nose on the back of your hand. I mean, don’t do that anyway because, gross.
(Laughter)
Don’t wear a face mask. Face masks are for sick people and health care providers. If you’re sick, your face mask holds in all your coughing and sneezing and protects the people around you. And if you’re a health care provider, your face mask is one tool in a set of tools called personal protective equipment that you’re trained to use so that you can give patient care and not get sick yourself. If you’re a regular healthy person wearing a face mask, it’s just making your face sweaty.
(Laughter)
Leave the face masks in stores for the doctors and the nurses and the sick people.
If you think you have symptoms of COVID-19, stay home, call your doctor for advice. If you’re diagnosed with COVID-19, remember it’s generally very mild. And if you’re a smoker, right now is the best possible time to quit smoking. I mean, if you’re a smoker, right now is always the best possible time to quit smoking, but if you’re a smoker and you’re worried about COVID-19, I guarantee that quitting is absolutely the best thing you can do to protect yourself from the worst impacts of COVID-19.
COVID-19 is scary stuff, at a time when pretty much all of our news feels like scary stuff. And there’s a lot of bad but appealing options for dealing with it: panic, xenophobia, agoraphobia, authoritarianism, oversimplified lies that make us think that hate and fury and loneliness are the solution to outbreaks. But they’re not. They just make us less prepared.
There’s also a boring but useful set of options that we can use in response to outbreaks, things like improving health care here and everywhere; investing in health infrastructure and disease surveillance so that we know when the new diseases come; building health systems all over the world; looking at strengthening our supply chains so they’re ready for emergencies; and better education, so we’re capable of talking about disease outbreaks and the mathematics of risk without just blind panic.
We need to be guided by equity here, because in this situation, like so many, equity is actually in our own self-interest.
So thank you so much for listening to me today, and can I be the first one to tell you: wash your hands when you leave the theater.
(Applause)
在开始演讲之前，我想要申明自己的相关资历，这样做，老实说是因为你在新型冠状病毒（COVID-19）这件事上，真的不应该倾听任何一个长者的想法。
（笑声）
我从事全球卫生工作大约有 20 年了，我的特定技术专长是卫生系统以及当卫生系统遭到严重冲击时 会发生什么。 我也一直在全球卫生相关的新闻业工作，我为报纸和网络媒体撰写过不少关于全球卫生和生物安全的文章，在几年前也我也出版过一本书，这本书讲述了我们星球所面临的主要全球卫生威胁。我支持并领导了许多流行病相关的工作 —— 从评估埃博拉治疗中心到研究医疗机构中肺结核的传播机制，再到禽流感的准备工作。我是国际卫生专业的硕士。我不是医生，也不是护士。我的专长不是照顾病患，或照顾个体。我的专长是研究总体人口、卫生系统，并研究当疾病大规模传播时会发生什么。如果我们把关于全球卫生的知识来源用 1 到 10 来形容其专业度，1 是随意一个在 Facebook 上肆意怒吼的人，10 是世界卫生组织（WHO）， 我会说你大概能把我放在 7 或 8 的位置上。接下来我进行演讲的时候，请你记住这一点。
我先从最基础的开始，因为我觉得这在许多嘈杂的关于 COVID-19 的媒体报道中被遗漏了。所以，COVID-19 是一种冠状病毒（Coronavirus）。冠状病毒是病毒的一个特定子集，它们具有某些特定的病毒特征 —— 它们使用 RNA 而非 DNA 作为它们的遗传物质，它们的外表面被棘突包围，并以此来入侵细胞。这些棘突使得冠状病毒看起来像皇冠。 COVID-19 被认为是一种新型冠状病毒，因为在 12 月之前，我们只知道 6 种冠状病毒。COVID-19 是第 7 种。对我们来说是新的。它们刚经历了基因测序，才有了自己的名字。这也就是为何它们是“新型的”。
如果你记得非典，重症急性呼吸综合征（SARS），或是 MERS 病毒，中东呼吸综合征（MERS），这些都是由冠状病毒引发的。而且它们都被称作为呼吸综合征，是因为这是冠状病毒的特长 —— 它们专攻肺部。它们不会让你呕吐或是让你从眼睛里流血，它们也不会让你大出血。而是直奔你的肺部。
COVID-19 也一样。它能引发一系列呼吸道症状，从干咳、发烧等一系列症状，到致命的病毒性肺炎。如此广泛的症状也就是为何如此难以追踪疾病爆发的原因之一。不少人感染了 COVID-19 ，但是非常轻度的感染。他们的症状如此轻微，甚至不用去医疗机构，也不用将自己上报到系统中。尤其是孩子，能够非常轻易地抵抗 COVID-19。这是我们所有人都应该感到庆幸的一个事实。
冠状病毒是动物源性病毒，这意味着它们能从动物传播至人类。有些冠状病毒，例如 COVID-19 也能通过人与人传播。人人传播的方式感染得更快且范围更广，就像 COVID-19。动物源性疾病真的很难摆脱，因为它们有着一个很大的动物储备。一个例子就是禽流感，我们可以在农场动物比如火鸡和鸭子中消灭它，但它依旧每年都会发生，因为禽流感能通过野鸟传播到人。你不常听到人们谈及它，因为禽流感不会人人传播，但其实世界范围的家禽农场每年都会出现禽流感的大爆发。COVID-19 很可能就是在中国武汉的野生动物市场中从动物身上转移到了人。
现在说点不是那么基础的东西。这不是我们人类历史上能看到的最后一场重大疾病爆发。往后将会有更多的爆发，更多的流行病。这不是概率事件，而是既定事实。这是我们作为人类，与地球互动方式的结果。人类的选择把我们推入一个未来会看到更多流行病爆发的境地。其中一部分，是气候变化，变暖的气候让世界对病毒和细菌变得更加生存环境友好。但这也与我们逼近地球上最后的野外空间的方式有关。
当我们在亚马逊雨林的土地上焚烧并耕种，我们以此希望低成本经营牧场，当最后一片非洲丛林被转化为农场，当中国的野生动物被猎杀到几近灭绝，人们与不同野生动物种群开始了前所未有的联系，之后那些野生动物种群可携带各种新的疾病：细菌、病毒，我们毫无准备的东西。尤其是蝙蝠，有一种本事：它们能作为可以传染给人的疾病的宿主，不过不仅蝙蝠有这种能力。所以只要我们继续逼近偏远的地方，流行病的爆发将会一直持续。
我们无法用隔离或旅行限制来停止疾病大爆发。这是每个人的第一反应：“我们要禁止人口流动，我们要阻止这场疫情的发生。” 但实际上，真的很难做到有效适当的隔离，也真的很难做到设置旅行限制。 即使是在公共卫生领域投入足够预算的国家，像是美国和韩国，都无法快速做到那样有效的限制隔离以即刻阻止这场疫情的爆发。这其中有物流原因，也有医学原因。如果你现在看看 COVID-19，看起来会有一段时间 —— 你已经被感染但没有任何症状 —— 能长达 24 天。所以人们携带着这个病毒走来走去，没有任何征兆。他们不会被隔离，也没人知道他们自己需要被隔离。
隔离和旅行限制也有一些真实代价。人类是一种社交动物，当你尝试把他们限定在一个地方，尝试把他们分隔开来，他们会反抗。在埃博拉的时候，我们看到只要你开始实行隔离，人们就会开始尝试逃离。 个别病人，如果知道有一个严格的隔离处理流程的存在，可能就不会选择去看病，因为他们害怕这样的医疗流程，或他们担心自己经济上无法承担，而且，他们不想要与自己的家人和朋友分开。政客和政府官员，当他们知道自己将会被隔离，如果他们谈及疫情和病例，可能会隐藏真实信息，从而避免触发隔离处理流程。当然，正是这些回避的态度与不诚实的手段 让疫情控制变得如此困难。通过隔离和旅行限制，我们能好得更快，我们也应该这么做，但是这不是唯二的方法，也不是我们应对这些疾病爆发的最佳选择。
能够长期预防流行病爆发的真正方法是建立一个全球卫生系统以支持世界上每个国家核心医疗保健的职能运作，以让所有的国家，乃至于贫穷国家，在新的传染病萌发之时都能够快速识别并治疗它。中国应对 COVID-19 的措施受到了很多批判。但实际，倘若 COVID-19 出现在在每 10 万人口只有 3.5 名医生的乍得？要是 COVID-19 出现在最后一名埃博拉病人刚出院的刚果民主共和国 ？真相是，这些国家没有资源来应对这样的一种传染病。 它们无法治疗病患且无法快速上报该疾病的爆发来帮助世界上其它国家共同应对这场危机。
我曾领导了一场在塞拉利昂埃博拉治疗中心的评估工作，事实是塞拉利昂当地的医生很快就识别到了埃博拉危机，首先，是危险的，具有传染性的出血性病毒，之后再是埃博拉病毒本身。但是，尽管识别到了病毒，他们没有资源去应对。他们没有足够的医生，没有充足的床位，而且他们没有足够的信息去了解如何治疗埃博拉，或是如何实施感染控制。在塞拉利昂有 11 名医生死于埃博拉。在这场危机开始之前，这个国家只有 120 名医生。相比之下，仅是达拉斯贝勒大学医学中心就拥有超过 1 千名医生的团队。
诸如此类的不平等会导致人们的死亡。首先，在疫情萌芽时，最先受到死亡威胁的是穷人，其后，当疫情爆发，再是全世界的人。如果我们真的想要 减少这些流行病的爆发并且最小化它们的影响，我们需要确保世界上每个国家都有能力识别新的疾病、治疗它们，并且及时上报以共享信息。
COVID-19 将会成为卫生体系的一个重大负担。 COVID-19 已经揭示了我们全球卫生供应链中一些真实存在的弱点。实施准时下单和精益生产系统在正常情况下很管用，但是在危机时刻，这意味着我们没有足够的物资储备。如果一家医院，或一个国家，耗空了口罩或个人防护用品，又没有一个大满仓的物资储备供我们继续使用，你就不得不从供应商那里买更多，之后你得等供应商生产，你还得等他们发货送货，一般都是从中国发货。在非常需要快速行动的时候，这是一个时间滞后。
如果我们早前已经为 COVID-19 做好了充分的准备，中国就能更快地识别疫情。他们就不用临时建造新楼为感染者提供医疗照顾。他们也就能如实地和群众分享信息，这样在中国的社交媒体上谣言不会如我们所见般四散。 而且他们也能和全球卫生机构分享信息，这样他们就能开始向国家卫生系统上报并为病毒的传播做足准备。国家卫生系统接到上报后也能大量储备他们所需数量的防护用品以及针对治疗和感染控制，为医疗机构进行培训。我们也就会有基于科学的处理流程，告诉我们事情发生的时候该怎么处理，例如有被感染患者搭乘的邮轮。如果我们能为各地所有人放出真实准确的信息，我们也不会看到那么多令人难堪且羞耻的仇外事件的发生，例如具有亚洲长相的人在费城街头被攻击。但即使，我们能把所有的这些都做到位，流行病的爆发依旧会发生。我们对如何霸占这个星球的选择使之变成了一个无法逃避的现实。
目前而言，专家们 针对 COVID-19 的一个共识是：在美国，和全世界，情况在变好之前，会先变得更糟。我们看到很多人传人的病例，这并非由旅行归来引发，而是正在社区中传播，我们甚至在感染源未知的情况下，不断看到人们被 COVID-19 感染。这些都是疫情加剧的迹象，而非受到控制。
这很令人沮丧，但并不令人意外。全球卫生专家，当他们讨论新病毒的情景时，这是他们所关心的一种情景。我们都希望此次疫情能很快过去，但当专家们谈论病毒规划时，他们预判病毒会以这种情景和这种方式继续传播。
我想要以一些个人建议收尾。洗手。勤洗手。我知道你经常洗手，因为你是爱干净的，但是请洗手洗得更勤快一些。在你日常生活中，设置一些能让你洗手的小提示和常规。每次进出大楼，洗手。每次开始和结束会议，洗手。养成洗手相关的习惯。
清洁你的手机。你总是用脏手碰你的手机。我知道你会带着手机进洗手间。
（笑声）
所以清洁你的手机，尽量不要在公共场合过度使用。抖音和 Instagram 在家看看可能就够了。
不要摸脸。不要揉眼睛。不要咬手指甲。不要用手背擦鼻子。不管怎样别那么做，因为有点恶心。
（笑声）
不要戴口罩。口罩是生病的人和医务人员使用的。如果你生病了，你的口罩可以兜住所有咳嗽和打喷嚏的飞沫并且保护你周围的人。如果你是一名医务人员，你的口罩是众多个人防护用品中的一个工具，你也被训练说：戴上口罩再治疗病患，并且保证自己不生病。如果你是一个正常的健康的人，戴口罩只能让你的脸出汗。
（笑声）
把商店里的口罩留给医生、护士和病人。
如果你认为你有 COVID-19 的症状，呆在家，打电话给你的医生以寻求建议。如果你被检测为 COVID-19 阳性，记住普遍上说它是很轻度的。之后如果你是烟民，现在可能是你的最佳戒烟时机。我是说，如果你是烟民，任何时刻都可能是你最佳戒烟时机，但如果你是烟民并且担心 COVID-19 找上门，我保证戒烟绝对是你能做出的保护自己免受病毒入侵最糟影响的最好的选择。
COVID-19 是一个恐怖的东西，这段时间几乎每一条新闻看起来都很恐怖。之后也有很多不好却吸引人的方式来应对这件事：恐慌、仇外、广场恐惧、权威主义，以及过度简化的谎言使我们认为厌恶、愤怒和孤独是疫情的解决方案。但它们不是。它们只会让我们变得更脆弱。
我们也可以使用一些无聊但有用的方式来应对流行病的爆发。比如改善全球每个地方的医疗保健；投资于卫生基础设施和疾病监测这样我们能知道新疾病的到来；建立全球卫生体系；致力于加强我们的供应链以让它们能准备好应对突发情况；还有更好的教育，以让我们能在不建立盲目恐慌的前提下，正常地谈论疾病的爆发和风险的数学可能。
在这种情况下，我们需要以公平为指导，因为很多时候，在危机下，公平实际上是我们的自身利益。
非常感谢今天在座的聆听，而且我能成为第一个人，告诉你：当你离开剧场的时候请认真洗手。
（掌声）