圖源： NEJM
北京時間10月8日，權威醫學期刊《新英格蘭醫學雜志》（NEJM）發表編輯部聯名社論，譴責特朗普政府在此次新冠疫情中的表現，指其讓一場公共衛生危機一步步演變成爲一出“悲劇”。
新冠疫情對全球所有國家來說，都是一場難度巨大的挑戰。在疫情面前，唯一能把握住的就是積極應對。而在美國，“我們一直以來都應對地極其糟糕”。社論表示，“我們基本上每一步都失敗了”：
明明有足夠的預警，但當疾病傳播到美國時，卻沒有能力進行高效的檢測；疾病在許多社區蔓延後，美國遲遲沒有實施隔離措施； 在疾病得到充分控制之前，關于社交距離的規定也已經放松了限制；在美國大多數地區，人們根本不戴口罩，主要是因爲特朗普政府明確表示，口罩只是政治工具，而非有效的防疫措施；在疫苗研發方面，雖然政府投入了大量資金，但其言論使得研發過程政治化，並招致公衆的不信任。
社論進一步指出，無論從醫療技術、科研水平還是生産能力來說，美國都是享有巨大優勢的。然而，在疫情應對上，美國政府沒有好好利用這些優勢，做出了種種錯誤決定：
聯邦政府基本上將疾病防控的工作甩給了各州，然而各州州長卻沒有聯邦政府擁有的各項條件和手段；美國國立衛生研究院（NIH）在疫苗研發中起了重要作用，卻被排除在政府決策的大門之外；政府不依靠科學家和專業人員，反去求助于不了解情況的所謂“意見領袖”和假充內行的“門外漢”，而這些人通常掩蓋事實真相並散布謊言。
社論最後呼籲民衆通過投票改變如今的局面：“在我們這個時代最嚴重的公共衛生危機面前，我們的領導人表現出了引致危險的無能。我們不應該助纣爲虐，不應該讓這些德不稱位的人繼續屍位素餐，而令美國的死亡人數再多出成千上萬人。”
值得一提的是，在過去的200多年中，《新英格蘭醫學雜志》作爲在世界醫療領域享譽盛名的頂級學術期刊，從未涉足過政治領域或是表明過政治立場。
（钛媒體編輯萌萌整理）
以下爲社論原文及譯文，來自微信公號“NEJM醫學前沿”：
Dying in a Leadership Vacuum
在領導力真空中死去
The Editors
N Engl J Med 2020; 383:1479-1480
Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.
Covid-19造成了全球性危機。這場危機是對領導力的一場考驗。由于並無對抗新型病原體的理想手段，因此各國被迫就如何應對做出艱難選擇。而美國的領導人沒有通過這場考驗。他們把危機變成了悲劇。
The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.
此次失敗觸目驚心。根據約翰霍普金斯大學系統科學與工程中心（Johns Hopkins Center for Systems Science and Engineering）[1]數據，美國Covid-19患病人數和死亡人數都居于世界首位，遠遠超過中國等人口更多的國家。美國的病死率是加拿大的2倍多，比人口老齡化並因而擁有衆多Covid-19高危人群的日本高出近50倍，甚至比越南等中低收入國家高出近2,000倍。Covid-19是一項巨大挑戰，許多因素造成了其嚴峻程度。但如何應對是一個我們可以控制的因素，而美國的表現自疫情暴發就一直不佳。
We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.
我們知道我們原本可以做得更好。最早暴發疫情的中國經曆最初的拖延後，選擇了嚴格的隔離措施。這些措施雖然嚴厲但很有效，基本上在疫情暴發之初就遏制了傳播。據報道，其病死率降低至每百萬人中有3人死亡，而美國每百萬人中有超過500人死亡。新加坡和韓國等與中國往來比較多的國家很早就加強了檢測，同時還積極追蹤接觸者並采取適當隔離措施，因而疫情相對較輕。新西蘭也采取了同樣措施，加上該國的地理優勢，他們幾乎清除了Covid-19，因而可以縮短封鎖時間，其社會基本上已經重新開放至疫情前水平。總的來說，許多民主國家不僅比美國做得好，而且比美國做的好得多。
Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.
爲什麽美國此次應對疫情表現如此糟糕？我們基本上每一步都失敗了。我們得到了充分預警，但當疾病傳播到美國時，我們沒有能力進行有效檢測，甚至無法爲醫護人員和公衆提供最基本的個人防護設備。我們在檢測能力方面仍然遠遠落後。雖然檢測的絕對數量已大幅增加，但更有用的衡量指標是每檢出一例感染的檢測數量。就這一指標而言，我們在國際上的排名非常靠後，甚至落後于生物醫學基礎設施和生産能力不及我們的哈薩克斯坦、津巴布韋和埃塞俄比亞等國家[2]。此外，由于美國不重視提高檢測能力，因此常需等待很長時間才能拿到結果，此時檢測結果對于疾病控制已經毫無用處。
Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.
我們往往關注技術，而大多數成效顯著的幹預措施並不複雜。Covid-19在許多社區蔓延之後，美國才采取隔離措施，不僅爲時已晚，政策不統一，而且並未嚴格執行這些措施。我們執行保持社交距離的規定，在許多地方充其量只能說是漫不經心，並且早在疾病得到充分控制之前就已放寬限制。在美國很多地方，人們根本就不戴口罩，很大程度上是因爲我們的領導人已經明確表示，口罩只是政治工具，而不是有效的感染控制措施。政府在疫苗開發方面投入了大量資金，這是恰當的做法，但其言論卻使疫苗開發過程政治化，導致公衆的不信任日益加深。
The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.
美國遭遇這場危機時擁有巨大優勢。除了巨大的生産能力，我們還有全世界稱羨的生物醫學研究體系。我們在公共衛生、衛生政策和基礎生物學方面擁有強大專業能力，並且一直能夠將這些專業能力轉化爲新療法和預防措施。這些專業能力很多來自政府機構，可我們的領導人卻選擇無視甚至诋毀專家。
The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.
國家領導人應對疫情的措施一直不夠充分。聯邦政府基本上已經將疾病控制工作甩給了各州。各州州長的應對各不相同，原因主要不是黨派政治，而是能力。但不論他們能力如何，州長都不擁有在聯邦政府控制下的各種應對手段。聯邦政府沒有應用這些手段，而是削弱了它們。美國疾病控制與預防中心曾是世界領先的疾病防控組織，如今卻遭受重創，並且在檢測和政策方面遭遇慘敗。美國國立衛生研究院在疫苗開發方面發揮了關鍵作用，但卻被排除在政府的許多關鍵決策之外。美國食品藥品管理局已經被可恥地政治化了[3]，他們似乎屈從于政府壓力，而不是遵循科學證據。我們的領導人破壞了人們對科學和政府的信任[4]，造成的損害肯定會比他們本人更長久。政府沒有依賴專業知識，而是求助于無知的“意見領袖”和冒牌內行，他們掩蓋真相，助長了徹頭徹尾的謊言的傳播。
Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.
我們要明確我們爲連簡單措施都不采取所付出的代價。此次令有色人種社區損失尤重的疫情加劇了與種族不平等相關的緊張關系。正處于社交和智力發展關鍵時期的許多兒童無法上學。醫護人員將自己生命置于危險之中，辛勤工作，但他們的這些付出卻未能得到妥善運用。我們本屆領導人以經濟爲傲，可在全球大多數國家已經一定程度開放經濟活動的情況下，美國Covid-19患病率仍然居高不下，許多行業無法重新開業，因而損失數千億美元和數百萬就業機會。而且，已經有超過20萬美國人在此次疫情中喪生。我們無法完全避免Covid-19造成的患者死亡。但是，盡管無法准確預測美國政策不力和不當造成的額外死亡人數，但這一數字至少有數萬之多，而且此次疫情造成的美國死亡人數已經超過了二戰以來的任何一場沖突。
Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.
假如有其他人如此毫無顧忌地糟蹋生命和金錢，他們一定會受到法律懲罰。我們的領導人卻聲稱他們的行爲享有豁免權。但是，即將到來的選舉賦予了我們審判其行爲的權力。理性的人當然會對候選人的許多政治立場持不同意見。但真相本身既不持自由派觀點，也不持保守派觀點。在我們這個時代最嚴重的公共衛生危機面前，我們的領導人表現出了危險的無能。我們不應該縱容他們，不應該讓這些人繼續屍位素餐，而令美國的死亡人數再多出成千上萬人。
參考文獻
1. Johns Hopkins University Coronavirus Resource Center. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (https://coronavirus.jhu.edu/map.html).
2. Total number of COVID-19 tests per confirmed case, September 14, 2020. Our World in Data (https://ourworldindata.org/grapher/number-of-covid-19-tests-per-confirmed-case).
3. McGinley L, Abutaleb L, Johnson CY. Inside Trump’s pressure campaign on federal scientists over a Covid-19 treatment. Washington Post. August 30, 2020 (https://www.washingtonpost.com/health/convalescent-plasma-treatment-covid19-fda/2020/08/29/e39a75ec-e935-11ea-bc79-834454439a44_story.html).
4. Haberman M. Trump admits downplaying the virus knowing it was ‘deadly stuff.’ New York Times. September 9, 2020 (https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-book-virus.html).