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科学美国人(翻译):COVID-19病毒如何以及为什么传播迅速 2020.03.16

COVID-19: How and Why the Virus Spreads Quickly

COVID-19:病毒如何以及为什么传播迅速

This is another in our series of coronavirus episodes of Scientific American’s Science Talk, posted on March 23, 2020. I’m Steve Mirsky.In this two-part episode, our contributing editor W. Wayt Gibbs in Washington state—a state hit early and hard by COVID-19—reports on scientists’ fast-evolving understanding of this new coronavirus and the probable trajectory of this pandemic.Today, in part one, he focuses on why the new coronavirus is spreading so quickly and is so difficult to control.

这是《科学美国人》科学讲座中关于冠状病毒的另一个系列,发表于2020年3月23日。我是史蒂夫·米尔斯基。在这个分为两部分的章节中,我们的特约编辑W. Wayt Gibbs在华盛顿州——一个科学家对这种新型冠状病毒的快速发展的理解和这次大流行的可能轨迹的covid19报告的早期重击的州。今天,在第一部分中,他着重解释了为什么这种新型冠状病毒传播如此迅速,又如此难以控制。

Check back in tomorrow for part two, when Gibbs looks at computer models that are predicting how long we’ll need to shut down large parts of society to prevent hospitals from being overwhelmed. He also looks at how emerging tests for immunity to the virus could pose thorny ethical issues in the months to come.Wayt recorded this episode on March 22nd. The first voice you hear: Governor Jay Inslee of Washington.

明天再看第二部分,吉布斯将研究计算机模型,这些模型预测我们需要关闭社会的大部分多久才能避免医院人满为患。他还研究了新出现的对病毒的免疫测试如何在未来几个月引发棘手的伦理问题。Wayt在3月22日录制了这一集。你听到的第一个声音是:华盛顿州长杰伊·英斯利。

JI: “It is not rhetorical or hyperbolic when I say that everyone needs to change their behavior, change the way that we live—temporarily—if we are going to prevent significant loss of life for the people we love in the state of Washington. And when I say everyone, I mean, frankly, everyone. Because we all are potential transmitters of this virus, and we all, to some varying degree, are potential victims of this virus.”

JI:“我说每个人都需要改变他们的行为,改变我们暂时生活的方式,如果我们要防止我们在华盛顿州所爱的人的重大生命损失,这不是修辞或夸张。当我说每个人,我的意思是,坦白地说,每个人。因为我们都是这种病毒的潜在传播者,在某种程度上,我们都是这种病毒的潜在受害者。”

WWG: That was Governor Jay Inslee, pleading with people in my state on March 20th to stay home and stay away from each other. All around the U.S.—and around the world—governors and mayors and prime ministers are urging, begging, in many places even ordering their citizens to shelter in place.

《华尔街日报》:这是杰伊·英斯利州长在3月20日向我所在州的人们发出的呼吁,希望他们呆在家里,远离彼此。全美国。世界各地的州长、市长和总理都在敦促、乞求,在许多地方甚至命令他们的公民就地避难。

But it’s not easy to resist our hard-wired desires to spend time with our friends, to visit our parents and grandparents, to go to work.So here in Washington, like in lots of other places, compliance has been—kind of spotty. Traffic on some of the major highways here—a good proxy for human intermingling—is down only about 20% or so from normal.

但是,我们很难抗拒与朋友共度时光、看望父母和祖父母、去工作的强烈欲望。因此,在华盛顿,就像在其他许多地方一样,遵守规定的情况——有点参差不齐。这里的一些主要高速公路上的交通流量(这是一个很好的反映人际交往的指标)只比正常水平下降了20%左右。

But as scientists learn more about the SARS-CoV-2 virus and the COVID-19 pandemic, it’s becoming apparent that we’re facing a much more serious situation than most of us thought even a couple weeks ago.

但是,随着科学家对SARS-CoV-2病毒和COVID-19大流行了解得越来越多,我们面临的形势显然比我们大多数人几周前想象的要严重得多。

Let me give you one example from here in Washington. On March 10th, despite stern official warnings not to gather in groups, 56 people met for an event in Skagit County. All of them were apparently healthy at the time. But ten days later, 43 of those 56 people have either been confirmed to have COVID-19 or are showing symptoms of the disease. Experts suspect that one or more people in the group was a so-called “super-shedder,” someone who has yet to show symptoms but is transmitting lots of infectious virus.

让我举一个华盛顿的例子。3月10日,尽管官方严令禁止集会,仍有56人聚集在斯卡吉特县参加活动。他们当时都很健康。但10天后,这56人中有43人要么被证实患有COVID-19,要么出现了该疾病的症状。专家们怀疑这群人中有一个或更多的人是所谓的“超级谢顶者”,即那些尚未出现症状但正在传播大量传染性病毒的人。

In this two-part episode, we’ll look at several new research studies and new tests announced this week that may help answer four crucial questions.Question 1: Can you catch this disease from someone who isn’t in the same room as you?

在这两节课中,我们将会看到几项新的研究和本周宣布的新测试,这些研究和测试可能有助于回答四个关键问题。问题1:你能从和你不在一个房间的人那里感染这种疾病吗?

Question 2: Can you catch it from somebody who isn’t sick—and is there a way to test for that?

Question 3: What combination of shutdowns and closures will do the most to minimize the number of people who die from the pandemic? And how long will those tough restrictions need to continue?

And question 4: How will each of us know when we’re immune and no longer need to worry about catching COVID-19 or giving it to someone else? And what will we do with that information once we have it?

问题2:你能从没有生病的人那里感染吗?有办法检测吗?

问题3:关闭和关闭哪些措施能最大限度地减少死于流感大流行的人数?这些严格的限制还需要持续多久?

问题4:我们每个人如何知道自己已经免疫了,不再需要担心感染或传染给别人?一旦我们有了这些信息,我们会怎么做呢?

Let’s start with that first question: do you have to come in contact with someone who has the virus—or with droplets they are spraying from a cough or a sneeze—to catch it?Well, that’s almost certainly the easiest way to get it. So keeping your distance from others greatly reduces your risk of infection.

让我们从第一个问题开始:你是否必须与感染病毒的人接触——或者与他们咳嗽或打喷嚏时喷出的飞沫接触——才能感染病毒?这几乎是最简单的方法了。因此,与他人保持距离可以大大降低感染的风险。

But in a study out this week in the New England Journal of Medicine, researchers at a Montana biohazard lab run by the National Institutes of Health confirmed what many experts had feared: this coronavirus can also be infectious outside of a living body, in some cases for days.

但在本周《新英格兰医学杂志》(the New England Journal of Medicine)上发表的一项研究中,美国国家卫生研究院(National Institutes of Health)在蒙大拿州的一个生物危害实验室的研究人员证实了许多专家此前的担忧:这种冠状病毒也可能在活体外具有传染性,在某些情况下会持续数日。

The other night I watched the 2011 movie Contagion, which certainly has some eerie parallels to the present. There’s a scene where Kate Winslet’s character, a CDC disease investigator, explains why that kind of durability is so troubling in a virus.[[audio from clip from Contagion]]KW: “So at this point I think we have to believe this is respiratory—maybe fomites, too.

前几天晚上,我看了2011年的电影《传染病》(Contagion),它与现在当然有一些诡异的相似之处。有一个场景,凯特·温斯莱特扮演的角色,疾病预防控制中心的疾病调查员,解释了为什么这种持久性对病毒来说是如此的麻烦。KW:“所以在这一点上,我认为我们必须相信这是一种呼吸器——也许也是一种污染物。

“What’s that, fomites?

“It refers to transmission from surfaces. The average person touches their face two or three thousand times a day…three to five times, every waking minute. In between, we’re touching doorknobs, water fountains, elevator buttons, and each other. Those things become fomites.”

“那是什么,污染物?

“它指的是从表面传播。一般人每天触摸自己的脸两三次,醒着的每分钟三到五次。在这期间,我们接触门把手、饮水机、电梯按钮,以及彼此。这些东西变成了污染物。”

The N.I.H. researchers tested whether the SARS-CoV-2 virus can spread via fomites—which, by the way, is how you actually pronounce it. They sprayed infectious droplets onto cardboard, stainless steel, and plastic. Then they checked the spatter as time passed to see how quickly the viral particles dried out and fell apart.

美国国立卫生研究院的研究人员测试了SARS-CoV-2病毒是否可以通过污染物传播,顺便说一句,污染物的发音就是污染物。他们把传染性液滴喷在硬纸板、不锈钢和塑料上。然后,随着时间的推移,他们检查了病毒粒子的飞溅,看看病毒粒子干化和分裂的速度有多快。

On cardboard, it took a good four hours before the amount of live virus started to fall significantly, and the surface remained quite infectious eight hours later.So when an Amazon box appeared on my front porch a couple days ago, I was glad to see that the delivery man was wearing gloves. But after I opened the box, I still went to the sink and washed my hands.

在硬纸板上,过了整整4个小时,活病毒的数量才开始显著下降,8个小时后,纸板表面的传染性仍然很强。因此,几天前,当一个亚马逊(Amazon)的盒子出现在我的前廊时,我很高兴地看到送货员戴着手套。但当我打开盒子后,我还是走到水池边洗手。

On stainless steel—think railings, shopping carts, gas pumps, jungle gyms—the coronavirus remained infectious for more than a day.And on plastic—so, our pens, our credit cards, our keyboards and keypads—it stayed viable for two to three days.

在不锈钢的栏杆上,在购物车里,在加油站里,在丛林里,冠状病毒在一天多的时间里保持着传染性。而在塑料上,我们的笔、信用卡、键盘和键盘,它可以存活两到三天。

Here in the Seattle area, store managers and bus operators have been wiping down surfaces more frequently and making disinfecting wipes available at the door for customers to use. We now know that should be standard practice everywhere.Inside that box I received from Amazon was a set of white cotton gloves that I had ordered for me and my family to wear when we go out.

在西雅图地区,商店经理和公共汽车运营商一直在更频繁地擦拭表面,并在门口提供消毒湿巾供顾客使用。我们现在知道,这应该成为世界各地的标准做法。在我从亚马逊收到的那个盒子里,有一套白棉手套,是我为我和我的家人订购的,我们出去时戴的。

Tests have shown that a standard face mask really doesn’t protect you from catching this virus because so much of the air you inhale leaks in around the edges rather than going through the filter. Wearing a mask is a nice courtesy, though, if you’re going to be around others who may be vulnerable.

测试表明,一个标准的口罩并不能保护你不感染这种病毒,因为你吸入的空气中有很多是从边缘漏气的,而不是通过过滤器。不过,如果你要和那些脆弱的人在一起,戴上面具是一种很好的礼貌。

But a pulmonary surgeon advised me to wear cotton gloves, as they do at his hospital, because the natural fibers trap the virus and it dries out and becomes inactive. Also, I find that wearing gloves helps me remember to avoid touching my face.So we can get infected from people we never even see—from the fomites they leave behind.But now let’s turn to that second question: can you catch COVID-19 from someone who hasn’t tested positive, or even from someone who may feel perfectly healthy?

但一位肺部外科医生建议我戴上棉质手套,就像他们在医院里做的那样,因为天然纤维会把病毒困住,病毒会变干,变得不活跃。此外,我发现戴手套可以帮助我记住避免触摸我的脸。所以我们可能会从那些我们从未见过的人身上感染——从他们留下的污染物。但现在让我们转到第二个问题:你能从那些没有检测出阳性的人,甚至是那些感觉完全健康的人那里感染COVID-19吗?

Studies seem to confirm that the answer is yes. In a paper that appeared on March 16th in the journal Science, an international group of researchers analyzed data on the outbreak in China in January. They concluded that only 14% of COVID-19 infections were documented, meaning that 86%—that’s six out of seven cases—never showed up in the statistics as a confirmed case.

研究似乎证实了答案是肯定的。在3月16日《科学》杂志上发表的一篇论文中,一个国际研究小组分析了1月份中国爆发禽流感的数据。他们的结论是,在19例covid感染中,只有14%被记录在案,这意味着86%——也就是7例中的6例——从未作为确诊病例出现在统计数据中。

Here’s what Jeffrey Shaman of Columbia University, one of the authors of that paper, said about that in a news briefing last week:

JS: “These undocumented infections were … about half as infectious per person as a documented case who has more severe symptoms and maybe shedding more. Because, however, there are many more of these undocumented cases, it’s the undocumented infections that are driving the spread and growth of the outbreak.”

哥伦比亚大学(Columbia University)的杰弗里·萨满(Jeffrey Shaman)是这篇论文的作者之一,他在上周的新闻发布会上是这样说的:

JS:“这些无文件记录的感染…大约是有文件记录的病例的一半,谁有更严重的症状,可能脱落更多。然而,因为还有更多的无证病例,正是这些无证感染推动了疫情的蔓延和增长。”

Shaman says these undocumented cases are mostly quite mild.JS: “And so most people may not recognize that they may think they have another cold, or they may not even really recognize that they're ill. If you were to project that number globally, given that we have 150,000 confirmed cases … it says that we're approaching close to a million infections globally…. Generally, you’re looking at about an order of magnitude more cases than have been confirmed.”

萨满说,这些没有记录在案的案件大多相当轻微。JS:“所以大多数人可能没有意识到他们可能认为自己又感冒了,或者他们甚至没有意识到自己生病了。如果你在全球范围内预测这个数字,考虑到我们有15万确诊病例,它表明我们在全球范围内接近100万感染病例。一般来说,你看到的病例比已经证实的要多一个数量级。”

VO: Of course, every day the count of confirmed cases rises. But the idea is that if you take the count today and multiply by seven, that’s a more realistic estimate of the number of infections to date.

VO:当然,确诊病例每天都在增加。但我们的想法是,如果你计算今天的感染人数并乘以7,这是迄今为止对感染人数的更现实的估计。

So who is transmitting the virus? Obviously people who are very sick and have tested positive. Plus maybe seven times more people, many of them young, who have caught it but feel well enough that they wouldn’t think to get tested or to self-quarantine.

那么是谁在传播病毒呢?很明显,那些病得很重的人检测结果呈阳性。另外,可能还有七倍多的人,其中很多是年轻人,他们感染了埃博拉病毒,但感觉很好,不想去做检测或自我隔离。

And then there’s a third group: the fast-increasing numbers of people who are infected, and who—five or ten days from now—will fall ill and become a confirmed case, but who feel perfectly fine at the moment.In a preprint article published on March 18th, researchers with the World Health Organization studied 94 COVID-19 patients in Guangzhou, China to determine when they became infectious—and when they stopped shedding the virus. The scientists collected throat swabs from the patients as soon as they began showing symptoms and then tested them again every day for the following month.

还有第三类人:被感染的人数迅速增加,从现在起5天或10天内,他们将病倒,成为确诊病例,但目前他们感觉非常好。在3月18日发表的一篇预印本文章中,世界卫生组织(World Health Organization)的研究人员研究了94名covid19名中国广州的患者,以确定他们何时开始感染以及何时停止了病毒的传播。科学家们在病人开始出现症状后立即采集他们的咽喉拭子,然后在接下来的一个月里每天都对他们进行测试。

They saw a lot of variation from patient to patient. But overall, the patients tended to become less infectious as their symptoms progressed. Through some calculations, the scientists concluded that these coronavirus patients shed the most virus, and were probably most infectious to others, up to two days before they started feeling ill. So these are people like Senator Rand Paul of Kentucky, who we learned on March 22nd has tested positive for COVID-19 even though he isn’t yet feeling any symptoms.

他们发现病人之间有很大的差异。但总的来说,随着症状的进展,患者的传染性往往会减弱。通过一些计算,科学家们得出结论,这些冠状病毒患者在发病前两天传播的病毒最多,对其他人的传染性可能也最强。这些人就像肯塔基州的参议员兰德·保罗,我们在3月22日得知他的COVID-19检测呈阳性尽管他还没有任何症状。

These W.H.O. researchers estimate that around half of the people who caught this virus in Guangzhou got it from someone who was still feeling healthy at the time. And other studies from China have documented cases where patients have fully recovered from COVID-19 but continued to test positive for the virus for more than a week after their symptoms disappeared.

世卫组织的研究人员估计,在广州感染这种病毒的人中,约有一半是从当时仍感觉健康的人那里感染的。来自中国的其他研究也记录了一些病例,这些病例的患者已完全从COVID-19中恢复,但在症状消失后的一个多星期里,病毒检测仍呈阳性。

This phenomenon of pre-symptomatic and post-symptomatic transmission really complicates efforts to contain this virus, in particular because it will be a long time before we have enough coronavirus tests to check people who aren’t yet showing symptoms.

这种症状前和症状后传播的现象确实使控制这种病毒的努力复杂化,特别是因为我们还需要很长时间才能有足够的冠状病毒测试来检查那些尚未出现症状的人。

In a move to help ease shortages of coronavirus tests, the U.S. Food and Drug Administration last week gave emergency authorization to hospitals and labs to use a new automated test for COVID-19 that can detect infections in minutes rather than days. Cepheid, a biotech company in California, says it will start shipping the test kits this week.

为了缓解冠状病毒检测的短缺,美国食品和药物管理局(fda)上周紧急授权医院和实验室使用一种新的covid19自动检测方法,这种方法可以在几分钟内而不是几天内检测出感染情况。位于加州的生物科技公司Cepheid表示,他们将于本周开始运送测试工具。

The Cepheid test performs essentially the same real-time-PCR process that existing tests do, just much faster, says Cepheid's Chief Medical Officer, David Persing:

“造父变星”的首席医疗官大卫·珀辛说,“造父变星”的检测过程与现有的实时pcr检测过程基本相同,只是速度快得多。

DP: “So what we've developed is a reference-lab-quality test that can be run at the point of care in about 45 minutes or less. You take a sample, put it into this new cartridge that we've developed, and about 45 minutes later, you'll have the result. And that test can be run at the hospital as patients are being admitted. So the results are available much more quickly. And that means that those results will play into how those patients are managed: who gets respiratory isolation. Who needs antibiotics who doesn't need antibiotics? Those kinds of decisions can be made in real time.”

Persing says that while the test could be used for screening in the community—and may be sensitive enough to detect pre-symptomatic super-shedders—initially it will be available only for hospitals to use on their patients and healthcare workers.

DP:“所以我们开发了一个参照实验室质量测试,可以在45分钟或更少的时间内在护理点运行。你取一个样本,把它放进我们开发的新墨盒里,大约45分钟后,你就会得到结果。该测试可以在病人入院时在医院进行。所以结果很快就出来了。这意味着这些结果将影响到这些病人的治疗:谁会被隔离呼吸系统。谁需要抗生素谁不需要抗生素?这些决定可以实时做出。”

Persing说,虽然这项测试可以用于社区的筛查,而且它可能足够敏感,可以检测出症状出现前的超级乳房剥离症,但在最初阶段,它只会用于医院的病人和医护人员。

DP: “We think this will be a very important tool in being able to get rapid, actionable results to let patients know if they're carriers, even if they're asymptomatic, to quarantine. And to know that they're being quarantined for a reason, not because they may have hay fever or some other cause, but really give them a reason for quarantine.”

DP:“我们认为这将是一个非常重要的工具,能够得到快速、可操作的结果,让患者知道他们是否是携带者,即使他们没有症状,也可以进行隔离。要知道他们被隔离是有原因的,不是因为他们可能有花粉症或其他原因,而是真正给了他们隔离的理由。”

Faster, easier tests should help us get a better handle on the true extent of this pandemic. But these tests aren’t perfect. A number of studies, including one done by scientists at Wuhan University in February, have found that these RT-PCR tests we’re relying on today aren’t sensitive enough to reliably catch the infection in its early stages. So a negative test result is no guarantee that you’re not carrying the virus.

更快、更简单的检测应该有助于我们更好地了解这场大流行的真实程度。但这些测试并不完美。包括武汉大学科学家今年2月进行的一项研究在内的多项研究发现,我们目前依赖的这些RT-PCR检测不够敏感,不足以在感染的早期阶段准确地捕捉到病毒。所以一个阴性的检测结果并不能保证你没有携带病毒。

Nor does it tell you whether or not you are immune to the disease. But new tests for immunity are coming.

These characteristics of the new coronavirus—it’s ability to lie in wait on surfaces and to spread easily among people who feel fine or well enough—that is what make this virus so contagious and hard to stop, as Elizabeth Halloran of the Fred Hutchinson Cancer Research Center explained at news briefing last week:

它也不能告诉你你是否对这种疾病有免疫力。但是新的免疫测试即将到来。

这些特征的新coronavirus-it谎言的能力之间轻易传染等表面,人感觉好或桥梁是什么让这种病毒会传染的,而且很难停下来,Elizabeth Halloran指出的弗雷德哈钦森癌症研究中心上周在新闻发布会上解释说:

EH: “the basic reproductive number—that is the average number of people that an average person infects at the beginning—is estimated … to be about 2.5. And there are actually estimates that are higher.

EH:“最基本的生殖数字——也就是一个人一开始感染的平均人数——估计是2.5左右。实际上估计的数字更高。

“That’s before, of course, all this behavioral reduction and social distancing which would reduce it. But it’s going to be difficult even if it does go down somewhat seasonally in the summer to bring that down necessarily below one.”

“当然,这是在所有这些行为减少和社会距离减少之前。但即使在夏季的季节性下降,也很难把这个数字降至1以下。”

And until we can drag that reproductive number from 2.5 or so down to less than one, the pandemic will continue to accelerate.In part two of this episode, we’ll look at how computer models of the pandemic are predicting when we’ll be able to emerge from our state of sequestration and start hanging out with each other again. Also in part 2, I’ll update you on antibody tests for immunity to the virus that are now emerging from research labs. And we’ll look at some tough ethical questions that society may confront as it uses this technology.

除非我们能把繁殖数量从2.5个左右降低到1个以下,否则流感大流行将继续加速。在这一集的第二部分,我们将看看计算机模型是如何预测我们什么时候能从隔离状态中出来,并重新开始相处。在第二部分中,我还将向您介绍目前正在研究实验室中出现的针对病毒的免疫抗体测试。我们将会看到一些棘手的道德问题,社会在使用这项技术时可能会面临这些问题。

Until then, for Scientific American’s Science Talk, I’m Wayt Gibbs.

在那之前,我是《科学美国人》的韦特·吉布斯。

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