Abstract 摘要
新冠病毒的全球大流行使全人类都深受其害，对人们的健康、财富以及福祉都带来了巨大的影响。这就像一场世界大战，但不同的是，我们都在同一条战线上。全人类可以通力合作，了解这种疾病并开发工具与之斗争。我认为全球创新是减轻伤害的关键。这包括在检测、治疗、疫苗和政策上的创新，以遏制病毒的传播并最大程度地减少对经济和福祉的损害。
The coronavirus pandemic pits all of humanity against the virus. The damage to health, wealth, and well-being has already been enormous. This is like a world war, except in this case, we’re all on the same side. Everyone can work together to learn about the disease and develop tools to fight it. I see global innovation as the key to limiting the damage. This includes innovations in testing, treatments, vaccines, and policies to limit the spread while minimizing the damage to economies and well-being.
这份备忘录分享了我对当前情况的看法，以及我们如何能够加速这些创新。情况每天都在变化，有很多信息，其中许多都相互矛盾，而且你很难在诸多不同建议和想法中得出结论。听起来我们似乎具备了重新开放经济所需要的所有科学手段，但事实并非如此。尽管这篇文章里的部分内容技术性很强，但我希望它能帮助人们理解正在发生的事情，明白我们仍然急需的创新，并就应对这种大流行病做出明智的决定。
This memo shares my view of the situation and how we can accelerate these innovations. (Because this post is long, it is also available as a PDF.) The situation changes every day, there is a lot of information available—much of it contradictory—and it can be hard to make sense of all the proposals and ideas you may hear about. It can also sound like we have all the scientific advances needed to re-open the economy, but in fact we do not. Although some of what’s below gets fairly technical, I hope it helps people make sense of what is happening, understand the innovations we still need, and make informed decisions about dealing with the pandemic.
Exponential growth and decline指数级增长和下降
In the first phase of the pandemic, we saw an exponential spread in a number of countries, starting with China and then throughout Asia, Europe, and the United States. The number of infections was doubling many times every month. If people’s behavior had not changed, then most of the population would have been infected. By changing behavior, many countries have gotten the infection rate to plateau and start to come down.
在大流行的第一阶段，我们看到了它在许多国家呈指数级传播，从中国开始，然后遍及亚洲、欧洲和美国。每个月的感染人数都在不断翻倍。如果人们的行为没有改变，那么大多数人都会被感染。通过改变人们的行为，许多国家的感染率已趋于稳定并开始下降。
Exponential growth is not intuitive. If you say that 2 percent of the population is infected and this will double every eight days, most people won’t immediately figure out that in 40 days, the majority of the population will be infected. The big benefit of the behavior change is to reduce the infection rate dramatically so that, instead of doubling every eight days, it goes down every eight days.
指数增长并不是直观的。如果说有2％的人口受到感染，并且感染人数每8天就会增加一倍，那么大多数人不会立即明白——在40天内大多数人口都会被感染。行为改变的最大好处是可以大大降低感染率，因此，它不是每8天翻一倍，而是每8天都会显著减少。
We use something called the reproduction rate, or R0 (pronounced “are-nought”), to calculate how many new infections are caused by an earlier infection. R0 is hard to measure, but we know it’s below 1.0 wherever the number of cases is going down and above 1.0 wherever the number of cases is going up. And what may appear to be a small difference in R0 can lead to very large changes.
我们使用基本传染数R0来计算有多少新的感染是由先前的感染引起的。R0很难测量，但我们知道，当病例数下降时它小于1.0，当病例数上升时它大于1.0。R0的微小差异也会导致非常大的变化。
If every infection goes from causing 2.0 cases to only causing 0.7 infections, then after 40 days you have one-sixth as many infections instead of 32 times as many. That’s 192 times fewer cases. Here’s another way to think about it: If you started with 100 infections in a community, after 40 days you would end up with 17 infections at the lower R0 and 3,200 at the higher one. Experts are debating now just how long to keep R0 very low to drive down the number of cases before opening up begins.
如果每次感染从引发2个病例减少到引发0.7例，那么40天后，感染的病例数将是原来的1/6，而不是32倍，也就是说减少了192倍的病例数。换一种方式思考：假设一个社区最开始有100个感染病例，40天后，在R0较低的情况下会有17个感染病例，而R0较高的情况下会有3200个感染病例。专家们正在辩论，在解禁前到底需要在多长时间内保持R0在很低水平才能拉低病例数。
Exponential decline is even less intuitive. A lot of people will be stunned that in many places we will go from hospitals being overloaded in April to having lots of empty beds in July. The whiplash will be confusing, but it is inevitable from the exponential nature of infection.
相比较而言，指数下降就更不直观了。许多人都会惊讶的发现，很多地方的医院4月份还超负荷运转，而到了7月份就出现大量空床。突如其来的变化令人难以理解，但是从感染的指数性质来看，这是必然的。
As we get into the summer, some locations that maintain behavior change will experience exponential decline. However, as behavior goes back to normal, some locations will stutter along with persistent clusters of infections and some will go back into exponential growth. The picture will be more complex than it is today, with a lot of heterogeneity.
随着夏天的到来，做到行为改变的一些地区将经历指数级下降。但是，当人们的行为恢复正常时，一些地方会出现疫情反弹，而一些则将回到之前的指数级增长。未来的局面将比现在更加复杂并且差异化更大。
Have we overreacted? 我们反应过度了吗？
It is reasonable for people to ask whether the behavior change was necessary. Overwhelmingly, the answer is yes. There might be a few areas where the number of cases would never have gotten large numbers of infections and deaths, but there was no way to know in advance which areas those would be. The change allowed us to avoid many millions of deaths and extreme overload of the hospitals, which would also have increased deaths from other causes.
人们有理由提出疑问，这种行为的改变是否有必要？很显然，答案是肯定的。可能一些地区永远不会出现大量的感染和死亡病例，但我们无法预知会是哪些地区。行为的改变可以让我们避免数以百万计的死亡和医院的超负荷运转，后者会导致因其他原因造成的死亡增加。
The economic cost that has been paid to reduce the infection rate is unprecedented. The drop in employment is faster than anything we have ever experienced. Entire sectors of the economy are shut down. It is important to realize that this is not just the result of government policies restricting activities. When people hear that an infectious disease is spreading widely, they change their behavior. There was never a choice to have the strong economy of 2019 in 2020.
为降低感染率所付出的经济代价是史无前例的。就业率下降的速度超过我们以往的认知。许多行业都关停了。必须认识到这不仅仅是政府出台相关隔离政策的结果。当人们听说传染病正在广泛传播时，他们自己就会改变行为。像2019年那样强劲的经济增长在2020年是不可能看到的。
Most people would have chosen not to go to work or restaurants or take trips, to avoid getting infected or infecting older people in their household. The government requirements made sure that enough people changed their behavior to get the reproduction rate below 1.0, which is necessary to then have the opportunity to resume some activities.
大多数人会选择不去上班、不去餐馆、不去旅游，以避免自身感染或传染家中的老年人。政府的要求确保了有足够多的人改变了行为，以确保基本传染数小于1.0，这样将来才有机会恢复一些活动。
The wealthier countries are seeing reduced infections and starting to think about how to open up. Even as a government relaxes restrictions on behavior, not everyone will immediately resume the activities that are allowed. It will take a lot of good communication so that people understand what the risks are and feel comfortable going back to work or school. This will be a gradual process, with some people immediately doing everything that is allowed and others taking it more slowly. Some employers will take a number of months before they require workers to come back. Some people will want the restrictions lifted more rapidly and may choose to break the rules, which will put everyone at risk. Leaders should encourage compliance.
富裕国家的感染率正在下降并已经开始考虑如何解禁。即使政府放宽了对民众行为的限制，也不意味着每个人都可以立即恢复生产生活。这需要很多良好的沟通，才能让人们理解其中的风险，并安心重返工作或学校。这是一个循序渐进的过程，有些人会立即恢复正常生活，而另一些人可能会慢慢来。一些雇主可能会等几个月的时间才要求员工回来工作。有些人会希望限制措施更快解除，并可能选择违反规定，这将使所有人面临风险。领导者应鼓励大家遵守规则。
Differences among countries 国家之间的差异
The pandemic has not affected all countries equally. China was where the first infection took place. They were able to use stringent isolation and extensive testing to stop most of the spread. The wealthier countries, which have more people coming in from all over the world, were the next to be affected. The countries that reacted quickly to do lots of testing and isolation avoided large-scale infection. The benefits of early action also meant that these countries didn’t have to shut down their economies as much as others.
此次大流行对所有国家的影响并不相同。中国是最早发现感染的地方。他们能够实施严格的隔离和广泛的测试来阻止大面积传播。第二波遭受影响的是那些比较富裕的国家，因为有来自世界各地的人会涌向那里。那些反应迅速、进行大量测试并采取隔离措施的国家避免了大规模感染。尽早采取行动的好处还意味着这些国家不必像其他一些国家那样令经济停摆。
The ability to do testing well explains a lot of the variation. It is impossible to defeat an enemy we cannot see. So testing is critical to getting the disease under control and beginning to re-open the economy.
检测能力的高低导致了许多差异化的存在。我们无法打败看不见的敌人，检测对控制疾病并重新启动经济至关重要。
So far, developing countries like India and Nigeria account for a small portion of the reported global infections. One of the priorities for our foundation has been to help ramp up the testing in these countries so they know their situation. With luck, some factors that we don’t understand yet, like how weather might affect the virus’s spread, will prevent large-scale infection in these countries.
到目前为止，印度和尼日利亚等发展中国家在已报告的全球感染病例中只占很小一部分。盖茨基金会的首要任务之一就是帮助提高这些国家的检测水平，以便他们了解自己的状况。幸运的话，我们尚不了解的一些因素，例如天气或许会影响病毒的传播，可能防止这些国家出现大规模感染。
However, our assumption should be that the disease dynamics are the same as in other countries. Even though their populations are disproportionately young—which would tend to mean fewer deaths from COVID-19—this advantage is almost certainly offset by the fact that many low-income people’s immune systems are weakened by conditions like malnutrition or HIV. And the less developed a country’s economy is, the harder it is to make the behavior changes that reduce the the virus's reproduction rate. If you live in an urban slum and do informal work to earn enough to feed your family every day, you won’t find it easy to avoid contact with other people. Also, the health systems in these countries have far less capacity, so even providing oxygen treatment to everyone who needs it will be difficult.
但是，我们的假设应该是，这种疾病的表现在每个国家都是一样的。尽管他们的年轻人口比例特别高——这往往意味着死于新冠病毒的人数会更少——但几乎可以肯定的是这一优势会被抵消，因为营养不良或艾滋病病毒已经削弱了许多低收入人群的免疫系统。而且，一个国家的经济越不发达，就越难做到行为的改变以降低病毒的基本传染数。如果你生活在城市贫民区，每天做着非正式工作养家糊口，你会发现很难避免与他人接触。此外，这些国家的卫生系统能力远远不足，所以即使向有需要的人提供氧气治疗也很困难。
Tragically, it is possible that the total deaths in developing countries will be far higher than in developed countries.
令人悲哀的是，发展中国家的死亡人数可能远远高于发达国家。
What we need to learn我们需要学习什么
Our knowledge of the disease will help us with tools and policies. There are a number of key things we still don’t understand. A number of studies are being done to answer these questions, including one in Seattle done with the University of Washington. The global collaboration on these issues is impressive and we should know a lot more by the summer.
我们对疾病的了解将有助于我们开发工具和制定政策。有很多关键的事情我们仍然不明白，许多研究正在解答这些问题，其中就包括在西雅图的华盛顿大学进行的一项研究。在这些问题上的全球合作令人钦佩，到今年夏天我们应该会看到很多突破。
- Is the disease seasonal or weather dependent? Almost all respiratory viruses (a group that includes COVID-19) are seasonal. This would mean there are fewer infections in the summer, which might lull us into complacency when the fall comes. This is a matter of degree. Because we see the novel coronavirus spreading in Australia and other places in the Southern hemisphere, where the seasons are the opposite of ours, we already know the virus is not as seasonal as influenza is.
- 这种疾病是季节性的还是气候性的？ 几乎所有的呼吸道病毒（包括冠状病毒在内）都是季节性的。这意味着夏季感染病例会减少，而这可能会在秋季到来时使我们放松警惕。但这种季节性有个程度问题。因为我们看到新冠病毒正在澳大利亚和南半球的其他地方传播，而那里的季节与我们的相反，所以我们知道这种病毒不像流感那么具有季节性。
- How many people who never get symptoms have enough of the virus to infect others? What about people who are recovered and have some residual virus—how infectious are they? Computer models show that if there are a lot of people who are asymptomatic but infectious, it is much harder to open up without a resurgence in cases. There is a lot of disagreement about how much infection comes from these sources, but we do know that many people with the virus don’t report symptoms, and some portion of those might end up transmitting it.
- 有多少无症状感染者携带了足以感染他人的病毒？那些康复后还带有残留病毒的人，他们的传染性有多强？计算机模型显示，如果有很多人无症状却具备传染性，一旦解禁就很可能让疫情卷土重来。关于有多少感染来自这些无症状感染者有很多分歧，但我们知道很多人感染病毒后没有症状，而其中一些人最终传播了病毒。
- Why do young people have a lower risk of becoming seriously ill when they get infected? Understanding the dynamics here will help us weigh the risks of opening schools. It is a complicated subject because even if young people don’t get sick as often, they might still spread the disease to others.
- 为什么年轻人感染后重症的风险比较低？ 了解这种动态将有助于我们评估开学的风险。这是一个复杂的问题，因为即使年轻人不经常发病，他们仍可能将疾病传播给其他人。
- What symptoms indicate you should get tested? Some countries are taking the temperature of lots of people as an initial screening tool. If doing this helps us find more potential cases, we could use it at airports and large gatherings. We need to target the tests we have at the people at greatest risk since we don’t have enough tests for everyone.
- 出现什么症状表明你应该接受检测？一些国家把对大众的体温检测作为初步筛查的工具。如果这种方法有助于我们发现更多的潜在病例，我们可以在机场和大型集会上广泛使用它。我们需要针对高风险人群进行检测，因为我们没有足够的资源检测每个人。
- Which activities cause the most risk of infection? People ask me questions about avoiding prepared food or door knobs or public toilets so they can minimize their risk. I wish I knew what to tell them. Judgements will have to be made about different kinds of gatherings like classes or church going and whether some kind of spacing should be required. In places without good sanitation, there may be spread from fecal contamination since people who are infected shed the virus.
- 从事哪些活动导致感染的风险最大？人们会问我避免点外卖、碰触门把手或使用公共厕所是否可以最大程度地降低风险。我也希望我有答案。人们需要对不同类型的聚集进行判断，例如上课或参加教堂聚会，是否需要保持距离。在卫生条件不好的地方，病毒也会通过被感染者的粪便传播。
- Who is most susceptible to the disease? We know that older people are at much greater risk of both severe illness and death. Understanding how gender, race, and co-morbidities affect this is a work in progress.
- 谁最容易感染这种疾病？ 我们知道，老年人重症和死亡的风险要大得多。而针对性别、种族和并发症的影响的研究工作还在进行中。
The Gates Foundation’s role盖茨基金会的角色
In normal times, the Gates Foundation puts more than half of its resources into reducing deaths from infectious diseases. These diseases are the reason why a child in a poor country is 20 times more likely to die before the age of five than one in a rich country. We invest in inventing new treatments and vaccines for these diseases and making sure they get delivered to everyone who needs them. The diseases include HIV, malaria, tuberculosis, polio, and pneumonia. Whenever there is an epidemic like Ebola, SARS, or Zika we work with governments and the private sector to help model the risks and to help galvanize resources to create new tools to stop the epidemic. It was because of these experiences that I spoke out about the world not being ready for a respiratory epidemic in my 2015 TED talk. Although not enough was done, a few steps were taken to prepare, including the creation of the Coalition for Epidemic Preparedness Innovation, which I will discuss below, in the vaccine section.
通常情况下，盖茨基金会将其一半以上的资源用于减少传染病造成的死亡。这些疾病正是导致贫穷国家5岁以下儿童死亡率比发达国家高20倍的原因。我们投资研发针对这些疾病的新疗法和疫苗，并努力确保将它们提供给每一个有需要的人。这些疾病包括艾滋病、疟疾、结核病、脊髓灰质炎和肺炎。每当像埃博拉、非典型肺炎或寨卡这样的大流行病出现时，我们都会与政府和私营部门合作，帮助建立风险模型并调动资源开发新的工具来遏制疫情。正是基于这些经验，我在2015年的TED演讲中公开表示，世界还没有做好应对呼吸道传染病的准备。尽管做得还不够，但有一些准备工作还是启动了，包括建立流行病防范创新联盟（Coalition for Epidemic Preparedness Innovation，CEPI），我将在下面有关疫苗的部分对此进行讨论。
Now that the epidemic has hit, we are applying our expertise to finding the best ideas in each area and making sure they move ahead at full speed. There are many efforts going on. More than 100 groups are doing work on treatments and another 100 on vaccines. We are funding a subset of these but tracking all of them closely. It is key to look at each project to see not only its chance of working but also the odds that it can be scaled up to help the entire world.
疫情暴发后，我们正在运用所有的专业知识，在每个领域中寻找最好的想法，并确保它们得到全速推进。很多工作都在进行中，有超过100个团队正在研发新的治疗方法，而另外100个团队正在攻关疫苗。我们资助了其中一部分，但对所有项目的进展都密切关注。每个项目的关键不仅在于其成功的可能性，还要看它能否实现规模化来帮助整个世界。
One urgent activity is to raise money for developing new tools. I think of this as the billions we need to spend so we can save trillions. Every additional month that it takes to get the vaccine is a month when the economy cannot return to normal. However, it isn’t clear how countries will come together to coordinate the funding. Some could go directly to the private sector but demand that their citizens get priority. There is a lot of discussion among governments, the World Health Organization, the private sector, and our foundation about how to organize these efforts.
眼下极为紧迫的是为研发新工具筹集资金。我认为在这方面投资数十亿美元可以帮助我们最终节省数万亿美元。距离最终用上疫苗的时间每增加一个月，经济就会晚一个月恢复正常。但是，尚不清楚各国将如何合作来协调资金。有些国家可以直接寻求私营部门的帮助，但会要求其公民享有优先权。各国政府、世界卫生组织、私营部门和盖茨基金会就如何协调各方的努力进行了很多探讨。
Innovation to beat the enemy用创新战胜敌人
During World War II, an amazing amount of innovation, including radar, reliable torpedoes, and code-breaking, helped end the war faster. This will be the same with the pandemic. I break the innovation into five categories: treatments, vaccines, testing, contact tracing, and policies for opening up.Without some advances in each of these areas, we cannot return to the business as usual or stop the virus. Below, I go through each area in some detail.
第二次世界大战期间，包括雷达、鱼雷和破译密码在内的大量创新使战争得以更快地结束。大流行病也将如此。我将创新分为五个领域：治疗方法、疫苗、检测、接触者追踪和复工复产政策。如果在这些领域不能取得特定进展，我们将无法恢复正常或阻止病毒传播。下面，我将就每个领域做详细介绍。
Treatments 治疗方法
Every week, you will be reading about new treatment ideas that are being tried out, but most of them will fail. Still, I am optimistic that some of these treatments will meaningfully reduce the disease burden. Some will be easier to deliver in rich countries than developing countries, and some will take time to scale. A number of these could be available by the summer or fall.
每周你都会了解到一些新的治疗方法正在进行测试，但绝大多数都会失败。尽管如此，我仍乐观地认为，其中一些治疗方法将能够真正地减轻疾病负担。有些方法在发达国家要比在发展中国家更容易开展，还有一些则需要更多的时间才能扩大规模。很多疗法要到夏天或秋天才可能落地实施。
If in the spring of 2021 people are going to big public events—like a game or concert in a stadium—it will be because we have a miraculous treatment that made people feel confident about going out again. It’s hard to know precisely what the threshold is, but I suspect it is something like 95 percent; that is, we need a treatment that is 95 percent effective in order for people to feel safe in big public gatherings. Although it is possible that a combination of treatments will have over 95 percent effectiveness, it’s not likely, so we can’t count on it. If our best treatments reduce the deaths by less than 95 percent, then we will still need a vaccine before we can go back to normal.
如果在2021年的春天，人们纷纷去参加大型的公共活动，比如在体育场举办的比赛或演唱会，那将会是因为我们有了一个奇迹般的疗法，让人们有了再次出门的信心。目前很难给出精确的标准，我猜测是95%左右，也就是说，我们需要一种有效率达到95%的疗法，这样人们才能有足够的安全感去参与大型公开活动。尽管某种联合疗法可能达到95%以上的有效性，但这仅仅是种可能性，我们无法指望它。如果我们最好的治疗方法也不能将死亡降低95%的话，我们仍需要疫苗才能恢复正常生活。
One potential treatment that doesn’t fit the normal definition of a drug involves collecting blood from patients who have recovered from COVID-19, making sure it’s free of the coronavirus and other infections, and giving the plasma to people who are sick. The leading companies in this area are working together to get a standard protocol to see if this works. They will have to measure each patient to see how strong their antibodies are. A variant of this approach is to take the plasma and concentrate it into a compound called hyperimmune globulin, which is much easier and faster to give a patient than unconcentrated plasma. The foundation is supporting a consortium of most of the leading companies that work in this area to accelerate the evaluation and, if the procedure works, be ready to scale it up. These companies have developed a Plasma Bot to help recovered COVID-19 patients donate plasma for this effort.
有一种不符合常规药物定义的潜在疗法是从新冠肺炎康复者身上采集血液，确保它没有冠状病毒和其他感染，然后将血浆提供给其他病人。这个领域的领先公司正在共同努力制定一个标准化方案，以检验血浆疗法是否有效。他们必须检测每个病人的血液来确认抗体的强度。这种方法的一个变体是将血浆浓缩成一种称为超免疫球蛋白的化合物，可以比未经处理的血浆更容易也更快地提供给病人。盖茨基金会正在支持许多这一领域的领先企业加速评估进程，并在该方案证明有效的情况下做好规模化的准备。这些公司开发了血浆机器人程序（Plasma Bot）帮助已康复患者为这一治疗方案捐献血浆。
Another type of potential treatment involves identifying the antibodies produced by the human immune system that are most effective against the novel coronavirus. Once those antibodies have been found, they can be manufactured and used as a treatment or as a way to prevent the disease (in which case it is known as passive immunization). This antibody approach also has a good chance of working, although it’s unclear how many doses can be made. It depends on how much antibody material is needed per dose; in 2021, manufacturers may be able to make as few as 100,000 treatments or many millions. The lead times for manufacturing are about seven months in the best case. Our grantees are working to compare the different antibodies and make sure the best ones get access to the limited manufacturing capacity.
另一种可能的疗法是发现人体免疫系统所产生的抗体，这些抗体对新冠病毒是最为有效的。一旦我们找到这些抗体，就可以制造它们并用于治疗或作为预防疾病的方法（通常被称为“被动免疫”）。这种抗体疗法也很有可能起作用，虽然还不确定我们能够生产多少剂量，这取决于每一剂需要多少抗体。到2021年，我们可能能够生产出10万甚至数百万制剂。最好的情况下生产制剂的准备时间在7个月左右。我们资助的伙伴正在比较不同的抗体，以确保那些最好的能在产能有限的情况下被优先生产。
There is a class of drugs called antivirals, which keep the virus from functioning or reproducing. The drug industry has created amazing antivirals to help people with HIV, although it took decades to build up the large library of very effective triple drug therapies. For the novel coronavirus, the leading drug candidate in this category is Remdesivir from Gilead, which is in trials now. It was created for Ebola. If it proves to have benefits, then the manufacturing will have to be scaled up dramatically.
有一类药物被称作“抗病毒药物”，可以阻止病毒的作用或繁殖。制药行业已经制造出神奇的抗病毒药物来帮助艾滋病病毒携带者，尽管建立一个有效的三联药物疗法的庞大数据库用了几十年的时间。对于新冠病毒，这一类别的领先候选药物是来自吉利德公司的瑞德西韦，它目前正在临床试验中。瑞德西韦本是为应对埃博拉病毒而研发成功的，如果证明对新冠肺炎有效，那么则需要大幅扩大生产规模。
The foundation recently asked drug companies to provide access to their pipeline of developed antiviral drugs so researchers funded by the Therapeutics Accelerator can run a screen to see which should go into human trials first. The drug companies all responded very quickly, so there is a long list of antivirals being screened.
盖茨基金会最近要求制药公司开放他们正在开发的抗病毒药物管线，以便那些得到“（新冠肺炎）治疗加速器”（Therapeutics Accelerator）资助的研究人员能够筛选可率先进行人体试验的药物。这些制药公司都很快做出了回应，因此目前有一长串有待筛选的抗病毒药物。
Another class of drugs works by changing how the human body reacts to the virus. Hydroxychloroquine is in this group. The foundation is funding a trial that will give an indication of whether it works on COVID-19 by the end of May. It appears the benefits will be modest at best. Another type of drug that changes the way a human reacts to a virus is called an immune system modulator. These drugs would be most helpful for late-stage serious disease. All of the companies that work in this area are doing everything they can to help with trials.
另一类药物的工作原理是改变人体对病毒的反应方式。羟氯喹就属于这类药物。盖茨基金会正在资助一项试验，将在5月底之前证明它是否对新冠病毒有效。目前来看，它的疗效不大。另一种改变人类对病毒反应的药物被称为免疫系统调节剂，这些药物对严重的晚期重症最有疗效，该领域的所有公司都正在倾其所能进行试验。
Vaccines 疫苗
Vaccines have saved more lives than any other tool in history. Smallpox, which used to kill millions of people every year, was eradicated with a vaccine. New vaccines have played a key role in reducing childhood deaths from 10 million per year in 2000 to fewer than 5 million per year today.
疫苗挽救的生命比历史上任何其他工具都多。曾经造成每年数百万人死亡的天花，通过疫苗被根除。新开发的疫苗在减少儿童死亡人数方面发挥了关键作用，使儿童死亡人数从2000年的每年1000万减少到今天的每年不到500万。
Short of a miracle treatment, which we can't count on, the only way to return the world to where it was before COVID-19 showed up is a highly effective vaccine that prevents the disease.
我们不能只寄希望于奇迹般的治疗方法。要想让世界恢复到新冠肺炎出现之前的状态，唯一的办法就是用高效的疫苗来预防这种疾病。
Unfortunately, the typical development time for a vaccine against a new disease is over five years. This is broken down into: a) making the candidate vaccine; b) testing it in animals; c) safety testing in small numbers of people (this is known as phase 1); d) safety and efficacy testing in medium numbers (phase 2); e) safety and efficacy testing in large numbers (phase 3); and f) final regulatory approval and building manufacturing while registering the vaccine in every country.
遗憾的是，一种新疾病的疫苗开发通常需要5年以上。这个流程可以被细分为：a)制造候选疫苗；b)动物试验；c) 对小规模人群进行安全试验（1期临床试验）；d) 对中等规模人群进行安全和有效性试验（2期临床试验）; e)对大规模人群的安全和有效性试验（3期临床试验）；f)在每个国家进行疫苗注册时同步进行最终监管审批和生产制造准备。
Researchers can save time by compressing the clinical safety/efficacy phases while conducting animal tests and building manufacturing capacity in parallel. Even so, no one knows in advance which vaccine approach will work, so a number of them need to be funded so they can advance at full speed. Many of the vaccine approaches will fail because they won’t generate a strong enough immune response to provide protection. Scientists will get a sense of this within three months of testing a given vaccine in humans by looking at the antibody generation. Of particular interest is whether the vaccine will protect older people, whose immune systems don’t respond as well to vaccines.
通过在做临床安全及有效性试验的同时，平行开展动物试验以及产能建设，研究人员可以从中节省一些时间。即便如此，没有人能提前知道哪种疫苗会有效，所以我们需要资助若干疫苗开发，以便它们都能够全速推进。许多疫苗最终都会失败，因为它们无法产生足够强大的免疫反应保护人体。通过观察抗体的产生，我们预计将在三个月内从人体测试中得到答案。特别值得关注的是，疫苗是否能够保护老年人，因为他们的免疫系统对疫苗的反应并不是很理想。
The issue of safety is obviously very important. Regulators are very stringent about safety, to avoid side effects and also to protect the reputation of vaccines broadly, since if one has significant problems, people will become more hesitant to take any vaccines. Regulators worldwide will have to work together to decide how large the safety database needs to be to approve a COVID-19 vaccine.
安全问题显然是非常重要的。监管机构对于疫苗的安全性要求非常严格，一方面是为了避免副作用，另一方面也是为了广泛地保护疫苗的声誉。如果一个疫苗出现重大问题，人们就会因此对任何免疫接种犹豫不决。世界各地的监管机构将需要共同努力以决定需要多少安全性数据才能批准新冠肺炎疫苗。
One step that was taken after the foundation and others called for investments in pandemic preparedness in 2015 was the creation of the Coalition for Epidemic Preparedness Innovations (CEPI). Although the resources were quite modest, they have helped advance new approaches to making vaccines that could be used for this pandemic. CEPI added resources to work on an approach called RNA vaccines, which our foundation had been supporting for some time. Three companies are pursuing this approach. The first vaccine to start human trials is an RNA vaccine from Moderna, which started a phase 1 clinical safety evaluation in March.
盖茨基金会和其他组织在2015年共同呼吁对大流行病防范工作进行投资，并随后创建了流行病预防创新联盟。虽然资源相当有限，但该联盟帮助推进了新方法，可以用于这一次大流行病的疫苗开发。CEPI正在加大投入研究RNA疫苗，这种方法一直获得盖茨基金会的支持。现在，有三家公司正在采用这种疫苗开发手段。第一个开始人体试验的疫苗是来自Moderna的RNA疫苗，该疫苗于3月份开始了1期临床安全性评估。
An RNA vaccine is significantly different from a conventional vaccine. A flu shot, for example, contains bits of the flu virus that your body’s immune system learns to attack. This is what gives you immunity. With an RNA vaccine, rather than injecting fragments of the virus, you give the body the genetic code needed to produce lots of copies of these fragments. When the immune system sees the viral fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit.
RNA疫苗与传统疫苗有显著差异。例如，流感疫苗中含有少量流感病毒，而人体的免疫系统会学会攻击这些病毒，这就是人体获得免疫的方法。RNA疫苗并非注射病毒片段，而是给身体提供产生大量病毒片段副本所需的遗传密码。当免疫系统看到这些病毒片段，它会学习如何攻击它们。RNA疫苗本质上就是把人体变成自己的疫苗生产部门。
There are also at least five leading efforts that look promising and that use other approaches to teach the immune system to recognize and attack a viral infection. CEPI and our foundation will be tracking efforts from all over the world to make sure the most promising ones get resources. Once a vaccine is ready, our partner GAVI will make sure it is available even in low-income countries.
现在还有至少5种项目看起来很有希望，它们使用其他方法来“教会”免疫系统识别和攻击病毒感染。CEPI 和盖茨基金会将继续跟踪世界各地的项目，以确保最有前景的疫苗能获得资源。一旦疫苗准备就绪，我们的合作伙伴全球疫苗免疫联盟（Gavi）将确保低收入国家也能获得疫苗。
A big challenge for vaccine trials is that the time required for the trials depends on finding trial locations where the rate of infection is fairly high. While you are setting up the trial site and getting regulatory approval, the infection rate in that location could go down. And trials have to involve a surprisingly large number of people. For example, suppose the expected rate of infection is 1 percent per year and you want to run a trial where you would expect 50 people to be infected without the vaccine. To get a result in six months the trial would need 10,000 people in it.
疫苗试验的一大挑战是，试验所需的时间取决于找到高感染率的试验地点。而在设置试验站点并寻求监管机构批准的过程中，该地的感染率可能已经下降，而试验需要大量的人参与。举例来说，假设预期的感染率是每年1%，那你要开展的试验就预期有50人在没有接种疫苗的情况下被感染。那么，为了在6个月内得到结果，这个试验就需要10,000人参与。
The goal is to pick the one or two best vaccine constructs and vaccinate the entire world—that’s 7 billion doses if it is a single-dose vaccine, and 14 billion if it is a two-dose vaccine. The world will be in a rush to get them, so the scale of the manufacturing will be unprecedented and will probably have to involve multiple companies.
我们的目标是选择一到两种最好的疫苗，并为全世界人口进行疫苗接种——如果是单剂疫苗，那么就需要70亿剂；如果是两剂疫苗，则为140亿剂。全世界都将争相获得这些疫苗，因此生产疫苗的规模将是前所未有的，很可能需要多家公司参与。
I am often asked when large-scale vaccination will start. Like American’s top public health officials, I say that it is likely to be 18 months, even though it could be as short as nine months or closer to two years. A key piece will be the length of the phase 3 trial, which is where the full safety and efficacy are determined.
我常被问及大规模疫苗接种何时可以开始。和美国权威的公共卫生官员们的估计一样，我认为可能需要18个月，尽管也可能短至9个月或长至近2年。关键在于3期试验的时长，这将充分确保安全性和有效性。
When the vaccine is first being manufactured, there will be a question of who should be vaccinated first. Ideally, there would be global agreement about who should get the vaccine first, but given how many competing interests there are, this is unlikely to happen. The governments that provide the funding, the countries where the trials are run, and the places where the pandemic is the worst will all make a case that they should get priority.
当首批疫苗被产出时，将会出现一个问题：谁应该优先接种疫苗。理想情况下，全球应该就此达成共识。但鉴于存在太多相互竞争的利益关系，这种共识不太可能发生。那些提供资金的政府、进行临床试验的国家，以及疫情最严重的地方，都会提出他们应该得到优先接种的理由。
Testing 检测
All of the tests to date for the novel coronavirus involve taking a nasal swab and processing it in a Polymerase Chain Reaction (PCR) machine. Our foundation invested in research showing that having patients do the swab themselves, at the tip of the nose, is as accurate as having a doctor push the swab further down to the back of your throat. Our grantees are also working to design swabs that are cheap and able to be manufactured at large scale but work as well as ones that are in short supply. This self-swab approach is faster, protects health care workers from the risk of exposure, and should let regulators approve swabbing in virtually any location instead of only at a medical center. The PCR test is quite sensitive—it will generally show whether you have the virus even before you have symptoms or are infecting other people.
迄今为止，对新冠病毒的所有检测都包括鼻拭子采样并用聚合酶链式反应分析仪（PCR仪）对样本进行处理分析。盖茨基金会投资的一项研究证明了让患者自己在鼻腔前端采样，与医生将拭子一直深入咽喉采样一样准确。我们资助的伙伴也正在努力研发低价且能大规模生产的拭子，这种新型拭子会和那些供货不足的拭子一样好用。这种自查工具更加快捷，也避免了医护人员每次检测前都需要更换防护装备，监管机构应该批准在家自测，不用都去医疗中心。PCR检测非常灵敏——它通常会在患者出现症状或感染其他人之前就显示你已经感染了病毒。
There has been a lot of focus on the number of tests being performed in each country. Some, like South Korea, did a great job of ramping up the testing capacity. But the number of tests alone doesn’t show whether they are being used effectively. You also have to make sure you are prioritizing the testing on the right people. For example, health care workers should be able to get an immediate indication of whether they are infected so they know whether to keep working. People without symptoms should not be tested until we have enough tests for everyone with symptoms. Additionally, the results from the test should come back in less than 24 hours so you quickly know whether to continue isolating yourself and quarantining the people who live with you. In the United States, it was taking over seven days in some locations to get test results, which reduces their value dramatically. This kind of delay is unacceptable.
每个国家的检测数量一直是人们关注的焦点。一些国家，比如韩国，在提高检测能力方面做得非常好。但是，单看检测数量本身并不能说明它们得到了有效使用，还必须确保优先对适当人群进行检测。例如，医务工作者应该可以立即得到检测结果来确定他们是否能够继续工作。而在我们有足够的能力为每个有症状的人提供检测之前不该检测那些未出现症状的人。此外，检测结果应该在24小时内出来，这样就可以尽快知道你是否要继续隔离自己和那些与你住在一起的人。美国有些地方需要7天以上才能得到检测结果，这大大降低了检测的价值，这样的滞后是不能接受的。
There are two types of PCR machines: high-volume batch processing machines and low-volume machines. Both have a role to play. The high-volume machines provide most of the capacity. The low volume machines are better when getting a result in less than an hour is beneficial. Everyone who makes these machines, and some new entrants, are making as many machines as they can. Adding this capacity and making full use of the machines that are already available will increase the testing capacity. The foundation is talking to the manufacturers about different ways to run the big machines that could make them more than twice as productive.
PCR仪有两种类型：大批量处理机和小批量处理机，两种都有各自适用的场景。大批量处理机提供了大量的检测能力，小批量处理机有利于在一个小时内得到检测结果。原有的以及新加入的PCR仪器制造商都在竭尽所能地生产。加大产能并充分利用已有的仪器将会增加检测能力。盖茨基金会也正在与制造商讨论如何以不同的方法运行这些大机器从而让它们的效率提高一倍以上。
Another type of test being developed is called a Rapid Diagnostic Test (RDT). This would be like an in-home pregnancy test. You would swab your nose the same way as for the PCR test, but instead of sending it into a processing center, you would put it in a liquid container and then pour that liquid onto a strip of paper that would change color if it detects the virus. This form of test may be available in a few months. Even though it won’t be as sensitive as a PCR test, for someone who has symptoms it should be quite accurate. You would still need to report your test result to your government since they need visibility into the disease trends.
另一种正在开发的检测方法叫做快速诊断检测（Rapid Diagnostic Test, RDT）。这种检测就像家用验孕棒一样。你可以用PCR检测的方法进行鼻拭子采样，但不用送到检测中心，只要把样本放入容器中，再把液体倒在试纸上。如果检测到病毒，试纸就会变色。这种快速检测可能在几个月后就可以使用了。尽管可能不如PCR检测一般灵敏，但对于那些已经出现症状的人来说，这种检测方法还是相当准确的。你仍然需要向当地政府报告检测结果，因为他们仍需要借此了解疾病发展趋势。
A lot of people talk about the serology test, where you give blood and it detects whether you have antibodies against the virus. If you do, it means you have been exposed. These tests only show positive results late in your disease, so they do not help you decide whether to quarantine. Also, all the tests done so far have problems with false positives. Until we understand what level of antibodies is protective and have a test with almost no false positives, it is a mistake to tell people not to worry about their exposure to infection based on the serology tests that are available today. In the meantime, serology tests will be used to see who can donate blood and to understand the disease dynamics.
许多人也在谈论血清检测，这种检测方法是利用血液样本来检测人体是否含有对抗病毒的抗体。如果含有抗体，这就意味着你已经暴露于病毒了。然而，这种检测方法只能在疾病后期才能检测出阳性，所以无法帮助人们决定是否要自主隔离。此外，到目前为止所有检测方法都存在有假阳性的问题。除非我们已经了解什么水平的抗体才是具有保护性的，并且研发出一个几乎没有假阳性的检测方法，否则基于现有的血清检测就告诉人们不要担心感染是错误的。与此同时，血清检测将被用来了解谁可以献血及疾病动态。
A lot of countries did a good job focusing the PCR capacity on the priority patients. Most countries had their government play a central role in this process. In the United States, there is no system for making sure the testing is allocated rationally. Some states have stepped in, but even in the best states, the access isn’t fully controlled.
许多国家在集中PCR检测能力用于紧急患者方面做得很好。大多数国家的政府在这一进程中都发挥着核心作用。美国目前还没有一套可以确保检测能力合理分配的制度。一些州政府已经介入，但即使在做的最好的州，也没有完全掌控检测能力的分配。
Testing becomes extremely important as a country considers opening up. You want to have so much testing going on that you see hot spots and are able to intervene by changing policy before the numbers get large. You don’t want to wait until the hospitals start to fill up and the number of deaths goes up.
当一国考虑开放边境时，检测将变得极其重要。你会希望检测越多越好，以便看到发病热点区域，并且能够在数据激增之前通过改变政策进行干预。你不希望等到医院人满为患、死亡人数上升时才开始注重检测。
Basically, there are two critical cases: anyone who is symptomatic, and anyone who has been in contact with someone who tested positive. Ideally both groups would be sent a test they can do at home without going into a medical center. Tests would still be available in medical centers, but the simplest is to have the majority done at home. To make this work, a government would have to have a website that you go to and enter your circumstances, including your symptoms. You would get a priority ranking, and all of the test providers would be required to make sure they are providing quick results to the highest priority levels. Depending on how accurately symptoms predict infections, how many people test positive, and how many contacts a person typically has, you can figure out how much capacity is needed to handle these critical cases. For now, most countries will use all of their testing capacity for these cases.
基本上有两种情况应该接受检测，一种是有症状的人，另一种是任何与检测呈阳性病例有过接触的人。理想情况是，上述的两类人员都可以在家检测，而无需前往医疗中心。你仍然可以在医疗中心进行检测，但最简单的方法是让大多数人在家里完成检测。要实现这一点，政府必须建立一个网站，供人们访问并提交包括症状在内的相关情况。你会就此得到一个优先级排序，最后应确保所有检测中心可以根据优先级提供快速的检测结果。根据由症状预测感染的准确程度、检测出阳性的人数，以及一个人通常有多少接触者，你可以计算出处理这些病例所需要的资源。目前，绝大多数的国家都将使用其所有的检测能力来应对新冠病例。
There will be a temptation for companies to buy testing machines for their employees or customers. A hotel or cruise ship operator would like to be able to test everyone even if they don’t have symptoms. They will want to get PCR machines that give quick results or the rapid diagnostic test. These companies will be able to bid very high prices—well above what the public health system would bid—so governments will have to determine when there is enough capacity to allow this.
企业将倾向于为员工或客户购买检测设备。酒店或游轮运营商也希望能够检测每个客人，即使他们没有症状。他们希望获得PCR仪或快速诊断检测工具以尽快获得检测结果，而这些公司出价很高——远高于公共卫生系统——因此政府必须确定何时才有足够的检测能力可以允许这样的情况发生。
One assumption is that people who need to get tested will isolate themselves and quarantine those in their household. Some governments police this carefully, whereas others simply assume people will follow the recommendation. Another issue is whether a government provides a place for someone to isolate themselves if they can’t do it at their home. This is particularly important if you have older people in close quarters at your house.
一种假设是，需要接受检测的人都会把自己和家人隔离起来。有些政府对此进行严格的监管，而有些政府则简单地设想人们会自发遵循隔离建议。另一个问题是，如果不能在家隔离，政府是否能够提供隔离的场所。当家里有老人时，这一点尤其重要。
Contact tracing 接触者追踪
I mentioned in the testing section that one of the key priorities for testing is anyone who has been in close contact with someone who has tested positive. If you can get a list of these people quickly and make sure they are prioritized for a test like the PCR test (which is sensitive enough to detect a recent infection), then these people can isolate themselves before they infect other people. This is the ideal way of stopping the spread of the virus.
我在检测部分提到，为测试结果呈阳性患者的密切接触者提供检测是工作重点之一。如果你能够迅速拿到这些人的名单，确保他们可以优先进行PCR检测 （这些检测足够灵敏可以甄别出近期感染患者），那么在传染其他人之前，这些人就能够进行自我隔离。这是阻断病毒传播的理想方式。
Some countries, including China and South Korea, required patients to turn over information about where they have been in the last 14 days by looking at GPS information on their phone or their spending records. It is unlikely that Western countries will require this. There are applications you can download that will help you remember where you have been; if you ever test positive, then you can voluntarily review the history or choose to share it with whoever interviews you about your contacts.
包括中国、韩国在内的一些国家要求患者通过手机GPS信息或消费记录，来提供他们过去14天行踪信息。而在另外一些国家，你可以通过下载一些应用程序来帮助你回忆之前去过的地方。如果你的检测结果呈阳性，你可以自主查看相关历史记录，或选择分享给前来询问你过去接触史的人。
A number of digital approaches are being proposed where phones detect what other phones are near them. (It would involve using Bluetooth plus sending a sound out that humans can’t hear but that verifies that the two phones are reasonably close to each other.) The idea is that if someone tests positive then their phone can send a message to the other phones and their owners can get tested. If most people voluntarily installed this kind of application, it would probably help some. One limitation is that you don’t necessarily have to be in the same place at the same time to infect someone—you can leave the virus behind on a surface. This system would miss this kind of transmission.
很多诸如让手机探测周围手机的数字解决方案正在被提出来（这将涉及到使用蓝牙，以及发送一个人耳无法听到的声音，来验证两部手机是否离得很近）。这个方法是如果有人检测结果呈阳性，那他的手机可以给其他手机发送信息，让这些手机的持有者也进行检测。如果大多数人都自愿安装这样的应用程序，这或许能够有些帮助。一个不足之处在于，你不一定要通过直接接触感染他人——你可能会将病毒留在物体表面，而这一方法会遗漏这种传播方式。
I think most countries will use the approach that Germany is using, which requires interviewing everyone who tests positive and using a database to make sure there is follow-up with all the contacts. The pattern of infections is studied to see where the risk is highest and policy might need to change.
我认为很多国家将采取德国的方式，他们会询问每一个检测结果呈阳性的患者，并使用数据库来确保对所有接触者都进行追踪。通过研究感染的模式，来了解哪里风险最高，哪些政策可能需要改变。
In Germany, if someone is tested and confirmed positive, the doctor is legally required to inform the local government health office. The doctor must provide all personal data—name, address, phone number—so that the health office can contact the person and ensure they isolate themselves.
在德国，如果有人检测结果确认为阳性，医生必须依法通知当地卫生部门。医生必须提供患者的个人信息，包括姓名、地址、手机号码等，以便卫生部门能够联系到此人，并确保他们进行自我隔离。
Then the local health office begins the process of contact tracing. They interview the infected person, find out how to contact all the people he or she has met in the past couple of weeks, and contact those people to ask them to self-isolate and get a test.
随后，当地卫生部门开始进行接触者追踪。他们会与感染者沟通，找出他们过去几周的接触者，联系这些人并让他们进行自我隔离与检测。
This approach relies on the infected person to report their contacts accurately, and also depends on the ability of the health authorities to follow up with everyone. The normal health service staff can’t possibly do all this work even if the case numbers are fairly low. Every health system will have to figure out how to staff up so that this work is done in a timely fashion. Everyone who does the work would have to be properly trained and required to keep all the information private. Researchers would be asked to study the database to find patterns of infection, again with privacy safeguards in place.
这种方式既依赖感染者准确地报告他们的接触人群，又要看卫生部门是否有能力对每一个人进行追踪。即使在确诊病例数很少的情况下，常规卫生工作者也不可能完成这一切。每一个卫生系统都要想办法配备更多人员，以便及时完成这项工作。每一位从事此工作的人员必须接受相应的培训，并要求其对相关信息保密。研究者会被要求通过数据库发现感染的模式，同时需要再次强调隐私保护措施。
Opening up 重新开放
Most developed countries will be moving into the second phase of the epidemic in the next two months. In one sense, it is easy to describe this next phase. It is semi-normal. People can go out, but not as often, and not to crowded places. Picture restaurants that only seat people at every other table, and airplanes where every middle seat is empty. Schools are open, but you can’t fill a stadium with 70,000 people. People are working some and spending some of their earnings, but not as much as they were before the pandemic. In short, times are abnormal but not as abnormal as during the first phase.
大多数发达国家将会在未来两个月内进入疫情的第二阶段，从某种意义上来说，这个阶段很容易描述——半正常状态。人们可以外出，但并不像以前那样频繁，也不会去人多的地方。想象一下餐馆中人们隔桌就餐、飞机上每排中间的座位是空出来的场景，或者学校开学但是不会出现一个体育场坐满七万多人的情况。人们会做一些工作，有一些消费，但不像大流行病到来之前他们所做的那样。总之，这段时间人们的生活会受到影响，但也不像第一阶段那么不正常。
The rules about what is allowed should change gradually so that we can see if the contact level is starting to increase the number of infections. Countries will be able to learn from other countries that have strong testing systems in place to inform them when problems come up.
对活动限制的放宽应该逐渐调整，这样我们就可以观察，增加接触程度是否会导致感染人数的增加。各国可以向其他拥有强大检测体系从而能及时发现问题的国家学习。
One example of gradual reopening is Microsoft China, which has roughly 6,200 employees. So far about half are now coming in to work. They are continuing to provide support to employees who want to work at home. They insist people with symptoms stay home. They require masks and provide hand sanitizer and do more intensive cleaning. Even at work, they apply distancing rules and only allow travel for exceptional reasons. China has been conservative about opening up and has so far avoided any significant rebound.
微软中国是逐步复工的一个例子，它有大概6200名员工。目前有大约半数的员工回到了工作岗位。公司继续为希望在家办公的员工提供支持，并要求有症状的人待在家里。公司要求员工佩戴口罩、提供洗手液，并进行更密集的清洁消毒工作。即使在工作中，也要求员工保持一定社交距离，特殊情况下才允许出差。对于复工复产，中国一直保持谨慎的态度，截至目前没有出现明显的疫情反弹。
The basic principle should be to allow activities that have a large benefit to the economy or human welfare but pose a small risk of infection. But as you dig into the details and look across the economy, the picture quickly gets complicated. It is not as simple as saying “you can do X, but not Y.” The modern economy is far too complex and interconnected for that.
基本原则应该是允许那些对经济或人民福利有较大好处且感染风险较小的活动。然而，当你深入细节、审视经济方方面面时，情况很快就会变得复杂起来。你无法简单的说“可以做这个，但不能做那个”，因为现代经济是非常复杂且紧密连接的。
For example, restaurants can keep diners six feet apart, but will they have a working supply chain for their ingredients? Will they be profitable with this reduced capacity? The manufacturing industry will need to change factories to keep workers farther apart. Most factories will be able to adapt to new rules without a large productivity loss. But how do the people employed in these restaurants and factories get to work? Are they taking a bus or train? What about the suppliers who provide and ship parts to the factory? And when should companies start insisting their employees show up at work?
举例来说，餐厅可以让食客相互保持六尺（约1.8米）的距离，但是否有供应链为餐厅提供相应的食材？在如此低上座率的情况下，他们是否可以盈利？制造业需要调整工厂设施，以便让工人之间保持较远的距离。大多数工厂能够在没有很大生产力损失的情况下适应新的规定。但在这些餐馆和工厂的员工将如何上班？他们会搭乘公共汽车或轨道交通吗？那些为工厂提供和运输零件的供应商怎么办？企业应该从什么时候开始要求员工回到公司上班呢？
There are no easy answers to these questions. Ultimately, leaders at the national, state, and local levels will need to make trade-offs based on the risks and benefits of opening various parts of the economy. In the United States it will be tricky if one state opens up too fast and starts to see lots of infections. Should other states try to stop people moving across state boundaries?
这些问题都没有简单的答案。最终，国家、州、地方各级领导人都需要根据恢复经济不同部分的风险与收益进行权衡。在美国，如果一个州复工复产的速度过快，开始出现大量的感染，其他州是否应该阻断人们跨州移动呢？这就可能让问题变得棘手。
Schools offer a big benefit and should be a priority. Large sporting and entertainment events probably will not make the cut for a long time; the economic benefit of the live audience doesn’t measure up to the risk of spreading the infection. Other activities fall into a gray area, such as church services or a high school soccer game with a few dozen people on the sidelines.
复学的好处有很多，应该被优先考虑。大型体育及娱乐活动可能很长一段时间内都不会恢复正常，现场观众带来的经济收益与感染传播的风险无法相提并论。其他活动，例如教会活动或几十人在场边观看的高中足球比赛，则属于中间地带。
There is one other factor that is hard to account for: human nature. Some people will be naturally reluctant to go out even once the government says it is okay. Others will take the opposite view—they will assume that the government is being overly cautious and start bucking the rules. Leaders will need to think carefully about how to strike the right balance here.
还有一个很难计算的因素：人性。有些人不愿意出门，即便政府说这是可以的。另外一些人则完全相反，认为政府是过度谨慎，于是开始违背规则。领导人需要认真考虑在这方面如何取得平衡。
Conclusion 结语
Melinda and I grew up learning that World War II was the defining moment of our parents’ generation. In a similar way, the COVID-19 pandemic—the first modern pandemic—will define this era. No one who lives through Pandemic I will ever forget it. And it is impossible to overstate the pain that people are feeling now and will continue to feel for years to come.
梅琳达和我从小就知道，第二次世界大战是我们父母那一代人经历的决定性时刻，影响了他们的一生。同样，新冠肺炎——第一个现代大流行病——也将重新定义我们这个时代。经历过这个“1号现代大流行病”的人永远都不会忘记它。人们在当下正在经历的痛苦，和那些在今后几年里仍将持续感受到的痛苦，怎么描述都不为过。
The heavy cost of the pandemic for lower-paid and poor people is a special concern for Melinda and me. The disease is disproportionately hurting poorer communities and racial minorities. Likewise, the economic impact of the shutdown is hitting low-income, minority workers the hardest. Policymakers will need to make sure that, as the country opens up, the recovery doesn’t make inequality even worse than it already is.
这次大流行病给低收入者和贫困人群造成的沉重代价，是梅琳达和我特别关切的问题。这种疾病对贫困社区和少数族裔的伤害尤其大。同样，经济停摆对低收入群体和少数族裔的工薪阶层造成的影响也是最严重的。决策者需要确保随着国家的重新开放，经济复苏不会加剧不平等现象的恶化。
At the same time, we are impressed with how the world is coming together to fight this fight. Every day, we talk to scientists at universities and small companies, CEOs of pharmaceutical companies, or heads of government to make sure that the new tools I’ve discussed become available as soon as possible. And there are so many heroes to admire right now, including the health workers on the front line. When the world eventually declares Pandemic I over, we will have all of them to thank for it.
同时，世界各国正在齐心协力打好这场战役，这让我们深为感佩。每一天，我们都在与科学家们、制药企业的CEO们以及政府的领导人们进行交流，希望前面谈到的那些创新解决方案能够早日问世。每一天，都有太多的英雄人物值得敬仰，尤其是那些奋战在一线的医护工作者们。当世界最终宣布1号现代大流行病结束时，我们应该对他们所有人道一声感谢。
