<p class="ql-block" style="text-align: center;"><span style="font-size: 18px;">文/克里斯托弗·默里</span></p><p class="ql-block" style="text-align: center;"><span style="font-size: 15px;"> 原載：柳葉刀</span></p> <p class="ql-block" style="text-align: center;"><b style="font-size: 20px;">《柳葉刀》：</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 20px;">新冠病毒將持續(xù)存在</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 20px;">但是大流行疫情</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 20px;">即將終結(jié)</b></p><p class="ql-block">1月19日，《柳葉刀》雜志線上發(fā)表了數(shù)篇有關(guān)奧密克戎的文章，其中最引人注目的是由華盛頓大學(xué)健康指標(biāo)與評(píng)估研究所（IHME）主任默里（Chris Murray）撰寫(xiě)的一篇評(píng)論。從1990年開(kāi)始，默里一直專注于研究全球疾病造成的社會(huì)負(fù)擔(dān)。自疫情爆發(fā)以來(lái)，該所以對(duì)病死率的預(yù)測(cè)準(zhǔn)確而著稱。</p><p class="ql-block" style="text-align: center;"><b style="font-size: 22px;">本文可謂</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 22px;">對(duì)于目前疫情最</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 22px;">大膽的預(yù)測(cè)</b></p><p class="ql-block">默里指出全球新冠大流行很可能會(huì)在不久后結(jié)束，標(biāo)志時(shí)間節(jié)點(diǎn)為2022年3月。在這篇評(píng)論中，默里基于其研究所的模型提出了幾項(xiàng)預(yù)測(cè)：</p><p class="ql-block">1、奧密克戎正以前所未有的速度席卷全球，但當(dāng)中絕大多數(shù)為無(wú)癥狀感染；</p><p class="ql-block">2、盡管重癥率直線下降，但住院人數(shù)仍在上升，未來(lái)4-6周衛(wèi)生系統(tǒng)吃緊；</p><p class="ql-block">3、各種公共衛(wèi)生措施，包括佩戴口罩、推進(jìn)第三針等，從人口層面而言都難以遏制奧密克戎浪潮；</p><p class="ql-block">4、今年3月，全球半數(shù)以上人口將感染奧密克戎，感染病毒以及疫苗接種將使得全球免疫力達(dá)到高水平；</p><p class="ql-block">5、未來(lái)新冠病毒還會(huì)卷土重來(lái)，但大流行將銷(xiāo)聲匿跡。</p><p class="ql-block"><b style="font-size: 22px;">正文：</b></p><p class="ql-block">The world isexperiencing a huge wave of infection with the omicron variant of SARS-CoV-2. Estimates based on Institute for <b>Health Metrics and Evaluation (IHME，健康指標(biāo)和評(píng)估)</b> models suggest that on around Jan 17, 2022 there were 125 million omicron infections a day in the world, which is more than ten times the peak of the delta wave in April, 2021. The omicron wave is <b>inexorably（[?n?eks?r?bli]，adj. 無(wú)情地，不可阻擋地）</b> reaching every continent with only a few countries in eastern Europe, North Africa, southeast Asia, and Oceania yet to start their wave of this SARS-CoV-2 variant.</p><p class="ql-block">世界正經(jīng)歷一場(chǎng)巨大的新冠變種奧密克戎感染浪潮。IHME模型的預(yù)測(cè)表明，在2022年1月17日左右，<b>全球每天奧密克戎感染者達(dá)到1.25億</b>，超過(guò)2021年4月德?tīng)査逯档?0倍。奧密克戎浪潮正在毫不容情地席卷全球每個(gè)大陸，只有東歐、北非、東南亞和大洋洲的少數(shù)幾個(gè)國(guó)家尚未受到波及。</p> <p class="ql-block"> The unprecedented level of infection suggests that more than 50% of the world will have been infected with omicron between the end of November, 2021 and the end of March, 2022. Although IHME models suggest that global daily SARS-CoV-2 infections have increased by more than 30 times from the end of November, 2021 to Jan 17, 2022, reported COVID-19 cases in this period have only increased by six times. Because the proportion of cases that are <b>asymptomatic （無(wú)癥狀的）</b>or <b>mild（輕微癥狀的）</b> has increased compared with previous SARS-CoV-2 variants, the global infection-detection rate has declined globally from 20% to 5%.</p><p class="ql-block">這樣前所未有的感染水平表明，<b>2021年11月底至2022年3月底期間，全世界超過(guò)半數(shù)的人口將感染奧密克戎毒株</b>。盡管IHME模型顯示，從2021年11月底到2022年1月17日，全球每天新冠感染量增加了30多倍，但在此期間報(bào)告的新冠肺炎病例僅增加了6倍。相比以往的新冠變異病毒，奧密克戎無(wú)癥狀或輕癥病例的比例顯著增加，因此全球感染檢出率從20%降至5%。</p> <p class="ql-block" style="text-align: center;"><span style="font-size: 22px;">全球感染人數(shù)及預(yù)測(cè)</span></p><p class="ql-block">Understanding the burden of omicron depends crucially on the proportion of asymptomatic infections. A systematic review based on previous SARS-CoV-2 variants suggested that 40% of infections were asymptomatic. <b>Evidence suggests that the proportion of asymptomatic infections is much higher for omicron, perhaps as high as 80–90%. </b>Garrett and colleagues found that among 230 individuals in South Africa <b>enrolling（v. 報(bào)名參加，注冊(cè)，加入）</b> in a clinical trial, 71 (31%) were PCR positive for SARS-CoV-2 and had the omicron variant and no symptoms. Assuming this prevalence of infection was representative（n. 代表） of the population, the implied <b>incidence (發(fā)病率，發(fā)生率）</b>compared to detected cases suggests that <b>more than 90% of infections were asymptomatic in South Africa. </b></p><p class="ql-block">正確理解奧密克戎所造成的社會(huì)負(fù)擔(dān)，很大程度上在于無(wú)癥狀感染率。以往新冠變異病毒的系統(tǒng)性回顧表明無(wú)癥狀感染比例約為40%。<b>有證據(jù)表明，奧密克戎無(wú)癥狀感染率則遠(yuǎn)高于此，可能高達(dá)80-90%。</b>在南非參與臨床試驗(yàn)的230名志愿者中，有71人（31%）新冠 PCR測(cè)試呈陽(yáng)性，并感染奧密克戎病毒且完全無(wú)癥狀。假設(shè)上述感染率足以代表整體人口，通過(guò)對(duì)比確診病例和隱含發(fā)病率可看出，<b>在南非，超過(guò)90%的奧密克戎感染者沒(méi)有出現(xiàn)任何癥狀。</b></p> <p class="ql-block">The UK Office for National Statistics (ONS) infection survey estimated a point <b>prevalence（流行，盛行）</b> of PCR positive SARS-CoV-2 infection of 6·85% for England on Jan 6, 2022. </p><p class="ql-block">英國(guó)國(guó)家統(tǒng)計(jì)局（ONS）新冠感染調(diào)查估計(jì)，2022年1月6日，英國(guó)該時(shí)點(diǎn)PCR陽(yáng)性率為6.85%，也就是當(dāng)時(shí)每15人中有一人感染新冠病毒。</p><p class="ql-block">Hospital admission <b>prescreening（初篩）</b> of individuals without COVID-19 symptoms in the University of Washington Medical Center in Seattle, WA, USA, did not exceed 2% throughout the COVID-19 pandemic but exceeded 10% in the week of Jan 10, 2022 (Murray CJL, unpublished). In addition to the much larger proportion of asymptomatic infections, in the USA the ratio of COVID-19 hospitalisations to detected cases hospitalised has declined by about 50% in most states compared with previous peaks. <b>The proportion of COVID-19 patients in hospital who require intubation （氣管插管）or are dying has declined by as much as 80–90% in Canada and South Africa.</b></p><p class="ql-block">華盛頓州西雅圖的華盛頓大學(xué)醫(yī)學(xué)中心在對(duì)未出現(xiàn)新冠癥狀的患者進(jìn)行入院前篩查時(shí)發(fā)現(xiàn)，整個(gè)新冠疫情期間感染新冠者均不及2%，但是2022年1月10日那一周超過(guò)了10%。在無(wú)癥狀感染率飆升的同時(shí)，在美國(guó)大多數(shù)州，新冠住院與確診比例較此前峰值下降約50%。<b>在加拿大和南非，新冠住院患者中需要插管或?yàn)l臨死亡者的比例下降了80-90%。</b></p> <p class="ql-block">Despite the reduced disease severity per infection, the massive wave of omicron infections means that hospital admissions are increasing in many countries and will rise to twice or more the number of COVID-19 hospital admissions of past surges in some countries according to the IHME models. In countries where all hospital admissions are screened for COVID-19, a substantial proportion of these admissions will be among individuals coming to hospital for non-COVID-19 reasons who have asymptomatic SARS-CoV-2 infection. </p><p class="ql-block">盡管重癥率直線下降，但奧密克戎感染的巨大浪潮還是導(dǎo)致很多國(guó)家住院人數(shù)不斷上升，根據(jù)IHME模型，部分國(guó)家新冠住院患者人數(shù)比以往激增兩倍或更多。在所有入院患者均需接受新冠篩查的國(guó)家，為數(shù)眾多的新冠住院患者不是因?yàn)樾鹿谌朐旱臒o(wú)癥狀感染者。</p><p class="ql-block">Nevertheless, infection control requirements put increased demands on hospitals. Given population prevalence of SARS-CoV-2 infection of more than 10%, such as reported by the ONS infection survey in London, England, large numbers of health workers are testing positive and are required to <b>quarantine（隔離）</b>, which puts a double pressure on hospitals. 盡管如此，感染控制的需要讓醫(yī)院不堪重負(fù)?？紤]到整體人口的新冠感染率已超過(guò)10%，例如，據(jù)英國(guó)國(guó)家統(tǒng)計(jì)局在倫敦的感染調(diào)查報(bào)告，大量醫(yī)務(wù)工作者因新冠檢測(cè)呈陽(yáng)性而需要隔離，從而對(duì)醫(yī)院造成雙重壓力。Countries will need to <b>prioritise （優(yōu)先）</b>support for health systems in the next 4–6 weeks. Data from Greece, however, hold out hope that severe COVID-19 outcomes from the omicron wave will be limited; from Dec 21, 2021 to Jan 17, 2022， COVID-19 cases increased nearly 10 times but hospital intubations among COVID-19 hospital patients have remained the same as in December.未來(lái)4-6周內(nèi)，各國(guó)應(yīng)該對(duì)醫(yī)療衛(wèi)生系統(tǒng)予以優(yōu)先支持。不過(guò)，源自希臘的數(shù)據(jù)讓人看到希望：奧密克戎浪潮導(dǎo)致的重癥患者為數(shù)有限；<b>2021年12月21日至2022年1月17日間，雖然新冠病例增加近10倍，但新冠住院患者的插管率與12月持平</b>。</p> <p class="ql-block">Surprisingly, IHME models suggest that the transmission intensity of omicron is so high that policy actions—eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines—taken in the next weeks will have limited impact on the course of the omicron wave. IHME estimates suggest that increasing use of masks to 80% of the population, for example, will only reduce <b>cumulative（積累的，累計(jì)的）</b> infections over the next 4 months by 10%. Increasing COVID-19 vaccine boosters or vaccinating people who have not yet been vaccinated is unlikely to have any substantial impact on the omicron wave because by the time these interventions are scaled up the omicron wave will be largely over. 出人意料的是，IHME模型表明奧密克戎的傳染強(qiáng)度高得異乎尋常，因此未來(lái)數(shù)周內(nèi)，包括佩戴口罩，擴(kuò)大疫苗接種率，或施打疫苗加強(qiáng)針等在內(nèi)的新冠防控舉措對(duì)奧密克戎的傳播進(jìn)程造成的影響均極為有限。例如，<b>IHME的估計(jì)表明，即使80%整體人口均佩戴口罩，未來(lái)4個(gè)月內(nèi)也只能讓總感染人數(shù)減少10%</b>。擴(kuò)大疫苗接種率或施打加強(qiáng)針也無(wú)法對(duì)抑制奧密克戎傳播產(chǎn)生實(shí)質(zhì)性影響。因?yàn)楫?dāng)這些措施開(kāi)始奏效時(shí)，奧密克戎浪潮已經(jīng)基本宣告終結(jié)。</p><p class="ql-block">Only in countries where the omicron wave has not yet started can expanding mask use in advance of the wave have a more substantial effect. These interventions still work to protect individuals from COVID-19,but the speed of the omicron wave is so fast that policy actions will have little effect on its course globally in the next 4–6 weeks. The omicron wave appears to <b>crest（峰值）</b> in 3–5 weeks after the <b>exponential （[?eksp??nen?l] ，adj. 指數(shù)級(jí)的）</b>increase in reported cases begins.只有奧密克戎尚未開(kāi)始肆虐的國(guó)家，在疫情擴(kuò)散前就提高口罩佩戴率才能產(chǎn)生更具實(shí)質(zhì)性的效果。這些防控措施依然可保護(hù)大家免遭感染，但由于奧密克戎的傳染速度極為迅速，<b>未來(lái)4-6周內(nèi)，疫情防控措施對(duì)其全球擴(kuò)散幾乎毫無(wú)作用。</b>奧密克戎似乎將在確診病例呈指數(shù)級(jí)增長(zhǎng)后的3-5周內(nèi)達(dá)到峰值。</p> <p class="ql-block">As of Jan 17,2022, omicron waves were peaking in 25 countries in five WHO regions and in 19 states in the USA. It is expected that the omicron peak will occur in most countries between now and the second week of February, 2022. 截至2022年1月17日，奧密克戎浪潮已在五個(gè)世衛(wèi)組織區(qū)域的25個(gè)國(guó)家和美國(guó)的19個(gè)州見(jiàn)頂。預(yù)計(jì)從現(xiàn)在開(kāi)始至2022年2月的第二周，大多數(shù)國(guó)家也將出現(xiàn)奧密克戎感染峰值。The latest omicron peaks are expected to come in the countries where the omicron wave has not yet started, such as in eastern Europe and southeast Asia. Actions to increase SARS-CoV-2 testing, for example, are likely to increase disruption by having more individuals excluded from work or school, but are unlikely to impact the course of the omicron wave. In the era of omicron, I believe that COVID-19 control strategies need to be reset. Given the speed and intensity of the omicron wave, in my view efforts to contact trace seem to be futile.預(yù)計(jì)最新感染高峰將出現(xiàn)在奧密克戎尚未開(kāi)始肆虐的國(guó)家，例如東歐和東南亞。部分防控措施，如增加新冠檢測(cè)等，將使得更多人無(wú)法正常工作或?qū)W習(xí)，從而在造成困擾的同時(shí)卻很難阻斷奧密克戎的傳播。在奧密克戎時(shí)代，我認(rèn)為需要重新制定新冠防控策略，考慮到其傳播速度和強(qiáng)度，<b>在我看來(lái)任何嘗試追蹤其傳播軌跡的努力終將徒勞無(wú)功。</b></p> <p class="ql-block">A questionremains in relation to the countries pursuing zero COVID-19 strategies, such as C and New Zealand. Given the high transmissibility of omicron, it seems unlikely that C or New Zealand will be able to permanently exclude the omicron wave. For zero COVID-19 countries, the question will be one of timing. Later omicron surges will allow further progress on increasing vaccination coverage and better understanding of the impact of the omicron variant in a fairly immunologically naive population.部分國(guó)家實(shí)施的“清零戰(zhàn)略”也存在問(wèn)題。由于奧密克戎超強(qiáng)傳染性，這些國(guó)家似乎不太可能永久免遭奧密克戎的沖擊。對(duì)奉行“清零戰(zhàn)略”的國(guó)家而言，這只不過(guò)是時(shí)間問(wèn)題而已。不過(guò)，姍姍來(lái)遲的奧密克戎浪潮可以讓這些國(guó)家進(jìn)一步擴(kuò)大疫苗接種范圍，并有更多機(jī)會(huì)深入研究奧密克戎變異毒株對(duì)免疫水平空白人群的的影響。</p> <p class="ql-block">By March,2022 a large proportion of the world will have been infected with the omicron variant. With continued increases in COVID-19 vaccination, the use in many countries of a third vaccine dose, and high levels of infection-<b>acquired（獲得的）</b> immunity, for some time global levels of SARS-CoV-2 immunity should be at an all time high. For some weeks or months, the world should expect low levels of virus transmission.到2022年3月，全球相當(dāng)部分人口將感染奧密克戎變種病毒。隨著疫苗接種日益普及，很多國(guó)家推進(jìn)第三劑加強(qiáng)針疫苗，外加大量因感染導(dǎo)致的免疫人群，在后續(xù)時(shí)間段內(nèi)，<b>全球新冠免疫水平達(dá)到前所未有的高度。</b>未來(lái)數(shù)周或數(shù)月，全世界范圍內(nèi)的病毒傳播程度有望一落千丈。</p><p class="ql-block">I use the term pandemic to refer to the extraordinary societal efforts over the past 2 years to respond to a new pathogen that have changed how individuals live their lives and how policy responses have developed in governments around the world. These efforts have saved countless lives globally. New SARS-CoV-2 variants will surely emerge and some may be more severe than omicron. Immunity, whether infection orvaccination derived, will wane, creating opportunities for continued SARS-CoV-2 transmission. Given seasonality, countries should expect increased potential transmission in winter months.我通過(guò)“大流行”這個(gè)詞匯形容過(guò)去兩年間全社會(huì)應(yīng)對(duì)這種新型病毒所做出的非凡努力，后者改變了人們的生活方式以及世界各國(guó)政府制定防控舉措的方式。所有付出的努力在全球范圍內(nèi)拯救了無(wú)數(shù)生命。新的病毒變異株肯定會(huì)繼續(xù)出現(xiàn)，其中有些或許比奧密克戎更為嚴(yán)重。無(wú)論疫苗或感染所致的免疫力都會(huì)逐漸減弱，從而為新冠病毒的持續(xù)傳播帶來(lái)可乘之機(jī)。考慮到季節(jié)性因素，各國(guó)應(yīng)預(yù)期潛在傳染性在冬季將有所增加。The impacts of future SARS-CoV-2 transmission on health, however, will be less because of broad previous exposure to the virus, regularly adapted vaccines to new antigens or variants, the <b>advent（到來(lái)，出現(xiàn)）</b> of antivirals, and the knowledge that the vulnerable can protect themselves during future waves when needed by using high-quality masks and physical distancing. COVID-19 will become another recurrent disease that health systems and societies will have to manage. For example, the death toll from omicron seems to be similar in most countries to the level of a bad influenza season in northern hemisphere countries. The US Centers for Disease Control and Prevention estimated the worse influenza season during the past decade in 2017–18 caused about 52000 influenza deaths with a likely peak of more than 1500 deaths per day.盡管如此，<b>未來(lái)新冠傳播對(duì)健康的影響將變更加輕微</b>，這是因?yàn)榇饲皬V泛接觸過(guò)病毒、定期針對(duì)新病毒或變異株調(diào)整疫苗、抗病毒藥物的不斷涌現(xiàn)、以及必要時(shí)易感人群可通過(guò)佩戴高質(zhì)量口罩和保持社交間距保護(hù)自己。新冠將成為醫(yī)療系統(tǒng)和全社會(huì)必須管控的另一種復(fù)發(fā)疾病。作為參考，<b>在大多數(shù)國(guó)家?jiàn)W密克戎的致命率似乎與北半球國(guó)家的嚴(yán)重流感季節(jié)旗鼓相當(dāng)。</b>據(jù)美國(guó)疾病控制和預(yù)防中心（CDC）估計(jì)，過(guò)去十年最嚴(yán)重的流感季（2017-18年）導(dǎo)致約52000人死亡，最高峰期間每天病亡人數(shù)超過(guò)1500。</p> <p class="ql-block">2010-2020流感造成的社會(huì)負(fù)擔(dān)</p><p class="ql-block" style="text-align: center;">The era of extraordinary measures bygovernment and societies to control SARS-CoV-2 transmission will be over. Afterthe omicron wave, COVID-19 will return but the pandemic will not.政府和社會(huì)為管控新冠傳播而采取非常措施的時(shí)代即將終結(jié)。奧密克戎浪潮褪去以后，<b style="font-size: 22px;">新冠病毒或許卷土重來(lái)</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 22px;">但是</b></p><p class="ql-block" style="text-align: center;"><b style="font-size: 22px;">大流行將銷(xiāo)聲匿跡</b></p> <p class="ql-block" style="text-align: center;"><span style="font-size: 22px;">僅供參考</span></p>