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【聯合報╱By LAWRENCE K. ALTMAN, M.D.╱陳世欽譯】

Epidemics of Confusion

 

圖/udn tv提供

 

WASHINGTON — A mysterious virus emerges in Africa and spreads. An anxious and skeptical public rejects scientific evidence that the lethal virus is transmitted only through body fluids. There are no drugs to effectively treat infected patients, nor a vaccine to prevent new cases.

People shun the infected and their contacts; some demand quarantines. Conspiracy theorists contend the virus escaped from government laboratories.

No, th is is not Ebola. It is the outbreak in the early 1980s of H.I.V., the virus that causes AIDS.

一種神秘的病毒在非洲出現並擴散。焦慮的狐疑大眾不接受這種致命病毒只透過體液散播的科學證據。沒有藥物可以有效治療,也沒有可以防止病毒擴散的疫苗。

人們避開病人以及病人接觸過的人。有人要求隔離病人。陰謀論說,病毒自政府實驗室逸出。

這不是伊波拉病毒,而是1980年代初引起愛滋病的愛滋病毒。

The epidemics have prompted eerily similar reactions from health officials and the public, raising crucial questions about why the world remains persistently unprepared to react to sudden viral threats.

Experts underestimated the extent of the spread of both viruses. After development of an H.I.V. test, doctors discovered that millions of people were infected in one of the worst pandemics in history. The Ebola epidemic, which involves thousands, is confined to West Africa for now. But as long as the infection spreads in West Africa, it poses a major threat to the rest of the world; many countries will have a difficult time controlling its spread if it reaches them.

這兩種傳染病引起公衛官員與大眾的類似反應,同時衍生為何全球始終未能針對突如其來的病毒威脅作好準備的問題。

專家低估了這兩種病毒擴散的程度與範圍。醫學界研發出愛滋病毒檢測法後發現已有數百萬人感染,愛滋是歷來最厲害的流行疾病之一。牽連數千人的伊波拉疫情目前僅限於西非。然而只要當地病例持續增加,就會對世界其他地區構成重大威脅。如果病毒掩至,許多國家將難以招架。

Scientists quickly and clearly delineated how Ebola and H.I.V. are transmitted. But public officials, then and now, failed to communicate this information in ways most people understand.

At the onset of the AIDS epidemic, officials and journalists spoke of “bodily fluids” to avoid using words like penis, vagina and sperm. Only later did officials become explicit about the risks of rectal intercourse.

科學家迅即明確釐清伊波拉與愛滋病毒如何擴散。然而當時與現在的官員並未以多數人可以理解的方式加以說明。

愛滋病肆虐之初,官員與媒體提到「體液」,避免使用陰莖、陰道、精液等字眼。官員後來才明確談到肛交的危險性。

Ambiguity was costly. People avoided restaurants where waiters were perceived to be gay out of fear of getting the disease from “contaminated” food and dishes. Some people called for quarantines, which made no scientific sense.

Health officials have had ample time to polish their language skills. Yet the phrase “bodily fluids” is again with us, and confusion has arisen over whether the virus can be “airborne” as officials try to explain that Ebola virus is not dispersed like the influenza and measles viruses.

模糊代價高。人們避免前往侍者被視為同志的餐館用餐,唯恐因食物與餐盤「受到汙染」而中鏢。有人呼籲採取毫無科學意義的隔離措施。

官員有充分的時間磨練用字技巧。然而「體液」這個字眼再度出現,而在官員試著解釋伊波拉病毒傳染的方式不像流行性感冒或麻疹之際,有關這種病毒是否可能「透過空氣」散播的問題又引起混淆。

And so history repeats. An uncertain public has stigmatized many Ebola survivors , as AIDS patients once were, even though they are not infectious to others. Governors and health officials have clashed over the need to quarantine people returning from West Africa, though such policy is not based on scientific evidence.

By its very nature, public health involves politics. As politicians, health officials have traditionally tended to play down risks to calm anxiety .

歷史因此重演。困惑的大眾再度將許多伊波拉倖存者汙名化,就像以往的愛滋病人,儘管他們不會感染別人。雖然政策並無科學證據為依據,美國各州州長與公衛官員仍然對應否隔離自西非返國民眾爭論不休。

公衛本質上就涉及政治。政治人物與公衛官員往往為了安撫民心而傾向於淡化風險。

Officials have not been silent about Ebola, but sometimes they have been too emphatic and absolute in their choice of words. Despite lack of prior experience, the experts predicted that any American hospital could safely handle Ebola patients with little risk . That assurance came back to haunt them in Texas. To their credit, the officials quickly corrected themselves. But by then, the damage was done.

Fear of the unknown plays a great role in fanning anxiety during outbreaks of deadly diseases. H.I.V. was truly a mystery at the beginning of the AIDS epidemic. At first, scientists debated whether the cause was an infectious agent or a drug .

官員並未對伊波拉保持沉默,然而有時候選擇用字又過度強調與堅決。雖然前無經驗,這些專家卻預測美國任何醫院均可安全處理伊波拉病人,幾無風險。這種保證在德州砸了他們自己的腳。官員迅速認錯值得肯定,然而傷害已經造成。

致命疾病擴散時,對於未知的恐懼會引起焦慮。愛滋病流行之初病毒確是謎團。科學家最初曾就它是傳染原或藥物所致而起爭論。

Ebola was identified in Central Africa in 1976 but was unknown in West Africa when cases began to occur in Guinea earlier this year. As of November 7, Ebola had infected 13,268 people, of whom 4,960 had died, the World Health Organization said.

As in the early years of AIDS, standard support therapy is the only proven therapy. If drugs are found to treat Ebola, health workers will need ways to get them to Africa’s poor. If nothing else, the AIDS epidemic may have prepared us for that.

科學家1976年在中非確認伊波拉病毒,而今年稍早幾內亞出現病例之前,它在西非不為人知。世衛組織說,至11月7日為止已有13268人感染,其中4960人死亡。

就像愛滋病肆虐之初,標準的輔助(支持)治療是唯一經過驗證的療法。如果出現可以治療的藥物,公衛人員要有辦法送到非洲窮人手中。愛滋病可能讓我們對此有了些準備。

Both viruses continue to raise major challenges. A decrepit infrastructure for delivery of health care and other services is the result of years of political unrest in West Africa. Hundreds more doctors and nurses are needed from elsewhere to care for the ailing.

The fact is that Ebola, like AIDS, will leave behind a tragic legacy: hundreds of thousands of orphans.

這二種病毒仍然構成嚴峻挑戰。西非因為多年政治動盪而致基礎建設破敗,難以輸送醫療照護與其他服務。病人還需要來自其他地區的數百名醫護人員。

真相是,伊波拉會像愛滋般留下一種可悲的後遺症:孤兒成群。

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