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How Pandemics End

来源:纽约时报    2020-05-12 03:03

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        When will the Covid-19 pandemic end? And how?        Covid-19疫情什么时候才能结束?它会怎样结束?
        According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet, and the social, when the epidemic of fear about the disease wanes.        根据历史学家的说法,大流行通常有两种意义上的结束:一种是医疗意义上的结束,出现在发病率和病亡率大幅下降的时候;另一种是社会意义上的结束,发生在人们对疾病的恐惧逐渐消退的时候。
        “When people ask, ‘When will this end?,’ they are asking about the social ending,” said Dr. Jeremy Greene, a historian of medicine at Johns Hopkins.        “当人们问‘什么时候才能结束’时,”约翰斯·霍普金斯大学(Johns Hopkins)的医学历史学家杰里米·格林博士(Jeremy Greene)说,“他们问的是社会意义上的结束。”
        In other words, an end can occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease. Allan Brandt, a Harvard historian, said something similar was happening with Covid-19: “As we have seen in the debate about opening the economy, many questions about the so-called end are determined not by medical and public health data but by sociopolitical processes.”        换句话说,大流行的结束并不是因为征服了疾病,而是因为人们厌倦了恐慌模式,学会了与疾病共存。哈佛大学历史学家艾伦·勃兰特(Allan Brandt)表示,新冠病毒也出现了类似情况:“正如我们在有关开放经济的辩论中所看到的那样,许多关于所谓结束的问题不是由医疗和公共卫生数据决定的,而是由社会政治进程决定的。”
        Endings “are very, very messy,” said Dora Vargha, a historian at the University of Exeter. “Looking back, we have a weak narrative. For whom does the epidemic end, and who gets to say?”        埃克塞特大学(University of Exeter)的历史学家多拉·沃尔高(Dora Vargha)说,疫情的结束往往“非常、非常混乱”。她说:“回顾过去,我们的叙事很不周密。疫情究竟对于谁来说算是结束了,疫情结束又是谁说了算呢?”
        In the path of fear        恐惧之路
        An epidemic of fear can occur even without an epidemic of illness. Dr. Susan Murray, of the Royal College of Surgeons in Dublin, saw that firsthand in 2014 when she was a fellow at a rural hospital in Ireland.        即使没有疾病的流行,恐惧也会流传开来。都柏林皇家外科学院(Royal College of Surgeons)的苏珊·默里(Susan Murray)博士在2014年亲眼目睹了这种事,当时她正在爱尔兰一家乡村医院从事研究工作。
        In the preceding months, more than 11,000 people in West Africa had died from Ebola, a terrifying viral disease that was highly infectious and often fatal. The epidemic seemed to be waning, and no cases had occurred in Ireland, but the public fear was palpable.        在之前的几个月里,西非有超过1.1万人死于埃博拉病毒,这是一种可怕的病毒性疾病,传染性极强,往往致命。当时的疫情似乎正在减弱,爱尔兰也没有出现病例,但公众却非常恐惧。
        “On the street and on the wards, people are anxious,” Dr. Murray recalled recently in an article in The New England Journal of Medicine. “Having the wrong color skin is enough to earn you the side-eye from your fellow passengers on the bus or train. Cough once, and you will find them shuffling away from you.”        “在街头、在病房里,人们都很焦虑,”默里博士最近在《新英格兰医学杂志》(the New England Journal of Medicine)的一篇文章中回忆道。“肤色不对就足以让你在公交车或火车上被其他乘客侧目。咳一声,你就会看见他们慢慢地从你身边走开。”
        Dr. Murray wrote: “If we are not prepared to fight fear and ignorance as actively and as thoughtfully as we fight any other virus, it is possible that fear can do terrible harm to vulnerable people, even in places that never see a single case of infection during an outbreak. And a fear epidemic can have far worse consequences when complicated by issues of race, privilege, and language.”        默里博士写道:“如果我们没有准备好像抗击任何其他病毒那样,严肃积极地与恐惧和无知做斗争,恐惧就有可能对弱势群体造成可怕的伤害,即使在疫情暴发期间从未出现一例感染病例的地区也是如此。当种族、特权和语言问题令情况复杂化时,恐惧的流传可能会产生更可怕的后果。”
        Black Death and dark memories        黑死病与黑暗记忆
        Bubonic plague has struck several times in the past 2,000 years, killing millions of people and altering the course of history. Each epidemic amplified the fear that came with the next outbreak.        在过去2000年里,黑死病多次暴发,造成数以百万计的人死亡,并改变了历史的进程。每次疫情都加剧了人们对下一次暴发的恐惧。
        The disease is caused by a strain of bacteria, Yersinia pestis, that lives on fleas that live on rats. But bubonic plague, which became known as the Black Death, also can be passed from infected person to infected person through respiratory droplets, so it cannot be eradicated simply by killing rats.        这种疾病是由一种名为耶尔森氏菌的细菌引起的,它寄生在老鼠身上的跳蚤身上。但这种后来被称为“黑死病”的淋巴腺鼠疫也可以通过呼吸道飞沫在人与人之间传播,所以不能简单地通过杀死老鼠来消灭它。
        Historians describe three great waves of plague, said Mary Fissell, a historian at Johns Hopkins: the Plague of Justinian, in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that struck in the late 19th and early 20th centuries.        约翰霍普金斯大学的历史学家玛丽·菲塞尔(Mary Fissell)说,历史学家描述了三次黑死病瘟疫潮:6世纪的查士丁尼瘟疫,14世纪的中世纪疫情,以及19世纪末20世纪初的大流行。
        The medieval pandemic began in 1331 in China. The illness, along with a civil war that was raging at the time, killed half the population of China. From there, the plague moved along trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least a third of the European population. Half of the population of Siena, Italy, died.        中世纪的那次大流行始于1331年的中国。这种疾病加上当时肆虐的内战,夺去了中国一半人口。鼠疫从中国沿着贸易路线传播到欧洲、北非和中东。在1347年到1351年间,它杀死了至少三分之一的欧洲人。意大利锡耶纳有一半的人口死亡。
        That pandemic ended, but the plague recurred. One of the worst outbreaks began in China in 1855 and spread worldwide, killing more than 12 million in India alone. Health authorities in Bombay burned whole neighborhoods trying to rid them of the plague. “Nobody knew if it made a difference,” the Yale historian Frank Snowden said.        那次大流行结束后,黑死病又多次卷土重来。其中最严重的一次暴发始于1855年的中国,并蔓延到世界各地,仅在印度就造成了1200多万人死亡。为消除瘟疫,孟买卫生当局把许多社区整个付之一炬。“没人知道这种做法有没有用,”耶鲁大学历史学家弗兰克·斯诺登(Frank Snowden)说。
        It is not clear what made the bubonic plague die down. Some scholars have argued that cold weather killed the disease-carrying fleas, but that would not have interrupted the spread by the respiratory route, Dr. Snowden noted.        目前还不清楚鼠疫究竟为什么消失。斯诺登指出,一些学者认为,寒冷的天气杀死了携带疾病的跳蚤,但这并不会阻止跳蚤通过呼吸途径传播。
        Or perhaps it was a change in the rats. By the 19th century, the plague was being carried not by black rats but by brown rats, which are stronger and more vicious and more likely to live apart from humans.        也有可能是因为老鼠品种的变化。到了19世纪,鼠疫不再由黑鼠传播,而是由棕鼠传播。后者更加强壮凶狠,更有可能远离人类的生活。
        “You certainly wouldn’t want one for a pet,” Dr. Snowden said.        “你肯定不想豢养这样一个宠物,”斯诺登说。
        Another hypothesis is that the bacterium evolved to be less deadly. Or maybe actions by humans, such as the burning of villages, helped quell the epidemic.        另一种假设是,这种细菌进化过程中变得不再那么致命性。也有可能是烧毁村庄等人类行为有助于平息疫情。
        The plague never really went away. In the United States, infections are endemic among prairie dogs in the Southwest and can be transmitted to people. Dr. Snowden said that one of his friends became infected after a stay at a hotel in New Mexico. The previous occupant of his room had a dog, which had fleas that carried the microbe.        这种瘟疫从未真正消失。在美国,这种病是区域性质的,它在西南地区的土拨鼠中流行,可以传染给人类。斯诺登说,他的一个朋友在新墨西哥州的一家酒店住了一晚后遭到感染。他房间的前一名住宿者带着一条狗,狗身上的跳蚤携带有致病微生物。
        Such cases are rare, and can now be successfully treated with antibiotics, but any report of a case of the plague stirs up fear.        这样的病例很罕见,现在可以用抗生素成功治疗,但关于鼠疫病例的报道总是会激起恐惧。
        One disease that actually ended        一种真正灭绝的疾病
        Among the diseases to have achieved a medical end is smallpox. But it is exceptional for several reasons: There is an effective vaccine, which gives lifelong protection; the virus, Variola major, has no animal host, so eliminating the disease in humans meant total elimination; and its symptoms are so unusual that infection is obvious, allowing for effective quarantines and contact tracing.        天花是被医学战胜的疾病之一。但是,以下几个原因令它与众不同:有一种有效的疫苗可以提供终身保护;该病毒——主天花病毒——没有动物宿主,因此消除了人类的天花就意味着彻底灭绝;其症状的不寻常导致感染很容易被发现,可以进行有效的隔离和接触者追踪。
        The last person to contract smallpox naturally was Ali Maow Maalin, a hospital cook in Somalia, in 1977. He recovered, only to die of malaria in 2013.        最后一名自然感染天花的人是索马里的医院厨师阿里·马奥·马阿林(Ali Maow Maalin),他在1977年感染,后来康复,结果到2013年死于疟疾。
        Forgotten influenzas        被遗忘的流感
        The 1918 flu is held up today as the example of the ravages of a pandemic and the value of quarantines and social distancing. Before it ended, the flu killed 50 million to 100 million people worldwide. It preyed on young to middle-aged adults — orphaning children, depriving families of breadwinners, killing troops in the midst of World War I.        1918年流感如今被视为大流行病肆虐的例子,也彰显了隔离和保持社交距离的价值。在它结束之前,这场流感在全球范围内导致5000万至1亿人死亡。它“捕猎”成年人,从青年到中年——使孩子失去父母、家庭失去当家人,在一战中杀死士兵。
        After sweeping through the world, that flu faded away, evolving into a variant of the more benign flu that comes around every year.        席卷全球之后,这种流感逐渐消失,演变成较为温和流感的变种,每年都会出现。
        “Maybe it was like a fire that, having burned the available and easily accessible wood, burns down,” Dr. Snowden said.        斯诺登说:“也许像大火一样,烧掉了能烧掉且易接触到的木材,最后燃烧殆尽。”
        It ended socially, too. World War I was over; people were ready for a fresh start, a new era, and eager to put the nightmare of disease and war behind them. Until recently, the 1918 flu was largely forgotten.        它在社会层面上也结束了。一战结束了;人们准备好迎接新生活,新时代,并渴望将疾病和战争的噩梦抛在身后。直到最近,人们在很大程度上都忘记了1918年的流感。
        Other flu pandemics followed, none so bad but all nonetheless sobering. In the Hong Kong flu of 1968, one million people died worldwide, including 100,000 in the United States, mostly people older than 65. That virus still circulates as a seasonal flu, and its initial path of destruction — and the fear that went with it — is rarely recalled.        后来发生了其他流感大流行,虽然没有那么糟,但是仍然骇人。在1968年的香港流感中,全世界有100万人死亡,其中包括10万美国人,大多数是65岁以上的人。这种病毒仍以季节性流感的形式传播,并且它最初造成的破坏——以及所带来的恐惧——极少有人记得。
        How will Covid-19 end?        Covid-19将如何结束?
        Will that happen with Covid-19?        Covid-19会这样结束吗?
        One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.        历史学家说,一种可能性是新冠疫情可以在医学终结之前实现社会终结。即使病毒继续在人群中潜伏,甚至在找到疫苗或有效治疗之前,人们也许会因为越来越厌倦限制,以至于宣称疫情已经结束。
        “I think there is this sort of social psychological issue of exhaustion and frustration,” the Yale historian Naomi Rogers said. “We may be in a moment when people are just saying: ‘That’s enough. I deserve to be able to return to my regular life.’”        “我认为这是一个关于心力耗尽和沮丧感的社会心理学问题,”耶鲁大学历史学家娜奥米·罗杰斯(Naomi Rogers)说。“我们可能会经历一个时刻,当人们说:‘够了。我有资格回到我的正常生活。’”
        It is happening already; in some states, governors have lifted restrictions, allowing hair salons, nail salons and gyms to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say “enough.”        这已经在发生;在某些州,州长取消了限制,允许美发店、美甲店和健身房重新开放,无视了公共卫生官员认为这种措施为时过早的警告。随着封锁所带来的经济灾难的加剧,越来越多的人可能会说“够了”。
        “There is this sort of conflict now,” Dr. Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.        罗杰斯说:“现在有这种冲突。”公共卫生官员有医疗卫生上的目标,但一些公众有社会需求。
        “Who gets to claim the end?” Dr. Rogers said. “If you push back against the notion of its ending, what are you pushing back against? What are you claiming when you say, ‘No, it is not ending.’”        “谁来宣布结束?”罗杰斯说。“如果你反对它正在终结的结论,你在反对的是什么?当你说‘不,它没有结束’的时候,你在宣称什么?”
        The challenge, Dr. Brandt said, is that there will be no sudden victory. Trying to define the end of the epidemic “will be a long and difficult process.”        布兰特说,我们面临的挑战是胜利不会突然来临。试图定义流行病的终结“将是一个漫长而艰巨的过程”。

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