讓美國再次免疫

讓美國再次免疫

——這個國家很多的力量源泉已經付之東流

 

作者：Thomas Friedman (The New York Times) May 5,2020

見習翻譯：夏大愚

 

如果拜登先生，在與特朗普先生正在進行的總統競選中，需要一句口號，我會向他推薦這個：“讓美國再次免疫”。

我們正在與疫情戰鬥，來保衛我們的生命，拯救我們的生活。這時候我們發現，這個戰鬥所需要的所有的力量源泉，在這個國家都被我們自己破壞了。我們破壞了了我們的認知，破壞了我們的環境，破壞了經濟和社會管理，破壞了公共和個人衛生的防疫體係。疫情打了我們的臉，暴露了這些問題。而且，情況還在變得更糟。

種瓜得瓜，種豆得豆。很多年來我們裝聾作啞，於是我們得到了這樣一個免疫功能失調的國家，這是如此公平和符合邏輯。我們嘲笑科學和讀書，任憑政黨政治搞垮我們的專業公務員隊伍，把嚴肅的政治搞成一出鬧劇。甚至於在這種裝聾作啞和明知故犯中，美國人養成了可怕的飲食習慣，把我們當中超過40%的人吃成了肥仔。

在田納西州的奧斯汀，一名公園管理員正在進他的職責，向遊客們解釋需要保持社交距離。可是一個遊客將這名管理員扔進了河裏。多少年來我們裝聾作啞，造成的這種愚昧和無知，難道還不足夠可怕嗎？

沃倫·巴菲特說過一句話，當潮水退去，你會看見誰在裸泳。現在我們舉頭四望，發現是我們自己光著屁股。事實上，我們美國在確診人數和死亡人數兩個方麵領導了世界。

在我老家明尼蘇達，有一個75歲的退休老太太，她叫Gloria Jackson, 她向《華盛頓郵報》的記者抱怨說：“在我年輕的時候，我們美國在所有方麵，堪稱這個世界的楷模。但是現在呢？我們自私，虛弱而又難纏，別的國家都為我們感到臉紅。這個國家已經脫軌了，沒有了領導力，也不再團結，每個美國人都在為此蒙受巨大損失。”

這些年來，很多原因造成了這個國家患上了社會綜合免疫係統失調症。其中最要命的，是共和黨政府把病情的惡化推上了快車道。特朗普總統本來就是社會免疫失調症的產物，他上任後投桃報李，狠狠踩下加重病情的油門。

在疫情的絕望中，人們最需要的是科學的拯救。但是我們選出的總統先生，隻管每天張開大嘴，狂噴各種謊言和謬論，而且將所有他不喜歡的消息稱為“假新聞”。特朗普先生對破壞我們的認知免疫力“貢獻”太大了，以至於我們已經分不清什麽是真實，什麽是謊言，什麽是科學，什麽是幻想小說。

在我們最需要國際合作的時候，特朗普總統搞垮了我們所有的聯盟。在我們最需要社會信任，合作抗疫的時候，特朗普總統卻在跳動群眾鬥群眾。他把民眾分成兩派，拉一派，打一派。他讓選民站起來反對他們的州長，因為這符合他的競選策略。我們沒法團結在一起，如何能夠戰勝疫情？

特朗普總統一上台，就一腳踢飛了他的前任奧巴馬總統費盡力氣搞出來的全民可負擔醫療法案。特朗普先生甚至不屑於考慮一下一個替代的辦法。其結果是疫情來了，我們沒有醫療保險。就連那些上第一線與病毒搏鬥的醫護人員，也需要擔心，萬一自己被傳染上，是不是有人會救治他們？

特朗普總統對於敢於反對的他的意見的官員，也采取一腳踢開的策略。其結果是當疫情在全世界泛濫，負責為保衛美國提供早期預警的國土安全部和國家情報辦公室裏，坐的都是不知所措的臨時工。所以我們麵對危局無動於衷，坐失良機。國家疾控中心的人同樣不敢舉手，提出反對意見，隻能看著總統先生任意胡來。

那麽我們怎樣才能有效的對抗這次的病毒呢？目前已知的有三個有效的途徑。首先是爆發的前幾個星期最為重要，必須要盡可能的減緩疫情的流行。然後需要一個可持續的計劃，救助病患，一直等到老天爺，或者人工的疫苗，讓我們集體免疫。瑞典在這方麵就做出了榜樣，他們局部封鎖了社區，保護住最脆弱的人群，然後讓最健康的人經受考驗，逐步接受自然形成的群體免疫。

另外一個看起來有效的辦法就是中國人幹的，他們的國家機器全力開動，凶狠的封城，阻擋住要回去工作的人潮，強迫公民帶口罩，保持距離。進行大規模的檢測，建立隔離區，把病患關起來，直到疫情過去，或者疫苗出現。我們看起來是要以一種相對民主的方式學習中國人的做法，但是幹的全都亂了套。各個州各自為戰，是否有效隻能憑運氣了。奧巴馬總統的衛生部長 Dr. Vivek Murthy告訴我，我們即便沒辦法像強悍的中國政府一樣工作，能夠做到他們的10%也是好的。不幸的是，我們也沒能做到。這位博士剛剛非常及時的出版了他充滿智慧的新書：《讓我們一起在孤獨中治愈》。

這位博士補充說，針對不同風險的人群采取不同級別的封城是行之有效的辦法。但是這一切取決於大範圍的快速檢測，並且要將結果立即應用於分析和預測疫情的傳播。但是跟特朗普總統吹噓的情況不一樣，我們的檢測遠遠跟不上形勢。最糟糕的是，檢查自己有沒有被感染，成為了每個公民自己的職責，然後他們的聯係人也一樣。

“時間就是一切，失去時間等於失去很多生命。”我們已經失去了太多時間。

我們現在麵臨的最大威脅是社區傳染。設想一下，一對夫妻帶著三個孩子，大人要去上班，小孩要去上學，怎麽能夠保證不帶病毒回家？這位博士建議學習中國的做法，政府租用空置的旅館酒店，將病患集中隔離，並且雇傭失業者，在專家指導下追蹤和照顧患病者。為了能夠讓更多的人盡快去複工，避免失業帶來的憂鬱與絕望，我們迫切需要聯邦以更加民主的方式，效仿中國的做法。

但是特朗普總統拒絕了這樣一套通過聯邦和社會合作來對抗疫情的方案。因為這樣自打嘴巴的做法會讓他受到支持者的反對，在政治上等於自殺。他能做的隻有繼續耍開兩片嘴皮子，大談什麽“大自然母親”，繼續糊弄和恐嚇他的支持者。他從當房地產開發商時就是這麽幹的，他的那些同黨也已經習慣於給他不停的擦屁股。

可惜談論大自然母親並不管用。大自然就是冷冰冰的化學、生物學、物理學公式。我們不能拿她老人家練手，是她一直拿我們練手。我們不能對她發火，是她一直要對我們發火。她把瘟疫、颶風、洪水、幹旱、熱浪，種種災難，不斷扔在我們頭上，就是想讓那些基因不能適應的家夥們去死。

這就是全部的事實。如果我們自己無所作為，很多人就要提早回到造物主的懷抱。

（原文附後）

Make America Immune Again

Many sources of the nation’s strength have eroded.

If Joe Biden is looking for a bumper sticker for his campaign against Donald Trump, I’d suggest this one: “Make America Immune Again.”

This pandemic has both exposed and exacerbated the fact that over the last 20 years we as a country have weakened so many sources of our strength. We’ve simultaneously eroded our cognitive, ecological, economic, social, governance, public health and personal health immune systems — all the sources of resilience we need to get through this pandemic with the least damage to lives and livelihoods.

All these immune deficiencies are the logical outcome of how we’ve let ourselves go as a country, how we’ve let ourselves be dumb-as-we-wanna-be for so many years — devaluing science and reading, bashing public servants for political sport, turning politics into entertainment, not to mention adopting horrible eating habits that have left 40 percent of Americans obese.

Dumb-as-we-wanna-be is epitomized by the guy in Austin, Texas, who last week shoved a “park ranger into the water while the ranger was explaining to a crowd the need for social distancing,” as CNN reported.

Warren Buffett was right: When the tide goes out you see who’s swimming naked. And now it’s us. We are still exceptional, but now it’s in the fact that we lead the world in total coronavirus cases and deaths from Covid-19.

“We were the leading country in everything when I was young,” Gloria Jackson, a 75-year-old retiree from my home state, Minnesota, told The Washington Post. “And what are we now? We’re mean. We’re selfish. We’re stubborn and sometimes even incompetent. … It seems like some of these other countries almost feel sorry for us. … We can’t get out of our own way. … There’s no leadership and no solidarity, so everybody’s doing whatever they want … which means everyone who’s vulnerable is losing big.”

This erosion of our collective societal immunity has been fed by many sources over the years, but none more than a Republican Party that has simply jumped the tracks. Donald Trump’s election was a byproduct of our lost immunity, but his leadership has now become a giant accelerant of it.

At a time when we desperately need to be guided by the best science, Trump’s daily fire hose of lies, and his denunciations of anything he doesn’t like as “fake news,” has contributed mightily to the loss of our “cognitive immunity” — our ability to sort out truth from lies and science from science fiction.

At a time when we need a globally coordinated response to a pandemic, Trump has wrecked every alliance we have.

At a time when we need high social trust in order to have a coordinated response at home, Trump’s political strategy of dividing us and playing everything both ways — even telling people both to rise up against their governors and to lock down according to his guidelines — is the opposite of the “all in this together” approach we need to win this battle.

At a time when access to affordable health care is extra-important — when frontline workers need to know that if they go to work and fall ill, they will have some safety net to protect them — Trump has been trying to destroy the Affordable Care Act enacted by President Barack Obama without even thinking through an alternative.

At a time when we’ve never more needed our early warning systems to be operating at peak potential, the four top jobs at the Department of Homeland Security and the Office of the Director of National Intelligence “have all been filled with temporary acting officials for literally every day that Covid-19 has been on the world stage,” Garrett Graff recently noted in Politico.

And Trump’s vindictiveness toward any career public servant who challenges his narrative has surely contributed to the weak response from the Centers for Disease Control and Prevention. Experts are afraid to raise their hands to contradict the president.

What would it take to make ourselves collectively more immune to Covid-19? It starts with the understanding that the only thing these weeks of lockdown have done is slow the spread of the virus. We still need a sustainable plan for saving lives and livelihoods until we get herd immunity, naturally or from a vaccine. There are three basic approaches.

One is the Swedish approach of partial lockdown, protecting the most vulnerable and gradually allowing the healthiest to acquire the infection, recover and build herd immunity naturally.

The other is the Chinese strategy: strict lockdown followed by back-to-work flows, accompanied by masks, social distancing and the full use of China’s state surveillance systems to test, trace and quarantine any carriers of the virus to keep it contained until a vaccine can provide herd immunity.

We seem to be opting for a more democratic version of the China model — but in a totally haphazard, every-state-for-itself manner.

What are our prospects of success?, I asked Dr. Vivek Murthy, Obama’s surgeon general, who has just published a thoughtful and timely book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World.”

“Even if we can’t be as aggressive as China in terms of surveillance and testing, the truth is, we are at best only 10 percent of the way there. Simply put, we are behind,” said Murthy.

Yes, a strategy of gradually lifting lockdowns based on different risk categories can make sense, he added, but only if every state has in place widely available testing that generates rapid results — results that are efficiently turned over to teams empowered to immediately trace and then quarantine the infected or the most vulnerable, in big towns and small, to block any further spread of Covid-19.

“Speed is everything,” said Murthy. “Time lost equals lives lost.”

The number of tests we are doing — which Trump is always boasting about — is irrelevant unless you can reliably and quickly get a test when and where you need it, and the results can be converted into efficient tracing of others who might be infected.

“By that measure we are falling far short,” said Murthy. “It is your ability to find an infected person through testing — and then all their contacts — that matters most.”

That’s because the biggest challenge we face in America today is “community spread,” explained Murthy. “Consider a diabetic parent living in a small home with three children who need to go back to school and the other parent needs to go back to work. How do we open up safely and prevent them from bringing the disease home? Practically speaking, how do we actually protect the vulnerable?”

Murthy suggests the federal government do a version of what China did: rent empty hotels to provide quarantine options to the most vulnerable or those infected and hire some of the massive numbers of unemployed workers to become part of tracing teams in every state under the lead of public health experts.

In sum, if we are going to save the most lives while getting the most people back to work to prevent an epidemic of unemployment, depression and despair, it is going to require a federally coordinated, democratic version of the China strategy.

But Trump resists that kind of science-based, nationally coordinated approach, because it serves him politically to urge his supporters to resist his own administration’s health guidelines.

Trump seems to think he can bluster, bluff and talk out of both sides of his mouth with Mother Nature — the way he did in real estate and has done on so many issues as president, when his party could always cover for him.

But it doesn’t work that way with Mother Nature. She is not a contestant on “The Apprentice.” She is just chemistry, biology and physics. We’re the contestants on her show. We don’t get to fire her. She gets to fire us.

She throws viruses, hurricanes, floods, droughts, heat waves and pandemics at us to sort out who’s the fittest. And the ones who survive have one thing, and one thing only, in common: They are the most adaptive at generating the chemistry, biology and physics needed to meet the challenge.

That’s all that matters. All those who can’t, get fired or, rather, are returned to the manufacturer.