疾病大流行之中的我们，其实选择非常有限

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以下是约翰霍普金斯大学校刊去年11月发表的一篇文章，用宏观流行病学模型预推演灾难性公共卫生事件（冠状病毒大流行）未来的走向。国家最高层和国际社会对重大灾难性公共卫生事件必须给予及时极高度重视。文章作者提出：ONCEYOU'REINTHEMIDSTOFASEVEREPANDEMIC,YOUROPTIONSAREVERYLIMITED.THEGREATESTGOODCANHAPPENWITHPRE-PLANNING.（一旦你身处一场严重的流行病之中，你的选择就非常有限。预先计划可以带来最大的好处）

阅读英文有困难的读者，可以用谷歌浏览器GoogleChrome的网页翻译功能进行阅读。我们也推荐约翰霍普金斯大学基于地理信息系统开发的COVID-19实时地图。这个项目由约翰霍普金斯大学LaurenGardner教授主导，历经数次更新目前的功能和准确性都大幅提升。地图链接：https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

HEALTHSECURITY

PandemicsimulationexercisespotlightsmassivepreparednessgapEvent201,hostedbytheJohnsHopkinsCenterforHealthSecurity,envisionsafast-spreadingcoronaviruswithadevastatingimpact

ByKatiePearce

/PublishedNov6,2019

Backin2001,itwasasmallpoxoutbreak,setoffbyterroristsinU.S.shoppingmalls.Thisfall,itwasaSARS-likevirus,germinatingquietlyamongpigfarmsinBrazilbeforespreadingtoeverycountryintheworld.

WitheachfictionalpandemicJohnsHopkinsexpertshavedesigned,thetakeawaylessonisthesame:Wearenowherenearprepared.

Onceyou'reinthemidstofaseverepandemic,youroptionsareverylimited,saysEricToner,aseniorscholarattheCenterforHealthSecurityatJohnsHopkinsUniversity.Thegreatestgoodcanhappenwithpre-planning.

ONCEYOU'REINTHEMIDSTOFASEVEREPANDEMIC,YOUROPTIONSAREVERYLIMITED.THEGREATESTGOODCANHAPPENWITHPRE-PLANNING.

EricToner

Seniorscholar,JohnsHopkinsCenterforHealthSecurity

Thatcenter'slatestpandemicsimulation,Event201,droppedparticipantsrightinthemidstofanuncontrolledcoronavirusoutbreakthatwasspreadinglikewildfireoutofSouthAmericatowreakworldwidehavoc.AsfictionalnewscastersfromGNNnarrated,theimmune-resistantvirus(nicknamedCAPS)wascripplingtradeandtravel,sendingtheglobaleconomyintofreefall.Socialmediawasrampantwithrumorsandmisinformation,governmentswerecollapsing,andcitizenswererevolting.

ForthoseparticipatinginNewYorkCityonOct.18aheavyweightgroupofpolicymakers,businessleaders,andhealthofficialsEvent201wasachancetoseehowmuchcatch-upworkisneededtobolsterourdisasterresponsesystems.Fullvideosofthediscussionareavailableonline.

Itreallydoesshakeupassumptionsandchangethinkingabouthowwecanprepareforaglobalpandemic,saysTomInglesby,directoroftheCenterforHealthSecurity.

Event201isthefourthsuchexercisehostedbytheJohnsHopkinscenter,whichworkstopreparecommunitiesforbiologicalthreats,pandemics,andotherdisasters.Thesimulationsstartedwith2001'sDarkWinter,whichgatherednationalsecurityexpertsforitssimulatedsmallpoxoutbreak.ThegroundbreakingeventturnedouttobeinfluentialinshapingU.S.effortsaroundpandemicpreparednessparticularlyduetoitstiming,rightbefore9/11.

DarkWinterresultedinmorethanadozencongressionalhearings,wasbriefedtotheWhiteHouse,andultimatelyinfluencedthedecisiontostockpileenoughsmallpoxvaccineforallAmericans,Inglesbysays.

ThatsimulationanditstwosuccessorsAtlanticStorm,conductedin2005,andlastsummer'sCladeXhavealsodemonstratedlastingvalueaseducationalandadvocacytools,withreenactmentsormodifiedversionstakingplaceinsettingsincludinguniversities,theCDC,andCapitolHill,accordingtoInglesby.Theseexerciseshavealongfuse,hesays.

ForEvent201,hostedincollaborationwiththeWorldEconomicForumandtheBill&MelindaGatesFoundation,theexpertsaddedanewlayerofrealismbyreachingbeyondgovernmentandNGOstoleadersintheprivatesectorandbusinesscommunity.ParticipantsincludedrepresentativesfromNBCUniversal,UPS,andJohnson&Johnson.

Veryfewpeoplehaveincludedtheprivatesectorinpandemicpreparedness,butthat'swheremostoftheresourcesare,Tonersays.

That'sparticularlytruewhenitcomestovaccinedevelopment.TheCAPSviruswhichTonerdescribesasacousinofSARS,butslightlymoretransmissible,liketheflu,andslightlymorelethalwaspresentedasresistanttoanyexistingvaccine,asscientistsscrambledtocomeupwithone.Citizens,meanwhile,wereriotingoverscarceaccesstothenextbestthing:afictionalantiviralknowntotreatsomeCAPSsymptoms.

Thatscenario,Tonersays,isutterlyrealistic.Wedon'thaveavaccineforSARS,orMERS,orvariousavianfluvirusesthathavecomeupinthepastdecade,henotes.That'sbecausevaccinedevelopmentisslowanddifficultifthereisn'tanimmediatemarketforit.

Inthesimulation,CAPSresultedinadeathtollof65millionpeoplewithin18monthssurpassingthedeadliestpandemicinhistory,the1918Spanishflu.

FromthediscussionsEvent201inspired,theCenterforHealthSecurityplanstoreleaseasetofformalrecommendationswithinthecomingweeks.

Shortlyafterthesimulation,thecenterreleasedtheGlobalHealthSecurityIndex,thefirst-evercomprehensiverankingofcountriesontheirpandemicpreparedness.Allinall,thepicturewasdiscouraging:Theaveragescore,across195countries,was40outofapossible100.

It'sourhope,Inglesbysays,thatcountrieswillusethistoconsiderwheretheyarestrongandwheretheyareweak.

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