文字实录 | ICU和疫苗——疫情下的伦理挑战
本期嘉宾
Jonathan D. Moreno,CCG特邀嘉宾、宾夕法尼亚大学医学伦理与卫生政策学教授。
Steven Joffe,CCG特邀嘉宾、宾夕法尼亚大学医学伦理与卫生政策学教授
凤凰卫视主持人朱梓橦:全球疫情下,很多国家都面临医疗器械紧缺的困境,此时,究竟什么样的患者能优先进入icu使用呼吸机?是老人、青年还是儿童?是重症患者还是有望治愈的患者?疫情下如何面对一些伦理问题,我们来看看来自美国宾州大学的两位生物学教授怎么说。
Globally, the number of confirmed cases has exceeded 2 million. As of today. Obviously, there’s a serious outbreak in the US as well. Do you think in the history of epidemics pandemic?
(到目前为止,全球的确诊病例已超过200万例。显而易见地,疫情在美国的爆发情况也不容乐观。您认为在流行病历史上这是最严重的吗?)
Jonathan D. Moreno:This is the most serious, I’m sure numbers. It doesn’t compare. Fortunately to the Spanish flu of 1918, 1919. It’s been estimated that as many as a 3rd of the world’s people were infected. In 2020, we have such a an intensely global, globalized world.
(肯定的说,幸运的是,病例数字不能与西班牙在1918-1919年爆发的流感相提并论。据估计,世界上有三分之一的人被感染。在2020年,我们有这样一个高度全球化的世界。)
The the medical effects, the public health effects are are horrid. But the effects on the way we relate to each other as a global community are also in many ways much worse even than in 1918-1919.
(在医疗效果上,它对公众健康的影响是可怕的。但是,作为一个全球社会,这次疫情对我们相互关系的影响,在很多方面也比1918、1919年严重得多。)
Steven:I think about five or 600000 americans to date have been infected in America. One thing that we have not done well is test comprehensively. So the numbers that are actually have been infected may be much greater than that.
(我认为大约有五六十万美国人已经被感染。在美国,我们没有做好的一件事是全面测试。所以实际被感染的人数可能比这多得多。)
It’s hard to know how it’s going to end and how much worse it’s going to get. Certainly the worst thing that we’ve seen in this country in a hundred years terms of infectious epidemics.
(很难知道它将如何结束,也很难知道它会变得有多糟糕。这肯定是我们国家百年来所见过的最严重的传染病。)
主持人:And we know this time the virus is more likely to infect the elderly people and people with chronic conditions were in poor health. Have you seen selective treatment, for example, treating those who are elderly and those who are in milder conditions? in your opinion? And in your experience,
(我们知道这一病毒更有可能感染老年人、慢性病患者和健康状况不佳的人群。就你的经验,你见过选择性治疗的使用吗,如优先治疗老年人和病情较轻的人? 你的看法是什么?)
Steven:I think the virus, to my knowledge, is not more likely to infect those who are elderly or frail, but it is more likely to make them very sick. So children will get infected by the virus, in fact, quite commonly, but they tend not to get very sick. On the other hand, people who are elderly, people who do have chronic conditions, people who are more frail when they get sick, they are much more likely to get very, very sick and to require hospitalization, to require intensive care and to die.
(据我所知,这种病毒不会使老人或体弱的人更易感染,但却更可能使他们病得很重。所以,孩子们会被病毒感染,事实上还比较常见,但他们不会病得很严重。而年老者、有慢性疾病的人,那些生病时身体更虚弱的人,他们更有可能病得非常非常严重,需要住院治疗,需要重症监护,严重的会导致死亡。)
There have been policies developed, including by some colleagues of mine, to try to say, which are the patients? If not, everybody can be given an ICU better a ventilator, who should get it? And those decisions have taken into account factors like where those policies have taken into account factors like how sick is the patient, how likely does it seem that they will recover from this illness.
(现在已经制定了相关政策,包括我和我的同事,试图说明如果不是每个人都可以在ICU使用呼吸机,哪些病人应该得到它? 这些决策考虑了很多因素,比如病人的病情有多严重,他们康复的可能性有多大。)
And also factors like, if the patient has an underlying disease that is likely to cause them to die. Even without the co bid within, let’s say the next year, they would receive a lower priority for the ventilator. In some cases, perhaps patients who were older might receive a lower priority for the ventilator as well. These have been very controversial policies and discussions in the united states and with lots of people saying that they think it is unethical to deny a ventilator, let’s say, to somebody who’s older compared to somebody who’s younger.
(还有其他因素比如,如果病人有潜在疾病,即使没有得上新冠病毒也可能在一年内死亡,他们得到的呼吸机的优先权也会更低。在某些情况下,可能年龄较大的患者优先使用呼吸机的可能性也比较低。在美国,这是非常有争议的政策和讨论,比如,很多人说,他们认为拒绝提供呼吸机给年纪更大的人是不道德的。)
So this is still an issue of debate and discussion. And there have been some complaints filed about discrimination with the federal government. A lot of ongoing discussion about what to do. If you can’t give everybody these lifesaving treatments, who should get them. And it’s still being argued in our country today.
(所以,这仍然是一个值得争论和讨论的问题。联邦政府还收到一些有关歧视的投诉。很多人都还在讨论该怎么做,如果你不能给每个人都提供这些挽救生命的治疗,谁应该得到它们。直到今天,这个问题仍在我国争论不休。)
主持人:你认为开发有效的疫苗需要多长时间?
Moreno:Yeah, yeah. Everybody seems to be in pretty much agreement that it will take somewhere between 12 and 18 months As far as the number of volunteers is concerned. that will depend on the many different ways that different groups are designing their trials. But I think that in order you can’t speed up the biology only to a certain point. You can speed up the methodology a bit. In general, we prefer to see a vaccine deployed over two or three years and then get the experience with it. We don’t have that kind of time. So I think there will be more aggressive methodologies used with healthy young volunteers who will be challenged by the virus.
(大家似乎都一致认为,这将需要12到18个月的时间,要考虑到志愿者的数量,也将取决于针对不同群体设计的多种试验方式。但我认为,为了达到这个目的,你不能加速生物学,只有在一定程度上,可以稍微加快研究方法。一般来说,我们更希望看到疫苗在两到三年内投入使用,然后获得经验。我们没有那么多时间。因此,我认为将采取更激进的方法,健康的年轻志愿者将受到病毒的挑战。
Steven:So one place to look for volunteers may actually be among doctors and nurses and respiratory therapists and others who work in hospitals who have a heavy dose of exposure. And I’m quite sure that there will be a pretty high level of willingness to participate. In those trials. People realize the importance of developing the vaccine, and they also hope it will be beneficial to them.
(寻找志愿者的一个地方实际上可能是医生、护士、呼吸科治疗师和其他在医院工作的人,他们是高危易感人群。我非常确定,他们之中会有很多人愿意参与这些试验。人们认识到开发疫苗的重要性,他们也希望疫苗对他们有益。)
主持人:So once the vaccines are developed, who do you think will get the first batch of vaccines? How;s the distribution process?
(所以一旦疫苗被开发出来,你认为谁会得到第一批疫苗?分配流程会是怎样的?)
Stevev:This is going to be a challenge for us in the united states. I certainly hope that we can ramp up production of the vaccine. One once of an effective vaccine is developed so that it can be made available to everybody. And we can vaccinate essentially everybody.
(这对美国来说将是一个挑战。我当然希望我们能加大疫苗的生产。一旦一种有效的疫苗被开发出来,它就可以提供给每个人。)
Medical care in the united states,unfortunately, is by wealth, by whether you can pay by whether you’ve got good insurance. And I certainly hope and expect that’s not going to be the case. That would be a real mistake.
(不幸的是,美国的医疗保健是由财富决定的,看你能否支付得起,看你是否有良好的保险。我当然希望并期待情况不会是这样,那将是一个真正的错误。)
The other thing that we can think about is who are the people who are most at risk, let’s say, because of their work. Again, healthcare workers. But also I was reading today that many people who drive the buses or run the trains on in the new york public transit system, they’ve had something like 50 or 60 people die from corona virus, many of them presumably exposed because they go to work and they’re exposed to large numbers of people. So it’s not just health care workers who were getting exposed. It’s lots of other people who get exposed in the course of their work.
(我们可以考虑的另一件事是,谁是风险最大的人,比如因为工作。医疗行业工作者,除此之外,我今天看到,在纽约公共交通系统中的巴士火车的司机,有50或60人死于冠状病毒,他们中许多人患病是因为工作接触到大量人群,所以不仅仅是医护人员在承受患病的风险。很多人在工作中有患病的风险。)
Another Challenge is going to be children. Again, children may not be getting so sick themselves from the virus, but they are spreading it. Yeah, to stop this epidemic and to stop the spread, it’s going to be really important to include children from the beginning.
(另一个挑战将是儿童。重申一下,孩子们自己可能不会因为病毒而病重,但是他们正在传播病毒。为了阻止这种流行病和它的传播,从一开始就把儿童考虑进来是非常重要的。)
【往期回看】
全球战“疫”观察1 | 我们不是孤岛,全球危机如何“破题”?
文章选自凤凰卫视《寰宇同舟—全球战“疫”观察》栏目,2020年4月20日