水鏡居

公衛
H1N1是全球性大流行嗎？
疾病的嚴重程度和世界的經濟復甦
與疾病是否大流行無關

 

                                                                               
http://www.time.com/time/health/article/0,8599,1903712,00.html
                                                                               
                                                                               
                                                                               
    The world needs an impartial referee to call a pandemic a pandemic; and the WHO is the only judge we have.

                                                                                
                                              --Bryan Walsh, TIME

 

這篇是時代雜誌的公衛與環保專欄作家Bryan Walsh在TIME.com的最新文章
文章的重點在於ＷＨＯ不應該因為經濟復甦等政治因素干擾科學的專業判斷
                                                                               
                                                                               
                                                                               
文章要覽
    澳州目前即將進入冬季流感的流行期，而澳州的Ｈ１Ｎ１疫情其實已經進入爆發期，光是維多利亞一省就傳出一千名病例，此外澳洲已經明顯有社區感染的現象，也就是說，在學校或醫院以外的大規模傳染流行，使得澳洲成為美國和墨西哥外地三個全面性大規模感染的地區。
                                                                               
    這已經符合了ＷＨＯ的大規模傳染病第六級（Phase6）的標準，但是ＷＨＯ還是不願提升疫情等級；ＷＨＯ表示，雖然全球已經"接近"第六級標準，但是他們相當謹慎，不願貿然提升等級，害怕引起民眾恐慌，甚至導致醫療資源錯置（請見詞彙要點說明）。
                                                                               
    對此不少流行病學專家批評，ＷＨＯ是受到來自各國的壓力，害怕提升警戒等級會妨礙經濟復甦，因此不願遵循純科學證據行事。
                                                                               
    然而贊同ＷＨＯ作為的人認為，雖然仍有死亡病例發生，其中有些甚至是本來很健康的人，但Ｈ１Ｎ１的威脅已不如原先預期強大，不需要如此驚慌。

    但問題在於，ＷＨＯ是國際間最高也唯一有公信力的國際衛生機構，它必須依照表定的規章行事，有什麼樣的證據，就做什麼樣的公告，這樣才能維繫組織的威信，同時也讓各國的公衛組織能與ＷＨＯ妥善協調運作；如果ＷＨＯ先失去公信力，國際防疫系統必然大亂，各國各行其政，那麼全球面臨下一波全面性大流行時將不堪一擊。
                                                                               
    ＷＨＯ的流行病層級考慮的只有"流行的程度"，"病毒的嚴重性"或"各國政經考量"並不在評估範圍內，現在的事實是世界已經符合第六級大流行的程度，ＷＨＯ應該秉持科學證據，告訴全球民眾他們該知道的相關公衛訊息，如果專業的數據顯示情況不妙，全球民眾應該要能聽到警告。
                                   

                                             
                                                                               
單字要點
很簡單，大概就這個字
                               

                                                
spasm  n.  痙攣

* The WHO says that it still respects the science, but is mindful of the public reaction to the pandemic alert phases — perhaps even more so after the global media went into spasms after the level rose to 5 on April 29.
                                                                               
                                                                               
 

詞彙要點
                                                                               
國際傳染病疫情等級
ＷＨＯ的流行病等級分成六級：(引自世界衛生組織網站)
                                                                               
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
                                                                               
美國和墨西哥在同區
                                                                               
Phase 6, the pandemic phase, is characterized by community level outbreaks in
at least one other country in a different WHO region in addition to the
criteria defined in Phase 5. Designation of this phase will indicate that a
global pandemic is under way.
                                                                               
美墨一區  澳洲一區
                                                                               
傳染病發生時間進程與其等級的關係可見本圖：
http://www.who.int/entity/csr/disease/influenza/phases5-6.gif

更多當前流行等級的資訊可見此頁面
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
                                                                               
                                                                               
worried well
這可以有很多翻法  "無病呻吟" "困擾的正常人" "風險悲觀者" "過度敏感的民眾"
簡單就是說
許多正常人其實沒有病痛  也因為ＷＨＯ的警戒提升產生恐慌
湧入醫院就醫  搶走了醫療資源  使其不能用在真正需要的人身上
這也就是醫療資源的錯置
                                                                               
                                                                               
流感的基本資料
http://www.cdc.gov/germstopper/chinese/pdf/work.pdf