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(CNN)Less than a month ago, India''s future looked dire.

(CNN)不到一個月前,印度的未來看起來還很危急。



Experts predicted that the country could expect millions of coronavirus cases. Doctors warned that India needed to prepare for an onslaught of cases that could cripple the country''s ill-equipped health system. Onlookers worried that the virus could spread like wildfire through India''s slums, where residents live in cramped quarters and basic sanitation often isn''t available.

專家預測,該國可能會出現數百萬例冠狀病毒病例。醫生們警告說,印度需要做好準備,以應對可能使該國裝備不良的醫療系統癱瘓的大量病例。旁觀者擔心這種病毒會像野火一樣蔓延到印度的貧民窟,那里的居民居住在狹小的地方,基本的衛生設施也常常無法提供。

But so far, the world''s second-most populous country appears to have avoided the worst.

但到目前為止,這個世界第二人口大國似乎避免了最糟糕的情況。

As of Tuesday, India had reported 31,360 coronavirus cases and 1,008 deaths, or about 0.76 deaths per million. Compare that to the United States, where the number of deaths per million is more than 175.

截至周二,印度報告了31360例冠狀病毒病例和1008例死亡,約為百萬分之0.76。與美國相比,美國每百萬人的死亡人數超過175人。



How swift were Modi''s decisions?

莫迪的決定有多快?

On March 24, Modi announced that the country was going into a three-week lockdown.

3月24日,莫迪宣布該國將進入為期三周的封鎖期。

The scale of it was unprecedented. India has a population of 1.3 billion, and the only country with a bigger population -- China -- had imposed citywide lockdowns, but never a nationwide one.

封鎖規??涨?。印度有13億人口,唯一一個人口更多的國家——中國——實施了全市范圍的封鎖,但從未實施全國范圍的封鎖。

It was a high-stakes decision. Going into lockdown meant millions of daily-wage workers would be deprived of an income. But not imposing a lockdown risked overwhelming India''s health care system. One model estimated that without social distancing measures, about 150 million people in India would be infected by June. On Friday, India''s top pandemic official said that the country would have had more than 100,000 cases by now if it weren''t for the lockdown.

這是一個高風險的決定。進入停工期意味著數以百萬計的日薪工人將被剝奪收入。但如果不實行封鎖,印度的醫療體系將面臨無法承受的風險。一個模型估計,如果不采取社會疏遠措施,到6月份,印度約會有1.5億人將受到感染。上周五,印度最高流行病官員說,如果沒有封鎖,到目前為止印度可能已經有超過10萬例病例。

India moved into lockdown relatively quickly -- it was announced when the country had reported 519 coronavirus cases.

印度相對較快地進入了封鎖狀態——該國報告了519例冠狀病毒病例后宣布了這一決定。

By comparison, Italy waited until it had more than 9,200 coronavirus cases before it went into a nationwide lockdown, while the United Kingdom had about 6,700.

相比之下,意大利等到有9200多個冠狀病毒病例后才進入全國范圍的封鎖,而英國則是大約6700個病例。

Following the lockdown, thousands of migrant workers attempted to leave India''s major cities after the restrictions left them without jobs. That prompted fears that the migrants could spread the virus, with some officials in the Indian state of Uttar Pradesh even spraying returning workers with disinfectant -- an ineffective approach to controlling coronavirus.

封鎖之后,數千名移民工人試圖離開印度的主要城市,因為這些限制使他們失去了工作。這引發了人們對移民可能傳播病毒的擔憂,印度北方邦的一些官員甚至向返回的工人噴灑消毒劑——這是控制冠狀病毒的無效方法。

Around a week after the lockdown began, two people had died from coronavirus in Mumbai''s densely packed slums. Following the second death, several of the man''s family members had been tested and placed under home quarantine, and the block of 300 homes and 90 shops that make up his neighborhood have been sealed off.

在封鎖開始一周后,孟買擁擠的貧民窟里有兩人死于冠狀病毒。第二次死亡后,這名男子的幾名家屬接受了檢測,并接受了家庭隔離,構成他居住區的300戶人家和90家商店也被封鎖。

By the time the lockdown was imposed, India had already taken other measures.

在實施封鎖時,印度也已經采取了其他措施。

On March 11, India suspended all tourist visas, and announced that all travelers who had been in the most-affected areas of the world in the past few weeks would be quarantined for at least 14 days. From March 22, all international commercial flights were banned from landing in India and all passenger train services in the country were suspended.

3月11日,印度暫停了所有的旅游簽證,并宣布,過去幾周來去過世界上受影響最嚴重地區的所有游客將被隔離至少14天。從3月22日起,印度禁止所有國際商業航班降落,印度所有客運列車服務暫停。

The United States, by comparison, has restricted foreigners traveling from China, Iran, and certain European countries, but there is no blanket ban on foreigners entering the country.

相比之下,美國限制了來自中國、伊朗和某些歐洲國家的外國人入境,但沒有全面禁止外國人入境。

What if the numbers aren''t right?

數字會不會是不正確的?

As with every country, our understanding of the outbreak is only as good as the numbers we have available. And that depends on testing.

和每個國家一樣,我們對疫情的了解只能取決于我們有的數字。而數字取決于檢測量。

According to India''s Health Ministry, the country has conducted more than 625,000 tests as of Sunday -- more than South Korea, which has been praised for its approach to testing.

據印度衛生部統計,截至周日,該國已經進行了超過62.5萬次檢測,超過了因大量檢測而受到贊揚的韓國。

When public health experts are assessing how aggressively a country is testing, they don''t look at the total numbers alone -- instead, they often look at the country''s test positivity rate. If a large proportion of the tests are coming back positive, that suggests that only the most serious cases -- such as those in hospital -- are being tested.

當公共衛生專家評估一個國家的檢測力度時,他們并不是只看總數,而是經??催@個國家的檢測陽性率。如果很大一部分的檢測結果呈陽性,那就意味著只有最嚴重的病例——比如住院的病例——才能接受檢測。

According to Mike Ryan, the executive director of the WHO''s Health Emergencies Programs, a good benchmark is to have at least 10 negative cases for every positive one.
據世衛組織緊急衛生方案執行主任邁克·瑞安說,一個好的基準是,每一個陽性病例至少伴隨10個陰性病例。

Around 4% of India''s tests are positive, according to data from India''s Health Ministry -- well below that benchmark. It''s also a significantly lower rate than the US, where the rate is about 17%, according to data from Johns Hopkins University (JHU). It''s also lower than the UK, where the rate is around 21%, based on government data.

印度衛生部的數據顯示,印度約4%的檢測結果為陽性,遠遠低于這一基準。根據約翰霍普金斯大學的數據,這一比例也明顯低于美國,美國的比例約為17%。根據政府數據,這一比例也低于英國,英國的比例約為21%。

Another useful measure is the proportion of cases that are fatal. In India, about 3% of cases have died, compared with more than 13% in Italy, the UK and France, according to JHU. That suggests that India is testing people besides those with the most serious symptoms.

另一個有用的指標是致命病例的比例。在印度,約3%的病例已經死亡,而在意大利、英國和法國,這一比例超過了13%。這表明,除了那些有最嚴重癥狀的人之外,印度還在測試其他人。



For now, there''s no indication of either. However, there is a growing body of evidence that Covid-10 causes symptoms far beyond influenza-like symptoms.

目前,還沒有這種跡象。然而,越來越多的證據表明Covid-19引起的癥狀遠遠超過流感樣癥狀。

Could more people be dying than we know?

死亡的人是否比我們知道的多?

Even when India isn''t facing a pandemic, only about 22% of all registered deaths are medically certified. That means that, in the majority of deaths, the official cause of death has not been certified by a doctor.

即使在印度沒有面臨大流行病的時候,也只有22%的登記死亡病例得到了醫學證明。這意味著,在大多數死者中,官方死因并沒有得到醫生的證實。

And there''s already evidence that some deaths may be flying under the radar. A resident doctor at one of the main government hospitals in Mumbai said last week that when dead bodies were brought into the hospital, they didn''t test them for coronavirus, even if they suspected that was how patients died.

而且已經有證據表明,一些人的死亡可能根本沒有被注意。孟買一家主要政府醫院的住院醫生上周說,當死尸被帶進醫院時,他們沒有對尸體進行冠狀病毒檢測,即使他們懷疑病人就是因此死亡的。

"If the personal history shows that the person came in contact with someone who tested positive for the virus, we dispose of the body in the same way that we would for Covid-positive patients," said the doctor, who asked not to be named as they were not authorized to speak to media.

這位不愿透露姓名的醫生說:“如果個人病史顯示此人與病毒檢測呈陽性的人接觸,我們處理尸體的方式與處理新冠陽性患者的方式相同?!?。

But, experts say, at this stage, it doesn''t look like there is a huge flood of coronavirus deaths.

但是,專家說,在現階段,冠狀病毒造成的死亡似乎并不多。

"Even if we are not testing enough and are not discovering enough, there are not enough bodies being piled up in hospitals or in ICUs or in mortuaries ... to suggest we are in the midst of something really dramatic at this stage," said Saran.

“即使我們沒有進行足夠的檢測,也沒有足夠的去了解,但我們也沒有那么多的尸體被堆在醫院、ICU或太平間里。。?!斑@表明我們正處于一個非常戲劇性的階段,”薩拉說。

Even so, the true count of Covid-19 deaths will only come much later, when we are able to compare statistics from this year with past years, said CCDEP''s Laxminarayan.

即便如此,Covid-19的真正死亡人數也只有在很久以后才會統計出,屆時我們才能將今年和過去幾年的統計數據進行比較,疾病動力學、經濟與政策中心(CCDEP)的拉斯米納雷安說。

When did coronavirus take hold?

冠狀病毒什么時候開始流行的?

India''s swift policy measures only tell part of the story. Even before India''s lockdown, coronavirus was present in the country, the country had reported some coronavirus cases, but not many.

印度迅速的政策措施只是整個疫情的一部分。早在印度封鎖之前,該國就已經出現了冠狀病毒,該國當時就已經報告了一些冠狀病毒病例,但數量并不多。

On January 30, India reported its first case -- a student who had been studying at Wuhan University in China.

1月30日,印度報告了第一例病例——一名在中國武漢大學學習的學生。

It was around the same time that the UK, France, and Italy also reported their first cases, although their coronavirus outbreaks followed dramatically different trajectories. All three countries now have well over 100,000 coronavirus cases.

大約在同一時間,英國、法國和意大利也報告了他們的第一例病例,盡管他們的冠狀病毒爆發遵循截然不同的軌跡。這三個國家現在都有超過10萬例冠狀病毒病例。

Experts still aren''t sure why the virus would have shown a different pattern of spread in India.

專家們仍然不確定為什么這種病毒會在印度表現出不同的傳播模式。

One possible reason, said Reddy, is that coronavirus may thrive in colder conditions, meaning that it might not spread so efficiently in India, where temperatures are often more than 30 degrees Celsius (96.8 degrees Farenheit).

雷迪說,一個可能的原因是冠狀病毒可能適合在較冷的條件下繁殖,這意味著它可能不會在印度傳播得如此迅速,那里的溫度通常超過30攝氏度(96.8華氏度)。

But scientific evidence so far contradicts this idea. The World Health Organization says the evidence so far shows the virus can be transmitted in all areas, including those with hot and humid weather. The US''s National Academy of Sciences committee said the data is mixed on whether coronavirus spreads as easily in warm weather as it does in cold weather.

但迄今為止的科學證據與這一觀點相悖。世界衛生組織說,迄今為止的證據顯示,病毒可以在所有地區傳播,包括那些炎熱潮濕的天氣。美國國家科學院委員會表示,有關冠狀病毒在溫暖天氣中是否像在寒冷天氣中一樣容易傳播的數據好壞參半。

Another possibility, Reddy said, is that India''s population may be less susceptible due to the country''s policy of universal Bacillus Calmette-Guerin (BCG) vaccination. BCG -- which was developed to fight tuberculosis -- is being studied in clinical trials around the world as a possible way to fight the novel coronavirus.

雷迪說,另一種可能性是,由于印度實行卡介苗(BCG)普及接種政策,印度人口可能不易受感染??ń槊纾˙CG)是為抗擊結核病而研制的,目前正在世界各地進行臨床試驗,作為對抗新型冠狀病毒的一種可能途徑。



The determining factor will likely be what restrictions are still in place when the lockdown lifts. As Reddy put it: "It''s not as though tomorrow we declare victory and then we get back to normal."

決定因素可能是在解除封鎖時仍保留哪些限制。正如雷迪所說:“并不是說明天我們宣布勝利,然后我們就能恢復正常?!?br />
Experts say that social distancing will need to be maintained, although some states with fewer cases may be able to ease restrictions. Uttar Pradesh -- India''s most populous state with 200 million residents -- has extended a ban on public gatherings until the end of June.

專家說,社交距離需要保持,盡管一些州的案件較少,可能能夠放寬限制。印度人口最多、擁有2億居民的北方邦已經將禁止公眾集會的禁令延長至6月底。

Laxminarayan warned that if social distancing and hygiene measures "are not taken seriously, we will have a serious issue that the health system is not equipped to handle."

拉斯米納雷安警告說,如果“不認真對待社交距離和衛生措施,我們將面臨衛生系統無法處理的嚴重問題”

One thing that won''t work in India is an age-specific lockdown, where elderly stay inside and the young are allowed to go back to work. Around the world, the elderly have been at a higher risk of dying from coronavirus -- in the US, 80% of deaths have been those ages 65 or older.

有一件事在印度是行不通的,那就是針對年齡的封鎖,指讓老人呆在家里,年輕人可以回去工作。在全世界,老年人死于冠狀病毒的風險更高——在美國,80%的死亡是65歲或65歲以上的人。

India has a relatively young population -- 44% of the population are 24 or younger, compared with 23% in Italy and 29% in China, according to data from the CIA World Factbook. But many Indians live in a three-generation household, meaning that there is significant contact between younger and older generations, said University of Cambridge mathematician Ronojoy Adhikari, who modeled India''s outbreak.

中情局世界概況的數據顯示,印度人口相對年輕——44%的人口年齡在24歲或24歲以下,而意大利為23%,中國為29%。但為印度的疫情建模的劍橋大學數學家Ronojoy Adhikari說,許多印度人生活在一個三代家庭中,這意味著年輕一代和年長一代之間有著緊密接觸。

"This makes the elderly in India particularly vulnerable, as they are far more likely to catch the infection from the second and third generations, on whom the infection will, statistically speaking, only have mild effects," he said.

他說:“這使得印度的老年人特別脆弱,因為他們更容易被第二代或第三代人感染,而從統計學上講,感染對年輕代的影響只是輕微的?!?br />
Even if India does manage to avoid the worst of the virus this time around, there''s plenty to be done. The government needs to be working to support the country''s informal workforce, who are "underwriting the cost of the lockdown," as Saran puts it. The government needs to strengthen the public health system to prepare for a possible return and resurgence in the winter, said Reddy.

即使印度這次成功地避免了病毒最嚴重影響,也依然還有很多事情要做。政府需要努力支持該國的非正規勞動力,正如薩蘭所說,他們正在“承擔封鎖的成本”。雷迪說,政府需要加強公共衛生系統,為病毒可能在冬季的卷土重來做好準備。

"This is not a one month challenge, this is going to be a 12-month challenge," said Saran. "I think this is a good 18-month examination of how we respond as people, communities, countries, states."

“這不是一個月的挑戰,而是一個12個月的挑戰,”薩蘭說我認為這是對我們作為人民、社區、國家和州如何應對疫情的一次為期18個月的良好檢查?!?br />