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《经济学人》新冠疫情:缓和 vs. 封锁

2020 年 03 月 22 日 • 经济学人,Leaders

本期经济学人杂志【Leaders】板块下这篇题为《Closed by covid-19: Paying to stop the pandemic》的文章认为各国政府正面临非常艰难的抉择——挽救人们生命的同时要稳住经济。

The Economist, March 21st-27th 2020.

随着新冠肺炎疫情不断扩散,许多国家接连要求国民减少社交活动呆在家中。3 月 18 日,新冠病毒已造成中国以外 155 个国家和地区的 13.4 万人被感染,距之前报告的 43 个国家和地区的大约 9 万病例仅仅过去了 7 天。

疫情对经济的冲击要比分析师们原先预计的严重得多。中国国家统计局 3 月 16 日公布的 1 至 2 月经济数据显示,工业、消费、投资三项主要数据下滑都超过两位数——规模以上工业增加值,同比下降 13.5%(预计下降 3%);社会消费品零售总额,同比降 20.5%(预计下降 4%);固定资产投资,同比下降 24.5%,比预计的多 6 倍。各国政府正不断出台救援计划,其规模甚至超过了 2007-09 年金融危机。

各国应当具体采取何种措施来应对此次疫情?主要有以下两种方法:

  • 缓和(mitigation)——通过隔离患者和密切接触者来控制疫情蔓延。
  • 封锁(suppress)——旨在切断病毒传播途径。使用包括要求所有人居家隔离、关闭学校等措施在内的更广泛的严格措施。封锁措施虽然更为严厉,对经济损害更大,但一个重要优势是中国使用这种方法取得了成功,3 月 18 日,意大利新增患者 4,207 例,武汉为 0。

文章认为,各国在实际使用过程中会具体权衡以上两种方法的利弊。目前很多国家都不计代价坚定地采用“封锁”(suppress)的方法,但如果病毒仍无法快速得到控制(注一),这些国家可能转而使用“缓和”(mitigation)的方法,尽管可能会带来更多伤亡。没有哪个政府愿意面临这样艰难的选择

注一:自 3 月 8 日以来,意大利伦巴第大区就一直处于封锁状态,当局希望在那里首先看到抗疫结果。尽管意大利目前采取了严格的防控措施,但新确诊病例和死亡病例仍在继续增长。3 月 21 日意大利新增新冠肺炎确诊病例 6557 例,新增死亡病例 793 例,均为疫情爆发以来的最高数值。3 月 21 日晚上,北部疫情最严重的伦巴底大区(Lombardy)宣布将采取更严格的防控措施。

面对当前疫情在全球蔓延的严峻形势,文章提出以下三点建议:

  • 中国、韩国和意大利的经验表明,如果一开始就进行大规模检测,将能够更好地分辨患者和非患者,减少对人们的不加区分的限制措施。
  • 利用新技术来更好地实施隔离和让人们保持社交距离。中国和韩国都利用大数据和社交媒体来追踪病毒传播路径,警示人们不要聚集或前往疾病高发区。
  • 目前英美等国急缺床位、专家和呼吸机等设备。政府应当加大健康护理的投资,增加重症监护病床数量。政府还应当制定最佳治疗方案、研发疫苗并测试有疗效的新药等。

Closed by covid-19: Paying to stop the pandemic

Closed by covid-19
Paying to stop the pandemic

The struggle to save lives and the economy is likely to present agonising choices
Leaders
Mar 19th 2020 edition
Mar 19th 2020

PLANET EARTH is shutting down. In the struggle to get a grip on covid-19, one country after another is demanding that its citizens shun society. As that sends economies reeling, desperate governments are trying to tide over companies and consumers by handing out trillions of dollars in aid and loan guarantees. Nobody can be sure how well these rescues will work.

But there is worse. Troubling new findings suggest that stopping the pandemic might require repeated shutdowns. And yet it is also now clear that such a strategy would condemn the world economy to grave—perhaps intolerable—harm. Some very hard choices lie ahead.

Barely 12 weeks after the first reports of people mysteriously falling ill in Wuhan, in central China, the world is beginning to grasp the pandemic’s true human and economic toll. As of March 18th SARS-CoV-2, the virus behind covid-19, had registered 134,000 infections outside China in 155 countries and territories. In just seven days that is an increase of almost 90,000 cases and 43 countries and territories. The real number of cases is thought to be at least an order of magnitude greater.

Spooked, governments are rushing to impose controls that would have been unimaginable only a few weeks ago. Scores of countries, including many in Africa and Latin America, have barred travellers from places where the virus is rife. Times Square is deserted, the City of London is dark and in France, Italy and Spain cafés, bars and restaurants have bolted their doors. Everywhere empty stadiums echo to absent crowds.

It has become clear that the economy is taking a much worse battering than analysts had expected (see Briefing). Data for January and February show that industrial output in China, which had been forecast to fall by 3% compared with a year earlier, was down by 13.5%. Retail sales were not 4% lower, but 20.5%. Fixed-asset investment, which measures the spending on such things as machinery and infrastructure, declined by 24%, six times more than predicted. That has sent economic forecasters the world over scurrying to revise down their predictions. Faced with the most brutal recession in living memory, governments are setting out rescue packages on a scale that exceeds even the financial crisis of 2007-09 (see leader).

This is the backdrop for fundamental choices about how to manage the disease. Using an epidemiological model, a group from Imperial College in London this week set out a framework to help policymakers think about what lies ahead. It is bleak.

One approach is mitigation, “flattening the curve” to make the pandemic less intense by, say, isolating cases and quarantining infected households. The other is to suppress it with a broader range of measures, including shutting in everybody, other than those who cannot work from home, and closing schools and universities. Mitigation curbs the pandemic, suppression aims to stop it in its tracks.

The modellers found that, were the virus left to spread, it would cause around 2.2m deaths in America and 500,000 in Britain by the end of summer. In advanced economies, they concluded, three months of curve-flattening, including two-week quarantines of infected households, would at best prevent only about half of these. Moreover, peak demand for intensive care would still be eight times the surge capacity of Britain’s National Health Service, leading to many more deaths that the model did not attempt to compute. If that pattern holds in other parts of Europe, even its best-resourced health systems, including Germany’s, would be overwhelmed.

No wonder governments are opting for the more stringent controls needed to suppress the pandemic. Suppression has the advantage that it has worked in China. On March 18th Italy added 4,207 new cases whereas Wuhan counted none at all. China has recorded a total of just over 80,000 cases in a population of 1.4bn people. For comparison, the Imperial group estimated that the virus left to itself would infect more than 80% of the population in Britain and America.

But that is why suppression has a sting in its tail. By keeping infection rates relatively low, it leaves many people susceptible to the virus. And since covid-19 is now so widespread, within countries and around the world, the Imperial model suggests that epidemics would return within a few weeks of the restrictions being lifted. To avoid this, countries must suppress the disease each time it resurfaces, spending at least half their time in lockdown. This on-off cycle must be repeated until either the disease has worked through the population or there is a vaccine which could be months away, if one works at all.

This is just a model, and models are just educated guesses based on the best evidence. Hence the importance of watching China to see if life there can return to normal without the disease breaking out again. The hope is that teams of epidemiologists can test on a massive scale so as to catch new cases early, trace their contacts and quarantine them without turning society upside down. Perhaps they will be helped by new drugs, such as a Japanese antiviral compound which China this week said was promising.

But this is just a hope, and hope is not a policy. The bitter truth is that mitigation costs too many lives and suppression may be economically unsustainable. After a few iterations governments might not have the capacity to carry businesses and consumers. Ordinary people might not tolerate the upheaval. The cost of repeated isolation, measured by mental well-being and the long-term health of the rest of the population, might not justify it.

In the real world there are trade-offs between the two strategies, though governments can make both more efficient. South Korea, China and Italy have shown that this starts with mass-testing. The more clearly you can identify who has the disease, the less you must depend upon indiscriminate restrictions. Tests for antibodies to the virus, picking up who has been infected and recovered, are needed to supplement today’s which are only valid just before and during the illness (see article). That will let immune people go about their business in the knowledge that they cannot be a source of further infections.

A second line of attack is to use technology to administer quarantines and social distancing. China is using apps to certify who is clear of the disease and who is not. Both it and South Korea are using big data and social media to trace infections, alert people to hotspots and round up contacts. South Korea changed the law to allow the state to gain access to medical records and share them without a warrant. In normal times many democracies might find that too intrusive. Times are not normal.

Last, governments should invest in health care, even if their efforts take months to bear fruit and may never be needed. They should increase the surge capacity of intensive care. Countries like Britain and America are desperately short of beds, specialists and ventilators. They should define the best treatment protocols, develop vaccines and test new therapeutic drugs. All this would make mitigation less lethal and suppression cheaper.

Be under no illusions. Such measures might still not prevent the pandemic from extracting a heavy toll. Today governments seem to be committed to suppression, whatever the cost. But if the disease is not conquered quickly, they will edge towards mitigation, even if that will result in many more deaths. Understandably, just now that is not a trade-off any government is willing to contemplate. They may soon have no choice. ■

This article appeared in the Leaders section of the print edition under the headline"Closed"

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