生物与医学2020pnas.org
1918 年流感大流行期间的公共卫生干预与疫情强度
Public health interventions and epidemic intensity during the 1918 flu pandemic
进阶 · 约 35 分钟读完前置知识：流行病学基础、基础统计、1918年流感历史背景
导读
这篇 PNAS 论文系统考察了 1918 年流感大流行期间美国各城市采取的公共卫生干预措施（关闭学校、教堂、剧院，禁止集会等），发现早期实施干预与更低的峰值死亡率相关，但没有哪一项单一干预与整体死亡结局的改善相关；病例被分散到更长的时间段，且一旦放松干预，病毒传播随即回升。
HN 关注点：历史上的非药物干预究竟只是“拉平曲线、推迟感染”，还是真能减少总死亡——这对 COVID-19 防控争论直接相关。
后来怎么样
这篇论文成为 COVID-19 早期政策讨论中“拉平曲线”和早期非药物干预的重要历史证据之一，被广泛用于说明干预可降低峰值死亡率、但可能只是推迟感染而非减少总死亡。
HN 评论精选
这几条评论里：质疑 1 补充 2
质疑干预只是拉平曲线、推迟感染，并未减少总死亡人数，标题有误导性。
标题的措辞被编辑得带有误导性。摘要原文说：早期实施某些干预（包括关闭学校、教堂和剧院）与更低的峰值死亡率相关，但在 1918 年这一阶段，没有任何单一干预显示出与整体结局改善的相关性。换句话说，无论是否干预，死亡人数大致相当，只是病例被摊到了更长的时间段里。他们还指出，一旦放松干预，病毒就会传播，说明许多城市只是把感染推迟了。（补充：我的评论只是想指出，这些干预并没有把死亡率减半——快速扫一眼标题可能会这么以为。）
nostromo查看英文原文
The headline is editorialized in a way that is misleading. > Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. In other words, a similar amount of people died regardless of these interventions, but the cases were spread out over a longer time period. They also note that the virus spreads as soon as interventions are relaxed, suggesting many cities just delayed the infection. Edit: thanks for the comments below - my comment was just to point out that these interventions didn't cut the death rate in half, as a quick reading of the submitted headline might suggest.
补充历史案例表明非药物干预可成功遏制传播，但代价是极大的不便，现代人难以接受。
非药物干预的潜在益处虽有数学模型支持，但过去大流行中这类干预效果的历史证据尚未被系统检验。我的回忆是：有一本书叫《血疫》(The Hot Zone)，讲述了非洲丛林中被称为“未开化的野蛮人”的村民如何成功遏制埃博拉。村中长者决定封锁道路、不让外人进入；他们告诉族人“别去白人的医院”，因为你可能只是带着骨折这类能治的病进去，却死于致死率约九成的埃博拉。他们要求病人待在家里作为隔离，把食物放在门口；如果食物三天没被动过，就直接烧掉茅屋，不进去查看人是否还活着。显然我不提倡烧人房子，但这是一个用非药物干预成功遏制疫情的有趣案例。如果你愿意扔东西、疯狂消毒、限制社交接触等等，不用药物也能做很多事来阻断传播。但这极其不便，而大多数现代人似乎只想吃颗药然后照常生活——我们对“不方便”的反感异常强烈。
DoreenMichele查看英文原文
Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. My recollection: There is a book called The Hot Zone that examines the successful containment of Ebola by "uneducated savages" in the jungles of Africa. The village elders decided to barricade roads and stop letting in outsiders. They told their people "Don't go to the white man's hospital" because you would go with something fixable, like a broken leg, and die of Ebola, which was killing like 90 percent of people. They quarantined you by insisting you stay home if you got sick. They would leave food on your doorstep for you. If the food sat there untouched for three days, they burned your hut down without going in to check if you were alive. Obviously, I'm not advocating for burning people's houses down. But it's an interesting case study of successful containment using non-pharmaceutical interventions. If you are willing to throw things out, disinfect like crazy, limit social contact, etc, there's a lot you can do without drugs to stop the spread. But it's damnably inconvenient and most modern people's seem to want to take a pill and carry on as usual. We seem extraordinarily averse to being inconvenienced.
补充借鉴 1918 经验须考虑 ICU 床位瓶颈，当下关键是拉平曲线、分散感染。
1918 年对控制病毒传播有一些好教训，但与 COVID-19 存在关键差异。1918 年死得最多的是 20 岁的人，而这次病毒针对老年人。现在最大的问题是需要 ICU 护理才能存活。我们已知死亡率，但那是以能获得救治为前提的，否则就会变成武汉那样。全美总共只有 9 万张 ICU 病床，而意大利眼下正是这种局面。所以既然病毒多少已是地方性流行，把感染分散到更长时间是挽救生命的最好办法。洗手和取消所有大型集会（至少到夏天）是两项显而易见的举措。
lubujackson查看英文原文
1918 has some good lesssons about controlling viral spread, but there are some key differences with COVID19. 1918 hit 20 year olds the worst while this virus targets the elderly. The biggest issue now is the need for ICU care to survive. We know mortality rates but that implies care, otherwise it turns into Wuhan. Only 90,000 ICU beds in the whole U.S. and this is the situation happening in Italy right now. So since the virus is more or less endemic, spreading infections over time is the best way to save lives. Washing hands and canceling all big group events at least until summer are the teo obvious moves.
历次讨论
- 2020Hacker News 讨论帖145 分 · 34 评
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