2020年经济学人 Covid-19:世界已做好准备(5)（在线收听）

The swine-flu pandemic, which was caused by the h1n1 virus and infected 16% of the world’s population in 2009, brought home the message that doctors would have to make such tough decisions when big epidemics strike, says Dan Hanfling of In-Q-Tel, an American organisation that invests in national-security technology. Between the first and the second wave of h1n1 infections in America, the country’s National Academies of Sciences developed a set of “crisis standards of care”. These specify what doctors should do as shortages of medical supplies become worse.

一家投资国家安全技术的美国组织In-Q-Tel的丹·汉弗林表示，2009年由h1n1病毒引起、感染了全球16%人口的猪流感疫情，让人们明白，当大的流行病来袭时，医生们必须做出如此艰难的决定。在美国第一波和第二波h1n1感染之间，美国国家科学院制定了一套“危机护理标准”。 规定了医生在医疗用品短缺变得更严重时应该怎样做。

One course of action is to substitute treatments with near-equivalents, such as drugs that have a similar effect. Another is to adapt what is available for different uses. For example, simpler breathing machines from ambulances may be used as substitutes for the sophisticated machines in intensive- care units. Medics may have to clean and re-use equipment, such as catheters, rather than throw it away after each use (as doctors in poor countries do every day, Dr Hanfling points out).

一种做法是用类似的方案来替代，比如有类似效果的药物。另一种方法是对不同用途的可用性进行调整。例如，救护车上比较简单的呼吸器可以代替重症监护病房中比较复杂的呼吸器。医生们可能不得不清洗和重复使用设备，比如导尿管，而不是每次使用后就把它扔掉(正如贫穷国家的医生每天所做的那样，汉弗林博士指出)。

The hardest decisions would come when all these options are exhausted. Few countries have discussed how doctors would choose which patients get ventilators when there are not enough for everyone who needs one. If doctors have one patient who is on a ventilator but clearly getting worse, and another who is healthier and more likely to survive, they can justify reallocating the ventilator to the second patient. But such decisions would be particularly hard to make with covid-19, based on what doctors already know about the disease. A patient may be on a ventilator for several weeks and show little improvement but still make a good recovery.

当所有这些选择都用尽时，最艰难的决定就会出现。很少有国家讨论过，当没有足够的人工呼吸器来满足每个人的需求时，医生该如何选择哪些患者使用人工呼吸器。如果医生有一个病人使用呼吸机，但病情明显恶化，而另一个病人更健康，更有可能活下来，他们就有理由将呼吸机重新分配给第二个病人。但这是基于医生对这种疾病的已知知识，而covid-19尤其难以做出这样的决定。病人可能需要使用呼吸机几周，但几乎没有好转，但仍能很好地恢复。