全球新冠疫情将于今年三月宣告终结（中英全文）

识途

文/克里斯托弗·默里

原载：柳叶刀

《柳叶刀》：

新冠病毒将持续存在

但是大流行疫情

即将终结

1月19日，《柳叶刀》杂志线上发表了数篇有关奥密克戎的文章，其中最引人注目的是由华盛顿大学健康指标与评估研究所（IHME）主任默里（Chris Murray）撰写的一篇评论。从1990年开始，默里一直专注于研究全球疾病造成的社会负担。自疫情爆发以来，该所以对病死率的预测准确而著称。

本文可谓

对于目前疫情最

大胆的预测

默里指出全球新冠大流行很可能会在不久后结束，标志时间节点为2022年3月。在这篇评论中，默里基于其研究所的模型提出了几项预测：

1、奥密克戎正以前所未有的速度席卷全球，但当中绝大多数为无症状感染；

2、尽管重症率直线下降，但住院人数仍在上升，未来4-6周卫生系统吃紧；

3、各种公共卫生措施，包括佩戴口罩、推进第三针等，从人口层面而言都难以遏制奥密克戎浪潮；

4、今年3月，全球半数以上人口将感染奥密克戎，感染病毒以及疫苗接种将使得全球免疫力达到高水平；

5、未来新冠病毒还会卷土重来，但大流行将销声匿迹。

正文：

The world isexperiencing a huge wave of infection with the omicron variant of SARS-CoV-2. Estimates based on Institute for Health Metrics and Evaluation (IHME，健康指标和评估) models suggest that on around Jan 17, 2022 there were 125 million omicron infections a day in the world, which is more than ten times the peak of the delta wave in April, 2021.  The omicron wave is inexorably（[ɪnˈeksərəbli]，adj. 无情地，不可阻挡地） reaching every continent with only a few countries in eastern Europe, North Africa, southeast Asia, and Oceania yet to start their wave of this SARS-CoV-2 variant.

世界正经历一场巨大的新冠变种奥密克戎感染浪潮。IHME模型的预测表明，在2022年1月17日左右，全球每天奥密克戎感染者达到1.25亿，超过2021年4月德尔塔峰值的10倍。奥密克戎浪潮正在毫不容情地席卷全球每个大陆，只有东欧、北非、东南亚和大洋洲的少数几个国家尚未受到波及。

 The unprecedented level of infection suggests that more than 50% of the world will have been infected with omicron between the end of November, 2021 and the end of March, 2022.  Although IHME models suggest that global daily SARS-CoV-2 infections have increased by more than 30 times from the end of November, 2021 to Jan 17, 2022, reported COVID-19 cases in this period have only increased by six times.  Because the proportion of cases that are asymptomatic （无症状的）or mild（轻微症状的） has increased compared with previous SARS-CoV-2 variants, the global infection-detection rate has declined globally from 20% to 5%.

这样前所未有的感染水平表明，2021年11月底至2022年3月底期间，全世界超过半数的人口将感染奥密克戎毒株。尽管IHME模型显示，从2021年11月底到2022年1月17日，全球每天新冠感染量增加了30多倍，但在此期间报告的新冠肺炎病例仅增加了6倍。相比以往的新冠变异病毒，奥密克戎无症状或轻症病例的比例显著增加，因此全球感染检出率从20%降至5%。

全球感染人数及预测

Understanding the burden of omicron depends crucially on the proportion of asymptomatic infections. A systematic review based on previous SARS-CoV-2 variants suggested that 40% of infections were asymptomatic.  Evidence suggests that the proportion of asymptomatic infections is much higher for omicron, perhaps as high as 80–90%. Garrett and colleagues found that among 230 individuals in South Africa enrolling（v. 报名参加，注册，加入） in a clinical trial, 71 (31%) were PCR positive for SARS-CoV-2 and had the omicron variant and no symptoms. Assuming this prevalence of infection was representative（n. 代表） of the population, the implied incidence (发病率，发生率）compared to detected cases suggests that more than 90% of infections were asymptomatic in South Africa. 

正确理解奥密克戎所造成的社会负担，很大程度上在于无症状感染率。以往新冠变异病毒的系统性回顾表明无症状感染比例约为40%。有证据表明，奥密克戎无症状感染率则远高于此，可能高达80-90%。在南非参与临床试验的230名志愿者中，有71人（31%）新冠 PCR测试呈阳性，并感染奥密克戎病毒且完全无症状。假设上述感染率足以代表整体人口，通过对比确诊病例和隐含发病率可看出，在南非，超过90%的奥密克戎感染者没有出现任何症状。

The UK Office for National Statistics (ONS) infection survey estimated a point prevalence（流行，盛行） of PCR positive SARS-CoV-2 infection of 6·85% for England on Jan 6, 2022.  

英国国家统计局（ONS）新冠感染调查估计，2022年1月6日，英国该时点PCR阳性率为6.85%，也就是当时每15人中有一人感染新冠病毒。

Hospital admission prescreening（初筛） of individuals without COVID-19 symptoms in the University of Washington Medical Center in Seattle, WA, USA, did not exceed 2% throughout the COVID-19 pandemic but exceeded 10% in the week of Jan 10, 2022 (Murray CJL, unpublished). In addition to the much larger proportion of asymptomatic infections, in the USA the ratio of COVID-19 hospitalisations to detected cases hospitalised has declined by about 50% in most states compared with previous peaks. The proportion of COVID-19 patients in hospital who require intubation （气管插管）or are dying has declined by as much as 80–90% in Canada and South Africa.

华盛顿州西雅图的华盛顿大学医学中心在对未出现新冠症状的患者进行入院前筛查时发现，整个新冠疫情期间感染新冠者均不及2%，但是2022年1月10日那一周超过了10%。在无症状感染率飙升的同时，在美国大多数州，新冠住院与确诊比例较此前峰值下降约50%。在加拿大和南非，新冠住院患者中需要插管或濒临死亡者的比例下降了80-90%。

Despite the reduced disease severity per infection, the massive wave of omicron infections means that hospital admissions are increasing in many countries and will rise to twice or more the number of COVID-19 hospital admissions of past surges in some countries according to the IHME models. In countries where all hospital admissions are screened for COVID-19, a substantial proportion of these admissions will be among individuals coming to hospital for non-COVID-19 reasons who have asymptomatic SARS-CoV-2 infection. 

尽管重症率直线下降，但奥密克戎感染的巨大浪潮还是导致很多国家住院人数不断上升，根据IHME模型，部分国家新冠住院患者人数比以往激增两倍或更多。在所有入院患者均需接受新冠筛查的国家，为数众多的新冠住院患者不是因为新冠入院的无症状感染者。

Nevertheless, infection control requirements put increased demands on hospitals. Given population prevalence of SARS-CoV-2 infection of more than 10%, such as reported by the ONS infection survey in London, England, large numbers of health workers are testing positive and are required to quarantine（隔离）, which puts a double pressure on hospitals. 尽管如此，感染控制的需要让医院不堪重负。考虑到整体人口的新冠感染率已超过10%，例如，据英国国家统计局在伦敦的感染调查报告，大量医务工作者因新冠检测呈阳性而需要隔离，从而对医院造成双重压力。Countries will need to prioritise （优先）support for health systems in the next 4–6 weeks. Data from Greece, however, hold out hope that severe COVID-19 outcomes from the omicron wave will be limited; from Dec 21, 2021 to Jan 17, 2022， COVID-19 cases increased nearly 10 times but hospital intubations among COVID-19 hospital patients have remained the same as in December.未来4-6周内，各国应该对医疗卫生系统予以优先支持。不过，源自希腊的数据让人看到希望：奥密克戎浪潮导致的重症患者为数有限；2021年12月21日至2022年1月17日间，虽然新冠病例增加近10倍，但新冠住院患者的插管率与12月持平。

Surprisingly, IHME models suggest that the transmission intensity of omicron is so high that policy actions—eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines—taken in the next weeks will have limited impact on the course of the omicron wave. IHME estimates suggest that increasing use of masks to 80% of the population, for example, will only reduce cumulative（积累的，累计的） infections over the next 4 months by 10%. Increasing COVID-19 vaccine boosters or vaccinating people who have not yet been vaccinated is unlikely to have any substantial impact on the omicron wave because by the time these interventions are scaled up the omicron wave will be largely over. 出人意料的是，IHME模型表明奥密克戎的传染强度高得异乎寻常，因此未来数周内，包括佩戴口罩，扩大疫苗接种率，或施打疫苗加强针等在内的新冠防控举措对奥密克戎的传播进程造成的影响均极为有限。例如，IHME的估计表明，即使80%整体人口均佩戴口罩，未来4个月内也只能让总感染人数减少10%。扩大疫苗接种率或施打加强针也无法对抑制奥密克戎传播产生实质性影响。因为当这些措施开始奏效时，奥密克戎浪潮已经基本宣告终结。

Only in countries where the omicron wave has not yet started can expanding mask use in advance of the wave have a more substantial effect. These interventions still work to protect individuals from COVID-19,but the speed of the omicron wave is so fast that policy actions will have little effect on its course globally in the next 4–6 weeks. The omicron wave appears to crest（峰值） in 3–5 weeks after the exponential （[ˌekspəˈnenʃl] ，adj. 指数级的）increase in reported cases begins.只有奥密克戎尚未开始肆虐的国家，在疫情扩散前就提高口罩佩戴率才能产生更具实质性的效果。这些防控措施依然可保护大家免遭感染，但由于奥密克戎的传染速度极为迅速，未来4-6周内，疫情防控措施对其全球扩散几乎毫无作用。奥密克戎似乎将在确诊病例呈指数级增长后的3-5周内达到峰值。

As of Jan 17,2022, omicron waves were peaking in 25 countries in five WHO regions and in 19 states in the USA.  It is expected that the omicron peak will occur in most countries between now and the second week of February, 2022. 截至2022年1月17日，奥密克戎浪潮已在五个世卫组织区域的25个国家和美国的19个州见顶。预计从现在开始至2022年2月的第二周，大多数国家也将出现奥密克戎感染峰值。The latest omicron peaks are expected to come in the countries where the omicron wave has not yet started, such as in eastern Europe and southeast Asia. Actions to increase SARS-CoV-2 testing, for example, are likely to increase disruption by having more individuals excluded from work or school, but are unlikely to impact the course of the omicron wave. In the era of omicron, I believe that COVID-19 control strategies need to be reset. Given the speed and intensity of the omicron wave, in my view efforts to contact trace seem to be futile.预计最新感染高峰将出现在奥密克戎尚未开始肆虐的国家，例如东欧和东南亚。部分防控措施，如增加新冠检测等，将使得更多人无法正常工作或学习，从而在造成困扰的同时却很难阻断奥密克戎的传播。在奥密克戎时代，我认为需要重新制定新冠防控策略，考虑到其传播速度和强度，在我看来任何尝试追踪其传播轨迹的努力终将徒劳无功。

A questionremains in relation to the countries pursuing zero COVID-19 strategies, such as C and New Zealand.  Given the high transmissibility of omicron, it seems unlikely that C or New Zealand will be able to permanently exclude the omicron wave. For zero COVID-19 countries, the question will be one of timing. Later omicron surges will allow further progress on increasing vaccination coverage and better understanding of the impact of the omicron variant in a fairly immunologically naive population.部分国家实施的“清零战略”也存在问题。由于奥密克戎超强传染性，这些国家似乎不太可能永久免遭奥密克戎的冲击。对奉行“清零战略”的国家而言，这只不过是时间问题而已。不过，姗姗来迟的奥密克戎浪潮可以让这些国家进一步扩大疫苗接种范围，并有更多机会深入研究奥密克戎变异毒株对免疫水平空白人群的的影响。

By March,2022 a large proportion of the world will have been infected with the omicron variant. With continued increases in COVID-19 vaccination, the use in many countries of a third vaccine dose, and high levels of infection-acquired（获得的） immunity, for some time global levels of SARS-CoV-2 immunity should be at an all time high. For some weeks or months, the world should expect low levels of virus transmission.到2022年3月，全球相当部分人口将感染奥密克戎变种病毒。随着疫苗接种日益普及，很多国家推进第三剂加强针疫苗，外加大量因感染导致的免疫人群，在后续时间段内，全球新冠免疫水平达到前所未有的高度。未来数周或数月，全世界范围内的病毒传播程度有望一落千丈。

I use the term pandemic to refer to the extraordinary societal efforts over the past 2 years to respond to a new pathogen that have changed how individuals live their lives and how policy responses have developed in governments around the world. These efforts have saved countless lives globally. New SARS-CoV-2 variants will surely emerge and some may be more severe than omicron. Immunity, whether infection orvaccination derived, will wane, creating opportunities for continued SARS-CoV-2 transmission. Given seasonality, countries should expect increased potential transmission in winter months.我通过“大流行”这个词汇形容过去两年间全社会应对这种新型病毒所做出的非凡努力，后者改变了人们的生活方式以及世界各国政府制定防控举措的方式。所有付出的努力在全球范围内拯救了无数生命。新的病毒变异株肯定会继续出现，其中有些或许比奥密克戎更为严重。无论疫苗或感染所致的免疫力都会逐渐减弱，从而为新冠病毒的持续传播带来可乘之机。考虑到季节性因素，各国应预期潜在传染性在冬季将有所增加。The impacts of future SARS-CoV-2 transmission on health, however, will be less because of broad previous exposure to the virus, regularly adapted vaccines to new antigens or variants, the advent（到来，出现） of antivirals, and the knowledge that the vulnerable can protect themselves during future waves when needed by using high-quality masks and physical distancing. COVID-19 will become another recurrent disease that health systems and societies will have to manage. For example, the death toll from omicron seems to be similar in most countries to the level of a bad influenza season in northern hemisphere countries. The US Centers for Disease Control and Prevention estimated the worse influenza season during the past decade in 2017–18 caused about 52000 influenza deaths with a likely peak of more than 1500 deaths per day.尽管如此，未来新冠传播对健康的影响将变更加轻微，这是因为此前广泛接触过病毒、定期针对新病毒或变异株调整疫苗、抗病毒药物的不断涌现、以及必要时易感人群可通过佩戴高质量口罩和保持社交间距保护自己。新冠将成为医疗系统和全社会必须管控的另一种复发疾病。作为参考，在大多数国家奥密克戎的致命率似乎与北半球国家的严重流感季节旗鼓相当。据美国疾病控制和预防中心（CDC）估计，过去十年最严重的流感季（2017-18年）导致约52000人死亡，最高峰期间每天病亡人数超过1500。

2010-2020流感造成的社会负担

The era of extraordinary measures bygovernment and societies to control SARS-CoV-2 transmission will be over. Afterthe omicron wave, COVID-19 will return but the pandemic will not.政府和社会为管控新冠传播而采取非常措施的时代即将终结。奥密克戎浪潮褪去以后，新冠病毒或许卷土重来

但是

大流行将销声匿迹

仅供参考