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“群體免疫”或許可行,但是代價(jià)有多大?

“群體免疫”或許可行,但是代價(jià)有多大?

Lauarie Garrett, John Moore 2020-07-30
采用群體免疫策略的瑞典出現(xiàn)更多的死亡病例,瑞典經(jīng)濟(jì)也沒(méi)有比其他的國(guó)家恢復(fù)得更好。

從華爾街到主街,處于新冠疫情中的人們對(duì)“群體免疫”給予了厚望。該理念認(rèn)為,足夠數(shù)量的人群最終會(huì)產(chǎn)生抗體,從而阻止病毒的傳播,并抑制疫情的發(fā)展。基于這一點(diǎn),美國(guó)總統(tǒng)唐納德?特朗普也堅(jiān)定地認(rèn)為:“病毒將會(huì)消失,一定會(huì)消失。”

不出所料,新冠病毒群體免疫策略在瑞典失敗了。人類通常會(huì)公然挑戰(zhàn)整個(gè)群體的最大利益,勞瑞?加勒特和約翰?摩爾寫(xiě)道。圖片來(lái)源:ALEXI ROSENFELD—GETTY IMAGES

瑞典政府在春季選擇采用群體免疫策略,當(dāng)時(shí)新冠疫情正在諸多歐洲國(guó)家肆虐。瑞典人民更贊成自愿控制舉措,而不是嚴(yán)格的封鎖令。本周,21名瑞典傳染病專家發(fā)文譴責(zé)了這項(xiàng)政策,他們寫(xiě)道:“在瑞典,這一策略導(dǎo)致了死亡、悲傷和痛苦。更重要的是,沒(méi)有跡象表明瑞典的經(jīng)濟(jì)要比其他很多國(guó)家更好。眼下,我們已經(jīng)成為了全世界的一個(gè)典型案例,也就是不應(yīng)該采用哪種方式來(lái)應(yīng)對(duì)這一致命的傳染病。”

英國(guó)在3月也曾經(jīng)認(rèn)真考慮過(guò)群體免疫策略,但很快因?yàn)樗劳鋈藬?shù)的上升而放棄,而且首相約翰遜也因?yàn)楦腥拘鹿诓《径≡骸?

群體免疫的問(wèn)題在于“群體”一詞。約400種疫苗已經(jīng)被用于全球的禽畜、魚(yú)、寵物和動(dòng)物園動(dòng)物:也就是所有那些沒(méi)有自由意愿的生物。在出現(xiàn)某一疾病時(shí),人們能夠通過(guò)在某一群體內(nèi)傳播病原體,以犧牲部分群體的代價(jià)讓幸存者產(chǎn)生免疫力,從而達(dá)到保護(hù)整個(gè)群體的目的。我們也可以通過(guò)向種群中足夠數(shù)量的個(gè)體注射疫苗,以更小的生命代價(jià)來(lái)實(shí)現(xiàn)同樣的結(jié)果。在這兩種情況下,需要保護(hù)的比例取決于病原體的傳染力。例如,如果70%的家養(yǎng)犬都注射了狂犬疫苗,那么全球的犬科群體就能得到保護(hù),而且即便被狗咬也不會(huì)傳播這種致命的病毒。

人類有其自由意愿,包括選擇做各類蠢事的能力,盡管這些蠢事會(huì)讓自己和他人成為高風(fēng)險(xiǎn)易感人群。這些人對(duì)約束感到焦躁不安,對(duì)限制十分不滿,而且通常會(huì)漠視群體的最大利益。

從新冠病毒的建模可以得知,要保護(hù)剩余隨心所欲的人類群體,那么感染率需要達(dá)到65%至70%。因此,在疫情從群體性災(zāi)難轉(zhuǎn)變?yōu)榕及l(fā)事件之前,三分之二的美國(guó)人口必須對(duì)病毒產(chǎn)生抗體。然而,讓約2億美國(guó)人感染意味著死亡人數(shù)將過(guò)百萬(wàn),這個(gè)數(shù)字從道德上來(lái)講著實(shí)讓人無(wú)法接受。瑞典10%的人產(chǎn)生了抗體,西班牙流感疫情的幸存者有5%產(chǎn)生了抗體,倫敦參與新冠疫情病患護(hù)理的醫(yī)療工作者有45%產(chǎn)生了抗體,但這些數(shù)字離群體免疫水平都還相差甚遠(yuǎn)。

一項(xiàng)研究顯示,在今春美國(guó)10個(gè)城市采集的血液標(biāo)本中,3月/4月疫情高峰期間紐約市的血清陽(yáng)性率最高,達(dá)到了22.7%。然而該市的首席醫(yī)療官杰?弗馬稱,這個(gè)數(shù)字也沒(méi)有什么好慶幸的,因?yàn)槲覀兒茈y用“群體免疫”來(lái)解釋這個(gè)現(xiàn)象……要讓免疫力在阻隔病毒傳播過(guò)程中發(fā)揮主要作用,這個(gè)數(shù)字還遠(yuǎn)遠(yuǎn)不夠。

此外,抗體測(cè)試呈陽(yáng)性并不能保證免疫就能奏效;檢測(cè)到的抗體可能還不足以對(duì)付病毒,或者不具有靶向性。這一點(diǎn)看起來(lái)似是而非,但危重病患的抗體反應(yīng)是最強(qiáng)烈的,包括那些已經(jīng)死亡的人士。無(wú)癥狀感染者或輕癥患者的免疫反應(yīng)通常較弱。

人們通常認(rèn)為,那些恢復(fù)得快的人擁有強(qiáng)有力的病毒抗體,這種看法是有問(wèn)題的。我們并不清楚較弱的抗體反應(yīng)是否能夠抵御再感染,而且T細(xì)胞免疫機(jī)制的觸發(fā)仍然是一個(gè)未解之謎。有越來(lái)越多的個(gè)體案例報(bào)道稱,一些個(gè)體在感染后得以治愈,而且病毒檢測(cè)為陰性,但數(shù)周后再次被感染并突然生病。這些案例很少,但可能會(huì)變得更常見(jiàn)。

關(guān)鍵問(wèn)題在于期限:新冠病毒免疫能力能夠持續(xù)多長(zhǎng)時(shí)間?我們依然處于這場(chǎng)疫情的初期。沒(méi)有研究能夠在超過(guò)三個(gè)月的時(shí)間內(nèi)跟蹤人們的免疫反應(yīng)。研究結(jié)果則是喜憂參半。在紐約市,當(dāng)?shù)匮芯咳藛T稱,人們似乎在三個(gè)月之后依然有著強(qiáng)勁的免疫力。但倫敦的一項(xiàng)調(diào)查顯示,免疫力在這個(gè)期間會(huì)逐漸變?nèi)酢T谥袊?guó)萬(wàn)州地區(qū),40%的無(wú)癥狀感染者和12.9%的新冠病患很快成為了無(wú)抗體人群。

這類發(fā)現(xiàn)并不令人吃驚。人體對(duì)于引發(fā)普通感冒的冠狀病毒的免疫力在一年之后就會(huì)消失,因此人們會(huì)不斷得感冒。沒(méi)有人會(huì)去探討用群體免疫療法來(lái)對(duì)付感冒病毒,因?yàn)檫@種做法毫無(wú)作用。

如果以感染為手段的群體免疫療法無(wú)法奏效,那么我們就需要使用疫苗。Operation Warp Speed(一家公私合營(yíng)項(xiàng)目,旨在加速新冠疫苗開(kāi)發(fā)和配送)的多個(gè)候選疫苗已經(jīng)在人體試驗(yàn)中激發(fā)了抗體和T細(xì)胞,但至于這些疫苗是否能夠防止感染或緩解病癥嚴(yán)重程度,現(xiàn)在做結(jié)論還為時(shí)尚早。只有大規(guī)模的療效試驗(yàn)才可以提供這些急需的答案。然而,疫情的緊急性以及帶來(lái)的其他壓力可能意味著,遠(yuǎn)在我們了解這些疫苗的保護(hù)時(shí)限之前,它們可能已經(jīng)得到了大規(guī)模應(yīng)用批準(zhǔn)。至于疫苗是否能夠讓70%的人群維持免疫力,沒(méi)有人會(huì)愿意為此等上一年的時(shí)間。

可以預(yù)測(cè)的是,首款獲批新冠疫苗所帶來(lái)的免疫力將隨著時(shí)間的流逝逐漸消失,因此需要多次進(jìn)行加強(qiáng)注射。

當(dāng)然,疫苗只有在廣泛接種之后才能帶來(lái)群體免疫。意見(jiàn)調(diào)查顯示,很多美國(guó)“群體”人員已經(jīng)決定拒絕使用新冠疫苗。5月的調(diào)查結(jié)果顯示,僅有49%的人愿意注射疫苗,31%的人表示不確定,但有20%的人在任何情況下都會(huì)拒絕。7月的調(diào)查亦得到了類似發(fā)人深省的結(jié)果。一個(gè)科學(xué)特別小組警告說(shuō),Operation Warp Speed疫苗舉措“基于一個(gè)令人信服但缺乏依據(jù)的假設(shè):‘如果我們開(kāi)發(fā)疫苗,那么人們就會(huì)接種。’”

為了提振公眾信心,我們必須確保疫苗只有在療效和安全性得到嚴(yán)格的檢測(cè)通過(guò)之后才能獲批。任何貿(mào)然的政治干預(yù)以及有礙安全評(píng)估的選舉年政治手段,可能會(huì)進(jìn)一步助長(zhǎng)公眾的不信任心理,繼而讓大眾免疫接種成為空談。

正如一名知名經(jīng)濟(jì)學(xué)家所說(shuō)的那樣:“絕對(duì)的經(jīng)濟(jì)恢復(fù)取決于新冠疫情的消失。現(xiàn)實(shí)在于,疫苗的時(shí)間線、療效、成本和配送都存在一些問(wèn)題,我們認(rèn)為市場(chǎng)和公眾意見(jiàn)并未充分意識(shí)到這些問(wèn)題。”

只要人類行為允許新冠病毒在群體中傳播,這種致命的病毒就不會(huì)簡(jiǎn)單地“消失”。華爾街式的奇跡——全體人群會(huì)突然獲得強(qiáng)有力的持續(xù)免疫力,并允許全球經(jīng)濟(jì)回歸2019年的水平——是不現(xiàn)實(shí)的。在研發(fā)出某款疫苗或多種疫苗、并通過(guò)在全球范圍內(nèi)使用來(lái)賦予人類群體免疫力之前,人類必須按照自由意愿,通過(guò)使用口罩、社交隔離和一些有效的常識(shí)性老辦法,來(lái)保護(hù)自身和其他人群。(財(cái)富中文網(wǎng))

勞瑞?加勒特是獲得過(guò)普利策獎(jiǎng)的科普文章作者,著有《背叛信任:全球公共衛(wèi)生的倒塌》(Betrayal of Trust: The Collapse of Global Public Health)一書(shū)以及其他書(shū)作,他也是MSNBC新聞的科學(xué)撰稿人。

約翰?摩爾是威爾康奈爾醫(yī)學(xué)院微生物學(xué)和免疫學(xué)教授,他一直在研究艾滋病病毒,最近在研究新冠病毒,中和抗體以及S糖蛋白。

譯者:Feb

從華爾街到主街,處于新冠疫情中的人們對(duì)“群體免疫”給予了厚望。該理念認(rèn)為,足夠數(shù)量的人群最終會(huì)產(chǎn)生抗體,從而阻止病毒的傳播,并抑制疫情的發(fā)展。基于這一點(diǎn),美國(guó)總統(tǒng)唐納德?特朗普也堅(jiān)定地認(rèn)為:“病毒將會(huì)消失,一定會(huì)消失。”

瑞典政府在春季選擇采用群體免疫策略,當(dāng)時(shí)新冠疫情正在諸多歐洲國(guó)家肆虐。瑞典人民更贊成自愿控制舉措,而不是嚴(yán)格的封鎖令。本周,21名瑞典傳染病專家發(fā)文譴責(zé)了這項(xiàng)政策,他們寫(xiě)道:“在瑞典,這一策略導(dǎo)致了死亡、悲傷和痛苦。更重要的是,沒(méi)有跡象表明瑞典的經(jīng)濟(jì)要比其他很多國(guó)家更好。眼下,我們已經(jīng)成為了全世界的一個(gè)典型案例,也就是不應(yīng)該采用哪種方式來(lái)應(yīng)對(duì)這一致命的傳染病。”

英國(guó)在3月也曾經(jīng)認(rèn)真考慮過(guò)群體免疫策略,但很快因?yàn)樗劳鋈藬?shù)的上升而放棄,而且首相約翰遜也因?yàn)楦腥拘鹿诓《径≡骸?

群體免疫的問(wèn)題在于“群體”一詞。約400種疫苗已經(jīng)被用于全球的禽畜、魚(yú)、寵物和動(dòng)物園動(dòng)物:也就是所有那些沒(méi)有自由意愿的生物。在出現(xiàn)某一疾病時(shí),人們能夠通過(guò)在某一群體內(nèi)傳播病原體,以犧牲部分群體的代價(jià)讓幸存者產(chǎn)生免疫力,從而達(dá)到保護(hù)整個(gè)群體的目的。我們也可以通過(guò)向種群中足夠數(shù)量的個(gè)體注射疫苗,以更小的生命代價(jià)來(lái)實(shí)現(xiàn)同樣的結(jié)果。在這兩種情況下,需要保護(hù)的比例取決于病原體的傳染力。例如,如果70%的家養(yǎng)犬都注射了狂犬疫苗,那么全球的犬科群體就能得到保護(hù),而且即便被狗咬也不會(huì)傳播這種致命的病毒。

人類有其自由意愿,包括選擇做各類蠢事的能力,盡管這些蠢事會(huì)讓自己和他人成為高風(fēng)險(xiǎn)易感人群。這些人對(duì)約束感到焦躁不安,對(duì)限制十分不滿,而且通常會(huì)漠視群體的最大利益。

從新冠病毒的建模可以得知,要保護(hù)剩余隨心所欲的人類群體,那么感染率需要達(dá)到65%至70%。因此,在疫情從群體性災(zāi)難轉(zhuǎn)變?yōu)榕及l(fā)事件之前,三分之二的美國(guó)人口必須對(duì)病毒產(chǎn)生抗體。然而,讓約2億美國(guó)人感染意味著死亡人數(shù)將過(guò)百萬(wàn),這個(gè)數(shù)字從道德上來(lái)講著實(shí)讓人無(wú)法接受。瑞典10%的人產(chǎn)生了抗體,西班牙流感疫情的幸存者有5%產(chǎn)生了抗體,倫敦參與新冠疫情病患護(hù)理的醫(yī)療工作者有45%產(chǎn)生了抗體,但這些數(shù)字離群體免疫水平都還相差甚遠(yuǎn)。

一項(xiàng)研究顯示,在今春美國(guó)10個(gè)城市采集的血液標(biāo)本中,3月/4月疫情高峰期間紐約市的血清陽(yáng)性率最高,達(dá)到了22.7%。然而該市的首席醫(yī)療官杰?弗馬稱,這個(gè)數(shù)字也沒(méi)有什么好慶幸的,因?yàn)槲覀兒茈y用“群體免疫”來(lái)解釋這個(gè)現(xiàn)象……要讓免疫力在阻隔病毒傳播過(guò)程中發(fā)揮主要作用,這個(gè)數(shù)字還遠(yuǎn)遠(yuǎn)不夠。

此外,抗體測(cè)試呈陽(yáng)性并不能保證免疫就能奏效;檢測(cè)到的抗體可能還不足以對(duì)付病毒,或者不具有靶向性。這一點(diǎn)看起來(lái)似是而非,但危重病患的抗體反應(yīng)是最強(qiáng)烈的,包括那些已經(jīng)死亡的人士。無(wú)癥狀感染者或輕癥患者的免疫反應(yīng)通常較弱。

人們通常認(rèn)為,那些恢復(fù)得快的人擁有強(qiáng)有力的病毒抗體,這種看法是有問(wèn)題的。我們并不清楚較弱的抗體反應(yīng)是否能夠抵御再感染,而且T細(xì)胞免疫機(jī)制的觸發(fā)仍然是一個(gè)未解之謎。有越來(lái)越多的個(gè)體案例報(bào)道稱,一些個(gè)體在感染后得以治愈,而且病毒檢測(cè)為陰性,但數(shù)周后再次被感染并突然生病。這些案例很少,但可能會(huì)變得更常見(jiàn)。

關(guān)鍵問(wèn)題在于期限:新冠病毒免疫能力能夠持續(xù)多長(zhǎng)時(shí)間?我們依然處于這場(chǎng)疫情的初期。沒(méi)有研究能夠在超過(guò)三個(gè)月的時(shí)間內(nèi)跟蹤人們的免疫反應(yīng)。研究結(jié)果則是喜憂參半。在紐約市,當(dāng)?shù)匮芯咳藛T稱,人們似乎在三個(gè)月之后依然有著強(qiáng)勁的免疫力。但倫敦的一項(xiàng)調(diào)查顯示,免疫力在這個(gè)期間會(huì)逐漸變?nèi)酢T谥袊?guó)萬(wàn)州地區(qū),40%的無(wú)癥狀感染者和12.9%的新冠病患很快成為了無(wú)抗體人群。

這類發(fā)現(xiàn)并不令人吃驚。人體對(duì)于引發(fā)普通感冒的冠狀病毒的免疫力在一年之后就會(huì)消失,因此人們會(huì)不斷得感冒。沒(méi)有人會(huì)去探討用群體免疫療法來(lái)對(duì)付感冒病毒,因?yàn)檫@種做法毫無(wú)作用。

如果以感染為手段的群體免疫療法無(wú)法奏效,那么我們就需要使用疫苗。Operation Warp Speed(一家公私合營(yíng)項(xiàng)目,旨在加速新冠疫苗開(kāi)發(fā)和配送)的多個(gè)候選疫苗已經(jīng)在人體試驗(yàn)中激發(fā)了抗體和T細(xì)胞,但至于這些疫苗是否能夠防止感染或緩解病癥嚴(yán)重程度,現(xiàn)在做結(jié)論還為時(shí)尚早。只有大規(guī)模的療效試驗(yàn)才可以提供這些急需的答案。然而,疫情的緊急性以及帶來(lái)的其他壓力可能意味著,遠(yuǎn)在我們了解這些疫苗的保護(hù)時(shí)限之前,它們可能已經(jīng)得到了大規(guī)模應(yīng)用批準(zhǔn)。至于疫苗是否能夠讓70%的人群維持免疫力,沒(méi)有人會(huì)愿意為此等上一年的時(shí)間。

可以預(yù)測(cè)的是,首款獲批新冠疫苗所帶來(lái)的免疫力將隨著時(shí)間的流逝逐漸消失,因此需要多次進(jìn)行加強(qiáng)注射。

當(dāng)然,疫苗只有在廣泛接種之后才能帶來(lái)群體免疫。意見(jiàn)調(diào)查顯示,很多美國(guó)“群體”人員已經(jīng)決定拒絕使用新冠疫苗。5月的調(diào)查結(jié)果顯示,僅有49%的人愿意注射疫苗,31%的人表示不確定,但有20%的人在任何情況下都會(huì)拒絕。7月的調(diào)查亦得到了類似發(fā)人深省的結(jié)果。一個(gè)科學(xué)特別小組警告說(shuō),Operation Warp Speed疫苗舉措“基于一個(gè)令人信服但缺乏依據(jù)的假設(shè):‘如果我們開(kāi)發(fā)疫苗,那么人們就會(huì)接種。’”

為了提振公眾信心,我們必須確保疫苗只有在療效和安全性得到嚴(yán)格的檢測(cè)通過(guò)之后才能獲批。任何貿(mào)然的政治干預(yù)以及有礙安全評(píng)估的選舉年政治手段,可能會(huì)進(jìn)一步助長(zhǎng)公眾的不信任心理,繼而讓大眾免疫接種成為空談。

正如一名知名經(jīng)濟(jì)學(xué)家所說(shuō)的那樣:“絕對(duì)的經(jīng)濟(jì)恢復(fù)取決于新冠疫情的消失。現(xiàn)實(shí)在于,疫苗的時(shí)間線、療效、成本和配送都存在一些問(wèn)題,我們認(rèn)為市場(chǎng)和公眾意見(jiàn)并未充分意識(shí)到這些問(wèn)題。”

只要人類行為允許新冠病毒在群體中傳播,這種致命的病毒就不會(huì)簡(jiǎn)單地“消失”。華爾街式的奇跡——全體人群會(huì)突然獲得強(qiáng)有力的持續(xù)免疫力,并允許全球經(jīng)濟(jì)回歸2019年的水平——是不現(xiàn)實(shí)的。在研發(fā)出某款疫苗或多種疫苗、并通過(guò)在全球范圍內(nèi)使用來(lái)賦予人類群體免疫力之前,人類必須按照自由意愿,通過(guò)使用口罩、社交隔離和一些有效的常識(shí)性老辦法,來(lái)保護(hù)自身和其他人群。(財(cái)富中文網(wǎng))

勞瑞?加勒特是獲得過(guò)普利策獎(jiǎng)的科普文章作者,著有《背叛信任:全球公共衛(wèi)生的倒塌》(Betrayal of Trust: The Collapse of Global Public Health)一書(shū)以及其他書(shū)作,他也是MSNBC新聞的科學(xué)撰稿人。

約翰?摩爾是威爾康奈爾醫(yī)學(xué)院微生物學(xué)和免疫學(xué)教授,他一直在研究艾滋病病毒,最近在研究新冠病毒,中和抗體以及S糖蛋白。

作者:Lauarie Garrett, John Moore

譯者:Feb

From Wall Street to Main Street, much hope in the COVID-19 crisis has been placed on “herd immunity,” the idea that a sufficient number of people will eventually develop antibodies to stop virus spread and curtail the pandemic. That thinking is behind President Donald Trump’s insisting, “The virus will disappear. It will disappear.”

The Swedish government chose to pursue herd immunity during the spring when COVID-19 overwhelmed many European nations, favoring voluntary control measures over strict lockdown procedures. This week, 21 Swedish infectious diseases experts denounced the policy, writing, “In Sweden, the strategy has led to death, grief, and suffering, and on top of that there are no indications that the Swedish economy has fared better than in many other countries. At the moment, we have set an example for the rest of the world on how not to deal with a deadly infectious disease.”

The United Kingdom also flirted with a herd immunity strategy in March, but it soon backtracked as the death toll rose and Prime Minister Boris Johnson was hospitalized with COVID-19.

The problem with herd immunity is the word “herd.” Some 400 vaccines are used on livestock, fish, pets, and zoo animals worldwide: all creatures without free will. A herd can be protected against a disease by allowing a pathogen to spread within it, killing some but leaving the survivors resistant to infection. The same outcome can be achieved, at less cost in lives, by vaccinating a sufficient percentage of the herd. In both scenarios, the percentage needing protection depends on the pathogen’s infectiousness. For example, if 70% of domestic dogs are vaccinated against rabies, the worldwide canine herd is protected and dog bites do not transmit this lethal virus to humans.

In a democracy, humans have free will, including the ability to choose to do idiotic things that put themselves and others at high risk for infection. They chafe at restriction, bridle at confinement, and often defy the best interests of the herd.

Modeling of SARS-CoV-2 indicates that an infection rate of 65% to 70% is needed to protect the rest of our freewheeling human herd. Thus, two-thirds of the U.S. population must become resistant to the virus before our epidemic shifts from collective catastrophe to isolated incidents. But allowing infection of about 200 million Americans translates to more than 1 million deaths, a morally reprehensible toll. The 10% antibody-positive rate among Swedes, the 5% seen in survivors of Spain’s epidemic, and even the 45% found among London health care workers involved in COVID-19 patient care come nowhere near herd immunity levels.

A study of blood samples collected this spring in 10 U.S. cities found the highest seropositivity rate, 22.7%, was in New York City at its March/April epidemic peak. The city’s chief medical officer, Jay Varma, says, however, that this antibody rate offers no solace, since “herd immunity is a very unlikely explanation…We’re not nearly at a level where we would expect that immunity would play a major role in decreasing transmission.”

Moreover, a positive result on an antibody test does not guarantee protective immunity; the detected antibodies may be neither strong enough to counter the virus nor targeted appropriately. It seems paradoxical, but the strongest antibody responses are seen in the sickest patients, including those who die. People with asymptomatic or mild infections usually develop weak responses.

The common perception that someone who recovered quickly had strong antibodies that “beat the virus” is flawed. It’s unknown whether the weaker antibody responses are protective against reinfection, and we’re still foggy on how T cell immunity kicks in. Isolated cases are increasingly reported of individuals who survived COVID-19, tested negative for the virus, and then weeks later were reinfected and took ill. These cases are rare but may become more common.

The key issue is duration: How long does immunity to SARS-CoV-2 last? We are still very early in this pandemic. No studies have tracked immune responses in people for much longer than three months. Results are mixed. In New York City, local researchers say people seem to still be robustly immune after three months. But a London study saw immunity waning strongly over that period, and in the Chinese district of Wanzhou, 40% of asymptomatically infected people and 12.9% of COVID-19 cases rapidly became antibody-negative.

Such findings should come as no surprise. Immunity to the related coronaviruses that cause common colds wanes after about a year, so people can catch colds over and over again. Nobody discusses herd immunity for common cold viruses—because there is no such thing.

If herd immunity via infections is off the table, the world needs a vaccine. Several Operation Warp Speed (a public-private program designed to speed up COVID-19 vaccine development and distribution) vaccine candidates have elicited antibodies and T cells in human trials, but it’s too early to tell whether any will protect against infection or reduce the severity of disease. Only large-scale efficacy trials can provide those much-needed answers. However, the urgency of the pandemic and other pressures will probably mean that vaccines will be approved for mass use well before we know their duration of protection. Nobody wants to wait a full year to see if immunity is sustained for 70% of the human herd.

It is quite foreseeable that immunity to the first approved COVID-19 vaccines will diminish over time, requiring frequent booster injections.

Of course, a vaccine can only confer herd immunity if it is widely used. Opinion surveys show many American “herd” members have already decided to reject a SARS-CoV-2 vaccine. Polling results in May found only 49% would take it, and 31% were unsure, while 20% would refuse a vaccine under any circumstances. A July survey found similarly sobering results. A scientific task force has warned that the Operation Warp Speed vaccine effort “rests upon the compelling yet unfounded presupposition that ‘if we build it, they will come.’”

To boost public confidence, it is essential that vaccines are approved only after both efficacy and safety are rigorously proved. Any rushed political interventions and election year politics that compromise safety assessments could render mass immunization impossible by further fostering public distrust.

As prominent economists have put it, “Absolute economic recovery rests on the eradication of COVID-19. The reality is that the timeline, efficacy, cost, and distribution of a vaccine all introduce factors that we do not believe are appropriately reflected in the markets and public sentiment.”

This killer coronavirus will not simply “disappear” as long as human behavior allows it to spread within the herd. A Wall Street miracle, where powerful, lasting immunity emerges en masse and allows the world economy to return to its 2019 ways, is delusional. Until a vaccine or multiple vaccines are developed and used on a global scale to confer herd immunity, human beings must exercise free will to protect themselves and the rest of the human herd by using masks, social distancing, and good old-fashioned common sense.

Laurie Garrett is a Pulitzer Prize–winning science writer, author of Betrayal of Trust: The Collapse of Global Public Health and other books, and a science contributor for MSNBC News.

John Moore is a professor of microbiology and immunology at Weill Cornell Medicine who has conducted research on HIV and, more recently, SARS-CoV-2, neutralizing antibodies, and spike glycoproteins.

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