鮮有病毒曾經被人類徹底消滅。事實上,人類徹底戰勝的病毒只有天花和牛瘟(一種折磨奶牛的病毒性疾病)兩種。新冠病毒也不例外,同樣不會銷聲匿跡。
在此背景之下,我們不免要問:十年之后,新冠病毒會有怎樣的影響?
十年之后,新冠病毒將與其他四種能夠引起輕、中度癥狀(例如普通感冒)的常見冠狀病毒一樣變為季節性傳播。不過,在此之前很長一段時間,這種病毒已經不會在世界各地引發緊急公共衛生事件。
新冠疫情之所以不再構成系統性風險,得益于若干因素,主要是因為各國、各地區的高危人群將普遍完成疫苗接種,自然感染也會產生相應的免疫力。不過遺憾的是,仍將有部分高危人群將會因為染疫而病逝。
現在很難預測新冠病毒未來將會產生多大影響,不過我們可以以季節性冠狀病毒和流感作為基準進行參照。也就是說,美國每年可能會有數萬人因為染疫而病逝,另有10萬人因此而住院接受治療。由于新冠病毒偏好氣溫較冷、陽光較少、濕度較低、社交距離較近的環境,病逝及住院病例很可能會在溫帶氣候的冬季集中爆發。
雖然患病人數、住院人數及病逝人數仍將達到一定水平,不過我們將不再需要擔心醫院的承載能力,因為即便染疫,很多人可能也僅是輕癥病例,無需住院治療。
由于病毒傳播仍將繼續,并且隨著時間推移,人體的免疫力將會逐漸下降,突破性感染和再次感染病例將會變得更為普遍。不過就像我們現在重復感染的季節性冠狀病毒一樣,此類感染的影響大多較為溫和。
用于治療輕癥病例的抗病毒療法也將得到廣泛使用。此類新型藥物或許能夠減輕癥狀、降低傳染性,并減少并發癥。在治療高危人群時,將會聯合使用抗病毒療法和單克隆抗體療法。醫院診療流程也將得到優化,有些最為危險的并發癥,比如細胞因子風暴,將納入常規診察并接受靶向治療。
十年之后,疫苗很可能已經經過改進。新一代疫苗將更為有效,不良反應發生率也更低,更容易納入常規的兒童免疫計劃,并有可能納入成人免疫計劃,按季節提供。
美國政府很可能將采取全新方法處理新冠疫情的防范工作,不再像以往那樣手忙腳亂,疲于應對。政府將利用分析、預測工具,積極主動地預測新冠疫情可能造成哪些威脅。政府還可能開發疫苗和抗病毒藥物,用于應對某些危害較大的病毒家族。
這些應對措施將以有效的新冠病毒、艾滋病毒檢測為基礎,打造出更為有力的居家檢測工具。大多數家庭將不僅獲得檢測新冠病毒的能力,還能夠檢測流感、鏈球菌性咽喉炎及其他常見感染。
十年之后,新冠肺炎將成為一種更為“溫和”的疾病。但這并不是說,新的致命病毒的威脅將會消失。不過只要有計劃,有遠見,在遇到下一次疫情的挑戰時,世界必將準備得更為充分。(財富中文網)
阿梅什·阿達利亞是約翰斯·霍普金斯大學布隆伯格公共衛生學院健康安全中心(Johns Hopkins Center for Health Security at the Bloomberg School of Public Health)的高級學者,內科、急診、傳染病及重癥醫學認證醫師。
譯者:馮豐
審校:夏林
鮮有病毒曾經被人類徹底消滅。事實上,人類徹底戰勝的病毒只有天花和牛瘟(一種折磨奶牛的病毒性疾病)兩種。新冠病毒也不例外,同樣不會銷聲匿跡。
在此背景之下,我們不免要問:十年之后,新冠病毒會有怎樣的影響?
十年之后,新冠病毒將與其他四種能夠引起輕、中度癥狀(例如普通感冒)的常見冠狀病毒一樣變為季節性傳播。不過,在此之前很長一段時間,這種病毒已經不會在世界各地引發緊急公共衛生事件。
新冠疫情之所以不再構成系統性風險,得益于若干因素,主要是因為各國、各地區的高危人群將普遍完成疫苗接種,自然感染也會產生相應的免疫力。不過遺憾的是,仍將有部分高危人群將會因為染疫而病逝。
現在很難預測新冠病毒未來將會產生多大影響,不過我們可以以季節性冠狀病毒和流感作為基準進行參照。也就是說,美國每年可能會有數萬人因為染疫而病逝,另有10萬人因此而住院接受治療。由于新冠病毒偏好氣溫較冷、陽光較少、濕度較低、社交距離較近的環境,病逝及住院病例很可能會在溫帶氣候的冬季集中爆發。
雖然患病人數、住院人數及病逝人數仍將達到一定水平,不過我們將不再需要擔心醫院的承載能力,因為即便染疫,很多人可能也僅是輕癥病例,無需住院治療。
由于病毒傳播仍將繼續,并且隨著時間推移,人體的免疫力將會逐漸下降,突破性感染和再次感染病例將會變得更為普遍。不過就像我們現在重復感染的季節性冠狀病毒一樣,此類感染的影響大多較為溫和。
用于治療輕癥病例的抗病毒療法也將得到廣泛使用。此類新型藥物或許能夠減輕癥狀、降低傳染性,并減少并發癥。在治療高危人群時,將會聯合使用抗病毒療法和單克隆抗體療法。醫院診療流程也將得到優化,有些最為危險的并發癥,比如細胞因子風暴,將納入常規診察并接受靶向治療。
十年之后,疫苗很可能已經經過改進。新一代疫苗將更為有效,不良反應發生率也更低,更容易納入常規的兒童免疫計劃,并有可能納入成人免疫計劃,按季節提供。
美國政府很可能將采取全新方法處理新冠疫情的防范工作,不再像以往那樣手忙腳亂,疲于應對。政府將利用分析、預測工具,積極主動地預測新冠疫情可能造成哪些威脅。政府還可能開發疫苗和抗病毒藥物,用于應對某些危害較大的病毒家族。
這些應對措施將以有效的新冠病毒、艾滋病毒檢測為基礎,打造出更為有力的居家檢測工具。大多數家庭將不僅獲得檢測新冠病毒的能力,還能夠檢測流感、鏈球菌性咽喉炎及其他常見感染。
十年之后,新冠肺炎將成為一種更為“溫和”的疾病。但這并不是說,新的致命病毒的威脅將會消失。不過只要有計劃,有遠見,在遇到下一次疫情的挑戰時,世界必將準備得更為充分。(財富中文網)
阿梅什·阿達利亞是約翰斯·霍普金斯大學布隆伯格公共衛生學院健康安全中心(Johns Hopkins Center for Health Security at the Bloomberg School of Public Health)的高級學者,內科、急診、傳染病及重癥醫學認證醫師。
譯者:馮豐
審校:夏林
Pathogens are rarely fully eradicated from the planet. In fact, this feat has only been achieved with smallpox and rinderpest (a viral disease that afflicts cows). SARS-CoV-2 will not break the trend: The virus is here to stay.
If that’s the case, it’s worth asking: What will COVID-19 look like in 10 years?
In 10 years, COVID-19 will be circulating seasonally alongside the four other major coronaviruses that cause mild to moderate illnesses, such as the common cold. Long before that time, however, the virus will have ceased being a public health emergency everywhere in the world.
The lack of a systemic risk posed by COVID-19 will be the result of several factors, chief of which will be the vaccination of high-risk people around the world coupled with prior immunity arising from natural infections. And unfortunately, a proportion of the most vulnerable will have succumbed to the disease.
It’s hard to forecast the exact niche SARS-CoV-2 will occupy in the future, but the seasonal coronaviruses are one benchmark and influenza is another. That means over the span of a year in the U.S., perhaps a maximum of tens of thousands may die and a hundred thousand may be hospitalized. These deaths and hospitalizations are likely to be clustered in the winter months in temperate climates, reflecting the favorability of colder, less sunny, less humid, and less socially distanced environments.
While there will be a baseline level of illnesses, hospitalizations, and deaths, what will be absent is a concern for hospital capacity. Cases will no longer mean that large surges of people will end up in the hospital or with severe disease.
Breakthrough infections and reinfections will be more common, as the virus will continue to circulate and, over time, immunity will wane. However, like reinfections with seasonal coronaviruses that we have now, the severity of these infections will be mostly mild.
Antiviral treatments for mild disease will also be widely available. These new medications will likely decrease symptoms, contagiousness, and complications. They will be used in combination with monoclonal antibodies in high-risk individuals. Hospital care will likely also be refined and some of the most dreaded complications, like cytokine storms, will routinely be recognized and amenable to targeted therapy.
In 10 years, vaccines will likely have undergone a refinement, with second generation vaccines being more potent, less likely to cause adverse reactions, and more easily incorporated into routine childhood immunization schedules and potentially offered seasonally as part of an adult immunization program.
In all likelihood, the U.S. government will adopt a new approach toward pandemic preparedness—abandoning its previously reactive, flat-footed approach. The government will be proactive in anticipating pandemic threats by using analytical and forecasting tools. And it should develop vaccines and antivirals to counter certain high-consequence viral families.
These countermeasures will complement a more robust range of at-home diagnostic tests, building on the momentum of effective COVID-19 and HIV testing. Most households could have the ability to test not only for COVID, but also the flu, strep throat, and other common infections.
A decade from now, COVID will be a tamer disease. But that doesn’t mean the threat of new, deadly viruses will disappear. With foresight and planning, the world will be more prepared for the next infectious disease challenge that emerges.
Amesh Adalja is a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. He is a board-certified physician in internal medicine, emergency medicine, infectious diseases, and critical care medicine.