2020-10-23 16:29:06
One of the most lethal leadership failures in modern times unfolded in South Africa in the early 2000s as AIDS spread there under President Thabo Mbeki.
现代最为致命的一个领导无方的事例，是21世纪初南非在总统塔博·姆贝基(Thabo Mbeki)治下发生的艾滋病传播。
Mbeki scorned science, embraced conspiracy theories, dithered as the disease spread and rejected lifesaving treatments. His denialism cost about 330,000 lives, a Harvard study found.
姆贝基藐视科学，推崇阴谋论，在艾滋病传播开来时犹豫不决，并且拒绝了能够挽救生命的治疗。哈佛一项研究发现，他这种拒绝面对的态度导致33万人丧生。
None of us who wrote scathingly about that debacle ever dreamed that something similar might unfold in the United States. But today, health experts regularly cite President Trump as an American Mbeki.
我们这些曾经用激烈言辞谈论这一灾祸的人怎么也想不到，类似的事情也发生在了美国。但今天，卫生专家常常将特朗普总统比作美国的姆贝基。
“We’re unfortunately in the same place,” said Anne Rimoin, an epidemiologist at U.C.L.A. “Mbeki surrounded himself with sycophants and cost his country hundreds of thousands of lives by ignoring science, and we’re suffering the same fate.”
“很不幸，我们处在同一境地，”加州大学洛杉矶分校(UCLA)流行病学家安·里莫因(Anne Rimoin)说。“姆贝基身边全是阿谀奉承的人，他无视科学，导致数十万人失去生命，我们现在也在遭受同样的命运。”
One role of journalism is to establish accountability, and that’s particularly important before an election. Trump says he deserves an A-plus for his “phenomenal job” handling the coronavirus, but the judgment of history is likely to be far harsher.
新闻的一个作用是问责，这一点在一场大选前尤为重要。特朗普说他在应对新冠病毒方面的“出色表现”应该拿个A+成绩，但来自历史的评判很可能要严厉得多。
“I see it as a colossal failure of leadership,” said Larry Brilliant, a veteran epidemiologist who helped eliminate smallpox in the 1970s. “Of the more than 200,000 people who have died as of today, I don’t think that 50,000 would have died if it hadn’t been for the incompetence.”
“在我看来，这是领导方面的巨大失败，”曾在20世纪70年代参与消灭天花资深流行病学家拉里·布里利安特(Larry Brilliant)说。“如果不是因为无能，在那些截至今天死亡的20多万人里，有5万人不会死。”
There’s plenty of blame to go around, involving Democrats as well as Republicans, but Trump in particular “recklessly squandered lives,” in the words of an unusual editorial this month in the New England Journal of Medicine. Death certificates may record the coronavirus as the cause of death, but in a larger sense vast numbers of Americans died because their government was incompetent.
在这件事上，民主党和共和党都难辞其咎，但本月《新英格兰医学杂志》(New England Journal of Medicine)一篇不同寻常的社论称，特朗普尤其“毫无顾忌地罔顾生命”。死亡证明上可能会将新冠病毒列为死亡原因，但从更宏观角度来说，大量美国人之所以死亡，是因为他们的政府无能。
As many Americans are dying every 10 days of Covid-19 as U.S. troops died during 19 years of war in Iraq and Afghanistan, and the economists David Cutler and Lawrence Summers estimate that the economic cost of the pandemic in the United States will be $16 trillion, or about $125,000 per American household — far more than the median family’s net worth. Then there’s an immeasurable cost in soft power as the United States is humbled before the world.
每10天死于Covid-19的美国人，相当于美国军队在伊拉克和阿富汗19年战争中死亡总数。经济学家戴威·卡特勒(David Cutler)和劳伦斯·萨默斯(Lawrence Summers)估计，大流行在美国造成的经济损失将达16万亿美元，即每个美国家庭损失约12.5万美元——比美国家庭净资产中位数要高得多。然后，由于美国在全世界面前的笨拙表现，还存在着软实力方面不可衡量的损失。
“It’s really sad to see the U.S. presidency fall from being the champion of global health to being the laughingstock of the world,” said Devi Sridhar, an American who is a professor of global health at the University of Edinburgh. “It was a tragedy of history that Donald Trump was president when this hit.”
“看到美国总统从全球卫生引领者沦为世界的笑柄，真的令人感到悲哀，”身为美国人的爱丁堡大学(University of Edinburgh)全球卫生教授德维·斯里达尔(Devi Sridhar)。“这件事发生时总统是唐纳德·特朗普，是个历史悲剧。”
The United States has made other terrible mistakes over the decades, including the Iraq War and the War on Drugs. But in terms of destruction of American lives, treasure and wellbeing, this pandemic may be the greatest failure of governance in the United States since the Vietnam War.
过去几十年来，美国也犯过其他可怕错误，包括伊拉克战争和反毒品战争。但在夺去美国人的生命、财产和福祉方面，这场大流行可能是自越南战争以来，美国治理的最大失败。
America Was the Leader in Pandemic Preparedness.
在防疫准备方面，美国曾是领导者
The paradox is that a year ago, the United States seemed particularly well positioned to handle this kind of crisis. A 324-page study by Johns Hopkins found last October that the United States was the country best prepared for a pandemic.
吊诡之处在于，一年前，在应对这种危机方面，美国似乎尤其做好了充分准备。约翰·霍普金斯大学(Johns Hopkins)一项324页的研究发现，去年10月，美国是大流行应对准备做的最好的国家。
Credit for that goes to President George W. Bush, who in the summer of 2005 read an advance copy of “The Great Influenza,” a history of the 1918 flu pandemic. Shaken, Bush pushed aides to develop a strategy to prepare for another great contagion, and the result was an excellent 396-page playbook for managing such a health crisis.
这要归功于乔治·W·布什(George W. Bush)总统，2005年夏季，他读到了讲述1918年流感大流行历史的《大流感》(The Great Influenza)预览样书。深受震撼的布什敦促顾问制定了能为又一场大型传染病做好准备的战略，结果便是一份极为出色的396页的此类卫生危机应对策略。
The Obama administration updated this playbook and in the presidential transition in 2016, Obama aides cautioned the Trump administration that one of the big risks to national security was a contagion. Private experts repeated similar warnings. “Of all the things that could kill 10 million people or more, by far the most likely is an epidemic,” Bill Gates warned in 2015.
奥巴马政府对这份策略进行了更新，在2016年总统交接时，奥巴马的顾问提醒特朗普政府，国家安全面临的一大风险是传染病。民间专家也多次作出类似警告。“在那些能导致1000万或更多人死亡的问题中，目前最有可能的就是一场大流行，”比尔·盖茨(Bill Gates)2015年警告说。
Trump argues that no one could have anticipated the pandemic, but it’s what Bush warned about, what Obama aides tried to tell their successors about, and what Joe Biden referred to in a blunt tweet in October 2019 lamenting Trump’s cuts to health security programs and adding: “We are not prepared for a pandemic.”
特朗普提出，没人能预见到这场大流行，但这正是布什曾警告过的，是奥巴马的顾问试图告诉其继任者的，也是乔·拜登(Joe Biden)在2019年10月一则直白的推文中，对特朗普削减卫生安全项目所惋惜的，他在其中还说：“我们没有准备好迎接一场大流行。”
The First Alarm Bells From Wuhan
来自武汉的第一声警钟
When the health commission of Wuhan, China, announced on Dec. 31 that it had identified 27 cases of a puzzling pneumonia, Taiwan acted with lightning speed. Concerned that this might be an outbreak of SARS, Taiwan dispatched health inspectors to board flights arriving from Wuhan and screen passengers before allowing them to disembark. Anyone showing signs of ill health was quarantined.
当中国武汉卫健委12月31日宣布识别出27例令人费解的肺炎病例时，台湾迅速行动了起来。由于担忧这可能是另一场SARS疫情，台湾派卫生检查员登上来自武汉的航班，对乘客筛查后，才允许他们下机。任何表现出生病迹象的乘客都被隔离。
If either China or the rest of the world had shown the same urgency, the pandemic might never have happened.
如果无论是中国，还是世界其他地区都表现出同样的紧迫感，这场大流行很可能不会发生。
In the United States, the Centers for Disease Control and Prevention issued a notice about the Wuhan outbreak on Jan. 1, but not much else happened for a time. In China, President Xi Jinping issued orders on Jan. 7 for handling the coronavirus, but they were inadequate. If, at that time or soon after, Xi had ordered a more modest version of the Wuhan lockdown that was to come, it is possible that the virus could have been stifled before it spread around the globe.
在美国，疾病控制和预防中心(Centers for Disease Control and Prevention)1月1日发布了一封关于武汉疫情暴发的通知，但自那之后有一段时间，就没有其他动作了。在中国，习近平主席1月7日下令要求应对新冠病毒，但没有拿出充分有力的应对。如果习近平在当时或很快下令进行比后来武汉封城相对温和的策略，很可能病毒会在传播全球之前就被压制住。
Instead, Wuhan held a banquet for 40,000 people on Jan. 18, and by the time the lockdown was ordered on Jan. 23, some five million people had already left Wuhan for the Chinese New Year. In hindsight, two points seem clear: First, China initially covered up the scale of the outbreak. Second, even so, the United States and other countries had enough information to act as Taiwan did. The first two countries to impose travel restrictions on China were North Korea and the Marshall Islands, neither of which had inside information.
相反，武汉在1月18日举行了一场4万人的宴会，到1月23日下令实行封锁时，约有500万人已经离开武汉过春节。事后看来，有两点似乎很清楚：第一，中国最初掩盖了疫情的规模。其次，即便如此，美国和其他国家仍有足够的信息，可以像台湾那样采取行动。首先对中国实施旅行限制的两个国家是朝鲜和马绍尔群岛，这两个国家都没有得到内部消息通报。
That first half of January represents a huge missed opportunity for the world. If the United States, the World Health Organization and the world media had raised enough questions and pressed China, then perhaps the Chinese central government would have intervened in Wuhan earlier. And if Wuhan had been locked down just two weeks earlier, it’s conceivable that this entire global catastrophe could have been averted.
1月的上半月，世界错失了一个重大机会。如果美国、世界卫生组织和世界媒体提出足够多的问题，并向中国施压，或许中国中央政府会更早对武汉进行干预。如果武汉在两周前就被封锁，这场全球性的灾难是可以避免的。
The Defiance of Science
对科学的蔑视
Perhaps the original sin of America’s response to the coronavirus came with the bungling of testing.
也许美国对新冠病毒反应的原罪在于检测方面的拙劣。
Without testing, health officials fight an opponent while blindfolded. They don’t know where the virus lurks, and they can’t isolate those infected or trace their contacts.
没有检测，卫生官员就像是蒙着眼睛同对手作战。他们不知道病毒潜伏在哪里，也无法隔离被感染者，或追踪感染者的接触者。
But the C.D.C. devised a faulty test, and turf wars in the federal government prevented the use of other tests. South Korea, Germany and other countries quickly developed tests that did work, and these were distributed around the world. Sierra Leone in West Africa had effective tests before the United States did.
但是疾控中心设计了一种有缺陷的检测，而且联邦政府内部的地盘之争阻止了其他检测方式的使用。韩国、德国和其他国家迅速开发出了行之有效的检测方法，并在世界各地推广。西非的塞拉利昂在美国之前就进行了有效的检测。
Trump supporters note, correctly, that within the United States, the states with the highest mortality rates have been Democrat-led: New Jersey has had the most deaths per capita, followed by New York. It’s true that local politicians, Democrats and Republicans alike, made disastrous decisions, as when Mayor Bill de Blasio of New York City urged people in March to “get out on the town despite coronavirus.” But local officials erred in part because of the failure of testing: Without tests, they didn’t know what they faced.
特朗普的支持者正确地指出，在美国，死亡率最高的几个州都是由民主党领导的：新泽西州按人口计死亡率最高，其次是纽约州。的确，做出了灾难性决定的地方政治人物里，有共和党人也有民主党人，就像纽约市长白思豪(Bill de Blasio)在今年3月敦促人们“别管新冠病毒，尽情出门去玩吧”。但地方官员的错误部分是由于检测失败：没有检测，他们不知道自己面临的是什么。
It’s unfair to blame the testing catastrophe entirely on Trump, for the failures unfolded several paygrades below him. Partly that’s because Trump appointees, like Robert Redfield, director of the C.D.C., simply aren’t the A team.
把检测灾难完全归咎于特朗普是不公平的，因为那是在他以下的几个级别展开。这在一定程度上是因为特朗普任命的官员根本就不是一流团队，比如疾控中心主任罗伯特·雷德菲尔德(Robert Redfield)。
In any case, presidents set priorities for lower officials. If Trump had pushed aides as hard to get accurate tests as he pushed to repel refugees and migrants, then America almost certainly would have had an effective test by the beginning of February and tens of thousands of lives would have been saved.
在任何情况下，总统都会为下级官员设定优先事项。如果特朗普像驱逐难民和移民那样大力敦促助手们进行准确的检测，那么几乎可以肯定，美国在2月初就能进行有效的检测，数万人的生命就将得到挽救。
Still, testing isn’t essential if a country gets backup steps right. Japan is a densely populated country that did not test much and yet has only 2 percent as many deaths per capita as the United States. One reason is that Japanese have long embraced face masks, which Dr. Redfield has noted can be at least as effective as a vaccine in fighting the pandemic. A country doesn’t have to do everything, if it does some things right.
不过，如果一个国家采取了正确的后备措施，检测也不是必不可少的。日本是一个人口密集的国家，没有进行太多检测，但其死亡率仅为美国的2%。原因之一是日本人长期以来一直接受口罩。雷德菲尔德指出，口罩在抗击疫情方面至少和疫苗同样有效。如果一个国家做对了一些事情，那么就不必做所有的事情。
Yet in retrospect, Trump did almost everything wrong. He discouraged mask wearing. The administration never rolled out contact tracing, missed opportunities to isolate the infected and exposed, didn’t adequately protect nursing homes, issued advice that confused the issues more than clarified them, and handed responsibilities to states and localities that were unprepared to act. Trump did do a good job of accelerating a vaccine, but that won’t help significantly until next year.
但回过头来看，特朗普几乎什么都做错了。他不鼓励戴口罩。政府从未推行过接触者追踪，错过了隔离感染者和暴露者的机会；没有充分保护疗养院；其发布的建议是对问题的混淆而不是澄清，并把责任交给没有准备好采取行动的州和地方。特朗普的确在加速研制疫苗方面做得很好，但这在明年之前不会有太大帮助。
Trump’s missteps arose in part because he channeled an anti-intellectual current that runs deep in the United States, as he sidelined scientific experts and responded to the virus with a sunny optimism apparently meant to bolster the financial markets.
特朗普的失误在一定程度上是因为他引导了美国深层之下的反智潮流，他排挤科学专家，以显然意在提振金融市场的阳光乐观态度去应对病毒。
“It’s going to disappear,” Trump said on Feb. 27. “One day — it’s like a miracle — it will disappear.”
“它会消失，”特朗普在2月27日表示。“有一天，它会奇迹般地消失。”
A conservative commentariat echoed Trump in downplaying the virus and deriding efforts to stay safe. Brit Hume of Fox News mocked Joe Biden for wearing a large mask, and the right-wing website RedState denounced“the public health Gestapo” and called Dr. Anthony Fauci a “mask Nazi.” A University of Chicago study found that watching the Sean Hannity program correlated to less social distancing, so watching Fox News may well have been lethal to some of its fans.
保守派评论界附和特朗普的说法，淡化病毒，嘲笑为保持安全所做的努力。福克斯新闻(Fox News)的布里特·休姆(Brit Hume)嘲笑乔·拜登(Joe Biden)戴着大口罩。右翼网站RedState谴责“公共卫生盖世太保”，并称安东尼·福奇(Anthony Fauci)博士为“口罩纳粹”。芝加哥大学(University of Chicago)的一项研究发现，观看肖恩·汉尼蒂(Sean Hannity)的节目同减少社交距离的保持存在关联，因此观看福克斯新闻很可能对部分粉丝产生致命的影响。
Echoes of the Soviet Union
苏联的回声
Americans have often pointed to the Soviet Union as a place where ideology trumped science, with disastrous results. Stalin backed Trofim Lysenko, an agricultural pseudoscientist who was an ardent Communist but scorned genetics — and whose zealous incompetence helped cause famines in the Soviet Union. Later, in the 1980s, Soviet leaders were troubled by data showing falling life expectancy — so they banned publication of mortality statistics. It was in the same spirit that Trump opposed testing for the coronavirus in the hope of holding down the number of reported cases.
美国人经常指出，在苏联，意识形态战胜了科学，造成了灾难性的后果。斯大林支持农业伪科学家特罗菲姆·李森科(Trofim Lysenko)，此人是狂热的共产主义者，鄙视遗传学——他的狂热无能导致了苏联的饥荒。后来，在1980年代，苏联领导人对显示出预期寿命下降的数据感到不安，于是禁止发布死亡率统计。特朗普也本着同样的精神反对新冠病毒检测，希望能压低报告病例的数量。
Of course, science sometimes gets it wrong. Many experts opposed closing borders, while Trump’s move to limit travel from China now appears sound — although 45 countries imposed such travel restrictions before the United States. Likewise, Fauci said on March 9: “If you’re a healthy, young person, if you want to go on a cruise ship, go on a cruise ship.”
当然，科学有时也会出错。许多专家反对关闭边境，而特朗普对中国的旅行限制现在看来是正确的——尽管45个国家在美国之前实施了此类禁令。同样，福奇在3月9日表示：“如果你是一个健康的年轻人，那么你想去坐邮轮就去坐邮轮。”
Inevitably, science errs, then self-corrects. But Trump was not self-correcting.
科学难免会出错，然后它会自我修正。但特朗普并没有进行自我修正。
Most striking, Trump still has never developed a comprehensive plan to fight Covid-19. His “strategy” was to downplay the virus and resist business closures, in an effort to keep the economy roaring — his best argument for re-election.
最令人吃惊的是，特朗普仍然没有制定出对抗新冠病毒的全面计划。他的“战略”是淡化病毒，制止企业倒闭，努力保持经济蓬勃发展——那是他争取连任的最佳论据。
This failed. The best way to protect the economy was to control the virus, not to ignore it, and the spread of Covid-19 caused economic dislocations that devastated even homes where no one was infected. Eight million Americans have slipped into poverty since May, a Columbia University study found, and about one in seven households with children have reported to the census that they didn’t have enough food to eat in the last seven days. More than 40 percent of adults reported in June that they were struggling with mental health, and 13 percent have begun or increased substance abuse, a C.D.C. study found. More than one-quarter of young adults said they have seriously contemplated suicide. Diane Reynolds, who runs an excellent addiction program called Provoking Hope, estimates that relapses have increased 50 percent during the pandemic.
这个策略失败了。保护经济的最佳方式是控制病毒，而不是忽视它，新冠病毒的传播造成了经济混乱，甚至摧毁了没有感染的家庭。哥伦比亚大学(Columbia University)的一项研究发现，自5月以来，有800万美国人陷入贫困，大约七分之一有孩子的家庭在这项调查中报告，他们在过去七天里没有足够的食物吃。疾控中心的一项研究发现，今年6月，超过40%的成年人报告说，他们存在心理健康困扰，13%的人开始或加剧了药物滥用。超过四分之一的年轻人说他们曾认真考虑过自杀。管理着一个名为“唤起希望”(Provoking Hope)的戒毒项目的黛安·雷诺兹(Diane Reynolds)估计，在大流行期间，复吸率增加了50%。
Taking a Threat Seriously
认真对待威胁
Instead of leading a war against the virus, Trump organized a surrender. He even held a super-spreader event at the White House, for Judge Amy Coney Barrett, and that’s why the White House recently had more new cases of Covid-19 than New Zealand, Taiwan and Vietnam combined.
特朗普没有领导对抗病毒的战争，而是组织了一场投降。他甚至在白宫为艾米·科尼·巴雷特(Amy Coney Barrett)法官举办了一场“超级传播者”活动，正因如此，白宫最近新增的新冠病例人数比新西兰、台湾和越南的总和还要多。
It didn’t have to be this way. If the U.S. had worked harder and held the per capita mortality rate down to the level of, say, Germany, we could have saved more than 170,000 lives. And if the U.S. had responded urgently and deftly enough to achieve Taiwan’s death rate, fewer than 100 Americans would have died from the virus.
事情本不必这样的。如果美国更努力地将死亡率控制在德国等国的水平上，我们本可以挽救超过17万人的生命。如果美国能够迅速而巧妙地做出反应，达到台湾的死亡率，那么死于该病毒的美国人将不到100人。
“It is a slaughter,” Dr. William Foege, a legendary epidemiologist who once ran the C.D.C., wrote to Dr. Redfield. Dr. Foege predicted that public health textbooks would study America’s response to Covid-19 not as a model of A-plus work but as an example of what not to do.
“这是一场屠杀，”传奇流行病学家、曾任疾控中心负责人的威廉·福格(William Foege)博士在给雷德菲尔德的信中写道。福格预测，公共卫生教科书将会研究美国对新冠病毒的反应，不是将它作为优秀工作的典范，而是作为反面教材。
纪思道(Nicholas Kristof)自2001年成为时报专栏作家。他曾因对中国及达尔富尔的报道两次获得普利策奖。欢迎注册他两周一次的免费新闻电邮，并且在Instagram、Twitter和Facebook上关注他。
翻译：Annie Xu、晋其角
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