解除疫情封锁措施涉及两大问题：如何分阶段、渐进地重开部分工作、教育、文化和娱乐场所；需要何种“检测和追踪”机制来发现和遏制新的疫情。

在英国和欧洲大部分地区享受复活节的灿烂阳光之际，几乎无人能参加传统的庆祝活动。为了减少新型冠状病毒肺炎（COVID-19，即2019冠状病毒病）的传播，多数国家已禁止旅行和社交聚会，很多人迫切期待解除封锁，这些封锁措施不仅限制个人生活，还破坏企业和全球经济。

包括奥地利、丹麦和挪威在内的一些欧洲国家宣布，已制定初步计划，将在本月晚些时候放松最严格的封锁措施，例如允许一些商店恢复营业和学校复课。但受疫情影响最严重的国家（意大利、西班牙、法国和英国）的政府不愿公开谈论封锁退出策略。它们不希望在死亡数字仍在上升之际分散人们对遵守封锁措施的关注。

正如英国财政大臣里希•苏纳克(Rishi Sunak)上周所宣称的那样：“目前的首要任务是阻止新冠病毒的传播，到达疫情高峰的另一边。”

但在幕后，全球各国的部长级官员和卫生官员都已开始讨论接下来的事情。围绕退出策略的辩论关注两个主题：如何分阶段、渐进地重新开放部分工作、教育、文化和娱乐场所；一旦最初的疫情浪潮消退，需要何种“检测和追踪”机制来发现和遏制新的疫情。

在欧洲，有迹象表明，绝大多数公众遵守严格的社交疏离措施（遵守度超过很多专家的预期），这导致疫情传播大幅下滑。

关键数据是“传染数”R，它衡量受感染个体传染的新病例的平均数量。如果R大于1，表明疫情会扩散；如果小于1，表明疫情会减弱。对于新冠疫情而言，如果不采取任何措施，多数地区的R在2.5到3之间。

英国抗击新冠疫情的一位权威科学家表示，最新证据显示，现在R大幅降至0.6左右，这将迅速抑制疫情。

然而，由于从感染到出现严重症状之间有时滞，死亡人数仍在迅速增长。

英国首席科学顾问帕特里克•瓦兰斯(Patrick Vallance)上周四表示，有明显迹象表明，新增确诊病例数量正趋于平稳。但他补充称：“我预测未来两周，死亡人数将继续增长。”

苏纳克和他手下的官员不得不快速拿出创新举措，将封锁造成的痛苦降至最低。但他们也明白，封锁持续的时间越长，破产的公司就越多。因此，大臣们正努力思考如何以及何时解除限制，即使是在尚未建立完善的检测和追踪机制的情况下。

一位大臣表示，重点是基于“人口、行业和地域”的3个潜在退出通道。一种选择可能是让年轻人先解禁，可能从学校复课开始，然后是让年轻人复工，这些人被感染后不太可能发展为重症。

一些人被华威大学(Warwick university)安德鲁•奥斯瓦尔德(Andrew Oswald)和纳塔武•鲍德塔威(Nattavudh Powdthavee)的一篇论文所吸引，这篇论文建议取消对20岁到30岁、不和父母一起住的人的限制，这可能会解放420万人。一位官员开玩笑说，“青年优先”政策可能意味着“你甚至会规定在酒吧喝酒的最高年龄”。

英国商务大臣阿洛克•夏尔马(Alok Sharma)上周提出了更为宽容的社交疏离规则指引，暗示了哪些行业可能成为经济复苏的先锋。他要求建筑、制造、物流、基本零售、废物管理和户外行业实施政府的建议，保持2米距离，不过这些行业也得到了如果做不到时如何继续复工的建议。

大臣们对英国分地区重新开放的想法不怎么感兴趣。大曼彻斯特市市长安迪•伯纳姆(Andy Burnham)表示，封锁只有在“全国统一”的情况下才能奏效。在接受BBC《新闻之夜》(Newsnight)采访时他补充道：“如果英国其他地方出现人们回到酒吧的景象，那这里就不可能持续封锁下去。”

尽管代表英国经济利益的大臣们强调首要任务是拯救生命，但他们开始就新冠病毒造成的更广泛损害展开讨论。

英国财相一直在提问，长时间封锁和深度衰退会对公众长期健康产生什么影响，尤其是对较贫困群体的心理健康和福祉的影响。伦敦财政研究所(Institute for Fiscal Studies)上周的一份报告加强了他的疑问。

上周在内阁会议上提出的这一观点的潜台词是：可以呼吁解除封锁，而不只是依靠冷冰冰的经济论据。一位政府官员表示：“你必须全面考虑健康方面的情况。”

等到最初的病例激增期过去，英国及其他各国在最终放松封锁的同时，将会有一个密集“检测和追踪”机制，以发现并消灭病毒的新爆发。许多国家的政府正在仔细研究韩国的经验，韩国建立了一个广泛的检测系统来监测新的感染病例。

如果英国能够在4月底前实现每天进行10万次检测的目标，并在未来几个月进一步提高检测能力，则有可能对社区中报告有新冠肺炎症状的人员进行检测。理论上，如果他们确诊的话，这一步之后是跟踪、检测和隔离与他们有过接触史的人。

这种接触者追踪还涉及直接询问病人，在英国报告出现第一批病例时就开始了，但很快就停止了，因为英国极其有限的检测能力已无法应对这次大流行。

伦敦帝国理工学院(Imperial College London)传染病动力学教授史蒂文•赖利(Steven Riley)表示：“有证据显示，那些能够进行极高水平检测的国家有更多选择，可以允许人们有更大社会流动性。一些真正创新的解决方案将发挥作用。基于一项手机应用的接触者追踪正受到考虑。”

然而，在公民遇到新冠病毒检测呈阳性的人后，能够追踪并通知他们的应用程序对西方民主国家造成了巨大的现实和政策挑战——从确保开放的操作标准到维护数据安全。

例如，在中国，这些健康应用程序在大多数地方并不是强制的，但如果人们无法在一款病毒追踪应用上显示自己的状态，就可能被禁止工作、禁止乘坐公共交通工具、甚至无法去公园。这种病毒追踪应用能够显示人们过去两周的行踪。

隐私保护倡导者的目标是发现潜在的隐私侵犯。Consumer Choice Center驻布鲁塞尔分析师比尔•沃茨(Bill Wirtz)说：“如果追踪个人行踪被提上日程，那么即使在危机时期，也不太可能符合现有隐私法。”

许多科学家认为，结束封锁的关键在于大规模进行能够发现新冠病毒感染的检测。诺贝尔奖得主、经济学家保罗•罗默(Paul Romer)概述了一项在美国进行大规模检测的计划，他认为，这项计划将使美国经济的大部分领域得以重新开放。

然而，这要求每人每14天检测一次，即全国每天检测2200万次。这对实验室、化学制剂、卫生工作人员和数据分析师而言是一项艰巨的任务，即使这些测试在宪法上是可以接受的。在英国，流行病学家朱利安•皮托(Julian Peto)也提出了类似的建议——每人每周检测一次，全国每天检测1000万次。

大规模抗体检测——可以显示出人们此前是否感染过新冠病毒，以及是否仍有一定免疫力——的前景更为诱人，因为这种测试只需要偶尔进行，而且有可能在药店买到。

但首先，它们必须确实可行。专业实验室正在进行研究，以确定人群样本中的抗体水平，但还没有人开发出一种足以在家里广泛使用的可靠抗体试剂盒。经英国政府评估的试剂盒的失败率为30%至50%。

最终，抗体检测可以为人们提供“免疫护照”，证明他们不会被感染，赖利教授表示，“但首先要做一些非常重要的科学研究”。仍然需要回答的关键问题是，不同的抗体水平与对感染的抵抗力有何关系，以及任何免疫保护可能持续多久。

摆脱新冠危机的长期途径需要安全有效的治疗方法和疫苗。目前有数十种药物正在进行临床试验，以确定它们是否对新冠患者有所帮助。一些药物可能会展现出疗效，但如果有任何一种被证明是神药，连药物学家都会感到震惊。即使拥有巨大的资源和监管方面的配合意愿，开发新药和疫苗也需要一年多的时间。

同时，各国政府仍然不知道新冠病毒可能如何出现第二波爆发，也不真正了解人群中能建立多少免疫。

正如帝国理工学院流行病学家、英国政府顾问尼尔•弗格森(Neil Ferguson)教授上周五告诉英国广播公司广播四台(BBC Radio 4)的那样，研究出一项退出策略“是科学界和政府在清醒的每一分钟里考虑的首要话题和重中之重。”

译者/何黎

Originally published here.

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Governments are beginning to discuss ways to reopen economies but massive investments and difficult choices lie ahead

As the UK and most of Europe enjoys glorious Easter sunshine, few people can take part in traditional festivities. With travel and social gatherings banned in most countries to reduce the transmission of coronavirus, many look forward desperately to emerging from a lockdown that is not only curtailing personal lives but also destroying businesses and the global economy.

Some European countries, including Austria, Denmark and Norway, have announced tentative plans to relax the most stringent measures later this month, for example by allowing some shops and schools to reopen. But governments in the nations hit hardest by Covid-19 — Italy, Spain, France and the UK — are reluctant to talk openly about exit strategies. They do not want to distract people from observing lockdowns while death tolls are still rising.

As Rishi Sunak, UK chancellor, declared this week: “The priority right now is to stop the spread of the virus and get us to the other side of the peak.” 

Behind closed doors, however, ministers and health officials everywhere are beginning to discuss what happens next. The debates about exit strategies focus on two themes: how to manage a staged and gradual reopening of some places of work, education, culture and entertainment; and what sort of “test and trace” regime would be needed to detect and suppress new virus outbreaks once the initial wave has subsided. 

Across Europe there are signs that observance of stringent social distancing measures by the vast majority of the public — better compliance than many experts had expected — has led to a big decline in viral transmission. The key figure is the “reproduction number” R measuring the average number of new cases generated by an infected individual. If R is above 1, an outbreak spreads; if it is below 1, it contracts. For Covid-19, R was between 2.5 and 3 in most places before any measures were introduced. 

According to a leading scientist in the UK’s fight against the disease, the latest evidence shows a steep fall in the R rate to around 0.6 now, which would quickly suppress the pandemic. However, deaths are still rising fast because of the delay between infection and when serious symptoms develop.  Patrick Vallance, UK chief scientist, said on Thursday there were clear signs of new cases levelling off. But he added: “I would expect the deaths to keep going up for two weeks.”  UK health secretary Matt Hancock.

Mr Sunak and his officials have had to innovate at speed to minimise hardship during the lockdown. But they also know that more companies will go bankrupt the longer the lockdown continues. As a result, ministers are thinking hard about how and when to lift restrictions, even if there is no perfect testing and tracing regime available. One minister says the focus was on three potential exit routes based on “populations, sectors and geography”. One option might be to let the young lead the way, perhaps starting by reopening schools, followed by a return to work for younger people who are less likely to become seriously ill if infected. Some are attracted to a Warwick university paper by Andrew Oswald and Nattavudh Powdthavee, suggesting removing restrictions on 20-30-year-olds who do not live with their parents, which could release 4.2m people. One official jokes that a “youth first” policy might mean “you could even have a maximum age for drinking in pubs”. 

Alok Sharma, business secretary, this week gave an indication of the kind of sectors that could be in the vanguard of an economic reawakening, when he offered more permissive guidance on social distancing rules. He told construction, manufacturing, logistics, essential retail, waste management and outdoor industries to apply the government’s advice to stay 2m apart but they were offered advice on how to stay open if that were not possible.  Ministers are less attracted to the idea of Britain reopening along geographical lines. Andy Burnham, mayor of Greater Manchester, says the lockdown can only work if it is “the same thing for the whole of the country.” Speaking to BBC Newsnight, he added: “It would be impossible to sustain here if there were images of people going back to pubs in other parts of the country.”

Although ministers representing the country’s economic interests stress that the priority is to save lives, they are starting to open up a debate about the wider damage caused by coronavirus.  The chancellor has been raising questions, reinforced this week by a report by the Institute for Fiscal Studies, about the longer-term health consequences of an extended lockdown and a deep recession, particularly on mental health and the wellbeing of poorer communities.  The subtext of this argument, raised at cabinet this week, is that it is possible to call for an easing of the lockdown without simply relying on cold economic arguments. “You have to look at the health picture in the round,” says one government official. 

The eventual easing of the lockdown in Britain and elsewhere will be accompanied by an intensive “test and trace” regime to detect and stamp out new outbreaks of the virus, once the initial surge has passed. Many governments are closely studying the experience in South Korea, which set up an extensive testing system to monitor new infections. If the UK can achieve its target of carrying out 100,000 tests a day by the end of April and ramp up capacity further over the following months, it will be possible to test individuals in the community who report Covid-19 symptoms.

In theory, this would then be followed by the tracing, testing and isolating of people who have been in contact with them if they are infected.  This type of contact tracing, which involves questioning patients directly, took place when the first UK cases were reported but soon stopped when the pandemic swamped the country’s extremely limited testing capacity.

“Evidence suggests that countries that are able to do very high levels of testing have many more options to allow people greater social mobility,” says Steven Riley, professor of infectious disease dynamics at Imperial College London. “Some really innovative solutions will play a part. Contact tracing based on a mobile phone app is being looked at.” 

However, apps designed to track and inform citizens when they meet people who have tested positive for coronavirus pose formidable practical and policy challenges for western democracies, from ensuring open operating standards to maintaining data security.  In China, for instance, these health apps are not mandatory in most places, but individuals can find themselves barred from work, public transport or even the public park if they cannot show their status on a virus-tracking app, which shows their movements in the previous fortnight. Privacy advocates aim to spot potential transgressions. “If tracking of individual movement is on the table, then that is unlikely to be in line with existing privacy laws, even in a crisis,” says Bill Wirtz, a Brussels-based analyst at the Consumer Choice Center. 

For many scientists, the key to ending the lockdowns is mass testing for Covid-19 infection, which detects the presence of the virus. Paul Romer, the Nobel Prize-winning economist, has outlined a plan for mass testing in the US that he believes would allow for much of the economy to reopen. However, this requires each person being tested every 14 days — or 22m tests a day — a mammoth undertaking in terms of labs, chemicals, health workers and data analysis, even if such tests are constitutionally acceptable.

In the UK, the epidemiologist Julian Peto has made a similar proposal — weekly tests, running to 10m a day. Large-scale antibody testing, to show whether individuals have been infected in the past and still have some immunity, is a more tantalising prospect because they would only need to be conducted occasionally and could potentially be bought at a pharmacy. But first they need to actually work. Specialised labs are carrying out studies to determine antibody levels in samples of the population but no one has yet developed an antibody kit reliable enough for widespread use in homes. Kits evaluated by the UK government have failure rates of 30 to 50 per cent.  Eventually antibody tests could give individuals “immunity passports” to show that they are safe from infection, Prof Riley says, “but there’s some very important science to do first”. The key questions that have still to be answered are how different antibody levels relate to resistance to infection and how long any immune protection is likely to last. 

Longer-term routes out of the coronavirus crisis require safe and effective treatments and vaccines. Dozens of existing drugs are in clinical trials to find out whether they help Covid-19 patients. Some may show efficacy but pharmacologists would be astonished if any turn out to be a magic bullet. Developing new drugs and vaccines will take more than a year, even with huge resources and regulatory goodwill.  Meanwhile governments still have a lack of knowledge about how the virus might return in a second wave and no real sense of how much immunity might build up in the population.  As Professor Neil Ferguson, the Imperial College epidemiologist and UK government adviser, told BBC Radio 4 on Friday, working out an exit strategy “is the number one topic and priority every waking minute, both in the scientific community and in government.” 

Originally published here.

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org