NEJM：打破200多年传统，怒对特朗普！呼吁民众把尸位素餐总统赶下台

当地时间7日，权威医学期刊《新英格兰医学杂志》（NEJM）发表编辑部联名社论——《死于领导力真空》，强烈谴责特朗普政府在此次新冠疫情中的表现，对美国政府在新冠疫情应对上的种种失败经历进行了深刻反思。

这篇名为《死于领导力真空》的文章指出，美国政府的糟糕应对，让一场公共卫生危机一步步演变成为一出“悲剧”。

值得一提的是，在过去的200多年中，《新英格兰医学杂志》作为在世界医疗领域享誉盛名的顶级学术期刊，从未涉足过政治领域或是表明过政治立场。

此次举动，可谓是前所未有。按中国的俗话说应该是出离于愤怒了！

文章开篇写道——

“Covid-19（新冠病毒）在全世界造成了一场危机。这场危机对领导力提出了考验。由于对新的病原体并没有很好的方法，各国被迫就如何应对作出艰难的选择。在美国，我们的领导人没有通过这一考验。他们把一场危机变成了一场悲剧。”

"Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy."

 "The magnitude of this failure is astonishing" 

文章指出，新冠疫情对全球所有国家来说，都是一场难度巨大的挑战。在疫情面前，唯一能把握住的就是积极应对。而在美国，“我们一直以来都应对地极其糟糕”，超高的死亡人数和死亡率就是证明。

“（美国）应对疫情的失败的严重性令人震惊。据约翰霍普金斯系统科学与工程中心的数据，美国的Covid-19病例和因该疾病死亡的人数居世界首位，远远超过其他国家的数字。美国的死亡率是加拿大的两倍多，超过了日本这个老龄化国家近50倍，甚至比越南等中低收入国家高出近2000倍。Covid-19是一个巨大的挑战，很多因素导致了它的严重性。但我们能控制的是我们的行为方式。而在美国，我们的行为一直很差。”

"The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly."

接下来是感叹

We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.

“我们知道我们本可以做得更好。中国面对第一次爆发的疫情，虽然在最初有所延搁，但是选择了严格的检疫和隔离。这些措施虽然严厉，但却很有效，基本上在疫情开始的地方就杜绝了传播，并将死亡率降至报道的百万分之三，而美国的死亡率为百万分之五百。而那些与中国有更多交流的国家，如新加坡和韩国，很早就开始了密集的检测，同时还进行了积极的接触者追踪和适当的隔离，疫情相对较小。而新西兰也利用这些措施，加上地理优势，接近消灭了这种疾病，这让新西兰缩短了封闭时间，社会基本重新开放到流行前的水平。总的来说，许多民主国家不仅做得比美国好，而且它们的表现也比我们好几个数量级。”

 "We have failed at almost every step" 

文章接着反问“为什么美国的疫情应对如此糟糕”，并列举了一系列事实得出结论——“我们基本上每一步都失败了”：

• 我们明明有充分的预警，却没能进行高效的检测，没能给医护人员和公众提供最基本的防护措施；

• 此后疫情逐步扩散，检测能力却始终没有更上；虽然检测的绝对数量大幅增加，但更有用的衡量标准是每个感染者进行的检测数量，这一比率使我们在国际名单上远远落在后面，低于哈萨克斯坦、津巴布韦和埃塞俄比亚等国，这些国家无法拥有像我们一样的生物医学基础设施或制造能力。

"Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn't provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing."

• 我们对社交隔离也不重视，很多地方在疫情还没得到控制之前就放松管理；美国在许多社区大量传播之后，才迟迟地、不一致地制定了检疫和隔离措施，而且往往没有努力去执行。在许多地方，我们关于社会隔离的规则也是乏善可陈的，在疾病得到充分控制之前很长时间就放松了限制。

• 而在美国的很多地方，人们根本就不戴口罩，这主要是因为我们的领导人直言口罩是政治工具，而不是有效的感染控制措施。政府在疫苗研发上适当地投入了大量资金，但其言辞却将研发过程政治化，导致公众的不信任感越来越强。

"Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures."

 "The United States came into this crisis with enormous advantages" 

文章进一步指出，无论从医疗技术、科研水平还是生产能力来说，美国都是享有巨大优势的。然而，在疫情应对上，美国政府不但没有好好利用这些优势，反而让全国上下在危机中越陷越深，可谓是“一手好牌打得稀烂”。

“美国是带着巨大的优势走进这场危机的。除了强大的生产能力，我们还有让全世界称羡的生物医学研究体系。我们在公共卫生、健康政策和基础生物学方面拥有丰富的专业知识，并且始终能够将这些专业知识转化为新的疗法和预防措施。这些专业知识和能力大多蕴藏在政府机构中。然而，我们的领导人却很大程度上选择了无视甚至诋毁这些专家。”

"The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts."

 "Our current political leaders have demonstrated that they are dangerously incompetent" 

在接下来的篇幅中，文章细数了特朗普政府在疫情应对上的种种错误决定：

• 我们国家领导人的反应一直不够充分。

• 联邦政府基本上将疾病防控的工作甩给了各州，然而各州州长却没有联邦政府拥有的各项条件和手段；

• 联邦政府不但没有使用这些抗疫工具，反而破坏了它们。美国国立卫生研究院（ NIH）在疫苗研发中起了重要作用，却被排除在政府决策的大门之外；美国疾病控制和预防中心曾是世界上最主要的疾病应对组织，但现在已经被削弱，其测试和政策失败可算得上戏剧性。食品和药物管理局被可耻地政治化了，似乎是为了应对来自政府的压力而不是科学证据。

• 政府不依靠科学家和专业人员，反去求助于不了解情况的所谓“意见领袖”和假充内行的“门外汉”，而这些人通常掩盖事实真相并散布谎言；

• 连最简单最基本的防控措施都不采取，让一线医护人员的付出付诸东流……

接下来谈疫情对美国社会的冲击，死亡人数超越二战。

Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.

• 疫情的爆发对有色人种社区的影响尤为严重，加剧了与平等有关的紧张局势。
• 我们的许多儿童在其社会和智力发展的关键时期缺课。冒着生命危险的保健专业人员的辛勤工作没有得到明智的利用。
• 我们目前的领导层对经济感到自豪，但尽管世界上大多数国家在某种程度上开放了，美国仍然饱受疾病的困扰，使许多企业无法重新开业，结果损失了数千亿美元和数百万个工作岗位。
• 而且已经有20多万美国人死亡。Covid-19造成的一些死亡是不可避免的。但是，虽然不可能推算出因为政府政策软弱和不当而导致的额外美国人生命损失的确切数字，但估计至少有数万人，这已经比二战以来任何一场冲突中死亡的美国人都多。
• 其他任何人以这种方式鲁莽地挥霍生命和金钱，都会承受法律后果。我们的领导人在很大程度上声称他们的行为可以豁免。

文章最后呼吁民众通过投票改变如今的局面，罕见地针对政治与选举发声——

“在我们这个时代最严重的公共卫生危机面前，我们的领导人表现出了导致危险的无能。我们不应该助纣为虐，不应该让这些德不称位的人继续尸位素餐，从而让成千上万的美国人死亡。”

"When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."

这篇文章刊出后，在海外社交媒体引发热议。有网友表示，《新英格兰医学杂志》此前几乎从未涉足过政治领域，而此次刊登联名社论进行反思和呼吁，足以证明特朗普政府在新冠疫情应对上的糟糕程度有多令人唏嘘。 

《新英格兰医学杂志》自1812年创刊以来，至今已有208年历史，是全球最负盛名的权威医学杂志之一。该篇社论的作者之一、杂志主编埃里克·鲁宾（Eric Rubin）在对CNN的采访中表示，这是创刊以来第4次发表由全体编辑署名的社论——

“我们从来没有发表过任何一篇关于选举的文章，因为我们并非政治期刊，我们也不想成为一本政治期刊。但现在的问题是关乎事实，而非意见。疫情应对中犯下的很多错误不止愚蠢，简直可以说是无所顾忌……口罩是有用的，保持社交距离也是奏效的，隔离也是有效的，这些并非意见或观点（而是事实）。不采纳这些举措的决定可能是政治性的，但说这些举措没有用就是纯属胡诌，更是危险的……在这场疫情中，我们没有正确的领导人，我觉得我们需要更好的领导层。”

事实上，这并非是第一本在疫情期间且在大选之前表明其政治立场的美国医学或科学刊物。

今年9月，著名科普杂志《科学美国人》宣布支持前副总统、民主党总统候选人拜登，谴责特朗普“无视科学”。这也是该杂志在其175年历史上第一次公开表示支持某位总统候选人。

文章内容来自于NEJM，CGTN，梅斯医学，生物谷，网络等

文章来源：https://www.nejm.org/doi/full/10.1056/NEJMe2029812