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十年之后,新冠病毒还在吗?

十年之后,新冠病毒还在吗?

Amesh Adalja 2021年09月15日
十年之后,新冠病毒将与其他四种能够引起轻、中度症状(例如普通感冒)的常见冠状病毒一样变为季节性传播。

新冠病毒不会销声匿迹。有一个问题值得我们思考:十年之后,新冠病毒影响几何?图片来源:Getty Images

鲜有病毒曾经被人类彻底消灭。事实上,人类彻底战胜的病毒只有天花和牛瘟(一种折磨奶牛的病毒性疾病)两种。新冠病毒也不例外,同样不会销声匿迹。

在此背景之下,我们不免要问:十年之后,新冠病毒会有怎样的影响?

十年之后,新冠病毒将与其他四种能够引起轻、中度症状(例如普通感冒)的常见冠状病毒一样变为季节性传播。不过,在此之前很长一段时间,这种病毒已经不会在世界各地引发紧急公共卫生事件。

新冠疫情之所以不再构成系统性风险,得益于若干因素,主要是因为各国、各地区的高危人群将普遍完成疫苗接种,自然感染也会产生相应的免疫力。不过遗憾的是,仍将有部分高危人群将会因为染疫而病逝。

现在很难预测新冠病毒未来将会产生多大影响,不过我们可以以季节性冠状病毒和流感作为基准进行参照。也就是说,美国每年可能会有数万人因为染疫而病逝,另有10万人因此而住院接受治疗。由于新冠病毒偏好气温较冷、阳光较少、湿度较低、社交距离较近的环境,病逝及住院病例很可能会在温带气候的冬季集中爆发。

虽然患病人数、住院人数及病逝人数仍将达到一定水平,不过我们将不再需要担心医院的承载能力,因为即便染疫,很多人可能也仅是轻症病例,无需住院治疗。

由于病毒传播仍将继续,并且随着时间推移,人体的免疫力将会逐渐下降,突破性感染和再次感染病例将会变得更为普遍。不过就像我们现在重复感染的季节性冠状病毒一样,此类感染的影响大多较为温和。

用于治疗轻症病例的抗病毒疗法也将得到广泛使用。此类新型药物或许能够减轻症状、降低传染性,并减少并发症。在治疗高危人群时,将会联合使用抗病毒疗法和单克隆抗体疗法。医院诊疗流程也将得到优化,有些最为危险的并发症,比如细胞因子风暴,将纳入常规诊察并接受靶向治疗。

十年之后,疫苗很可能已经经过改进。新一代疫苗将更为有效,不良反应发生率也更低,更容易纳入常规的儿童免疫计划,并有可能纳入成人免疫计划,按季节提供。

美国政府很可能将采取全新方法处理新冠疫情的防范工作,不再像以往那样手忙脚乱,疲于应对。政府将利用分析、预测工具,积极主动地预测新冠疫情可能造成哪些威胁。政府还可能开发疫苗和抗病毒药物,用于应对某些危害较大的病毒家族。

这些应对措施将以有效的新冠病毒、艾滋病毒检测为基础,打造出更为有力的居家检测工具。大多数家庭将不仅获得检测新冠病毒的能力,还能够检测流感、链球菌性咽喉炎及其他常见感染。

十年之后,新冠肺炎将成为一种更为“温和”的疾病。但这并不是说,新的致命病毒的威胁将会消失。不过只要有计划,有远见,在遇到下一次疫情的挑战时,世界必将准备得更为充分。(财富中文网)

阿梅什·阿达利亚是约翰斯·霍普金斯大学布隆伯格公共卫生学院健康安全中心(Johns Hopkins Center for Health Security at the Bloomberg School of Public Health)的高级学者,内科、急诊、传染病及重症医学认证医师。

译者:冯丰

审校:夏林

鲜有病毒曾经被人类彻底消灭。事实上,人类彻底战胜的病毒只有天花和牛瘟(一种折磨奶牛的病毒性疾病)两种。新冠病毒也不例外,同样不会销声匿迹。

在此背景之下,我们不免要问:十年之后,新冠病毒会有怎样的影响?

十年之后,新冠病毒将与其他四种能够引起轻、中度症状(例如普通感冒)的常见冠状病毒一样变为季节性传播。不过,在此之前很长一段时间,这种病毒已经不会在世界各地引发紧急公共卫生事件。

新冠疫情之所以不再构成系统性风险,得益于若干因素,主要是因为各国、各地区的高危人群将普遍完成疫苗接种,自然感染也会产生相应的免疫力。不过遗憾的是,仍将有部分高危人群将会因为染疫而病逝。

现在很难预测新冠病毒未来将会产生多大影响,不过我们可以以季节性冠状病毒和流感作为基准进行参照。也就是说,美国每年可能会有数万人因为染疫而病逝,另有10万人因此而住院接受治疗。由于新冠病毒偏好气温较冷、阳光较少、湿度较低、社交距离较近的环境,病逝及住院病例很可能会在温带气候的冬季集中爆发。

虽然患病人数、住院人数及病逝人数仍将达到一定水平,不过我们将不再需要担心医院的承载能力,因为即便染疫,很多人可能也仅是轻症病例,无需住院治疗。

由于病毒传播仍将继续,并且随着时间推移,人体的免疫力将会逐渐下降,突破性感染和再次感染病例将会变得更为普遍。不过就像我们现在重复感染的季节性冠状病毒一样,此类感染的影响大多较为温和。

用于治疗轻症病例的抗病毒疗法也将得到广泛使用。此类新型药物或许能够减轻症状、降低传染性,并减少并发症。在治疗高危人群时,将会联合使用抗病毒疗法和单克隆抗体疗法。医院诊疗流程也将得到优化,有些最为危险的并发症,比如细胞因子风暴,将纳入常规诊察并接受靶向治疗。

十年之后,疫苗很可能已经经过改进。新一代疫苗将更为有效,不良反应发生率也更低,更容易纳入常规的儿童免疫计划,并有可能纳入成人免疫计划,按季节提供。

美国政府很可能将采取全新方法处理新冠疫情的防范工作,不再像以往那样手忙脚乱,疲于应对。政府将利用分析、预测工具,积极主动地预测新冠疫情可能造成哪些威胁。政府还可能开发疫苗和抗病毒药物,用于应对某些危害较大的病毒家族。

这些应对措施将以有效的新冠病毒、艾滋病毒检测为基础,打造出更为有力的居家检测工具。大多数家庭将不仅获得检测新冠病毒的能力,还能够检测流感、链球菌性咽喉炎及其他常见感染。

十年之后,新冠肺炎将成为一种更为“温和”的疾病。但这并不是说,新的致命病毒的威胁将会消失。不过只要有计划,有远见,在遇到下一次疫情的挑战时,世界必将准备得更为充分。(财富中文网)

阿梅什·阿达利亚是约翰斯·霍普金斯大学布隆伯格公共卫生学院健康安全中心(Johns Hopkins Center for Health Security at the Bloomberg School of Public Health)的高级学者,内科、急诊、传染病及重症医学认证医师。

译者:冯丰

审校: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.

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