Bartlett John G, Borio Luciana
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2008 Mar 15;46(6):919-25. doi: 10.1086/528799.
The United States needs to be better prepared for a large-scale medical catastrophe, be it a natural disaster, a bioterrorism act, or a pandemic. There are substantial planning efforts now devoted to responding to an influenza pandemic. Here, we review these efforts and identify some harsh realities: (1) the US health care system is private, competitive, broke, and at capacity, so that any demand for surge cannot be met with existing economic resources, hospital beds, manpower, or supplies; (2) the emphasis placed on the development and rapid production of an effective vaccine is excellent, but the effort is underfunded to meet global demand; (3) and the Centers for Disease Control and Prevention's community mitigation measures, such as the use nonpharmacological and social interventions (e.g., use of face masks or respirators, social distancing, and closure of schools), lack validation and could have substantial indirect and unintended consequences. Finally, international collaborations are essential for disease surveillance and to assure investigator access to influenza strains, equitable vaccine distribution, and availability of critical supplies from offshore sources.
美国需要为大规模医疗灾难做好更充分的准备，无论是自然灾害、生物恐怖主义行为还是大流行病。目前有大量的规划工作致力于应对流感大流行。在此，我们回顾这些工作并指出一些严峻现实：（1）美国医疗保健系统是私立、竞争、资金短缺且已不堪重负的，因此现有的经济资源、医院床位、人力或物资无法满足任何激增的需求；（2）对有效疫苗的研发和快速生产的重视是很好的，但资金投入不足，无法满足全球需求；（3）疾病控制与预防中心的社区缓解措施，如使用非药物和社会干预措施（如使用口罩或呼吸器、保持社交距离以及关闭学校），缺乏验证，可能会产生重大的间接和意外后果。最后，国际合作对于疾病监测以及确保研究人员能够获取流感毒株、公平分配疫苗和从海外来源获得关键物资至关重要。
