节选翻译《张文宏教授为海外同胞防范新冠病毒来支招》_风闻

       微信公号“中国驻杜塞尔多夫总领馆”3月20日刊发特讯《张文宏教授为海外同胞防范新冠病毒来支招》。在新冠肺炎疫情全球爆发的情况下，海外华侨、华人、留学生难免有各种焦虑与担忧。中国驻杜塞尔多夫总领馆在上海市外办协助下，特别邀请到上海复旦大学附属华山医院感染科主任、上海市新冠肺炎医疗救治专家组组长、中华医学会感染病学分会常委张文宏教授于17日以视频连线方式举办专题讲座。这篇特讯是现场问答的实录节选，语言通俗，干货极多，虽然是主要针对德国当时的情况，但对所有在海外需要自我防护指导的人都很有参考意义。        

       我自己翻译了一个英文版，节选了有普遍意义的几个问题，有需要的请随便转载，注明出处即可。原文请搜索原公众号，观察者网转载链 https://www.guancha.cn/internation/2020_03_22_543022.shtml

       再说一句翻译体会，中文口语真的就人均散文，中文很好理解很接地气的行文翻译成英文就散乱得不成样子，所以我不可能保留原文语气风格直译，只能在不改变原文意思的前提下意译。英文像链条，上下文逻辑关系要清晰，而中文像立交桥，看起来没有处处相接但其实四通八达。中文很多话不用说透也能懂的，翻译成英文就真的不懂了，所以只能我自己加个半句话上去。中文是一种潇洒的语言。

Protect yourself from the COVID-19 

Professor Zhang Wen Hong, who is the head of the infectious disease department of Fudan University Affiliated Huashan Hospital in Shanghai, leader of the expert panel for COVID-19 treatment in Shanghai, and member of the standing committee for Chinese Medical Association’s infectious disease branch, answered questions in an on-line seminar held by the Chinese Consulate General in Dusseldorf, Germany, in March 17th. There are valuable information in the professor’s words for anyone who’s worried about the coronavirus, as the city of Shanghai has been successfully defended from the pandemic under his guidance. Among the 24 million population in Shanghai there were 350 plus diagnosed cases and 3 death at the time. Imported cases brought by oversea travels are still counting but are being tracked and quarantined. Community infection has been stopped in the megacity.

Q: What is COVID-19? What are its characteristics?

A: Our experience in epidemic control is accumulated through time. So far, what we have learned from this disease is that it is not as dangerous as SARS, assuming the patients are given the best treatment. SARS had a mortality rate of about 10%, that is to say, 1 out of 10 people caught it dies. So what is the mortality rate of COVID-19? According to Germany’s current data, less than one out of 100 people. You may ask that it’s not like this in Italy, but I will not talk about Italy today. Let’s just say the situation in Italy is different from that in Germany. And what is the situation in China now? The case fatality rate in Shanghai is about the same as that in Germany. The case fatality rate all over China except Hubei province is basically 1-2 deaths out of 100. And for Japan it’s 1.5 out of 100 people. There are no deaths in Singapore and Malaysia. Considering Malaysia now has more than 400 confirmed cases, we may have the hot weather there to thank for. There are more than 350 cases and 3 deaths in Shanghai for now. Taking a close look at the deceased, the first was 89 years old, the second was 78 years old, and the third had severe obesity with heart disease. What are these examples tell us? Compared with SARS, the threat level of this disease is low.

Q: What harm does COVID-19 do?

A: Since it’s not as severe as SARS, it can’t be identified at all in the early stage. It’s possible that the symptoms are very mild and you can’t feel them at all, so you may be in contact with infected people who show no symptoms or have very mild symptoms, such as low fever, which couldn’t be detected with a thermometer. What would this lead to? Patients with unnoticeable symptoms will walk around and infect more people. For example, more than 1000 people participated in an indoor activity some time back in Germany, a number of unknown patients with minor to none symptoms maybe among them without knowing it themselves. Even at early stage, it’s still very contagious. In the case of SARS, there will be more serious symptoms within 2 to 3 days, and the disease develops fast into very severe stage. How can it infect others if the patients couldn’t get off the bed? So, deadly viruses like SARS does not spread as widely nor as fast. COVID-19 is not as deadly as we think, but highly infectious. During the 2009 flu season, tens of million were infected in the United States, but the mortality rate was 0.1% to 0.2%. The world was very scared at the beginning and took very active measures. Later, people felt that given the fatality rate it was not worth it. Many people were infected, but most of them were OK. So you can understand why there are so many contradictory messages right now. Some countries take it seriously, some think it’s nothing to worry about, most countries think it’s nothing at first, but now they’ve changed their mind.

Q: If I get sick, what risks will I face? What should I do?

A: This is a matter of great concern to all of us today. The best way is that you don’t get sick. How likely is it not to get sick? If you’re a responsible person and you protect yourself properly, I think the risk of infection is pretty low. The infection only occurs during close contact. Please ask yourself: at this time of crisis, can I avoid all unnecessary social activities? Reducing the chance of exposure can greatly reduce the risk of infection.

Q: How to understand Germany’s epidemic prevention policy?

A: We see a lot of news on the Internet. The UK talks about herd immunity. Germany’s chancellor said that in the end 60-70% of German population could be infected.            It looks pretty grim, but in fact I think the decision made in Germany today has been well thought out. Different countries adopt different strategies. I’ll try to explain their considerations so we can also adopt the most favorable personal strategy for ourselves.

I will briefly review the situation of China’s epidemic control, the difference between the work done by various countries, the situation in Europe, and make a rough forecast of the future development. In fact, given the dynamic nature of the ongoing process, accurate prediction is very difficult at this time. The strategies adopted by each country are changing every day, but there is a trend that everyone is becoming more and more active, which is good. As long as various countries are taking active measures, it is only a matter of time before the international epidemic is finally effectively controlled. Is it the end of this summer, the end of the year, the end of next summer, or the end of next year? It depends on the joint effort we have taken globally.

Since the outbreak of the epidemic, China’s scientific institutions began research on the virus on January 1. It only took five to seven days to figure out the disease, which is very fast. When SARS broke out in 2003, we were not so fast. This time, between January 1 and 7, we figured out the virus sequence and made it public to the world on January 10. In Singapore, strict control measures were taken at the beginning. Even now it is stricter than that in Germany and most European countries. There are nearly 800 outpatient clinics in Singapore that can handle febrile patients. Once a patient is diagnosed, they will immediately track down who’s been in contact, and they did a good job. It is similar to most of our cities in China, such as Shanghai and Beijing. As I mentioned earlier, this virus is not as severe as SARS. It’s more like influenza in terms of infectivity. At first, we thought that the case fatality rate of 1% was no problem, but it’s not really so. With so many people infected, there will be many severe cases, about 20% of all patients. Most of these severe cases will recover after treatment, but when tens of thousands of people in one city get sick at the same time, the medical capacity of the city will be challenged. Singapore has been keeping the number of feverish patients at a few hundred, and dealing with it one at a time.

When there are a large number of patients in a city at the same time, the medical system will be out of capacity. Many severe patients will not get treatment at all, which is the reason for the high mortality. Light patients only need nasal catheters, but severe patients need oxygen treatment, which is a complex system, such as mechanical ventilation and even artificial lungs. 

Germany has purchased 10000 ventilators. Generally speaking, the number of patients who need to use ventilators is about 5% of the total number of patients. For example, about 20 out of 350 patients in Shanghai will eventually use ventilators. 10000 ventilators, plus the existing ones in Germany, can meet the needs of at least 100000 patients, if 10% of them are in need of ventilators. Germany has been preparing for at least 100000 patients, along with other measures like closing down schools, all contribute to its case fatality rate of less than 0.5%. The low rate has little to do with the skills of doctors, but mainly depending on disease control and medical resource management. Germany’s Robert Koch Institute is one of the best clinical microbiology laboratories on earth, with a history of more than 100 years. If the epidemic spreads further, the Institute and the German government will work together to make adjustment to the prevention and control strategies according to the development of the epidemic.

The strategy we adopted in Wuhan, China, is the most proper approach after a large number of patients had appeared. Look at Shanghai and Beijing, it’s been a while since we started to go back to work. However, if it wasn’t for the Spring Festival, would we take extreme measures like stop production, and close schools when there were only a few imported patients in Shanghai? In fact, it’s not easy to judge now. At that time, Spring Festival gave us a good opportunity to stay home. If you don’t get sick for two weeks, you will be fine. If you get sick, you will go to the hospital for treatment. Most cities in China take this measure. If two weeks are not enough, give it another two weeks, and the problem will be completely solved. Today, we are case free in most cities in China. There is no need to doubt the claim. We have all been stuck at home for four weeks. I know the test results in all of the large general hospitals in Shanghai. There are no new cases in recent weeks. To a large extent, it’s because of the spring festival that we are successful. Now, we are going back to work.

Now, with the exception of some states, the number of cases in most cities in Germany is one figure. Do you think Germany should adopt the strategy like China that stops all activities during the Spring Festival or like Singapore that maintains normal business operations? In fact, Singapore’s medical system is also similar to that of Europe and the United States. However, this country has gathered the wisdom of both Asia and Europe. With European standard medical system, Asian standard urban management and the cooperation of Asian people, Eastern and Western wisdom have been perfectly integrated. Will Germany adopt the Chinese approach? First, the situation in Germany is not as serious as that in China. Second, there is no such convenience as the Spring Festival. It all depends on the development of the epidemic.

The epidemic will last for a long time in Germany and other countries, especially with a global outbreak ongoing. To end the outbreak in a very short time requires extreme measures, which many countries are not ready to take. China has taken the most active measures since the beginning, because we were on a different developing stage of the epidemic compare to what Germany is in now. China was being responsible. We did it with good intensions and kindness at heart. Sacrificing our way of life is worth it if the epidemic gets under control. We actually did it. We’ve done our duty.            

However, right now even if Germany takes very active measures, as long as its neighbors act their usual ways, the risk of imported cases will be high. China is also facing such risks, just like Germany. So let’s not think that the situation in Germany is bad, while China can take a breath now, because all countries are facing import case risks every day. By closing down school, stopping entertainment activities, avoiding unnecessary gathering and unnecessary shopping, we slow down the pace of life, allowing patients to emerge on a rate well within the limit of the German medical system. So the current strategy, also the strategy of the whole Europe, is as follows: First, we need to greatly enhance the community medical strength. Second, we should improve the treatment of severe patients. Third, limit all kinds of activities in the city.

Q: when will the peak of the epidemic come?

A: I think the epidemic peak will come in April and go all the way into June. In the summer it will get better, but after that, is the disease gone? From today’s understanding of the disease, it won’t be so easy. 

Q: What should we do to avoid infection?

A: First, everyone should eat their meals from their own dishes. Second, masks should be worn on social occasions. When people are next to each other, wearing masks is beneficial. Lock yourself in at home alone will make anyone go crazy. It’s OK to meet people in small number while wearing a mask. Third, try to minimize social interaction. In Germany, there are many Chinese students who study hard, and there is a lot of pressure on the final exams. We should make good use of our time to study and try to reduce unnecessary social contact. Now a lot of entertainment places are closed. It’s OK to go out to restaurants, but I suggest Chinese restaurants for you will not feel awkward wearing a mask, and don’t share meals. The first thing to do when you go back from outside is to wash your hands. As long as you do these, you can basically avoid infection.            

The key is to prevent the risk of close contact with potential patients. If you’re not particularly sure if your girlfriend has an infection, stick to wearing a mask. So now at least you can still see each other, although wearing masks. Avoid close contact, wash hands, wear masks, and don’t socialize a lot. You will be safe in Germany.           

Q: If the epidemic develops further and medical resources are strained, Chinese students and the local Germans go to see a doctor at the same time, will they give priority to the local Germans?

A: Under the current circumstances, while Germany has abundant medical resources, it may be too early for us to discuss this issue. When you think about this problem, it means that you are afraid of being sick. Since you are afraid of being sick, you should control your behavior. If you have no fear that’s because you know there will be someone got your back. When you are alone in a foreign country, you will feel fear in your heart at a time like this. So show self-restrain. I personally think that as long as you follow the instructions given here today, this disease will not find you.

Q: Are young people safer?

A: According to our data in Shanghai, the risk for young people to develop severe illness is very low as long as the medical resources are not overly strained. Recently, our hospital has admitted more than a dozen young people coming back from Europe. These people are all coming back together by air. 90% of them have very mild symptoms. For the serious ones, they usually recover after oxygen treatment and other measures. So for young people, if you want to go to the hospital, first you need to call the COVID-19 hotline. If the hotline is not available, call your family doctor. If that doesn’t work, call our Consulate General for help. Don’t go straight to the emergency department of your local hospital. It won’t help. Why? If your symptoms are very mild, or even without fever, you will not be given the treatment for COVID-19. You will go home with cold pills. Do you really think it’s worth the trip? 

Remember, the severe pneumonia caused by COVID-19 has a characteristic feature: dyspnea. This is a very important symptom, and also the most important indicator for you to go to the emergency room. How do you know if you have breathing difficulties? I suggest you to take the stairs. If you live on the 20th floor, when you go home, before you take the elevator, walk up the stairs to the 3rd floor first. If you have no problem doing that. Your lung is in excellent condition. There’s no point for you to go to the hospital. If you have difficulty breathing when you reach the second or the third floor, that indicates impaired respiratory function, and you may now go to the emergency room in the hospital. 

Usually in the season there will be a frequent occurrence of cold and flu. Not all symptoms are necessarily caused by COVID-19. What if it is? Then isolate yourself at home, wear a mask and avoid contact with people around you. I don’t think that’s too difficult. If people around you still get infected, it is only possible in one situation: no mask, close contact and no hand washing.

Q: Are the current pandemic control measures really effective and proper for Europe, and especially for Nordrhein-Westfalen, Germany?

A: This is a very important question. I checked the situation in Nordrhein-Westfalen. As of yesterday (16th), the number of confirmed cases was 2744, and rising. It’s growing more rapidly by the day. The reason for this is that after the initial outbreak, patients are now scattered in various places. At this time, the most crucial measure is quarantine. If no quarantine is in effect, the days ahead will be very difficult.            

The biggest difference between Nordrhein-Westfalen and Shanghai during the outbreak is that people here are still working. The only real risk is that the people are still moving around. Only after Chancellor Merkel warned that 60% - 70% of the people will be infected, some necessary measures can now be carried out. By telling everyone the worst situation, she made the whole Germany pay attention.          

In the next few days, whether or not potential patients are still roaming freely, depends on two things. First, follow emergency-time routine while going to work. For instance, will young people in Germany or the UK know not to go to pubs for a few drinks or go to parties as usual after work? Second, keep everyone’s social distance in work places. Will people know how to minimize contact on all social occasions? If the answers are yes, I then think the current quarantine level is sufficient.            

Because the current patients were infected some time earlier, and the newly appeared patients in the last two days were infected before the measures were taken, the effectiveness of current measures cannot be judged based on the number of people infected right now. There will be a time lag of 14 days for the result of the measures to show, so we must pay close attention to the growth rate of patients 14 days after taking measures. If the result is not good after 14 days, Germany has to raise its level of response. Otherwise, Germany too, will face an increase of number in severe patients. I don’t know if this will push the hospitals to their limits, but there will sure be impact on the allocation of medical resources such as ventilators. That being said, I have confidence that the scientists of Robert Koch Institute in Germany are monitoring the situation and will adopt more active measures if they find the current response level is not compatible with the data.

Q: How can international students who share apartments effectively prevent infection in their daily life considering conditions such as shared kitchens, bathrooms, etc.? What if there are suspected symptoms?

A: In this case, we say that there is no best solution because the only best way is to live alone, but you can make improvements. It’s necessary to reduce the social distance with others. If we don’t eat together, we can reduce the risk. In fact, the risk has nothing to do with sharing kitchen and bathroom. As long as you keep your personal hygiene, wash your hands frequently, use the kitchen in turns, and dry your clothes after washing, there will be no problem. Heated drying is the best way to sterilize.

Q: Why hasn’t Germany suggested the use of facial masks?

A: Is it effective for ordinary people to wear masks? It is. If it doesn’t work, why do doctors wear masks? It’s a question of the risk level of infection. Your risk level of infection is directly affected by your level of protection. If the risk of infection is already high, we need the extra protection provided by masks. If the risk level of infection is low, we can evaluate the advantages and disadvantages of wearing masks before making a decision.            

Europeans never wear masks in everyday life, but in Japan and Hong Kong, healthy people often wear masks on the streets, which is a habit. If people wear masks all over the streets in Germany today, it will feel like the end of the world, which will cause great pressure to many people. Therefore, it is necessary to evaluate the benefit of wearing masks before deciding whether it’s necessary. Wearing a mask is to prevent others from infecting you. If the chance is very small, it’s probably not a good idea to have a whole city of people wearing masks. However, if you have symptoms of infection, you should wear a mask at once, even at home. There may be viruses in saliva droplets, wearing masks now can prevent infecting others. Wearing masks in this case is very effective.            

For doctors, N95 masks are only necessary when treating patients with COVID-19, otherwise standard surgical masks offer the same protection. However, when there is a chance to be in contact with potential COVID-19 patients, N95 masks will be needed for the increased threat.

In China we hope to minimize the risk. If people don’t feel uncomfortable wearing masks, they should wear them during the outbreak. If there are no patients around, they can take the masks off. Singapore does not suggest wearing masks because they believe that with 7 million people in the country, only a few hundred are infected. Masks are not necessary. 

Masks do offer protection from the virus. It’s simply how badly you need the extra protection versus your habit

Q: Do we Chinese need to wear masks in Germany?

A: I think wearing masks can help, but in regions with low incidence rate, the protective effect is overestimated. What can be achieved by wearing a mask can also be achieved by responsible behavior. First, if the epidemic develops rapidly and the number of people infected increases, the effectiveness of wearing masks will increase. Second, according to the current situation in Germany, we must keep social distances. You can avoid taking a bus during rush hour or just ride a bicycle to school. In work place, you can keep a certain distance while talking to others, and use technology to reduce the chance of face to face contact. Third, the German people did not have the habit of wearing masks. We suggest that we do not try to change their ideas. Fourth, we can employ the method of active defence by changing our behavior. Instead of persuading the Germans to put on masks, it’s better to start from changing your own behavior. I hope we can understand that the German people have their own reasons. In Germany, follow the German practice. If you don’t agree with the German practice, you can only change your own behavior, such as reducing social contact, increasing communication distance, shopping when there are few people in the market, etc..