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這個(gè)國家很小,但新冠病毒的檢測水平比美國還先進(jìn)

Vivienne Walt
2020-03-31

該國的一家生物制藥公司發(fā)揮了很大作用。

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新型冠狀病毒在世界范圍內(nèi)瘋狂肆虐的這兩個(gè)月里,包括美國在內(nèi),大多數(shù)國家都選擇只對(duì)那些出現(xiàn)了明顯癥狀的人進(jìn)行病毒檢測,并告訴其他人,如果他們懷疑自己感染了冠狀病毒,就去自我隔離。基于這種方法,自去年12月該病毒首次出現(xiàn)于中國武漢以來,已經(jīng)有80萬人的病毒檢測結(jié)果呈陽性,其中美國就有超過16萬人。

如果展開隨機(jī)檢測的話,當(dāng)局能了解到什么呢?或許,在冰島這個(gè)小國家能找到些線索。到目前為止,該國已經(jīng)對(duì)11727人進(jìn)行了檢測——約占其36.4萬總?cè)丝诘?.2%。之所以能夠如此,部分也是因?yàn)樵搰鴤涫苜澴u(yù)的生物制藥公司deCODE Genetics在這場危機(jī)中提供了幫助。

冰島雷克雅未克市中心議會(huì)大廈附近的一條購物街。該國針對(duì)新型冠狀病毒的檢測比例尤為突出。圖片來源:SPENCER PLATT—GETTY IMAGES

自3月14日起,加利福尼亞生物科技巨頭安進(jìn)公司(Amgen)的子公司deCODE就開始為全體冰島公民提供免費(fèi)的冠狀病毒檢測。無論身體健康還是出現(xiàn)病癥,冰島人只要在網(wǎng)上填寫一份表格即可參加檢測。本月,DeCODE將與冰島公共衛(wèi)生部門展開合作。自2月初以來,公共衛(wèi)生部門一直在對(duì)高危和感染人群進(jìn)行冠狀病毒篩查,而篩查開始數(shù)周之后,冰島才出現(xiàn)首個(gè)檢測結(jié)果呈陽性的病例。

科學(xué)家們表示,通過對(duì)健康和感染人群的篩查,冰島政府和deCODE公司已經(jīng)收集了一份相當(dāng)精確的新型冠狀病毒圖譜。篩查結(jié)果很能引人深思。上周三,在雷克雅未克的辦公室里接受《財(cái)富》雜志的電話采訪時(shí),deCODE公司創(chuàng)始人兼首席執(zhí)行官卡里·斯蒂芬森表示:“對(duì)高危易感人群的篩查結(jié)果顯示,這種病毒在社區(qū)內(nèi)的傳播范圍比我們想象的要大得多?!苯刂辽现芩?,?已有737人的病毒檢測結(jié)果呈陽性,約占冰島全國總檢測人數(shù)的6.3%。有15人住院治療,其中2人已經(jīng)進(jìn)了重癥監(jiān)護(hù)室。其余確診病患——有很多人都未出現(xiàn)癥狀——已被勒令進(jìn)行自我隔離。

斯蒂芬森說,該公司的最終目標(biāo)是對(duì)冰島三分之一的人口進(jìn)行檢測——其比例相當(dāng)于美國對(duì)約1.15億人進(jìn)行檢測。他補(bǔ)充說,本周deCODE公司的病毒檢測速度有所放緩,因?yàn)樗麄冋τ谘a(bǔ)充棉簽的庫存,這幾天就會(huì)開始提速。斯蒂芬森解釋說,檢測是為了追蹤每一個(gè)病例:“假設(shè)某社區(qū)約有3000人感染了病毒,那么為了在一段時(shí)間內(nèi)控制住疫情,我們就得進(jìn)行更多的篩查,找到被感染的人,把他們隔離起來。”

隨機(jī)檢測的意義

DeCODE公司的做法與美國及歐洲大多數(shù)國家的做法形成了鮮明對(duì)比。在歐洲,只有那些表現(xiàn)出明顯感染跡象的人才會(huì)接受冠狀病毒檢測。在周日的新聞發(fā)布會(huì)上,美國副總統(tǒng)邁克·彭斯說:“如果你沒有出現(xiàn)癥狀,就不需要做病毒檢測?!泵绹膊】刂婆c預(yù)防中心也給出了類似的建議,“不必給所有人做檢測。大多數(shù)人都只出現(xiàn)了輕微的癥狀,待在家里就能自己康復(fù)?!?/p>

現(xiàn)年70歲的斯蒂芬森曾是哈佛大學(xué)的一名神經(jīng)學(xué)教授。1996年,他回到冰島創(chuàng)辦了自己的公司。他認(rèn)為,政府沒有足夠的數(shù)據(jù)來追蹤冠狀病毒的起源,所以才不知道如何控制住疫情的傳播。

他說,在開始做隨即檢測之前,“他們對(duì)病毒在社會(huì)上傳播的方式和原因都完全沒有概念。事情就是這么簡單。”

斯蒂芬森表示,冰島政府2月份開始提供檢測時(shí),就估計(jì)那些在寒假期間從阿爾卑斯山滑雪旅行歸來的游客中會(huì)有人感染上病毒,因?yàn)楫?dāng)時(shí)意大利和法國的阿爾卑斯山地區(qū)已經(jīng)爆發(fā)了疫情。公共衛(wèi)生部門也確實(shí)發(fā)現(xiàn)了受感染的游客。但從英國返回冰島的人群中也發(fā)現(xiàn)了一組感染病例,還有從美國返回的一例:這些感染者體內(nèi)的冠狀病毒都經(jīng)過了變異。斯蒂芬森說:“截至昨天,我們已經(jīng)獲得了大約380種病毒的序列?!痹摴居?jì)劃在本周以公共數(shù)據(jù)庫的形式對(duì)外公布關(guān)于變異病毒的數(shù)據(jù)。

在圍繞自我隔離的激烈辯論中,冰島保持著令人驚奇的冷靜。該國沒有下達(dá)封鎖法令,只是敦促人們盡可能地呆在家里。各小學(xué)也依然照常上課。

相比于強(qiáng)調(diào)自我隔離,該國更加重視檢測。冰島前總理大衛(wèi)·京勒伊格松周二時(shí)在英國《旁觀者》(The Spectator)周刊上發(fā)表了一篇文章,表示:“所有國家都應(yīng)該聽從世界衛(wèi)生組織的建議,并以冰島為榜樣,‘檢測、檢測、再檢測’?!彼f,該國的檢測策略“在全世界范圍內(nèi)幾乎是獨(dú)一無二的”。

當(dāng)然,冰島人口稀少,所以做檢測要比其它大多數(shù)國家都容易得多,甚至比韓國容易。擁有5000萬人口的韓國之所以能迅速控制住冠狀病毒的傳播,很大程度上要?dú)w功于政府積極的檢測和隔離策略。在一封電子郵件中,冰島衛(wèi)生部的工作人員告訴《財(cái)富》雜志,該國參與檢測人口占總?cè)丝诘谋壤h(yuǎn)遠(yuǎn)高于韓國,“從而對(duì)病毒的狀態(tài)產(chǎn)生了有價(jià)值的見解?!?/p>

DeCODE公司——和冰島這個(gè)國家——在分析其關(guān)于冠狀病毒的發(fā)現(xiàn)方面都處于極其罕見的地位,或許還有可能發(fā)現(xiàn)一些人更容易感染、生病的原因。這對(duì)科學(xué)家來說非常有價(jià)值,因?yàn)樗麄冋诟傁嘌芯恐委煼椒ê鸵呙?,試圖避免冠狀病毒未來再度爆發(fā)。

自24年前成立以來,DeCODE公司已經(jīng)繪制了冰島一半以上人口的DNA圖譜。斯蒂芬森說:“我們可以從另一半人口中推斷出數(shù)據(jù)。我們正處于合理的有利位置,可以開始探索這種病毒的易感性是否在某種程度上是由基因決定的?!蹦壳?,科學(xué)家們正在把DeCODE數(shù)據(jù)庫中的DNA圖譜與冰島冠狀病毒隨機(jī)檢測的結(jié)果進(jìn)行對(duì)比,或許將成為新的可能。

斯蒂芬森說:“我們正在研究,試圖生成一組重疊的數(shù)據(jù)。我不認(rèn)為還有其它地方有這樣的數(shù)據(jù)?!保ㄘ?cái)富中文網(wǎng))

譯者:殷圓圓

新型冠狀病毒在世界范圍內(nèi)瘋狂肆虐的這兩個(gè)月里,包括美國在內(nèi),大多數(shù)國家都選擇只對(duì)那些出現(xiàn)了明顯癥狀的人進(jìn)行病毒檢測,并告訴其他人,如果他們懷疑自己感染了冠狀病毒,就去自我隔離?;谶@種方法,自去年12月該病毒首次出現(xiàn)于中國武漢以來,已經(jīng)有80萬人的病毒檢測結(jié)果呈陽性,其中美國就有超過16萬人。

如果展開隨機(jī)檢測的話,當(dāng)局能了解到什么呢?或許,在冰島這個(gè)小國家能找到些線索。到目前為止,該國已經(jīng)對(duì)11727人進(jìn)行了檢測——約占其36.4萬總?cè)丝诘?.2%。之所以能夠如此,部分也是因?yàn)樵搰鴤涫苜澴u(yù)的生物制藥公司deCODE Genetics在這場危機(jī)中提供了幫助。

自3月14日起,加利福尼亞生物科技巨頭安進(jìn)公司(Amgen)的子公司deCODE就開始為全體冰島公民提供免費(fèi)的冠狀病毒檢測。無論身體健康還是出現(xiàn)病癥,冰島人只要在網(wǎng)上填寫一份表格即可參加檢測。本月,DeCODE將與冰島公共衛(wèi)生部門展開合作。自2月初以來,公共衛(wèi)生部門一直在對(duì)高危和感染人群進(jìn)行冠狀病毒篩查,而篩查開始數(shù)周之后,冰島才出現(xiàn)首個(gè)檢測結(jié)果呈陽性的病例。

科學(xué)家們表示,通過對(duì)健康和感染人群的篩查,冰島政府和deCODE公司已經(jīng)收集了一份相當(dāng)精確的新型冠狀病毒圖譜。篩查結(jié)果很能引人深思。上周三,在雷克雅未克的辦公室里接受《財(cái)富》雜志的電話采訪時(shí),deCODE公司創(chuàng)始人兼首席執(zhí)行官卡里·斯蒂芬森表示:“對(duì)高危易感人群的篩查結(jié)果顯示,這種病毒在社區(qū)內(nèi)的傳播范圍比我們想象的要大得多?!苯刂辽现芩模?已有737人的病毒檢測結(jié)果呈陽性,約占冰島全國總檢測人數(shù)的6.3%。有15人住院治療,其中2人已經(jīng)進(jìn)了重癥監(jiān)護(hù)室。其余確診病患——有很多人都未出現(xiàn)癥狀——已被勒令進(jìn)行自我隔離。

斯蒂芬森說,該公司的最終目標(biāo)是對(duì)冰島三分之一的人口進(jìn)行檢測——其比例相當(dāng)于美國對(duì)約1.15億人進(jìn)行檢測。他補(bǔ)充說,本周deCODE公司的病毒檢測速度有所放緩,因?yàn)樗麄冋τ谘a(bǔ)充棉簽的庫存,這幾天就會(huì)開始提速。斯蒂芬森解釋說,檢測是為了追蹤每一個(gè)病例:“假設(shè)某社區(qū)約有3000人感染了病毒,那么為了在一段時(shí)間內(nèi)控制住疫情,我們就得進(jìn)行更多的篩查,找到被感染的人,把他們隔離起來。”

隨機(jī)檢測的意義

DeCODE公司的做法與美國及歐洲大多數(shù)國家的做法形成了鮮明對(duì)比。在歐洲,只有那些表現(xiàn)出明顯感染跡象的人才會(huì)接受冠狀病毒檢測。在周日的新聞發(fā)布會(huì)上,美國副總統(tǒng)邁克·彭斯說:“如果你沒有出現(xiàn)癥狀,就不需要做病毒檢測?!泵绹膊】刂婆c預(yù)防中心也給出了類似的建議,“不必給所有人做檢測。大多數(shù)人都只出現(xiàn)了輕微的癥狀,待在家里就能自己康復(fù)?!?/p>

現(xiàn)年70歲的斯蒂芬森曾是哈佛大學(xué)的一名神經(jīng)學(xué)教授。1996年,他回到冰島創(chuàng)辦了自己的公司。他認(rèn)為,政府沒有足夠的數(shù)據(jù)來追蹤冠狀病毒的起源,所以才不知道如何控制住疫情的傳播。

他說,在開始做隨即檢測之前,“他們對(duì)病毒在社會(huì)上傳播的方式和原因都完全沒有概念。事情就是這么簡單?!?/p>

斯蒂芬森表示,冰島政府2月份開始提供檢測時(shí),就估計(jì)那些在寒假期間從阿爾卑斯山滑雪旅行歸來的游客中會(huì)有人感染上病毒,因?yàn)楫?dāng)時(shí)意大利和法國的阿爾卑斯山地區(qū)已經(jīng)爆發(fā)了疫情。公共衛(wèi)生部門也確實(shí)發(fā)現(xiàn)了受感染的游客。但從英國返回冰島的人群中也發(fā)現(xiàn)了一組感染病例,還有從美國返回的一例:這些感染者體內(nèi)的冠狀病毒都經(jīng)過了變異。斯蒂芬森說:“截至昨天,我們已經(jīng)獲得了大約380種病毒的序列。”該公司計(jì)劃在本周以公共數(shù)據(jù)庫的形式對(duì)外公布關(guān)于變異病毒的數(shù)據(jù)。

在圍繞自我隔離的激烈辯論中,冰島保持著令人驚奇的冷靜。該國沒有下達(dá)封鎖法令,只是敦促人們盡可能地呆在家里。各小學(xué)也依然照常上課。

相比于強(qiáng)調(diào)自我隔離,該國更加重視檢測。冰島前總理大衛(wèi)·京勒伊格松周二時(shí)在英國《旁觀者》(The Spectator)周刊上發(fā)表了一篇文章,表示:“所有國家都應(yīng)該聽從世界衛(wèi)生組織的建議,并以冰島為榜樣,‘檢測、檢測、再檢測’。”他說,該國的檢測策略“在全世界范圍內(nèi)幾乎是獨(dú)一無二的”。

當(dāng)然,冰島人口稀少,所以做檢測要比其它大多數(shù)國家都容易得多,甚至比韓國容易。擁有5000萬人口的韓國之所以能迅速控制住冠狀病毒的傳播,很大程度上要?dú)w功于政府積極的檢測和隔離策略。在一封電子郵件中,冰島衛(wèi)生部的工作人員告訴《財(cái)富》雜志,該國參與檢測人口占總?cè)丝诘谋壤h(yuǎn)遠(yuǎn)高于韓國,“從而對(duì)病毒的狀態(tài)產(chǎn)生了有價(jià)值的見解?!?/p>

DeCODE公司——和冰島這個(gè)國家——在分析其關(guān)于冠狀病毒的發(fā)現(xiàn)方面都處于極其罕見的地位,或許還有可能發(fā)現(xiàn)一些人更容易感染、生病的原因。這對(duì)科學(xué)家來說非常有價(jià)值,因?yàn)樗麄冋诟傁嘌芯恐委煼椒ê鸵呙纾噲D避免冠狀病毒未來再度爆發(fā)。

自24年前成立以來,DeCODE公司已經(jīng)繪制了冰島一半以上人口的DNA圖譜。斯蒂芬森說:“我們可以從另一半人口中推斷出數(shù)據(jù)。我們正處于合理的有利位置,可以開始探索這種病毒的易感性是否在某種程度上是由基因決定的。”目前,科學(xué)家們正在把DeCODE數(shù)據(jù)庫中的DNA圖譜與冰島冠狀病毒隨機(jī)檢測的結(jié)果進(jìn)行對(duì)比,或許將成為新的可能。

斯蒂芬森說:“我們正在研究,試圖生成一組重疊的數(shù)據(jù)。我不認(rèn)為還有其它地方有這樣的數(shù)據(jù)?!保ㄘ?cái)富中文網(wǎng))

譯者:殷圓圓

In the two months since COVID-19 began its rampage across the world, most countries, including the U.S., have opted to test only those people with active symptoms, telling others to self-isolate if they suspect they are infected with the coronavirus. Based on that approach, more than?480,000?people have tested positive for the virus since it first appeared in Wuhan, China, last December, including more than 68,500 in the U.S.

But what might authorities learn if people were tested randomly instead? Some early clues may be found in the tiny country of Iceland. So far, the country has tested 11,727 people—about 3.2% of its population of 364,000. It has done so in part by enlisting the country’s prized biopharma company deCODE Genetics to help tackle the crisis.

Since March 14 deCODE, a subsidiary of the California biotech giant Amgen, has offered a free coronavirus test to any Icelander, sick or healthy, who simply fills out an online form. DeCODE joined forces this month with Iceland’s public health authorities, which had been screening high-risk or sick people for the coronavirus since early February, weeks before even the first Icelander tested positive for the virus.

By screening healthy as well as sick people, say scientists, Iceland and deCODE have assembled a far more accurate picture of COVID-19. And the results are sobering. “The virus had a much, much wider spread in the community than we would have assumed, based on the screening of high-risk people,” deCODE’s founder and CEO Kári Stefánsson told Fortune by phone from his office in Reykjavík on Wednesday. As of Thursday,?737 have tested positive, or roughly 6.3% of all people tested in the country. Of those, 15 are in hospitals, two of them in intensive care. The rest—many of whom are asymptomatic—have been ordered to self-quarantine.

Stefánsson says the company aims in the end to test about one-third of Iceland’s population—the equivalent of the U.S. testing about 115 million people. He adds that deCODE’s testing has slowed down this week, as the company scrambles to restock its supply of cotton swabs, but will ramp up again within days. “Let’s assume about 3,000 people in the community are infected,” Stefánsson says. The idea, he explains, is to track every case. “To contain the infection for some period of time, we need to screen more, find those individuals, and quarantine them.”

The value of random testing

DeCODE’s model stands in sharp contrast to that of the U.S. and most countries in Europe, where only those who show clear signs of infection have been tested for the coronavirus. “If you don’t have symptoms, you don’t need a test,” Vice President Mike Pence said in a press conference on Sunday. Similar advice comes from the Centers for Disease Control and Prevention, whose website notes, “[N]ot everyone needs to be tested. Most people have mild illness and are able to recover at home.”

Stefánsson, 70, who was a professor of neurology at Harvard University before returning to his homeland to launch his company in 1996, rejects that strategy. He believes it leaves governments unable to understand how to control the spread of the coronavirus, since they have too little data to track its origins.

Until they do random testing, he says, “they do not have the faintest idea of how and why it is spreading in the society,” he says. “It is as simple as that.”

Stefánsson says that when Iceland began testing people in February, it expected to find infections among those who had returned from skiing trips to the Alps during the winter vacation, because an outbreak was then beginning in Italy and France’s Alpine region. Indeed, public health authorities did find infected vacationers. But Iceland also found a cluster of infections among people who had returned from England, as well as one from the U.S.—each of which presented with a separate mutation of the coronavirus. “As of yesterday, we have sequences for about 380 viruses,” Stefánsson says. The company plans to release the data on those mutations in the form of public databases this week.

Amid the fraught debate over self-quarantining, Iceland has remained curiously calm. It has no lockdown laws in place, simply urging people to remain at home if possible. Elementary schools remain open.

Rather than stress self-distancing above all, the focus has been on testing. “All countries should listen to the World Health Organization and follow the example of Iceland when it comes to the mantra ‘Test, test, test,’” former Prime Minister David Gunnlaugsson wrote in Britain’s?The Spectator?on Tuesday. He called the country’s testing strategy “virtually unparalleled anywhere in the world.”

Of course, Iceland’s minuscule population makes it far easier to test there than in most other countries—including even South Korea, where the swift control of the coronavirus among its 50 million people is credited in large part to the government’s aggressive testing and quarantine strategy. In an email, Iceland’s Health Ministry tells Fortune the country has tested a far higher proportion of its population than South Korea has, “yielding valuable insights into the behavior of the virus.”

DeCODE—and Iceland in general—is in an exceedingly rare position in its ability to analyze its findings on the coronavirus, and perhaps detect what makes some people more susceptible to infection and illness. That could be hugely valuable for scientists as they race to develop treatments and vaccines, and try to stave off any future coronavirus outbreak.

Since launching 24 years ago, deCODE has mapped the DNA of more than half the population of Iceland, “and we can infer data from the other half,” Stefánsson says. “We are in a reasonably good position to begin to explore if the susceptibility to the infection is in part genetically dictated,” he says. As scientists compare the DNA in deCODE’s data banks with the results of Iceland’s random coronavirus testing, the possibilities might begin to emerge.

“We are working on that, trying to generate a set of overlapping data,” Stefánsson says. “I don’t think there is another place where there is data like this.”

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