作者：DAVID WALLACE-WELLS
全球超过六分之一的人口生活在中国。也就是说，在过去的三年里，有14亿人生活在采取了世界上最具侵入性的疫情监控措施的国家，为的是不惜一切代价限制新冠病毒的传播。
More than one in six people on the planet live in China. That’s 1.4 billion people who have spent the last three years in the world’s most intrusive pandemic surveillance state, designed to limit the spread of Covid-19 at almost any cost.
美国人，特别是右翼人士，在过去两年里把大量的时间和政治精力用于抱怨美国的防疫过度。但我们的限制措施与中国的完全不可同日而语。在美国，许多全州范围的居家令只持续了数周。没有一个超过三个月，而且大多数只是零星地执行。在上个月中国各地爆发抗议的时候，该国有三分之一的地区处于部分或完全封锁状态——工人困在隔离设施中，小区被封控，企业和学校关闭。
Americans, particularly on the right, have spent an awful lot of time and political energy complaining about pandemic overreach for the last two years. But our restrictions had nothing on China’s. In the United States, many statewide stay-at-home orders lasted just a few weeks. None exceeded three months, and most were only sporadically enforced. As protests erupted across China last month, one-third of the country was in partial or total lockdown — workers stuck in quarantine facilities, neighborhoods sealed, businesses and schools closed.
现在还无法断言这些抗议活动是否标志着中国疫情防控政策出现真正转变的开始——到目前为止，抗议活动不仅招致了警方的大规模镇压，也导致一些城市放松了限制措施。但对于世界各地充满兴趣又不无恐惧地关注着中国的旁观者来说，在世界上最后一个坚持新冠“清零”政策的大国，大规模的民众抗议活动似乎标志着一个全球性的转折点。几年来，许多公共卫生专家私下里都承认，控制和根除新冠的机会可能早在2020年的冬天就失去了。在这几年里，中国一直试图将病毒抵御于边境之外。
It is too soon to say whether the protests will mark the beginning of a true phase shift in China’s pandemic policy — so far, they have produced both a dramatic police crackdown and the relaxation of restrictions in some cities. But to a worldwide audience watching China with a mix of fascination and horror, mass public protest in the world’s last large “zero Covid” holdout seems to mark a global turning point. For several years now, many public health experts have acknowledged privately that the opportunity to contain and eradicate Covid-19 might have been lost as early as the winter of 2020. And for several years now China has tried to beat the disease back at the border anyway.
值得注意的是，它基本上还是成功的，三年来几乎完全平息了该病毒在境内的传播，这一努力使该国处于与世界其他大部分地区完全不同的疫情时间表上。这也使得将中国的情况进行类比的本能努力变得有些可疑。一些认为我们的疫情应对措施过度的美国人将中国发生的抗议视作对我们在疫苗接种后采取更自由放任之道的默默认同；那些可能认为美国做得还不够的人可能会将抗议活动视为一个迹象，表明相较于中国，美国最终还是做了正确的事情。
Remarkably, it has basically succeeded, almost entirely suppressing disease spread within the country’s borders for three years now, an effort that has put it on an entirely different pandemic timeline from most of the rest of the world. It has also made reflexive efforts to analogize the situation in China a bit suspect. Some Americans who believed our pandemic response was excessive have treated the protests as a tacit endorsement of the more laissez-faire approach we’ve embraced post-vaccines; others who might’ve argued for doing more here are also taking the protests as a sign that, in the end, compared with China, the United States got things right.
但不管外界是怎么看，中国领导人所处的风险环境不同于今天的美国人。在美国，九成以上的民众可能至少感染过一次新冠病毒，65岁以上人口的疫苗接种率超过九成。他们面临的情况跟我们几年前有些类似，当时通过疫苗和感染获得的免疫力要低很多。最能预示接下来的情况的，可能是香港今年与奥密克戎变异株的致命相遇——死亡率是英国或美国的两倍以上。
But however it may look from outside, China’s leaders are not operating in a risk landscape like the one Americans are in today, where more than 90 percent of the country has probably gotten Covid at least once and more than 90 percent of people over age 65 are vaccinated. They are looking at one somewhat more like the one we faced years ago, when immunity from vaccines and infections was substantially lower. And Hong Kong’s deadly brush with the Omicron variant this year — death rates were about twice as bad there as in Britain or the United States — may prove to be the closest harbinger of what’s to come.
中国现在有九成的人接种了疫苗。但那里的感染者要少得多，而且老年人的疫苗接种率很低——80岁以上的人口当中完全接种率只有65.8%，这意味着中国有大量脆弱的、免疫力低下的人口。在保护民众方面，中国可以很多事情可以做，比如引进mRNA疫苗，这种疫苗似乎比国产疫苗的保护力跟佳，并加大为脆弱的老年人口接种疫苗的努力。与此同时，重新开放的风险仍然很大。只要重新开放了，无论如何，都有可能导致数百万人死亡。
Ninety percent of people in China are now vaccinated. But many fewer infections there and a low uptake of vaccines among older people — only 65.8 percent of those over 80 are fully vaccinated — means an enormous population of vulnerable, immunologically naïve people. Considerably more could still be done to protect the population going forward, such as more fully embracing imported mRNA vaccines, which seem to offer greater protection than the vaccines produced in China, and pushing even harder to vaccinate vulnerable older people. In the meantime, the risks of reopening are still large. A true reopening, however unlikely, could lead to millions of deaths.
对于我们这些生活在遭受疫情重击地区的人而言，不管常态的恢复有多么顺其自然，但解决这一困境从不是简单明晰的事。我们的新常态在很大程度上是靠几乎全民接种疫苗以及大规模死亡才得以实现。截至目前，2022年美国的新冠死亡率低于2020年和2021年的水平，但也没低太多，今年的死亡人数是2020年的三分之二，是2021年的一半。新冠预计将连续第三年成为美国第三大死亡原因，仅次于心脏病和癌症。
There is no easy or obvious resolution to that dilemma, no matter how intuitive a return to normalcy may seem to those of us living in pandemic-battered parts of the world. Here a new normal was won through vaccination, to a large degree, but also through near-universal infection and mass death. So far, American Covid mortality in 2022 is below the levels of 2020 and 2021, but not that far below, with deaths this year two-thirds of those in 2020 and half as high as those in 2021. Covid-19 is on track to be the country’s third leading cause of death for the third straight year, behind only heart disease and cancer.
中国很可能遭遇类似情况，因为疫苗推广优先考虑的是年轻和健康的群体，而不鼓励老年和较脆弱的群体接种。（起初的疫苗仅被批准用于年轻和健康群体。）至少国际观察人士看不太懂这种做法的确切原因，他们可能会想，为何一个看上去十分威权的政府，在强制——哪怕只是非常积极地推广——老年群体接种疫苗上，会比一次性封锁多座城市数周时间还要困难。
Something like that could well lie ahead for China, given a vaccine rollout that prioritized uptake by the young and healthy and discouraged it by the older and more vulnerable. (At first, vaccination was only approved for the young and healthy.) Exactly why they did this is still not clear, at least to international observers, many of whom may have wondered why it is so much harder for an outwardly authoritarian regime to mandate vaccination for the old, or even very aggressively promote it, than it has been to lock down entire cities for weeks at a time.
或许就像抗议一样，这是一个迹象，说明党的控制没有我们想象得那么紧；或许是政府错过了更积极推广疫苗的善意窗口；亦或许，这也可能表明，与政治自主相比，身体自主是一种不同但更加深刻的自由权利。或许中国政府比全世界其他国家都更不信任自己的疫苗，更担心疫苗的副作用。或许其更担心的是反复感染的累积效应，并在等待鼻喷疫苗的问世，这种疫苗不仅能缓解疾病的严重程度，也能阻断病毒传播。（此类疫苗在美国因官僚主义和研发瓶颈而推出受阻，但在中国已经获批，只是尚未大规模推广。）或许，中国就是更相信新冠“清零”可以永远有效，对抗疫取得非凡成果的政治叙事已经投入太多，以至于在习近平看来，改变路线是不可想象的。
Perhaps it is a sign, like the protests themselves, that the party’s grip is less strong than we imagine it to be; perhaps that the government missed its good-will window for pushing more aggressively for shots; or perhaps it’s an indication that bodily autonomy is a different and more deeply held kind of liberty than political autonomy. Perhaps the regime distrusted its vaccines even more than the rest of the world did, or worried more about their side effects. Perhaps it was more concerned about the accumulating effect of reinfections and was waiting for nasal spray vaccines more capable not just of limiting disease severity but of stopping transmission. (Such vaccines, stuck in bureaucratic and developmental bottlenecks here, have been approved in China, though they haven’t been rolled out at scale yet.) Perhaps it was just more confident that zero Covid could work indefinitely, or so invested in the political narrative of the country’s exceptional pandemic success that a change of course was, to Xi, unthinkable.
现在可以想象了吗？本周，我的同事保罗·克鲁格曼写道，出现抗议意味着“中国输掉了防疫战争”，他强调，尽管疫情初期出现了种种表象，但现在，民主国家优于专制国家似乎已成必然，他也呼吁中国领导人认识到自己的路线错误，并做出改变。于洁（音）在《卫报》上指出，“新冠‘清零’不可持续，”重新开放“是平息公愤的唯一途径”。但在我个人看来，我敢说调整的程度会小得多，类似抗议发生前几周北京就已经提出的想法。
Is it thinkable now? This week, my colleague Paul Krugman wrote that the protests were a sign that “China lost the Covid war,” emphasizing that, despite appearances early in the pandemic, democracies now seem to have definitely outperformed autocracies, and calling on Chinese leaders to recognize the error of their ways and change course. In The Guardian, Yu Jie wrote that “zero Covid can’t continue,” with reopening “the only way to quell public anger.” But personally, I would bet only on much smaller-scale adjustments, of the kind that had already been floated by Beijing in the weeks before the protests began.
因为中国真正开放的最佳途径，应该就是香港应对奥密克戎的模式。自疫情开始以来到2022年2月中，该市一共仅报告了200多例死亡。到4月中，死亡人数已超过9000。就算大陆更积极地向老年群体提供mRNA疫苗能减少死亡，但从其他被认为基本没犯错的国家的经验来看，结束疫情紧急阶段的最优解可能照样还是会导致相当程度的混乱。
That’s because the best model of what might transpire in a truly opened-up China is Hong Kong’s experience with Omicron. By mid-February 2022, there had been a reported total of just over 200 deaths in the city since the beginning of the pandemic. By mid-April, it was over 9,000. And while a much more aggressive mainland campaign to deliver mRNA vaccines to older people could lessen the death toll, the experience of other countries largely credited with doing everything right suggests that even best-case exits from the emergency phase of the pandemic can be quite messy.
以日本为例，这是全球被称道最多的抗疫成功案例之一。在这个公历年，日本新冠死亡人数比疫情前两年之和还要高70%。在另一个总被引用的成功案例冰岛，2022年的新冠死亡人数是疫情前两年的五倍。澳大利亚的这个数字是六倍。今年1月，台湾报告的总死亡病例不到1000；今天，这个数字超过了1.4万。根据《经济学人》的精确追踪统计，新西兰是目前全球唯一一个疫情期间超额死亡率为负的国家，也就是说，该国自2020年来的死亡人数低于在没有SARS-CoV-2情况下的预期。然而即便在新西兰，过去一年也有叙事被颠覆：就在2022年1月，还只有52名新西兰人死于新冠；但现在，这一数字已超过2000人，是当时的40多倍。
Consider the experience in Japan, one of the world’s most celebrated pandemic success stories. Covid deaths there are 70 percent higher this calendar year than they were in the first two years of the pandemic combined. In Iceland, another often-cited success story, five times as many people have died from Covid in 2022 as in the first two years of the pandemic. In Australia, it is six times as many. This past January, Taiwan had registered under 1,000 deaths; today that figure is over 14,000. According to The Economist’s gold standard tracker, New Zealand is now the only nation in the world with negative excess mortality across the whole span of the pandemic — meaning that the country has had fewer deaths since 2020 than would have been expected in a world without SARS-CoV-2. And yet even there, the last year has upended some narratives: As recently as January 2022, only 52 New Zealanders had died from Covid; today the figure is above 2,000, more than 40 times as high.
在所有这些国家之中，今年新冠死亡率的快速增长都来自非常低的、可能不可持续的基线，但即便如此，它们也表明了一个惊人的情况。缓解措施很重要，特别是在疫苗到达之前，随后接种疫苗变得更为重要。但是，在任何一个特定的国家，真正彻底战胜疫情的梦想——或者甚至通过普及疫苗接种将病毒控制住足够长的时间，以充分保护民众——都胜不过疾病本身。最终，疫情在每个国家都暴发了。
In each of these countries, rapid increases in Covid mortality this year come from very low and presumably unsustainable baselines, but even so, they tell a striking story. Mitigation measures mattered, particularly until the arrival of vaccines, when vaccination mattered even more. But in any particular country the dream of actually defeating the pandemic outright — or even holding it at bay long enough to fully protect the population through universal vaccination — was no match for the disease itself. Eventually, every country got it.
或者说几乎每个国家。在疫情期间，许多国际观察人士质疑中国官方关于疫情死亡人数数据的可靠性。但考虑到全球背景，即使修正其不可靠性，这一数据仍然相当惊人：今年1月，中国报告的新冠死亡总人数不到5000人。如今，这一数字刚刚超过5000。一个拥有14亿人口的国家，在其疫情政策开始崩溃的这一年里，官方登记的死亡人数仅为500人。总的来说，在三年多的时间里，该国官方报告的感染病例只有160万例，虽然肯定是严重低估了，但这表明，该国只有千分之一的人曾经感染过新冠。在美国，我们的人口中死于这种疾病的比例都要比这个高——总数接近110万人。
Or almost every country. Throughout the pandemic, many international observers questioned the reliability of official Chinese data about the toll of the pandemic. But given the global context, that data remains pretty astonishing, even correcting for its unreliability: In January, China reported just under 5,000 total Covid deaths. Today that figure is just over 5,000. A nation of 1.4 billion registered barely 500 official deaths over the course of the year in which their pandemic policy began to crumble. In total, over three years, the country has reported only 1.6 million official infections, and while that is surely a gross underestimate, it suggests that only about one-tenth of 1 percent of the country has ever gotten sick with Covid. In the United States, a larger share of our population has died from it — nearing 1.1 million deaths in total.
这并不是说中国的永久性封锁是一种更好的模式，也不是说有哪个大国希望或应该争取能像中国那样。但是两种方法之间非黑即白的对比其实并不能说明太多问题。
That isn’t at all to suggest that China’s permanent lockdowns are a better model, or that any of the world’s major countries would or should want to trade places with China. But the binary contrast between the approaches is not as illuminating as it may seem.
在美国，人们有时说的“封锁”是指“强制佩戴口罩”和“关闭学校”，有时只是“广泛检测”，即使相对温和的缓解措施也会在政治和社会上产生负面影响。但是，限制持续传播最明显的工具并不特别引人注目：投资改善空气质量和提高工作场所安全标准、带薪病假、积极推广上呼吸道疫苗，以及重视老年人的脆弱性。在美国高到令人不安的死亡率中，老年人占了约90%。在中国，根据牛津大学政府应对追踪器计算的“严格指数”，疫情政策直到2021年夏天才明显比美国和英国更加严格，中国现在面临艰难选择，不是因为这些限制措施的有效性，而是因为与前者不相关的疫苗推广和效力方面的问题。
In the United States, where people sometimes say “lockdowns” and mean “mask mandates” and “school closures” or sometimes just “widespread testing,” even relatively mild mitigation measures have grown politically and socially toxic. But the most obvious tools to limit ongoing spread are not especially obtrusive: investments in air quality and better workplace safety standards, paid sick leave, aggressive rollout of those nasal vaccines and an emphasis on the vulnerability of the country’s older people, who make up about 90 percent of its distressingly high ongoing deaths. In China, pandemic policy only became significantly more restrictive than it was in the United States and Britain in the summer of 2021, according to a “stringency index” calculated by the University of Oxford’s government response tracker, and the country faces tough choices now not because of how effective those restrictions have been but because of unrelated problems in vaccine rollout and efficacy.
当世界上大多数用疫苗武装起来的国家放弃积极的缓解措施时，这在一定程度上是一种无奈之举——让真相大白于天下，承认病毒已在不可挽回地传播，而且民众已经获得相当大的自然免疫力，承认尽管持续感染令人遗憾，但接种疫苗和治疗可以减弱影响。在中国，感染人数和死亡人数都要少得多，抗议似乎更像是在表达纯粹的疫情疲劳。按照中国自己的标准，中国的“清零”政策并没有真正失败。但是无论如何，这个国家对它已经失去了耐心。
When most of the world, armed with vaccines, pulled back from aggressive mitigation, it was in part an act of resignation — an acknowledgment that the cat was out of the bag, that the virus was irretrievably in circulation and had conferred considerable natural immunity already, and that while continuing infections were regrettable, vaccination and treatments could blunt the impact. In China, where there has been much less infection and much less death, the protests appear to express something more like pure pandemic exhaustion. By its own standards, China’s zero Covid policy didn’t really fail. But the country is running out of patience for it anyway.
2022年12月6日
China Has an Extraordinary Covid-19 Dilemma
New York Times
