With flu season on the horizon and Donald Trump demanding that millions of students return to school in the fall – not to mention a presidential election quickly approaching – the country appears at risk of being torn apart.
流感季节即将到来、大选临近、总统又要求学校秋季开学——美国正面临被撕裂的危险。

本文在卫报当天的阅读量在全站第2位，内容均为原文原图

The virus doesn’t care about excuses’:US faces terrifying autumn as Covid19 urges

The breathing space afforded by lockdowns in the spring has been squandered, with new cases running at five times the rate ofthe whole of Europe. Things will only get worse, experts warn

by Tom McCarthy in New York
Coronavirus latest global updates
Main image: Composite: Guardian Design/Getty/Shutterstock
Sat 18 Jul 2020 06.00 BST

In early June, the United States awoke from a months-long nightmare.

Coronavirus had brutalized the north-east, with New York City alone recording more than 20,000 deaths, the bodies piling up in refrigerated trucks. Thousands sheltered at home. Rice, flour and toilet paper ran out. Millions of jobs disappeared.

But then the national curve flattened, governors declared success and patrons returned to restaurants, bars and beaches. “We are winning the fight against the invisible enemy,” vicepresident Mike Pence wrote in a 16 June op-ed, titled, “There isn’t a coronavirus ‘second wave’.”

Except, in truth, the nightmare was not over – the country was not awake – and a new wave of cases was gathering with terrifying force.

As Pence was writing, the virus was spreading across the American south and interior, finding thousands of untouched communities and infecting millions of new bodies. Except for the precipitous drop in New York cases, the curve was not flat at all. It was surging, in line with epidemiological predictions.

Now, four months into the pandemic, with test results delayed, contact tracing scarce， protective equipment dwindling and emergency rooms once again filling, the United States finds itself in a fight for its life: swamped by partisanship, mistrustful of science, engulfed in mask wars and led by a president whose ncompetence is rivaled only by his indifference to Americans’ suffering.

With flu season on the horizon and Donald Trump demanding that millions of students return to school in the fall – not to mention a presidential election quickly approaching – the country appears at risk of being torn apart.

“I feel like it’s March all over again,” said William Hanage, a professor of epidemiology at the Harvard TH Chan School of Public Health. “There is no way in which a large number of cases of disease, and indeed a large number of deaths, are going to be avoided.”

The problem facing the United States is plain. New cases nationally are up a remarkable 50% over the last two weeks and the daily death toll is up 42% over the same period. Cases are on the rise in 40 out of 50 states, Washington DC and Puerto Rico. Last week America recorded more than 75,000 new cases daily – five times the rate of all Europe.

“We are unfortunately seeing more higher daily case numbers than we’ve ever seen, even exceeding pre-lockdown times,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. “The number of new cases that occur each day in the US are greater than we’ve yet experienced. So this is obviously a very worrisome direction that we’re headed in.”

Donald Trump speaks to the media before boarding Marine One on 10 July to head to coronavirus-stricken Florida as he ramps up public appearances ahead of the election. Photograph: Shawn Thew/Bloomberg/Getty Images

The mayor of Houston, Texas, proposed a “two-week shutdown” last week after cases in the state climbed by tens of thousands. The governor of California reclosed restaurants, churches and bars, while the governors of Louisiana, Alabama and Montana made mask-wearing in public compulsory.

“Today I am sounding the alarm,” Governor Kate Brown said. “We are at risk of Covid-19 getting out of control in Oregon.”

As dire as the current position seems, the months ahead look even worse. The country anticipates hundred of thousands of hospitalizations, if the annual averages hold, during the upcoming flu season. Those hospitalizations will further strain the capacity of overstretched clinics.

But a flu outbreak could also hamper the country’s ability to fight coronavirus in other ways. Because the two viruses have similar symptoms – fever, chills, diarrhea, fatigue – mistaken diagnoses could delay care for some patients until it’s too late, and make outbreaks harder to catch, one of the country’s top health officials has warned.

“I am worried,” Dr Robert Redfield, the director of the Centers for Disease Control (CDC), said last week. “I do think the fall and the winter of 2020 and 2021 are probably going to be one of the most difficult times that we have experienced in American public health because of … the co-occurrence of Covid and influenza.”

Other factors will be in play. A precipitous reopening of schools in the fall, as demanded by Trump and the education secretary, Betsy DeVos, without safety measures recommended by the CDC, could create new superspreader events, with unknown consequences for children.

“We would expect that to be throwing fuel on the fire,” said Hanage of blanket school reopenings. “So it’s going to be bad over the next month or so. You can pretty much expect it to be getting worse in the fall.”

The list of aggravating circumstances goes on and on. A federal unemployment assistance program that gave each claimant an extra 600 a month is set to expire at the end of July. A new coronavirus relief package is being held up in Congress by Republicans’ accusations that states are wasting money, and their insistence that any new legislation include liability protections for businesses that reopen during the pandemic.

Customers shop for fruit at a street vendor in the Corona neighborhood in Queens, New York, on 27 June. Photograph: Amir Hamja/Bloomberg/Getty Images

Cable broadcasts and social media have been filled, meanwhile, with video clips of furious confrontations on sidewalks, in stores and streets over wearing facial masks. In Michigan, a sheriff’s deputy shot dead a man who had stabbed another man for challenging him about not wearing a mask at a convenience store. In Georgia, the Republican governor sued the Democratic mayor of Atlanta for issuing a city-wide mask mandate.

The partisan divide on masks is slowly closing as the outbreaks intensify. The share of Republicans saying they wear masks whenever they leave home rose 10 points to 45% in the first two weeks of July, while 78% of Democrats reported doing so, according to an Axios-Ipsos poll.

Another divide has proven tragically resilient. As hotspots have shifted south, the virus continues to affect Black and Latinx communities disproportionately. Members of those communities are three times as likely to become infected and twice as likely to die from the virus as white people, according to data from early July.

The raging virus has prompted speculation in some corners that the only way out for the United States is through some kind of “herd immunity” achieved by simply giving up. But that grossly underestimates the human tragedy such a scenario would involve, epidemiologists say, in the form of tens of millions of new cases and unknown thousands of deaths.

“I think that every single serology study that’s been done to date suggests that the vast majority of Americans have not yet been exposed to this virus,” Nuzzo said. “So we’re still very much in the early stages.

“Which is good, that’s actually really good news. I don’t want to strive for herd immunity, because that means the vast majority of us will get sick and that will mean many, many more deaths. The point is to slow the spread as much as possible, protect ourselves as much as possible, until we have other tools.”

But the ability of the US to take that basic step – to slow the spread, as dozens of other countries have done – is in perilous doubt. After half a year, the Trump administration has made no effort to establish a national protocol for testing, contact tracing and supported isolation – the same proven three-pronged strategy by which other countries control their outbreaks.

Critics say that instead, Trump has dithered and denied as the national death toll climbed to almost 140,000. The Democratic presidential candidate, Joe Biden, who is hoping to unseat Trump in November, blasted the president for refusing until recently to wear a mask in public.

“He wasted four months that Americans have been making sacrifices by stoking divisions and actively discouraging people from taking a very basic step to protect each other,” Biden said in a statement last weekend.

A healthcare worker talks to a patient in the ER at Oakbend medical center in Richmond, Texas, on 15 July. Photograph: Mark Felix/AFP/Getty Images

Meanwhile the White House has attacked Dr Anthony Fauci, the country’s foremost expert on infectious diseases whose refusal to lie to the public has enraged Trump, by publishing an oped signed by one of the president’s top aides titled “Anthony Fauci has been wrong about everything I have interacted with him on” and by releasing a file of opposition research to the Washington Post.

Trump claimed the number of cases was a function of unusually robust testing, though experts said that positivity rates of 20% in multiple states suggested that the United States is testing too little – and that in any case closing one’s eyes to the problem by testing less would not make it go away.

“We’ve done 45 million tests,” Trump said this week, padding the figure only slightly. “If we did half that number, you’d have half the cases, probably around that number. If we did another half of that, you’d have half the numbers. Everyone would be saying we’re doing well on cases.”

Such statements by Trump have encouraged unfavorable comparisons of the US pandemic response with those in countries such as Italy, which recorded just 169 new cases on Monday after a horrific spring, and South Korea, which has kept cases in the low double-digits since April.

The Senate majority leader, Mitch McConnell, walks to his office from the Senate floor on 13 May. Photograph: Shawn Thew/EPA

But the United States could also look to many African countries for lessons in pandemic response, said Amanda McClelland, who runs a global epidemic prevention program at Resolve to Save Lives.

“We’ve seen some good success in countries like Ghana, who have really focused on contact tracing, and being able to follow up superspreading events,” said McClelland. “We see Ethiopia: they kept their borders open for a lot longer than other countries, but they have really aggressive testing and active case-finding to make sure that they’re not missing cases.

“I think what we’ve seen is that you need not just a strong health system but strong leadership and governance to be able to manage the outbreak, and we’ve seen countries that have all three do well.”

Factory workers produce personal protective equipment for coronavirus frontline health workers at a factory commissioned by the government, in Accra, Ghana, on 17 April. The US pandemic response compares unfavorably with a number of African countries. Photograph: Nipah Dennis/AFP/Getty Images

But in America, the large laboratories that process Covid-19 tests are unable to keep up with demand. Quest Diagnostics announced on Tuesday that its average turnaround time for test results was a minimum of seven days for most patients.

“We want patients and healthcare providers to know that we will not be in a position to reduce our turnaround times as long as cases of Covid-19 continue to increase dramatically,” the lab said.

“You can’t have unlimited lab capacity, and what we’ve done is allow, to some extent, cases to go beyond our capacity,” said McClelland. “We’re never going to be able to treat and track and trace uncontrolled transmission. This outbreak is just too infectious.”

Public health experts emphasize that the United States does not have to accept as its fate a cascade of tens of millions of new cases, and tens of thousands of deaths, in the months ahead. Focused leadership and individual resolve could yet help the country follow in the footsteps of other nations that have successfully faced serious outbreaks – and brought them under control.

But it is clear that the most vulnerable Americans, including the elderly and those with preexisting conditions, face grave danger. Republicans have argued in recent weeks that while cases in the US have soared, death rates are not climbing so quickly, because the new cases are disproportionately affecting younger adults.

That is a false reassurance, health experts say, because deaths are a lagging indicator – cases necessarily rise before deaths do – and because large outbreaks among any demographic group speeds the virus’s ability to get inside nursing homes, care facilities and other places where residents are most vulnerable.

“If we don’t do anything to stop the virus, it’s going to be very difficult to prevent it from getting to people who will die,” said Nuzzo.

A United States flag flies at half-mast outside the Hammonton center for rehabilitation and healthcare in Hammonton, New Jersey, on 19 May. Photograph: Lucas Jackson/Reuters

There is a question of whether the United States, for all its wealth and expertise – and its selfregard as an exceptional actor on the world stage – can summon the will to keep up the fight. People are tired of fighting the virus, and of fighting each other.

“I think unfortunately people are emotionally exhausted from having to think about and worry about this virus,” said Nuzzo. “They feel like they’ve already sacrificed a lot. So the worry that I have is, what willingness is there left, to do what it takes?”

It is as if the country is “treading water in the middle of the ocean”, Hanage said.

“People tend to be shuffling very quickly between denial and fatalism,” he said. “That’s really not helpful. There are a number of things that can be done.

“What I would hope is that this marks a point when the United States finally wakes up and realizes that this is a pandemic and starts taking it seriously.

“Folks tend to look at what has happened elsewhere and then they make up some kind of magical reason why it’s not going to happen to them.

“People keep making these excuses, and the virus doesn’t care about the excuses. The virus just keeps going. If you give it the opportunity, it will take it.”

America faces an epic choice …

… in the coming months, and the results will define the country for a generation. These are perilous times. Over the last three years, much of what the Guardian holds dear has been threatened – democracy, civility, truth.

The country is at a crossroads. Science is in a battle with conjecture and instinct to determine policy in the middle of a pandemic. At the same time, the US is reckoning with centuries of racial injustice – as the White House stokes division along racial lines. At a time like this, an independent news organisation that fights for truth and holds power to account is not just optional. It is essential.

译文：

病毒才不会听你的借口： Covid使美国面临可怕的秋季

春季的封锁所争取到的机会已经被浪费，病例的增长速度是整个欧洲的五倍。专家警告说，情况只会变得更糟…

作者：纽约记者Tom McCarthy
栏目：病毒最新讯息
主要图片来源 Guardian Design/Getty/Shutterstock
时间：英国时间2020年7月18日 星期六 6：00

6月初，美国从长达数月的噩梦中醒来。

冠状病毒使东北部遭受重创，仅纽约市就有2万多人死亡，冷藏卡车中尸体堆积如山。 数千人躲在家里，用光了大米，面粉和纸巾。 数以百万计的岗位消失了。

但随后，全国病例增长曲线变得平坦，州长们宣布了胜利的消息，人们又回到了餐馆、酒吧和海滩。 副总统迈克·彭斯(Mike Pence)在6月16日发表的题为“不会出现‘第二波’冠状病毒”的专栏文章中写道：“我们正在赢得这场与看不见的敌人的战斗。”

但是，事实上，噩梦还没有结束——这个国家还没有醒来——新一波的病例正以可怕的力量涌现。

就在彭斯写这篇文章的时候，病毒正在美国南部和内陆蔓延，它找到了数千个之前未受影响的社区，并感染了数百万新的宿主。 除了纽约的病例急剧下降外，这条曲线根本不是平坦的。 与流行病学预测一致，感染者的数量正在激增。

现在，病毒已经肆虐四个月了，检测排查被推迟、对接触者的追踪几乎没有、防护设备越来越少、急诊室又一次挤满了人，美国发现自己陷入了一场关乎生存的战斗：既有党派之争，又有对科学的不信任，并身陷口罩战争（即：戴口罩还是不戴口罩在美国引起的政治/社会冲突，有点儿滑稽）的泥潭，而领导这场战斗的总统，既无能又对美国人们毫不关心。

流感季节即将到来、特朗普要求数百万学生在秋季重返校园——再加上总统选举的迅速临近——这个国家似乎面临被撕裂的风险。

哈佛大学公共卫生学院流行病学教授William Hanage说，“三月的情况又要重现。” “我们没有办法避免大量的病例，甚至是大量的死亡。”

美国面临的问题是显而易见的。在过去的两周里，全国的新病例上升了50%，而同时每天的死亡人数上升了42%。在50个州中的40个州，华盛顿特区和波多黎各的病例呈上升趋势。上周，美国每天记录到75000多个新病例，是整个欧洲病例增长速度的五倍。

约翰 · 霍普金斯健康安全中心(Johns Hopkins Center for Health Security)的流行病学家珍妮弗 · 努佐(Jennifer Nuzzo)说，“不幸的是，我们每天看到的病例数量比以往任何时候都多，甚至超过了封锁前。“美国每天的新病例数量正在刷新之前的记录。因此，我们显然正朝着一个非常令人担忧的方向前进。

(图片:7月10日，唐纳德·特朗普登上“海军一号”，前往遭受冠状病毒袭击的佛罗里达州，在大选前增加在公众的露面，在此之前他接受了媒体采访。图片来源：Shawn Thew/彭博社/盖蒂图像）

上周，得克萨斯州休斯敦市长提议“一切活动中止两周” ，此前该州的病例增加了数万例。加利福尼亚州州长重新关闭了餐厅、教堂和酒吧，而路易斯安那州、阿拉巴马州和蒙大拿州的州长则强制要求在公共场合戴口罩。

“今天我敲响警钟，”州长 Kate Brown 说，“我们正面临着新冠肺炎在俄勒冈州失控的危险。”

尽管目前的形势看起来很可怕，但未来几个月的情况或许更糟。 该国预计，在即将到来的流感季节，按照往年的平均水平，将有数十万人住院，这些人的住院将使本就超负荷运转的诊所更加不堪重负。

并且流感的爆发也会以其他方式阻碍该国抗击新冠病毒。该国一位高级卫生官员警告说，由于这两种病毒有相似的症状——发烧、发冷、腹泻、疲劳——错误的诊断可能会延误对一些病人的治疗，直到错过最佳治疗时期，并使新疫情的爆发更难被发现。

“我很担心，”疾病控制中心(CDC)Robert Redfield博士上周说。 “我认为2020年和2021年的秋天和冬天可能会是我们在美国公共卫生领域经历的最艰难的时期之一，因为… 冠状病毒和流感并存。”

其他因素也将发挥作用。 在没有采取疾控中心建议的安全措施的情况下，特朗普和教育部长贸然要求学校在秋季开学。这可能会引发新的超级传播事件，给孩子们带来未知的后果。

“我们预计这是火上浇油，” Hanage在谈到全日制学校重新开学时说,“所以下个月左右的情况会很糟糕。 并且几乎可以肯定，秋季会更糟糕。”

形势急转直下。 一项联邦失业援助计划将在7月底到期，该计划每月为每名索赔人补助600美元。 共和党人指责各州在浪费资金，并坚持要求任何新的立法都包括对在大流行期间重新营业的企业的责任保护，这是国会提出的一项新的冠状病毒救助方案。

图片：6月27日，在纽约皇后区科罗纳社区，顾客在街头小贩处选购水果 图片来源：Amir Hamja/彭博社/盖蒂图片社

与此同时，在人行道上、商店和街道上因戴不戴口罩而引起了激烈对抗，这类视频充斥于有线广播和社交媒体上。在密歇根州，一名警长的副手开枪打死了一名男子，该男子刺伤了另一名男子，起因是他因为不戴口罩而被这名被刺伤的男子责备。 在佐治亚州，共和党州长起诉亚特兰大民主市长，理由是他发布了在全市范围内佩戴口罩的命令。

随着疫情的加剧，党派在口罩问题上的分歧正在慢慢弥合。根据Axios-Ipsos的一项民意调查，在7月的前两周，共和党人说他们每次出门都戴口罩的比例上升了10个百分点，达到45%，而民主党人为78%。

另一个分歧在悲剧性地在现实中重演。 随着感染中心向南转移，该病毒继续不成比例地影响到黑人和拉丁裔社区。 根据7月初的数据，这些社区的成员被感染的几率是白人的三倍，死亡率是白人的两倍。

肆虐的病毒在一些角落引发了人们的猜测：美国唯一的出路就是通过简单的放弃来实现某种“群体免疫”。但流行病学家说，这严重低估了这种情况将导致的人类悲剧，即数以千万计的新病例和不可估计的死亡人数。

Nuzzo说：“我认为迄今为止进行的每项血清学研究都表明，绝大多数美国人尚未接触过这种病毒。” “因此，我们仍处于开始阶段。

“这很好，这实际上真的是个好消息。 我不想争取群体免疫力，因为这意味着我们中的绝大多数人会生病，这意味着会有更多的人死亡。 关键是要在找到新的手段前，尽可能地减缓扩散，尽可能地保护自己。”

但美国是否有能力采取基本措施，如数十个其他国家所做的那样，减缓扩散，这一点令人怀疑。疫情已经扩散半年，特朗普政府没有努力建立任何一项用于检测新病例、接触者追踪和支持隔离的政策——这套“三管齐下”的措施在其他国家已经被证明行之有效。

批评者说，随着全国死亡人数攀升至近14万人，特朗普不仅没有采取这些措施，并且犹豫不决甚至予以否认。民主党总统候选人Joe Biden希望在11月让特朗普下台，他抨击总统直到最近才拒绝在公共场合戴口罩。

拜登在上周末的一份声明中说：“他浪费了四个月的时间，一直在煽动分裂和积极劝阻人们采取基本的自我保护手段，这造成了人民不必要的牺牲”

图片：7月15日，在德克萨斯州里士满的奥克本德医疗中心，一名医护人员在急诊室与一名患者交谈。
图片来源：Mark Felix/法新社/盖蒂图片社

与此同时，白宫抨击了美国最重要的传染病专家安东尼·福奇(Anthony Fuci)博士。原因是他拒绝对公众撒谎激怒了特朗普。他之前发表了一篇由总统的一名高级助手签名的专栏文章，题为“安东尼·福奇在我与他互动的一切问题上都是错误的”，并向华盛顿邮报公布了一份反对党的研究文件。

特朗普声称，病例数量庞大是因为美国做了强有力的检测，尽管专家表示，多个州20%的阳性率表明美国检测太少——无论如何，通过减少检测而对问题视而不见并不能让问题消失。

“我们已经做了4500万次测试，”特朗普本周说，这个数字仅有略微的夸张。 “如果我们做这个数字的一半，病例就会减少一半，大约就是这个数字。 如果我们再做一半，你就有一半的数字。 每个人都会说我们在控制病例上做得很好。“

特朗普的这种言论助长了社会将美国的应对措施与其他国家的对比。在经历了一个可怕的春季之后，意大利周一仅出现169例新病例。而韩国，自4月份以来病例数一直维持在两位数。

（图片：5月13日，参议院多数党领袖米奇·麦康奈尔(Mitch McConnell)从参议院走到他的办公室。图片来源：Shawn Thew/EPA）

但Amanda McClelland说，美国也可以向许多非洲国家学习应对大流行的经验教训。McClelland负责一个全球流行病预防项目，名为Resolve To Save Life。

“在加纳这样的国家，我们已经看到了不错的成功，这些国家非常专注于联系追踪，并且能够跟进超级传播事件。” McClelland说，“我们看到埃塞俄比亚：他们的边境开放时间比其他国家长了很多，但他们确实积极地检测、主动地寻找病例，以确保不会遗漏病例。”

“我认为我们看到的情况是，你不仅需要强大的卫生系统，还需要强有力的领导和治理，才能控制疫情，我们已经看到这三个国家都做得很好。”

（图片：4月17日，在加纳阿克拉政府委托的一家工厂里，工厂工人为冠状病毒前线卫生工作者生产个人防护设备。 与许多非洲国家相比，美国的大流行应对措施并不让人满意。 图片来源Nipah Dennis /法新社/盖蒂图片社）

但在美国，处理新冠肺炎检测的大型实验室跟不上需求。 Quest Diagnostics周二宣布，对于大多数患者来说，得到测试结果的平均周期至少为7天。

该实验室表示：“我们希望患者和医疗服务提供者知道，只要新冠肺炎的病例继续大幅增加，我们就无法缩短检测周期。”

“你不可能拥有无限的实验室容量，我们所做的就是在某种程度上允许病例超出我们的能力。” McClelland说，“我们永远无法追踪和控制失控的传播，这次爆发的传染性太强了。”

公共卫生专家强调，在接下来的几个月中，美国不必认为数千万的新病例和数千人的死亡是已经注定的。 专注的领导力量和个人决心仍可帮助该国效仿成功应对严重疫情的其他国家，并使疫情受到控制。

但很明显，最脆弱的美国人，包括老年人和有既往疾病的人，面临着严重的危险。 共和党人最近几周辩称，尽管美国的病例激增，但死亡率并没有上升得那么快，因为新病例对年轻人的影响不成比例。

卫生专家表示，共和党人的保证是错误的，因为死亡率是一个滞后指标——病例必然先于死亡率上升——还因为任何大规模疫情爆发都会加速病毒进入疗养院、护理机构和其他居民最易感染的地方的能力。

Nuzzo说：“如果我们不采取任何措施来阻止这种病毒，将很难阻止它传播给将要死亡的人。”

（图5月19日，在新泽西州哈蒙顿的哈蒙顿康复和医疗中心外，一面美国国旗降半旗。图片来源: Lucas jackson/路透社）

有一个问题是，尽管美国拥有财富和专业知识，而且自诩为世界舞台上的杰出角色，但它是否能够鼓起继续战斗的勇气？人们厌倦了与病毒作斗争，也厌倦了相互斗争。

“我认为不幸的是，人们已经因为不得不思考和担心这种病毒而精疲力竭，” Nuzzo 说,“他们觉得自己已经牺牲了很多。因此，我担心的是，他们还有什么意愿去做需要做的事情呢? ”

Hanage说，这个国家仿佛正在“大洋中央涉水”。

“人们往往在肯定和否定宿命之间摇摆不定，”他说， “这真的没有什么用，有很多事情是可以做的。”

“我希望这标志着美国终于醒来，意识到这是一场流行病，并开始认真对待它。”

人们倾向于看看其他地方发生了什么，然后他们会编出某种神奇的理由，来说明为什么不会发生在他们身上。

美国面临史诗般的选择……

在接下来的几个月里，选举结果将定义这个国家的一代人。 这是一个危险的时代， 在过去的三年里，“卫报”珍视的许多东西都受到了威胁——民主、文明、真理。

这个国家正处于十字路口。 科学正在与猜想和本能作斗争，以便在大流行期间决定政策。与此同时，美国正在重新考虑几个世纪以来的种族歧视，因为白宫加剧了种族分歧。在这样的时候，一个为真理而战并拥有问责权的独立新闻机构不仅是可选的,更是必不可少的。