The government must be honest about the threat the pandemic still poses

政府必须诚实面对疫情仍在带来的威胁

Today may be the most difficult day the NHS has ever experienced. The headlines will focus on the pressures created by the heatwave and that most visible sign of healthcare failure—ambulances queuing outside hospitals. But, as readers of The BMJ and HSJ know all too well, this brutal situation is the culmination of many factors, which include but are not limited to prolonged periods of underfunding in the past decade, lack of an adequate workforce plan, and a cowardly and shortsighted failure to undertake social care reform.

今天可能是NHS史上最艰难的一天。新闻头条将会聚焦热浪带来的医疗压力，以及医疗系统崩溃最直观的迹象–救护车在医院外排队。但是，正如BMJ和HSJ的读者所深知，这样的窘境是多重因素共作带来的高峰，包括但不限于近年来医疗系统持续经费不足，缺乏适当的人力配置规划以及怯懦和短视造成的社保改革失败。

There is one more problem. Most people (including many in the NHS) are so tired of it that they are wilfully pushing it to the back of their minds, but now is the time to face the fact that the nation’s attempt to “live with covid” is the straw that is breaking the NHS’s back. In 2020 and 2021 the NHS coped with pandemic peaks by stopping or slowing much of its routine work. 2022 was meant to be the year of full speed recovery, when we would build back better and fairer, when record waiting lists in elective care, cancer diagnosis and treatment, and mental health would begin to reduce, and the workload on primary care would begin to ease.

此外还有一个问题。多数人（包括很多NHS内部人员）厌倦了这个问题，急于将其抛在脑后。但是，现在必须面对这个现实了:整个国家与新冠共存的尝试正是压垮NHS的最后一根稻草。在2020和2021年，NHS通过中断或减缓常规工作以应对新冠。2022本应是全速恢复的一年，医疗品质和公平性应该恢复，各种手术、肿瘤诊治以及精神科那些创纪录的等待名单应该开始缩短，普通门诊的工作量应该开始下降。

One of the assumptions underpinning this hope was that covid-19 would be nothing more than an irritant for most of the year, with perhaps a winter wave in December. It is now July, and not counting the first omicron surge that peaked in January, the UK and the NHS have experienced two further covid waves, with gaps of just under three months between peaks ([链接登录后可见]). The current wave of hospital admissions driven by the BA.4 and BA.5 variants is likely to peak in the next few days, but other variants will be ready for global distribution soon.

支持这种愿望的前提之一是新冠将会在大部分时间成为癣疥之患，顶多在年底爆一波。现在是七月。不算一月中见顶的第一波O浪，带英和NHS已经经历了另外两波疫情，中间仅仅间隔不到三个月。现下这波BA.4和BA.5带来的住院潮可能在未来几天见顶，但其它变体已经准备好在不久的将来扩散全球了。

Weekly hospital admissions to English hospitals, for those who test positive for covid-19, have averaged just over 9000 in the first six and half months of the year. In 2021 the number was just under 6000, with most admissions concentrated in the first two months of the year. The average in 2020 was just under 7000.

英格兰医院在今年前六个半月平均每周收治超过九千新冠阳性患者。2021年这个数字还不到六千，而且多数集中在去年前两个月。2020年的平均数字是不到七千。

The omicron variant is less severe, and just under 40% of hospital patients are being treated “primarily” for the disease. But a covid-19 diagnosis is a complicating factor for many conditions, worsening outcomes and lengthening recovery times. The need to keep people with covid-19, uninfected people, and contacts apart means an increase in effort. Higher rates of covid-19 in hospitals and the community also result in more staff sickness, further hollowing out an already overstretched and exhausted workforce.

O变体没有特别严重，不到四成的患者是因为新冠入院的。但新冠成了很多疾病的助燃剂，导致治疗效果下降，恢复时间变长。针对新冠的隔离措施也是医疗的额外负担。院内外的新冠流行也导致医疗人员短缺，影响了已经严重缺员和过劳的医疗人力。

What the hospital admissions figures hide is a rising tide of people with long covid, now at two million and likely to be a major burden on the health service and the nation’s productivity, for a generation. And there are many other much less recognised but still deeply disturbing effects of the continuing pandemic, including endangering the NHS’s supply of blood.

入院的数据还不包括窜起的长新冠人潮。如今长新冠患者约两百万人（译注：英国人口六千七百万人，迄今官方公布感染人次两千三百万），很可能会成为一代人需要背负的医疗系统和国家生产力的沉重负担。此外，持续的疫情还有很多不为人熟知，但依然受到严重影响的方面，例如NHS日渐艰难的血库供应。

Government complacency

政府的自满

How is the government responding to this crisis? Largely by pretending it is not happening or implying it is all under control. In the House of Lords last week government health spokesperson Lord Kammal repeated the spurious line: “We managed to break the link between infections and hospitalisations and hospitalisations and death.”

政府是怎样应对这样的危机呢？很大程度上仅仅是假装它不存在，或者推说疫情已经得到了完全的控制。上周，政府的卫生系统发言人Kammal勋爵在上议院重复这样的谎言“我们已经设法打破了感染与入院以及入院与死亡之间的连接。”（译注：意思是感染不住院，住院不死亡）

But the link between infections and hospital admissions has clearly not been broken, even if you just consider those being treated “primarily” for the disease. As for deaths, the latest ONS figures indicate just under 24 000 fatalities “involving covid” in the first six months of 2022. Yes, that figure is substantially smaller than the 66 000 recorded in the first half of 2021, but it is more than the 21 000 people who died in the last six months of that year. Excess deaths from all causes are also still running above five year averages before the pandemic.

然而即使仅仅考虑因新冠而入院的情况，感染与入院的连接都显然没有打破。至于死亡，最新的ONS数据显示2022年前六个月中有近两万四千例死亡“与新冠有关”。是的，这个数字比2021年上半年的六万六千人小得多，但仍多于2021年下半年的两万一千人。全因超额死亡也依然在疫情前的五年平均以上。

The constant pressure created by repeated covid waves is already the main reason that the NHS is nowhere near reaching the activity levels needed to begin to recover performance. By now the NHS had hoped to be operating better than before the pandemic; instead elective activity is around 10% below 2019.

反复的疫情带来的持续压力已经成为NHS无法完全恢复服务的主要原因。NHS原先被希望到现在这个时候已经恢复到疫情前的水平以上，而如今一般性医疗活动比2019年的水平仍低一成左右。

The Conservative Party leadership contest—which will deliver the UK’s next prime minister—is shedding little light on the crisis in the NHS and the government’s failing covid policy. The candidates seem more keen to talk about bringing in the army to shake up the NHS or criticise “unsustainable” spending on healthcare than tackle the immediate and pressing needs of the service. As the NHS is in crisis, health is barely mentioned in leadership debates.

决定下任首相的保守党选战完全没有反映出NHS和政府失败的新冠应对政策。候选人似乎更热衷于谈论如何用军队的力量帮助NHS或者批评医疗系统无法持续的花销，而不愿意解决医疗系统最急迫的需求。NHS处于危机之中，但医疗在选战中鲜有提及。

What is especially concerning—and makes the decline of the NHS a more realistic concern than it has been for decades—is the lack of great political, public, or media outcry about the covid-driven collapse in services.

NHS的衰落已经被讨论了数十年，但它从未比如今更真实。更令人担心的是，新冠导致的医疗系统崩溃完全得不到政治、公共以及媒体的重视。

Reintroducing pandemic measures

重回防疫模式

At no other time in the past 50 years have so many parts of the NHS been so close to ceasing to function effectively. The heart of the problem is the failure to recognise that the pandemic is far from over and that a return to some of the measures taken in the past two years is needed.

过去五十年中，从未发生过NHS如此多的部门接近丧失功能。问题的核心就是没有认识到疫情远未结束，而过去两年中的某些防疫举措需要重新实施。

Existing public health advice to wear masks in crowded places, ensure good ventilation, and test regularly need to be communicated much more powerfully and widely. This should include a return to mask wearing in healthcare settings and on public transport, as well as re-introduction of free tests for the public. Vaccination is the fourth pillar of action. Large sections of the population, particularly ethnic minorities and younger age groups, are still not fully vaccinated.

现行的防疫建议包括在人群密集的地方戴口罩，保证良好的通风和定期检测需要更大力和广泛地进行宣传。在医疗系统和公共交通的口罩令和免费的检测也应该恢复。此外，第四个重要措施是继续施打疫苗。仍然有大量的人口没有接种疫苗，特别是少数族裔和年轻的人群。

Other measures might include working from home when possible and restrictions on some types and sizes of gathering. The government must also work out how it will support the sections of the population and the economy that will be affected by those measures. The blueprint for managing the pandemic was described in the “vaccine plus strategy” proposed by Greenhalgh and others in The BMJ in January 2022.

其它措施还包括可能的情况下居家办公以及限制聚会。政府必须研究如何支持被这些措施影响到的人群和经济。控制疫情的蓝图在2022年一月发表于本刊BMJ的“疫苗加强版策略”有相关描述。

Above all, the government must stop gaslighting the public and be honest about the threat the pandemic still poses to them and the NHS. Being honest with the public will have two positive results, it will encourage the public to modify behaviour and, we hope, provoke urgent reflection about how the NHS is in such a mess so soon after the nation was applauding it on their doorsteps.

此外，政府必须停止愚弄民众（译注：原文为所谓“煤气灯效应”），并诚实应对疫情对民众和NHS的威胁。诚实面对民众将有两个积极的后果，一是鼓励民众配合防疫措施，二是希望全国可以更快对NHS的困境有清醒的认识。

我表个态：BMJ懂个屁的新冠，我只信张爸