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2020年3月13日 星期五

比較英國 vs 台灣的治理方式:Why is the UK not shutting schools like other countries?嚴重特殊傳染性肺炎(COVID-19,簡稱武漢肺炎)


■英國放任輕症自體免疫,指揮中心:不考慮這麼做
 
英國首相強森(Boris Johnson)12日宣布幾項防疫措施,包括不追溯旅遊史與接觸史,感冒輕症不要打給醫療緊急專線,在家自主隔離7天,並表示全英國已經有5,000至1萬人感染,現階段是延緩傳播,希望達到群體免疫(herd immunity),並呼籲70歲以上老人減少外出,所有人都要勤洗手等。
對於這樣的防疫作法,英國專家認為這是想藉由感染產生抗體,達到自體免疫效果,而不是全力壓制。陳時中認為,這是考量國家狀況已經達到醫療體系無法承擔的地步,但台灣距離這一步還非常遙遠,目前不考慮這麼做,而且也沒有百分之百的科學證據認為輕症不會演變成重症,當未來如果科學證據愈來愈明朗時,或許才有可能考慮。
中央流行疫情指揮中心專家諮詢小組召集人張上淳說明,確實人體發生感染後,會產生抗體與免疫力,輕症返家休養可能會自己痊癒,但英國是在醫療系統已經無法承擔下所採取的作為,目前國內專家還不會建議指揮中心這麼做。(文/嚴文廷;圖/中央流行疫情指揮中心提供;攝影/AP Photo/Matt Dunham/達志影像、報導者/余志偉)


Many countries are taking tough measures to crack down on the spread of coronavirus, including school closures - but why isn't the UK?

BBC.COM

Why is the UK not shutting schools like other countries?


Coronavirus: Why is the UK not shutting schools like other countries?


Prof Chris Whitty (left) and Sir Patrick VallanceImage copyrightREUTERS
Image captionArchitects of the UK's "nuanced" approach: Sir Patrick Vallance (left) and Prof Chris Whitty (left)

Many countries are taking tough measures to crack down on the spread of coronavirus, including school closures, an end to mass gatherings and severe travel restrictions. But the UK has adopted relatively modest control measures.
The differences can be partly explained by the fact some of these countries are further into their epidemics. But it's clear the UK has adopted a more nuanced approach.
Computer simulations indicate the UK is in the early stages of its epidemic which is expected to rise sharply in four weeks and peak in 10 and 14 weeks' time.
Sir Patrick Vallance, the UK government's chief scientific adviser, and chief medical officer Prof Chris Whitty have made the judgement call that it is too soon to impose severe restrictions at this stage.
Such restrictions might last several months and risk "self-isolation fatigue", with people leaving their homes just as the epidemic was at its height. The elderly are particularly at risk of developing severe symptoms. But many of them are already isolated. Cutting them off from their communities at this stage, when the risks are still relatively low, would create unnecessary difficulties for them.

Chart showing how control measures may reduce spread if virus in UK
Presentational white space

Sir Patrick and Prof Whitty have also advised against the suspension of mass gatherings. Again, their computer models indicate this would be less effective and more disruptive than the measures they have recommended: hand washing and asking people to self-isolate if they show symptoms of the disease.
These measures, if correctly implemented, could cut the peak of cases by 20%, says Sir Patrick.
"People are very much more likely to catch the virus from a family member or a friend somewhere in a small space rather than a big space [such as a sporting stadium]," he said.
It's the same with school closures. While Ireland, France and Denmark are among a host of northern European countries to shut schools, for the moment at least they remain open in the UK.
Closing schools is effective for controlling serious flu epidemics, but Covid-19 seems to affect children less. There's still a risk, though, they could transmit it to their parents and grandparents. In addition, school closures would take many much needed NHS staff away from their jobs while they look after their children.

Banner image reading 'more about coronavirus'


Banner

The British strategy is to delay the onset of the peak of the disease until the summer months, when the NHS is under less pressure, and to spread the peak of the epidemic to make treatment more manageable. The aim has also been to manage the spread of the infection so that the population builds up some immunity to the virus should it return in successive years.
Efforts to stamp it out too quickly risk leading to the epidemic returning, perhaps during the winter, once the extreme measures have been lifted. This would be a time when the health service was again under pressure.
It is important to stress that this strategy has been drawn up based on evidence and input from many of the world's leading scientists and doctors, many of whom have been involved in controlling the spread of the virus in China and Singapore. And it is notable that no scientists have spoken out against the UK government's approach.
There are undoubtedly some who do disagree with the strategy. But there is an acceptance by such critics that Sir Patrick and Prof Whitty are the ones in the hot seat, having to make the biggest calls they have made in their professional lives. So the science community is prepared to give them the benefit of the doubt and not speak out, for now at least.

Coronavirus: What you need to know graphic featuring three key points: wash your hands for 20 seconds; use a tissue for coughs; avoid touching your face

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台灣的衛服部 ,採用每日新聞發布會,網站上放在"焦點新聞"逐月累積;可搜索:譬如輸入:"武漢",約有 41,500 項結果 (搜尋時間:0.22 秒)。
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0305.22:20

【新增兩確診;外籍男2日搭長榮班機抵澳洲後確診;公布「公眾集會因應指引」和「企業持續營運指引」】
台灣今(5日)新增2名COVID-19(武漢肺炎)確診案例,分別為先前曾到中東旅遊返台確診者的插花班同學,以及一名到菲律賓旅遊返國後的30多歲男性,國內累計案例增為44例。
為避免集會群聚感染,中央流行疫情指揮中心今晚也公布「公眾集會因應指引」和「企業持續營運指引」,作為進入社區傳播階段的準備。
 
■中東旅遊史插花班同學1名確診,另1例為菲律賓境外移入
 
中央流行疫情指揮中心指揮官、衛福部長陳時中晚間召開記者會,公布國內第43、44例確定病例,案43(北部50多歲女性)為案39(曾到杜拜、埃及旅遊北部60多歲女性)確診前的接觸者;案44為菲律賓境外移入個案(北部30多歲男性)。
陳時中表示,北部50多歲女性近期無國外旅遊史,由於其2月24日、25日共兩天的下午,曾與到杜拜旅遊的女性一同在插花班上課,且坐正對面,故列為接觸者。其於3月3日因發燒及喉嚨痛症狀,由衛生單位安排就醫並住院隔離,4日採檢通報,於今日確診,研判為群聚事件,其家人目前均無疑似症狀,衛生單位已完成採檢,將持續追蹤個案接觸者健康情形。
關於菲律賓境外移入個案,陳時中指出,北部30多歲男性曾於2月28日至3月3日與友人至菲律賓旅遊,3月2日於菲律賓當地出現胃脹及腹瀉症狀,3月3日返國後因喉嚨乾、倦怠情形至診所就醫,4日至醫院就醫時,院方發現個案有國外旅遊史且出現症狀故採檢通報,於今日檢驗確診,目前個案已收治負壓隔離病房;同住接觸者無疑似症狀。依個案發病前活動史和時間序來研判,於境外感染的可能性較高。
 
■外籍男境外感染在台發病後,2日搭長榮抵澳洲後確診
 
澳洲廣播公司(ABC)今日報導,南澳州(South Australia)新增2名武漢肺炎確診病例,其中1名為近日到台灣旅遊的外籍58歲男性。該男性於3月2日從桃園機場搭乘長榮航空BR315班機出發,於3日抵達澳洲布里斯本(Brisbane),當日再轉乘維珍澳洲航空(Virgin Australia)VA1394客機,前往南澳州首府阿得雷德(Adelaide)。
陳時中表示,因為無法直接與該個案接觸對談詢問,疫調上有難度,目前還在跟澳洲當局確認該名男性的身分,但已鎖定一名可能個案。該個案在2月22日自英國倫敦經泰國曼谷到台灣,於2月23日入境,2月27日晚間因出現咳嗽、流鼻水症狀至診所就醫,並於3月2日離台。
陳時中指出,該個案初步研判於境外感染後在台發病的機會較高,目前正透過各項聯繫管道,積極調查個案2月23日至3月2日間在台行程,以進行接觸者匡列,請民眾勿過度恐慌。
長榮航空則發表聲明表示,長榮每一航班值勤後均會清潔與消毒,對於該確診者搭乘的BR315班機會採深度清潔及加強消毒之方式處理,當班之空服員原規劃值勤今日BR316布里斯本-台北航班,本航班將空機飛渡返台,旅客全數轉搭其他航空公司,空服組員不安排勤務,並以加大隔離空間及全程配戴口罩之方式搭機返台。與該名旅客接觸過的空、地勤員工,將配合疫情指揮中心之規範,進行相關檢疫或隔離。
 
■避免集會群聚感染,公布「公眾集會因應指引」
 
指揮中心今晚並公布「公眾集會因應指引」,呼籲民眾舉辦活動前必須先進行風險評估,包括舉辦活動的必要性,風險高就建議延期或取消,如果必須舉辦則要擬定防疫應變計畫,計畫中必須有六大指標:是否能事先掌握參加者、活動空間通風情況、參與活動是否有固定位置、參加者之間的距離、活動持續的時間以及是否能落實戴口罩與手部衛生。
在場媒體詢問以職棒為例,是一場超過千人以上的活動,是否會建議取消?陳時中表示,職棒球場很難掌握事先參與者,但空間算通風,位置也固定,只要參加觀眾之間距離能保持一公尺以上,落實戴口罩與手部清潔,加上3個多小時的活動也沒有過夜,如果主辦單位有提出應變計畫,對於這樣的活動「基本上不會反對」。
至於受居家檢疫/隔離者若違反規定外出的罰則部分,陳時中也說,指揮中心正在擬定裁罰指引,等確定就會馬上公布。
 
■社區區分所有權人會議延期不開罰,發布企業持續營運指引
 
內政部修訂「嚴重特殊傳染性肺炎因應指引:社區管理維護」,建議社區的遊戲室、多功能活動空間暫停開放,公寓大樓的區分所有權人會議如果在這段時間無法召開,不會開罰,並於今年底前擇期召開。
內政部次長陳宗彥說明,社區管理委員會如果沒有辦法如期改選,可以以書面的方式共推管理人,就可以維持正常的管理,不用急著在疫情緊繃期間召開,另外,如果要舉辦活動,建議配戴口罩、定期清潔消毒並與衛生單位討論形式、延期或取消。
指揮中心並發布「持續營運指引」,將疫情分為「零星社區感染」與「發生持續性或廣泛性社區傳播」,建議企業依疫情情境、風險評估、因應對策、組織應變與緊急聯絡網等五大架構,由企業訂定持續營運計畫。(文/林雨佑、嚴文廷;攝影/中央社/裴禛;圖片提供/中央流行疫情指揮中心)
 
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【疫情快訊】根據剛剛疫情指揮中心召開的記者會表示,今日於澳洲確診的來台人士,為2月28日晚間7點半曾與國家交響樂團(NSO)於台北國家音樂廳,以及3月1日下午2點半於國家演奏廳合作演出的國際音樂家。目前文化部與疫情指揮中心將針對接觸該音樂家的人員進行後續隔離與檢疫處理。
疫情指揮中心指揮官陳時中強調,由於舞台與觀眾席不論在距離與高度皆有一定程度,當日參與觀眾不須過度緊張,但須自主健康管理14日,如有健康不適情況請務必通報與就醫。
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英國醫生警告說,英國已經不堪重負的醫療系統可能難以應對疫情,該國已出現第二例死亡



英國政府根據歷史上的抗疫經驗,寫疫情"四行動階段"報告

疫情"四行動階段"報告


Policy paper
Coronavirus action plan: a guide to what you can expect across the UK
Published 3 March 2020




新冠肺炎疫情在英國加速擴散之際,政府宣佈抗疫從遏制進入延緩階段,但在行動上幾乎是按兵不動,批評者稱延誤時機。
英國政府周四(3月12日)召開內閣緊急會議決定,抗疫行動即日起從第一階段的防堵進入第二階段— 拖延。
宣佈了新的舉措:新近出現發燒和持續咳嗽症狀者在家自我隔離一周,無論之前是否去過疫情嚴重的國家或是否跟確診感染者有過接觸。
從周五開始, 學校組織的出國旅行活動一律取消,已經有疾患的老年人不建議去乘遊輪。
許多人期盼、呼籲的取消大型群體聚集活動和關閉校園等抗疫「硬」措施都不在決策之內,因為「時機不妥」。
約翰遜在記者會上表示,新冠疫情是一代人遇到的最嚴重的公共健康危機,疫情還會繼續蔓延,「坦白地說,更多家庭將有親人夭折。」
話音剛落,輿論嘩然。
有人認為約翰遜在「豪賭」,有人批評政府「沒睡醒」,正在延誤遏制疫情惡化的時機。
還有事先組織集體請願要求關校門禁大型活動者在社交網站傾訴失望和憤怒。


英國醫院圖片版權GETTY IMAGES

原先普遍的理解是一旦進入延緩階段,就需要開始「社會疏離」 措施, 包括取消大型活動、關閉校園、鼓勵和建議僱主允許員工在家遠程工作。
延緩的目的是推遲新冠肺炎疫情峰值到來的時間,盡量避開冬春流感季醫療系統資源和人手緊張的高峰期,另外也希望氣溫逐漸升高後病毒傳播受到自然遏制,疫情可以緩減。
但現在宣佈的防疫升級的主要行動只是把自我隔離的標凖降低了,而沒有直接切入病毒的群體聚集性傳播和社區傳播問題。
截止周四,英國確診感染病例接近600,10人死亡,近3萬人接受了病毒檢測。政府首席科學顧問帕特里克·瓦倫士勳爵認為感染病例應該介於5千到1萬人之間。
The UK government says it has moved to the "delay" phase of it's plan to tackle coronavirus - but what does that involve?


Coronavirus is spreading in the UK and a major epidemic is expected.
A worst case scenario could see 80% of people infected if nothing is done.

What is the UK now doing about coronavirus?

The UK government is attempting to delay the spread of coronavirus and reduce the epidemic's peak (when the number of cases is highest).
It says that from Friday:



Coronavirus: What you need to know graphic featuring three key points: wash your hands for 20 seconds; use a tissue for coughs; avoid touching your face

Further measures will be taken as the number of coronavirus infections moves towards its peak:
  • Older people and those with health conditions will be advised to cut social contact and stay at home
  • If someone in your home falls ill, the whole household will be told to isolate itself for 14 days
It is hoped these steps could significantly reduce the number of infections and cut deaths by up to a third.

Could schools close and public gatherings be banned?

The government has other powers it could use to protect people from infection:
  • School closures and - once a new law is passed - allowing bigger class sizes if there are teacher shortages
  • Restrictions on the use of public transport
  • Stopping big gatherings
  • Troops supporting the emergency services
  • Police focusing on the most serious crimes and maintaining public order
  • New legal powers to make people stay in quarantine
Some other countries like Italy have already taken some of these measures, but they tend to have more cases.
And officials in the UK have concerns about how effective they will be.








For example, while school closures could reduce the peak, forcing parents to stay at home would be a problem. It could reduce the number of health workers available, or mean grandparents - one of the at-risk groups - stepping in.


英國境內的新型冠狀病毒疫情擴大,確診數已經超過100,而且出現第一名死亡病例;面對疫情英國人是如何防疫的呢?

BREAKING: Professor Chris Whitty says the UK is "mainly" in the "delay" phase of the government's four-stage approach to COVID-19 - rather than the "contain" phase

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