zh-cn	新型冠状病毒肺炎疫情防控下的公共卫生思考
en-us	Perspectives: A Public Health Perspective on Preventing and Controlling the Spread of Coronavirus Disease 2019

zh-cn	2020 年 3 月 11 日，因全球新型冠状病毒肺炎（COVID-19）确诊病例和死 亡病例的指数增长，世界卫生组织（WHO）正式宣布将 COVID-19 列为全球性大流行病。
en-us	On March 11, 2020, the World Health Organization (WHO) formally declared coronavirus disease 2019 (COVID-19) a worldwide pandemic as the virus spreads rapidly with new cases and deaths rising exponentially in many countries.

zh-cn	截至 3 月 12 日，已有 118 个国家报告了 COVID-19 确诊病例共计125,048 例，病亡 4,613 例，并且仍在持续增加。
en-us	As of March 12, there were 125,048 confirmed cases and 4,613 deaths, and the numbers are still surging affecting 118 countries .

zh-cn	自2020 年 1月以来，中国已采取了多种措施， 包括大规模的强制封锁，以阻止疫情蔓延。
en-us	The next phase of epidemic control is mitigation, and China has implemented multiple effective measurements such as mandatory citywide lockdowns to isolate and block the spread since January 2020.

zh-cn	最新数据表明，这些措施确实有效。
en-us	Recent data has shown evidence of controlling the epidemic .

zh-cn	COVID-19 是如何开始流行的?
en-us	How did the COVID-19 epidemic start?

zh-cn	COVID-19 人群传播的起源尚不明确。
en-us	The exact origin of COVID-19 in humans has not been identified.

zh-cn	该传染病于2019年12月在湖北武汉的华南海鲜批发市场暴发。
en-us	This infectious disease is reported to have started in December 2019 from the Huanan Seafood Wholesale Market in Wuhan, Hubei Province of China.

zh-cn	截至12 月 31 日，武汉已有数十例不明原因的肺炎病例。
en-us	By December 31, 2019, officials in Wuhan confirmed dozens of pneumonia cases of unknown etiology.

zh-cn	1月初，中国疾病预防控制中心（ChinaCDC）的流行病学家和传染病专家对华南海鲜批发市场进行调查，但此时该市场已被关闭和清理。
en-us	Epidemiologists and infectious disease experts from China CDC investigated the seafood market in the early days of January 2020 but the market had already been closed and cleaned.

zh-cn	由于这种病毒具有无症状传播的能力，现在已很难识别零号病人。
en-us	Due to the possibility of asymptomatic transmission of the virus, identifying patient zero is incredibly difficult.

zh-cn	但另一方面，中国科学家迅速鉴定出COVID-19 的基因序列，并于 2020 年 1 月 7 日报告，为全球疫情防控做 出极大的贡献。
en-us	However, Chinese scientists quickly and successfully identified the genetic sequence of COVID-19 and reported the sequence on January 7, 2020 .

zh-cn	COVID-19 疫情的防控——浙江与杭州经验
en-us	Containing the spread of COVID-19 in China — lessons learned from Zhejiang Province and Hangzhou City

zh-cn	武汉封城后，浙江省于 2020 年 1 月 23 日率先启动重大突发公共卫生事件Ⅰ级响应。
en-us	A couple of days after the lockdown of Wuhan, the epicenter, on January 23, 2020, Zhejiang Province was the first provincial-level administrative division (PLAD) in the nation to raise the risk management response to the highest level.

zh-cn	浙江的省会——拥有 1100 万人口的杭州市，实施了一系列增加社会距 离的措施来遏制 COVID-19 的传播。
en-us	Hangzhou, the capital city of this province with a population of 11 million, started implementing extreme measures known as social distancing to contain the spread of COVID-19.

zh-cn	从流行病学的角度来看，越早实施严格的干预措施，收益越大。
en-us	From an epidemiological perspective, the benefits of stringent interventions are maximized if they are implemented early and maintained.

zh-cn	事实证明，杭州严格的防控措施取得了良好的效果，为其他城市的疫情防控工作起到了良好的示范作用。
en-us	Hangzhou has proven to be a perfect example of controlling the COVID-19 epidemic in a large metropolitan area .

zh-cn	但在 COVID-19 暴发初期，地方政府在做防控决策时面临着巨大的挑战，因为这可能会对数百万居民的生活产生巨大影响。
en-us	In controlling the COVID-19 outbreak in the early days of its emergence, the local officials often face significant challenges in making unprecedented decisions that will dramatically impact the economy and the social lives of millions of citizens.

zh-cn	时间在这一决策过程中也起着关键作用。
en-us	Timing also plays a key role in this decision-making process.

zh-cn	在省市主管部门与杭州市CDC 的紧密合作下，杭州采取了以下疫情防控措施：
en-us	The provincial and city authorities and experts from Hangzhou CDC worked closely to implement a series of actions :

zh-cn	建立覆盖全市的通信系统，通过公寓、社区、企业、组织机构、学校和 公共设施，使每个人都参与到疫情防控中。
en-us	Establishing a city-wide communication system to engage every individual to participate in implementing the city guidelines through apartments, communities, business, organizations, schools, and public facilities.

zh-cn	在全市的共同努力下，杭州成功实施了一个月以上的强制封锁，这是前所未有的。
en-us	This participation was major as it allowed the city, with the help of all involved, to successfully implement this mandatory lockdown for over a month.

zh-cn	相关的措施包括 出入城市人员全天候的严格控制、市民间的互相监督、公共场所的全面消毒（包括从门把手到电梯按钮）等。
en-us	Many citizens also monitored their neighbors. Sanitization measures were applied from every doorknob to every elevator keypad.

zh-cn	政府组织调控维持食品的正常供应。
en-us	Maintaining food and supply flow through organized and government-controlled arrangements.

zh-cn	通过在线订购和指定物流，对新鲜 食品供应和流通进行分区管理。
en-us	Through online ordering and designated delivery groups, the sustained flow of fresh food and supplies were managed and maintained by district areas.

zh-cn	设置传染病治疗和管理定点机构，以隔离、监测和治疗 COVID-19 患者。
en-us	Reserving and designating infectious disease care and management hospital facilities to isolate, monitor, and treat COVID-19 positive patients.

zh-cn	杭州共有 22 家医院,
en-us	There are 22 hospitals in Hangzhou.

zh-cn	其中两家为COVID-19 定点医院,并有 168 家定点旅馆被用于 COVID-19 轻症患者的隔离和监测。
en-us	The city designated two for COVID-19 patients and an additional 168 designated facilities (i.e., hotels) to isolate and monitor COVID-19 positive but clinically mild symptom patients.

zh-cn	此外，浙江共派出2018 名医护人员驰援武汉，其中杭州市级医院 318 名，浙江大学医学院 附属医院 525 名。
en-us	In addition, there were 2,018 doctors and nurses from Zhejiang deployed to Wuhan to aid the response to the disease, among them, 318 were from Hangzhou city level hospitals and 525 were from affiliated hospitals of Zhejiang University.

zh-cn	运用电子记录追踪系统和应急队伍实现智能防控。
en-us	Establishing electronic recording and tracking systems, and local response teams to continuously handle identified cases.

zh-cn	杭州市通过大数据分 析和信息技术，实行“一图、一码、一指数”。
en-us	Hangzhou implemented a big data analytics system and information technology that was named “one map, one QR code, and one index”.

zh-cn	“一码”指的是健康码， 每个城市居民和进出城市人员需自主申领健康码，
en-us	The health QR codes are established for everyone in the city and those who enter the city.

zh-cn	“绿码”可在市内亮码 通行，进出杭州扫码通行；
en-us	Green codes allow one to move freely in the city,

zh-cn	“黄码”和“红码”需分别进行 7 天和 14 天 的自我隔离，
en-us	yellow codes require 7-day self-quarantine, and red codes require 14-day self-quarantine.

zh-cn	待转换为“绿码”后方能正常出行。
en-us	Yellow and red codes can turn green after completion of the quarantine periods.

zh-cn	健康监视系统每天追踪两次体温自测数据。
en-us	The health surveillance system also tracks self-monitored temperature data that is recorded twice a day.

zh-cn	这些数据由杭州市 CDC 负责管理。
en-us	Hangzhou’s CDC monitors the data.

zh-cn	截至 2020 年 3 月 12 日，杭州已连续 22 天无新发确诊病例，现有的 169 例患者均已治愈出院。
en-us	As of March 12, 2020, there have been no new COVID-19 cases in Hangzhou for 22 days, and all 169 previously confirmed patients have been cured and discharged.

zh-cn	当前，该市仍处于严格控制之下，但已开始分层分级有序复工。
en-us	The city is still under tight controls but started to allow workers to come back in phases based on priority with close monitoring and strict guidelines in place.

zh-cn	在全国层面上，这些疫情防控措施也在大多数的省市得到实施。
en-us	At the national level, the disease control and prevention measures were also implemented for most PLADs and cities.

zh-cn	从公共卫生的角度来看，各级政府采取的控制策略和措施具有以下特征：
en-us	From a public health perspective, the national and local control strategies and measures have the following characteristics:

zh-cn	国家从中央政府到 单个家庭总体动员；
en-us	mobilizing the whole nation at multiple levels from central government to individual families,

zh-cn	快速响应（即识别和检测病毒）并迅速采取措施；
en-us	responding (i.e., identification and detection of the virus) and implementing measures quickly;

zh-cn	在政府和有关专家合作的基础上采取了系统的、主动的风险管理；
en-us	systematic and proactive risk management based on collaborations between government officials and health experts;

zh-cn	实施大数据和信息技术；
en-us	the implementation of big data and information technology;

zh-cn	保障公众知情权。
en-us	keeping the public well informed.

zh-cn	公共卫生系统在 COVID-19 疫情防控中的作用
en-us	Role of the public health system in controlling the COVID-19 epidemic

zh-cn	中国 CDC 是国家级疾病预防控制与公共卫生技术管理和服务的公益事业单位，
en-us	China CDC is a governmental and national-level technical organization specialized in disease control and prevention.

zh-cn	在国家卫生健康委员会的领导下，开展公共卫生技术指导与支持等方面工作。
en-us	Under the leadership of the National Health Commission (NHC), China CDC exerts its function by providing technical guidance and support of public health.

zh-cn	与属于政府机构的美国 CDC 不同，中国 CDC 并没有在应急状态下采取大范围措施的执行权限，
en-us	Unlike the US CDC which is part of a governmental agency, China CDC does not have executive authority to implement a wide range of measures in case of an emergency.

zh-cn	只有疫情的上报权而没有公布权,在公共卫生应急体系中，更多的是作为技术部门，参与突发公共卫生事件应急准备和应对的工作。
en-us	Its role only allows the organization to report an epidemic and/or emergency to the government and participate in the preparation and response of public health emergencies as technical and scientific resources.

zh-cn	2003 年 SARS 爆发后，中国颁布了两部法律：
en-us	Following the SARS outbreak in 2003, China enacted two laws:

zh-cn	《突发公共卫生应急条例》和《公共卫生突发事件与传染病疫情监测信息报告管理办法》。
en-us	The Regulation on Public Health Emergency and The Measures for the Administration of Information Reporting on Monitoring Public Health Emergencies and Epidemic Situation of Infectious Diseases .

zh-cn	政府建立了突发公 共卫生事件管理系统，并详细制定了预防和控制传染病的基本路径（即控制传染 源，阻断传播途径和保护易感人群）。
en-us	The government established a management system for public health emergencies and detailed the principal rules for the prevention and control of infectious disease (i.e., infection source control, interruption of route of transmission, and susceptible person’s protection).

zh-cn	各级政府在公共卫生应急响应工作上（如 技术、人员、材料和管理），均已做好了充分的准备。同时，建立了应急信息发 布系统，可提供及时（2 小时内）、准确而全面的信息发布。
en-us	Both central and local governments are in place to provide public health emergency responses (e.g., techniques, personnel, materials, and management preparedness), and an emergency information dissemination system that provides quick (within 2 hours), accurate, and comprehensive release of information.

zh-cn	公共卫生管理体制的 改革使得中国可以更快、更好地应对传染病的流行。
en-us	The public health management system reform led to better handling of an epidemic of infectious diseases.

zh-cn	如原中国卫生部（CMH，现 在中国卫生健康委）于 2009 年 4 月 29 日发布了猪流感预防指南，比第一例 H1N1 病例的确诊时间还要早 12 天。
en-us	For example, the Chinese Ministry of Health (CMH, the precursor to the NHC) issued a swine flu prevention guide on April 29, 2009, 12 days before the first reported H1N1 case in China .

zh-cn	2013 年 4 月 3 日，首例 H7N9 确诊病例后 4 天， CMH 发布了院内 H7N9 感染预防指南。
en-us	On April 3, 2013, 4 days after the first H7N9 confirmed case, the CMH also issued a nosocomial H7N9-infection prevention guide .

zh-cn	值得一提的是，中国的公共卫生响应和管理体系为疫情爆发后的危机处理做 出了重要贡献。
en-us	It is worth noting that China’s public health response and management system contributed significantly to handling the COVID-19 crisis after the outbreak.

zh-cn	例如，快速公布 COVID-19 基因序列信息使全球科学家可以立即 开始开发疫苗产品；
en-us	For example, the rapid publication of COVID-19 genetic sequence information allowed scientists across the globe to immediately start developing vaccines;

zh-cn	及时发表关于流行病学和临床病例分析等方面的同行评议的论文为医护人员提供了有关如何检测、分离和治疗 COVID-19 的第一手信息；
en-us	peer-reviewed publications of epidemiological and clinical case analysis provided first-hand information for healthcare workers on how to detect, isolate, and treat the disease caused by COVID-19;

zh-cn	有 关 COVID-19 的多个指南和病例追踪信息极大地提高了公众对该疾病的认识。
en-us	multiple guideline publications and case tracking information on COVID-19 greatly promoted public awareness of this disease.

zh-cn	中 国 COVID-19 疫情清楚地表明，若社区中的传染源未得到有效地控制，将会造成 多大的不良影响。
en-us	The COVID-19 epidemic in China showed a clear picture of what would happen if a potential human-to-human transmissible infectious source was left unattended in the community.

zh-cn	另一方面，国内各地疫情的扩散已得到有效的阻止，且近几天 大部分地区都已无新发病例。
en-us	However, other parts of China appeared to effectively mitigate the spread of the disease and many have shown significant improvements recently.

zh-cn	然而，公共卫生管理系统仍需要持续地改进，
en-us	Therefore, there is a need for the continuous improvement of the current public health management system.

zh-cn	具体建议如下：
en-us	Specific strategies include the following:

zh-cn	让各级 CDC、医院及高校的多学科专家（流行病学、传染病学、微生物学、 临床医学等）更多地参与到地方和中央政府的决策过程，以便快速地 对 COVID-19 这类高危传染病采取有效的防控措施。
en-us	To have more involvement of multidisciplinary experts (epidemiology, infectious disease, microbiology, clinical medicine, etc.) from CDCs, hospitals, and universities in the local and central government decision-making process.

zh-cn	完善医疗应急物资管理系统，确保应急物资储备，并对物资的储备和调动等工作进行规范化管理。
en-us	To improve the emergency medical supply management system and plans to ensure clear pathways to follow in case of an epidemic emergency.

zh-cn	建立疾病防控大数据平台。
en-us	To establish a big data platform for disease control and prevention.

zh-cn	在确保信息安全的前提下，高校与各级 CDC 合 作，整合基本人口信息、人口流动信息、患者信息、医保信息、诊疗信息及 各级 CDC 数据等，建立大数据平台。
en-us	On the premise of ensuring information security, colleges and universities cooperate with CDC to integrate basic population information, population movement information, patient information, medical insurance information, medical treatment information, and CDC data to establish a big data platform.

zh-cn	在实现新型传染病的实时、自动、量化 上报的同时，建立预测、预警、应急响应机制，防范突发公共卫生事件发现 与应对的滞后。
en-us	This platform can realize the real-time, automatic, and quantitative reporting of new infectious diseases, and establish a system for prediction, early warning, and emergency response mechanisms to prevent the delayed detection and response to public health emergencies.

zh-cn	建立强大的公共卫生队伍以保障人民健康
en-us	Building a strong public health team to safeguard people’s health

zh-cn	2018 年，全国各类医院财政补助收入为 2697 亿元人民币，而各级 CDC 仅 为 511 亿元。
en-us	In 2018, hospitals in China received a total budget of 269.7 billion RMB while CDC only received 51.1 billion .

zh-cn	这清楚地表明政府将重点放在疾病的治疗而不是预防上。
en-us	This is a clear reflection of the government’s primary focus on treatment versus the prevention of diseases.

zh-cn	总体而言， 我国公共卫生人才在数量和素质上都无法满足《健康中国 2030 规划纲要》实施的需求。
en-us	In general, our public health talent cannot meet the needs of the “Healthy China 2030” in terms of quantity and quality.

zh-cn	截至 2018 年，中国各级 CDC 从业人员 18.78 万人，即每万人口中仅有1.35 名从业人员，约为美国的五分之一。
en-us	As of 2018, there are 187,826 employees at all levels of CDCs in China and that is only 1.35 CDC employees per 10,000 population, which is about one-fifth that of the United States .

zh-cn	CDC 从业人员的总体素质不高，统计 显示，各级 CDC 卫生技术人员仅 44.2%拥有本科以上学历。
en-us	The overall quality of CDC employees is also a concern. Statistics show that only 44.2% of CDC health technicians have a bachelor’s degree or higher.

zh-cn	此外，基层公共卫生人员实践知识与技能也亟待提高。
en-us	In addition, the lack of practical skills and knowledge of grassroots public health personnel needs to be improved.

zh-cn	这些都与中国目前的公共卫生教育体系直接或间接相关。
en-us	All of those are directly and indirectly linked to the current public health education system in China.

zh-cn	尽管相较于SARS 之前，公共卫生高等教育已有显著提高，但国内大部分公共卫生学院仍作为医学院校的辅助机构。
en-us	Despite notable improvements in the higher education field, public health is still largely functioning as an auxiliary branch of a medical school.

zh-cn	高等教育体系的重大改革是未来成功实现《健康中国 2030 规划纲要》的关键：
en-us	Significant reforms in our higher education system are the key to future success in building “Healthy China 2030”:

zh-cn	提升公共卫生培养规模和学科水平：
en-us	Increasing the scale of training and scientific levels of public health:

zh-cn	布局国家试点重点公共卫生学院，
en-us	building public health colleges and universities;

zh-cn	鼓励筹建更多公共卫生学院和大学；
en-us	increasing governmental funds supporting schools and colleges of public health across the nation.

zh-cn	建立国家重点公共卫生研究中心，着力研究重大传染性疾病和非传染性疾病。
en-us	establishing key national public health research centers focusing on both major communicable and non-communicable diseases;

zh-cn	优化公共卫生人才培养方案：
en-us	Optimizing the public health personnel training system:

zh-cn	一是培养公共卫生高层次人才，建立公共卫生博士培养制度，着力培养公共卫生行业领军人才。
en-us	First, building a rigorous system to train leaders with high-level doctoral public health degrees.

zh-cn	二是培养公共卫生与全科 医学复合型人才，
en-us	Second is to train multidisciplinary professionals of public health and general medicine.

zh-cn	建立“4+3”培养机制，前 4 年学习医学和公共卫生学，后3 年进行全科医学规培，培养全科医生。
en-us	Establish a “4+3” training mechanism, where a student studies medicine and public health courses in the first 4 years and continues with general medical practical training in the following 3 years.

zh-cn	对预防医学专业学生进行全科医学 规范化培训，使部分学生同时具备全科医学临床资质。
en-us	Preventive medicine students should also be trained in general medicine and be allowed to practice clinically after graduation.

zh-cn	加强公共卫生实践能力培养：
en-us	Enhancing hands-on training in the public health professional curriculum:

zh-cn	加强针对本科生和研究生的公共卫生实践技能培训；
en-us	enhance practical trainings in various public health facilities for undergraduate and graduate students;

zh-cn	在本科课程中增加针对新发传染病的实用课程；
en-us	increasing practical-skills-oriented courses for emerging infectious diseases in the undergraduate curriculum; improving practical skills training;

zh-cn	加强关于新发传染病 的社会实践的教学，并增加对公共政策管理和应急反应的培训。
en-us	strengthening the teaching of social practices with respect to emerging infectious diseases, and increasing training for public policy management and emergency responses.

zh-cn	拓展公共卫生教育的覆盖面：
en-us	Expanding the coverage of public health education:

zh-cn	建立医疗卫生系统公共卫生知识轮训制度，
en-us	establishing a public health knowledge rotation training system for medical professionals;

zh-cn	定期对临床医护人员、公共卫生从业人员以及相关管理人员开展预防医学、疾病防控知识的培训考核。
en-us	regularly evaluate public health knowledge and practices of healthcare professionals and managers.