「冰山一角」：加州補報死亡病例，改寫美國疫情時間線
A Coronavirus Death in Early February Was 『Probably the Tip of an Iceberg』
THOMAS FULLER, MIKE BAKER, SHAWN HUBLER, SHERI FINK
2020年4月23日
早在今年1月，甚至在聯邦政府2月2日開始限制來自中國的旅行之前，新冠病毒就已經在加州灣區傳播了。
SAN FRANCISCO — Weeks before there was evidence that the coronavirus was spreading in U.S. communities, a 57-year-old woman developed flulike symptoms and abruptly died in her San Jose kitchen, triggering a search for what had killed her. Flu tests were negative. The coroner was baffled. It appeared that the woman had suffered a massive heart attack.
舊金山——在有證據表明新冠病毒在美國存在社區傳播幾周前，一名57歲的女性出現了類似流感的症狀，後來她在位於聖何塞家中的廚房裡突然死去，有關部門對其死因展開了調查。她的流感檢測結果是陰性。驗屍官百思不得其解。她看上去像是出現了一次嚴重的心臟病發作。
But tissue samples from the woman, who died on Feb. 6, have now shown that she was infected with the coronavirus — a startling discovery that has rewritten the timeline of the virus』 early spread in the United States and suggests that the optimistic assumptions that drove federal policies over the early weeks of the outbreak were misplaced.
但現在，這名2月6日去世的女子的組織樣本顯示，她感染了新冠病毒——這一令人震驚的發現改寫了該病毒在美國早期傳播的時間線，表明在疫情暴發的最初幾周裡決定了聯邦政策的樂觀假設是不準確的。
The unexpected new finding makes clear that the virus was circulating in the Bay Area of California as early as January, even before the federal government began restricting travel from China on Feb. 2. It also raises new questions about where else the virus might have been spreading undetected.
這一出乎意料的新發現清楚地表明，這種病毒最早在1月，在聯邦政府於2月2日開始限制來自中國的旅行之前，已在加州灣區傳播。這也引發了還有哪些地方有疫情卻未被發現的疑問。
With little local testing throughout February — in part because of botched testing kits from the Centers for Disease Control and Prevention, along with strict guidelines that limited who could get tested — officials were not aware of the virus transmitting locally in the country until Feb. 26, in Solano County, California.
在2月，由於疾控中心的檢測試劑盒質量不佳，加之檢測標準定得太高等原因，當地幾乎沒有開展檢測，所以加州索拉諾縣的官員並沒有意識到病毒已經到了美國。
Previous cases had involved people who had traveled to China, where the outbreak began, or who had been exposed to someone who was sick. But the Feb. 26 case in Solano County was of unexplained origin. Similar cases of community transmission were quickly identified in nearby Santa Clara County, which includes San Jose, as well as in Washington state and Oregon.
此前的感染者都有在疫情暴發地中國的旅行史，或者與患者有過接觸。但2月26日索拉諾縣的病例的感染源不明。在附近的聖克拉拉縣（包括聖何塞）以及華盛頓州和俄勒岡州，很快也發現了類似的社區傳播病例。
The new test results made public late Tuesday show that even this timeline failed to reveal how long the virus had been circulating. The woman in San Jose had not recently traveled outside the country, the authorities said, and yet she died a full 20 days before the earliest recorded case of community transmission. Another previously unconnected death in Santa Clara County, on Feb. 17, has also now been linked to the coronavirus.
周二晚些時候公布的新檢測結果顯示，即使是這條時間線也沒能揭示出這種病毒已經傳播了多長時間。當局表示，聖何塞的這名女性最近沒有出國旅行，但她的死亡卻比最早記錄到的社區傳播病例早了整整20天。2月17日，在聖克拉拉縣的另一例此前被認為無關的死亡，現在也確定跟新冠病毒有關。
「Each one of those deaths is probably the tip of an iceberg of unknown size,」 Dr. Sara Cody, Santa Clara County’s medical officer, said in an interview.
聖克拉拉縣的衛生主管薩拉·科迪(Sara Cody)博士在接受採訪時說：「這些死亡，每一例可能都只是冰山的一角。」
今年2月，聖塔克拉拉縣的衛生主管薩拉·科迪博士。她在本周表示，若是知道2月份就有人死於新冠病毒感染，她會更早發布居家令。
Gov. Gavin Newsom of California said on Wednesday that there could be 「subsequent announcements」 as investigations across the state further examine the early origins of the virus. He said investigators are looking at coroner and autopsy reports going back to December in some counties.
加州州長加文·紐瑟姆(Gavin Newsom)周三表示，隨著在全州範圍內進一步就該病毒的最早起源展開調查，可能還會有「進一步的消息宣布」。他說，調查人員正在查看一些縣去年12月的驗屍官和屍檢報告。
The earliest case discovered this week, friends and family members said, was of a woman who worked at a Silicon Valley semiconductor manufacturing company with offices worldwide, including in Wuhan, China, the city where the outbreak began.
據朋友和家人說，本周發現的這名最早的女性病患在矽谷一家半導體製造公司工作，公司在世界各地設有辦事處，包括在最早暴發疫情的中國武漢。
A longtime friend said that on Feb. 2, the woman had complained of flulike symptoms. Four days later, he said, she was working from home, still feeling under the weather. Her daughter came home and found her collapsed at the breakfast bar in her kitchen, according to the friend, who asked not to be identified because he did not want the woman’s identity to be disclosed.
她的一位老朋友說，她在2月2日抱怨自己出現了類似流感的症狀。他說，四天後，她還在家裡工作，身體仍然感到不適。據這位友人表示，她女兒回家後發現她倒在了廚房的早餐吧檯前。為了保護感染者的身份，這位友人要求匿名。
Family members said they initially had wondered if she had been suffering from COVID-19, the disease caused by the coronavirus. Her work as a company auditor for her firm, they said, brought her into contact with employees from all over the world and involved frequent travel.
她的家人說，他們一開始就懷疑她是否感染了冠狀病毒引起的COVID-19。他們說，她在公司擔任審計師，因此會接觸到來自世界各地的員工，並且經常出差。
Across the country, doctors and public health officials have reported earlier cases of serious illnesses and deaths that preceded official diagnoses of the coronavirus. Only now are some of them being examined, and the new findings in Santa Clara County — suggesting that these suspicious earlier cases were instances of community transmission — shed light on the understated public health response to the widening outbreak.
全國範圍內，在官方確診的冠狀病毒病例之前，醫生和公共衛生官員就已報告了重症和死亡病例。其中一些病例直到現在才得到檢測，而聖克拉拉縣的新發現表明，這些可疑的早期病例是社區傳播的實例，顯示出公共衛生應對措施在不斷擴大的疫情面前是不足的。
Had there been earlier proof that the virus had already found a foothold in the United States, experts said, public health officials would have had more urgency to ramp up testing, prepare hospitals and assemble protective gear that might have prevented infections among health care workers and others.
專家們說，如果有更早的證據表明這種病毒已經登陸美國，公共衛生官員就會更迫切地加強檢測，為醫院做好準備，並且調配防護裝備，防止醫護人員和其他人感染。
Instead, the focus in February was on quarantining thousands of travelers who were returning from China in the hope that infections could be identified, isolated and contained.
然而2月的工作重點是對數千名從中國歸來的旅客進行隔離，希望能夠發現、隔離和控制感染。
「What in the end was that really going to accomplish if it was already here?」 said Dr. Amesh Adalja, an infectious disease specialist and senior scholar at Johns Hopkins Center for Health Security.
「如果已經在這裡了，那麼這樣做又有什麼意義呢？」傳染病專家、約翰·霍普金斯健康安全中心(Johns Hopkins Center for Health Security)高級學者阿邁什·阿達爾賈(Amesh Adalja)博士說。
加州奧克蘭一個針對一線急救人員的免下車新冠病毒快速檢測站。
It is unclear how the virus reached the people in these earliest deaths. In January, health officials identified a series of people who had traveled from China and then tested positive for the virus, but those cases were largely contained. At the time, President Donald Trump said he did not think the virus would become a pandemic and declared that public health authorities 「have it totally under control.」
目前還不清楚最早的死亡者是如何感染這種病毒的。今年1月，衛生官員確認了一系列來自中國的病毒檢測呈陽性者，但這些病例基本得到了控制。當時，唐納·川普總統表示，他不認為這種病毒會成為大流行病，並宣布公共衛生當局「完全控制住了它」。
Federal health officials initially limited testing largely to those who had traveled from Wuhan, then expanded it to people coming from mainland China. Trump ordered travel restrictions, including health screenings for U.S. residents returning from mainland China, that began on Feb. 2.
聯邦衛生官員最初主要將檢測範圍限制在來自武漢的人身上，然後將檢測範圍擴大到來自中國大陸的人。川普下達了旅行限制令，包括自2月2日開始，對從中國大陸返回的美國居民進行健康檢查。
By Feb. 26, Trump claimed that the limited number of cases in the country 「within a couple of days is going to be down to close to zero. That’s a pretty good job we』ve done.」
到2月26日，川普聲稱，美國有限的病例數量「在幾天內將減少到接近於零。我們的工作做得相當棒」。
That was the same day community transmission began to emerge, first in California, then in the Portland, Oregon, area, and near Seattle.
就在同一天，社區傳播開始出現，首先在加州，然後是波特蘭、俄勒岡地區，以及西雅圖附近。
Cody led the effort to issue the nation’s first stay-at-home orders on March 16. But she said she would have issued them even earlier had she known about the February deaths.
3月16日，科迪率先發布了美國首個居家令。但她說，如果知道2月份的死亡事件，她可能會更早發布這樣的命令。
「I think if we had had widespread testing earlier and if we had been able to document the level of transmission in the county, if we had understood then that people were already dying, we probably would have acted earlier than we did,」 Cody said. She said officials had been hearing about a lot of people who were ill but did not meet the criteria for testing.
「我認為，如果我們能夠更早地進行廣泛檢測，如果我們能夠追蹤記錄縣內的傳播水平，如果我們當時就知道已經有人死亡，我們可能會比現在更早採取行動，」科迪說。她說，官員們聽說很多人都生病了，但他們沒有達到檢測標準。
「It was just sort of this understanding that the testing capacity at the CDC was very, very, very limited,」 she said. When doctors would call them with suspicious cases, she said, county health authorities would have to explain that the cases did not qualify for testing.
「只是因為我們認為疾控中心的檢測能力非常非常非常有限，」她說。如果有可疑病例，醫生會打電話給他們，縣衛生當局會解釋說，這些病例不符合檢測條件。
「It got increasingly uncomfortable, right?」 she said. 「It didn’t make any sense. How are you going to detect community transmission if you’re only testing people with a travel history? Well you’re not.」
「越來越讓人不安，對不對？」她說。「這完全說不通。如果你只檢測有旅行記錄的人，那要怎麼檢測出社區傳播？於是，就沒測出來。」
聖何塞一處關閉的遊樂場。根據最新發現，這座城市早在2月初就有一名女性死於新冠病毒。
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