Ve třetí kapitole Horton rozebírá úspěchy vědy během současné epidemie a paradoxně zároveň obrovské selhání vědecké politiky.
„The global scientific community made an unrivalled contribution to establising a reliable foundation of knowledge to guide the reponse to the SARS-CoV-2 pandemic. And yet the management of Covid-19 represented, in many countries, the greates science policy failure for a generation. What went wrong?“ s. 41.
Úspěchy vědy jsou společné, mezinárodní, podíleli se na něm i čínští vědci. Selhání vědecké politiky nastalo především v západních zemích (Horton se zabývá zejména USA a Velkou Británií).
Je zřejmé, že tento pohled bude mezi západními politiky mimořádně nepříjemný a budou v pokušení selhání popřít. A že mezi čínskými politiky by mohl vyvolat pokušení úspěchy zveličovat a využít pro další vnitřní i vnější mocenské ambice. Objektivní zhodnocení si vyžaduje nepodléhat ani jednomu z těchto dvou pokušení.
Úspěchy vědy
„After enduring the global opprobirum following its handling of SARS, Chinese leaders invested heavily in their universities, and specifically in their capacities for sicentific, technical, and medical research. Confronted by a new virus, Chinese scientists were ready, equipped and swung quickly into action“ s. 41
Jedna z prvních odborných zpráv o nové nemoc na Západě je z 24. ledna, v časopise The Lancet, Bin Cao (Peking) publikoval epidemiologické, klinické, laboratorní a radiologická data první skupiny pacientů. [2]
Další odborné milníky se týkaly např.:
- 24. ledna: human-to-human přenos (odborníci z Hongkongu a Szenzhen [3])
- 29. ledna: genomická sekvence publikovaná (týmem z čínské CDC s presidentem George Gao [4])
- 31. ledna: vysoká pravděpodobnost globální epidemie (Gabriel Leunge spolupracující s WHO a Univerzitou v Hongkongu, [5])
- od konce ledna a během února se i v odborných publikacích prokázala mimořádná rychlost zahlcení JIPek a ohrožení především starších pacientů. [6]
K úspěchům vědy jakožto mezinárodní, kooperativní aktivity patří mimojiné i to, že přes počáteční váhání (o němž příliš není známo), byla odpověď ČLR a dalších asijských zemí, velmi razantní a úspěšná i v olbasti vědecké politiky:
„The contrast between this impressive response and Chinese pitiful efforts during SARS in 2002-3 illustrates the remarkable scientific renaissance that had taken place in the country in just two decades. Bin Cao’s team was'n only able to gather the state of the art data on these early patients but also encouraged to write up their work, publish it free from consorship in foreign English-language medical journals, and make their findings available to others – all within weeks of the fire reports of the new disease. The culture, as well as the scientific shift that had taken place in China was monumental“ s. 43
Za zmínku také stojí to, co říká Horton na základě šetření teamu WHO z 16.2 až 24.2, jenž navštívil ČLR.
„In the face of a previously unknown virus, China has rolled perhpas the most ambitiou, agile and aggresive disease containment effort in history … Achieving China's exceptional coverage with and adherence to these containment measure has only been possible due to the deep commitment of the Chinese people to collective action in the face of this common threart … China’s bold approach to contain the rapid spread of this new resporatory pathohen has changed the course of a rapidly escalating and deadly epidemic.“ [7]
Horton uzavírá:
„Central to this success was the series of major emergency research program on virus genomics, antivirals, traditional Chinese medicines, clinical trials, vaccines, diagnostics and animal models‘. China's commitment to rapidly acquiring knowledge abou this new virus was a critical factor in enabling the country to contain, suppress and eventually extinguish the epidemic.“ (s. 45)
Selhání vědecké politiky
Zatímco věda jako taková během současné epidemie triumfuje, v oblasti aplikace těchto poznatků, tj. toho, co lze nazva vědecká politika (a co má i své aspekty etické a sociálně-espitemologické) došlo a stále dochází k velkému selhání:
„The story of COVID-19 in the US i some of the stangest paradoxes of the whole pandemic. No other country in the world has the concentration of scientific skill, technical knowledge and productive capacity possesed by the US. It is the worlds’s scientific superpower like none. And yet thsi colossus of science uttely failed to bring its epxertise successfully to bear on the policty and politics of the nations’s response. More people died inthe SU form COVID-19 in three months than during the entire Vietnam War. … The first case of COVID-19 in the US was reported on 21 January in a youn man from Washington state who had return from Wuhan a week earlier, on 15 January. … Commenting on the events unforlind in China, on 21 Janury President Trum worto on Titter that „It will al turn out well“. … by 30 January the US Centers for Disease Control and Prevention reported country’s first case of person-toperson transmission, in a woman whose husbnd had been in Wuhan. Still, the governmant assessed the risk to the American public as ‚low‘ (p. 46) [8]
31. ledna, tj. den po PHEIC Trum sice vyhlásil „public health emergency“ a zavedl některá omezení, ale vláda i nadále postupovala velmi málo razantně. Během února bylo zřejmé, že trasování a testování selhalo.
Srovnání situace ve Wuhanu, kde 23. ledna započala karanténa, se situací v USA nevypadá příznivě, následkem bylo zahájení anti-ČLR a anti-WHO kampaně v polovině dubna:
„Through strenuous efforst to cut the lines of viral transission, Cihina was able to begin to lift its restrictions on 8 April. As it did so, Deborah Birx, appointed by Pence as the coordinator of the White House coronavirus task forsce, reported that the epidemic had now reached its peak in the U.S. … As the economy imploded … President Trump turned his fire on China and WHO. On 14 April he announced that he would stop funding the agency, and he accused China of withholding curical information about the virus.“ (s. 49)
Co Velká Británie? Od konce ledna po celý únor a březen, asi sedm týdnů, vládní lékařští poradci příchod nového viru zcela ignorovali. 3. března Johnson doporučil mýt si ruce a tvrdil, že Británie je „extrémně dobře připravená“ (s. 50-51) 5. března v televizi prohlásil:
„Perhaps, you could sort of take it on the chin, take it all in the population without really taking as any draconinan measures“ (50).
Ostetativně si podával ruce se všemi, se kterými se setkal. 12. března vláda přestala trasovat. Graham Medley, jeden z vládních expertů prohlásil, že je v pořádku nechat velké množství lidí infikovat, aby se vytvořila skupinová imunita (herd immnuty). Jedná se o „a nice big epidemic“, kde jde pouze o to, aby se uchránila riziková část populace. Sir Patrick Vallance, hlavní porace mluvil o cíli infikovat 60 britské populace. Až v průběhu března se začaly zavírat školy, bary a vydán byl „stay at home“ příkaz.
„What is so mysteriious is that it didn’t need the predictions of scientists at Imperial College London in March to estimate impact … Any numerate school student could make the calculation. With a mortality of 1 per cent among 60 percent of a UK population of some 66 million people, the UK could expect almost 400,000 deaths. The huge wave of critically ill patients … would quickly overwhelm the NHS. The UK’s best scientits had known since the first report from China in January that COVID-19 was a lethal illness. Yet they too did too little, too late“ s. 52 [9]
21. února, tj. tři tydny po PHEIC, považovala klíčová vládní vědecká rada vir za středně rizikový:
"There was a genuinely fatal error of judgement“ (Horton, s. 54)
"This failure … led to mortal delays in preparing the NHS for the coming wave of infections. Ther desperate pleas I received during March and Aprill from frontline NGS staff are painful to read. ...Government knew it had failed to build the necesseary intensive care surge capacity … As one doctor wrote to me „It seems hat nobody wants to learn from the human tragedy that happened in Italy. China, Spain … This is realy sad“ (s. 55)
„The official government narrative was that the UK’s national health servise had succeeded in coping with the epidemic. Yet that assessment was only true because thousands of planned appointments and elective procedures were cancelled to create the capacity for the succeeding wave of Covid-10 admisions“ (s. 55)
Nalézt příčiny selhání bude patr zajímavé téma i pro budoucí historiky. Přinejmenším část vysvětlení spočívá v jednom z kognitivních biasů: Čína a další asijské země měly již jednu zkušenost se SARS-1, kdežto západ především s epidemiemi sezónní chřipky.
***
„Covid 19 has revealed the astonishing fragility of our societies, our shared vulneralbilty. It has revealed our inability to cooperate, to cocrdinate and to act together. Perhaps we cannot control the natural world after all. Perhaps we are not quite as dominant as we once thought. If Covid-19 eventually imbues human beings with some humility, then possible we will, after all, be receptive to the lessons of this lethal virus. Or perhaps we will sing back into our culture of complaten exceptionalism and await the next plague that will surely arrive.“ (s. 56-7)
„Something went badly wrong in the way many countries handled COVID.19. In the UK, the government had the servesies of some of the most talented researches in the world on which to draw. But somehow there was a collective failure to recognize the signals that Chinese and Italian scientists were sending“
Horton pak mluví o dvou selháních současného režimu a jak postupoval při epidemii:
(1) Zneužití moci:
„It was an abuse of power because the system of science policy formation failed to act on clear and unabbiguous signals from China that culminated in a PHEIC from WHO on 30 January. When a PHEIC was called, government sicentific advisory committees … should have urgently started asking questions. The should have contacted their counterparts in China and Hong kong – Bin Cao, George Gao, George Leung – to seek first-hand testimony about what was happening. They should have called WHO country office in Beijing to understand their assesment of the situation in Wuhan. If they had don seo, our most senior scientifc advisors would have heard the same messages so starkly reported in their published papers from January – a pandemic of a bitterly toxic virus on its way to Europe. The fact that they apparenty took none of these actions is what constitutes the abuse of entrusted power.“ (s. 58)
(2) Komplicita:
„scientists and politicians agreed to act together in order to protect the government, to give the illusion that the UK was an ‚international exemplar‘ in preparedness and made the right desicions at the right time, based upon the science. (s. 55)
Závěr
„Most countries eventually too the right actions to extinguish this pandemic. But their governments lost vauable time. There were preventable deaths. The system failed. … difficult questions will have to be asked and answered. Because we can’t afford to fail again. We may not have a second chance.“ (s. 62)
Poznámky (citations are work in progress)
[1] Inspirace: Lucy Jones, The Big Ones: How Natural Disasters Have Shaped Us (And what We can Do about Them), London, Icon Books 2018.
[2] Chaolin Huang Clinical features, The Lancet, 24. ledna
[3] Jasper Fuk-Woo Chan et al A familia cluster of pneumonia … The Lancet, 24. ledna
[4] Roujian Lu et al Genomic characterization and epidemiology of 2019 novel coronavirus: implication for virus origins and receptor binding, The Lancet, 29. ledna 2020
[5] Joseph T. Wu et al Nowcasting and foeracastin the potentia domestic and international spread of the 2019-nCov outbreak, The Lancet, 31. ledna 2020.
[6] Nanchan Chen et al. Epidemological and clinical characteristics of 99 cases … The Lancet, 29. January. Huijun Chen et al. Clinical characteristics and intraterine … The Lancet, 12 February, 2020. Xiabo Yang et al. Clinical course and outcomes … The Lancet Respiratory Medicine 21 February 2020.
[7] WHO, Report of the WHO-China Jounit Mission on Coronavirus Disease 2019 --- February 2020.
[8] Srv. Také Isaac Ghinai et al. First know person-to-person … in the USA, The Lancet, 12 March 2020.
[9] K nepřipravenosti: Institute of Health, learning from SARS: Preparing for the New Disease, Washington 2004.
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