為什么美國(guó)醫(yī)護(hù)人員的口罩快耗盡了?

Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?

為什么美國(guó)醫(yī)護(hù)人員的口罩快耗盡了?這個(gè)世界上最富有的國(guó)家怎么會(huì)看到自己陷入如此不幸且可以避免的境地?得到足夠的防護(hù)器材將需要多長(zhǎng)時(shí)間，如果現(xiàn)在還有這種可能的話?

I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.

過(guò)去幾天里，我一直在探究這些問(wèn)題，因?yàn)榉雷o(hù)器材的短缺，尤其是口罩的短缺，讓我覺(jué)得這是美國(guó)應(yīng)對(duì)新型冠狀病毒疫情的眾多荒謬之處當(dāng)中最令人不安的一個(gè)。

Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.

是的，如果盡早對(duì)新冠病毒做廣泛檢測(cè)的話，本來(lái)可以更好，韓國(guó)將疫情遏制住用的就是這個(gè)策略。如果我們能避免呼吸機(jī)和醫(yī)院床位不夠用的狀況，本會(huì)令人欣慰，醫(yī)院爆滿是意大利部分地區(qū)正在發(fā)生的災(zāi)難。但是，如果醫(yī)護(hù)人員根本不能在保護(hù)自己不生病的情況下接觸新冠病毒感染者，上述問(wèn)題就都不重要了，確切地說(shuō)，在這種情況下，不可能對(duì)患者采取多少干預(yù)措施。

That’s where cheap, disposable face masks, eye protection, gloves and gowns come in. That we failed to procure enough safety gear for medical workers — not to mention for sick people and for the public, as some health experts might have recommended if masks were not in such low supply — seems astoundingly negligent.

這就是便宜的一次性口罩、護(hù)目鏡、手套和防護(hù)服起作用的地方。我們沒(méi)有為醫(yī)護(hù)人員采購(gòu)足夠多的安全裝備似乎是個(gè)驚人的疏忽，更不用說(shuō)像一些衛(wèi)生專家可能會(huì)建議的那樣，如果口罩供應(yīng)不是這么少的話，本應(yīng)讓患者和公眾都戴上口罩。

What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.

這么小的事情搞垮一個(gè)強(qiáng)大的國(guó)家讓人多丟臉呀：因?yàn)槿鄙?5美分一個(gè)的口罩，一個(gè)國(guó)家完蛋了。

I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.

我很遺憾地說(shuō)，探究口罩短缺的問(wèn)題絲毫不能平息人們的憤怒。我們?yōu)槭裁慈鄙俜雷o(hù)器材這個(gè)問(wèn)題，答案涉及一組非常美國(guó)的資本主義病態(tài)——海外低成本制造的興起及其不可避免的吸引力，以及沒(méi)有從國(guó)家層面和醫(yī)療衛(wèi)生行業(yè)的角度認(rèn)真考慮降低成本的動(dòng)機(jī)所帶來(lái)的一連串脆弱性的戰(zhàn)略失敗。

Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.

也許現(xiàn)在解決這種短缺的唯一方法是認(rèn)識(shí)到市場(chǎng)已經(jīng)崩潰，需要政府介入，立刻鼓勵(lì)全球和國(guó)內(nèi)生產(chǎn)這些東西。奇怪的是，特朗普總統(tǒng)迄今一直拒絕下令企業(yè)生產(chǎn)更多的器材和設(shè)備。就口罩而言，制造商們說(shuō)，他們正在竭盡全力提高產(chǎn)量，一些大公司從自己的儲(chǔ)備中捐獻(xiàn)出來(lái)數(shù)百萬(wàn)個(gè)口罩。

But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.

但考慮到全球?qū)谡值木薮笮枨?mdash;—據(jù)美國(guó)衛(wèi)生與公眾服務(wù)部(Department of Health and Human Services)估計(jì)，僅美國(guó)一個(gè)國(guó)家，在抗擊新冠病毒的戰(zhàn)斗中將消耗35億個(gè)口罩——企業(yè)的慷慨不足以滿足需求?？谡中袠I(yè)的人士說(shuō)，至少需要幾個(gè)月的時(shí)間才能顯著擴(kuò)大生產(chǎn)規(guī)模。

“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.

“我們現(xiàn)在已經(jīng)滿負(fù)荷運(yùn)轉(zhuǎn)，通過(guò)再建一座工廠或進(jìn)一步擴(kuò)大產(chǎn)能來(lái)提高產(chǎn)量，將需要三到四個(gè)月的時(shí)間，”加拿大麥迪康(Medicom)的首席運(yùn)營(yíng)官紀(jì)堯姆·拉弗杜爾(Guillaume Laverdure)說(shuō)，麥迪康在世界各地有生產(chǎn)口罩和其他防護(hù)器材的工廠。

And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.

雖然一些非傳統(tǒng)生產(chǎn)商，比如T恤衫工廠和其他服裝生產(chǎn)商等，已經(jīng)宣布了加急生產(chǎn)口罩的計(jì)劃，但目前還不清楚它們能否達(dá)到所要求的安全標(biāo)準(zhǔn)，或能否及時(shí)轉(zhuǎn)移生產(chǎn)以滿足需求。

Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.

在防護(hù)裝備行業(yè)，很少有人對(duì)這種短缺感到驚訝，因?yàn)橄嚓P(guān)預(yù)測(cè)已經(jīng)存在數(shù)年時(shí)間了。2005年，喬治·W·布什(George W. Bush)政府曾呼吁協(xié)調(diào)防護(hù)裝備的國(guó)內(nèi)生產(chǎn)和儲(chǔ)備能力，以應(yīng)對(duì)大流行性流感。2006年，美國(guó)國(guó)會(huì)批準(zhǔn)了國(guó)家戰(zhàn)略儲(chǔ)備增購(gòu)防護(hù)裝備的資金，增加的庫(kù)存中除其他裝備外，還有5200萬(wàn)個(gè)醫(yī)用口罩和1.04億個(gè)N95口罩。

But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.

但2009年抗擊H1N1流感大流行用掉了大約一億個(gè)口罩的庫(kù)存，而政府從未考慮過(guò)補(bǔ)充它們。本月，美國(guó)衛(wèi)生與公眾服務(wù)部部長(zhǎng)亞歷克斯·阿扎爾(Alex Azar)在國(guó)會(huì)作證說(shuō)，庫(kù)存中只有大約4000萬(wàn)個(gè)口罩，約為全國(guó)預(yù)計(jì)需求的1%。

As the coronavirus began to spread early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.

隨著今年早些時(shí)候新型冠狀病毒開(kāi)始傳播，防護(hù)裝備的全球短缺問(wèn)題看來(lái)不可避免。但美國(guó)政府在這個(gè)時(shí)候?yàn)榻鉀Q短缺問(wèn)題采取行動(dòng)為時(shí)已晚。20年前，大多數(shù)醫(yī)院用的防護(hù)裝備都是美國(guó)國(guó)內(nèi)生產(chǎn)的。但與服裝和消費(fèi)者產(chǎn)品等許多其他行業(yè)一樣，口罩的生產(chǎn)已幾乎全部轉(zhuǎn)移到了海外。“中國(guó)生產(chǎn)全球80%的口罩，”拉弗杜爾說(shuō)。

Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.

醫(yī)院里口罩開(kāi)始缺貨的原因與超市里衛(wèi)生紙缺貨的原因一樣，都是因?yàn)樗鼈兊?ldquo;準(zhǔn)時(shí)制”(just-in-time)供應(yīng)鏈優(yōu)化的是效率，而非韌性。這種做法要求用盡可能少的庫(kù)存來(lái)滿足需求。

“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”

“你說(shuō)的是一種大宗商品，”為醫(yī)院和衛(wèi)生系統(tǒng)采購(gòu)醫(yī)療用品的公司Premier的總裁邁克爾·J·阿爾凱爾(Michael J. Alkire)說(shuō)。他說(shuō)，這種商品的供應(yīng)鏈“按照定義，不會(huì)有多少冗余，因?yàn)槿藗円氖堑统杀?rdquo;。

In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.

今年1月，這個(gè)脆弱的供應(yīng)鏈在壓力下開(kāi)始斷裂。為了應(yīng)對(duì)本國(guó)的疫情，中國(guó)開(kāi)始限制防護(hù)裝備出口。隨后，其他國(guó)家也跟著這樣做——德國(guó)、法國(guó)和印度都采取了停止醫(yī)療設(shè)備出口的措施。這使得美國(guó)的醫(yī)院不得不從越來(lái)越少的生產(chǎn)商那里尋找越來(lái)越多的口罩。

People in the industry assured me they would prepare better next time. “We are laserlike focused to ensure that our health care systems are never in this scenario again,” Alkire told me. “There will be a lot more domestic manufacturing of these products going forward.”

業(yè)內(nèi)人士向我保證，他們下次會(huì)準(zhǔn)備得更好。“我們正在專心致志地確保我們的衛(wèi)生保健系統(tǒng)不再出現(xiàn)這種情況，”阿爾凱爾對(duì)我說(shuō)。“未來(lái)將有更多的此類產(chǎn)品在國(guó)內(nèi)生產(chǎn)。”

I don’t doubt it — but that we did not plan, as a nation, for this entirely predictable shortage makes me wonder what other inevitable pothole is lurking out there for all to trip over. Getting enough protective gear was among the cheapest, most effective things we could have done to slow down the pandemic. That we failed on such an obvious thing reveals an alarming national incapacity to imagine and prepare for the worst.

我并不懷疑這點(diǎn)，但作為一個(gè)國(guó)家，我們沒(méi)有計(jì)劃應(yīng)對(duì)這種完全可以預(yù)見(jiàn)的短缺，這讓我想知道，前面的路上還有什么其他不可避免的坑洼會(huì)把所有的人絆倒。儲(chǔ)備足夠的防護(hù)裝備是我們減緩新冠病毒大流行本來(lái)可以采取的最便宜、最有效的措施之一。我們?cè)谌绱孙@而易見(jiàn)的事情上的失敗，暴露了這個(gè)國(guó)家在做最壞的打算方面的駭人的無(wú)能。

We will get enough masks in time for the next disaster. But wouldn’t it be nice, for once, if we prepared for trouble before it hit us in the face?

我們會(huì)弄到足夠多的口罩來(lái)應(yīng)對(duì)下一次災(zāi)難。但如果我們能在危機(jī)出現(xiàn)之前就做好準(zhǔn)備的話，那不是更好嗎?