2018年5月的文章：
下一场致命全球瘟疫超乎你的想象
我们不知道它的名字，不知道它从哪里开始，更不知道它什么时候结束。但我们几乎可以肯定，它一定会到来。
下一场致命全球流行病会是什么样子？针对这个问题，许多专家分享了他们的见解。
约翰霍普金斯大学的传染病专家Amesh Adalja等人认为，人们应该重视呼吸道病毒，这类病毒对人类文明的影响程度远远超过其它备受关注的疾病，例如埃博拉、寨卡病毒——这类疾病虽然严重威胁公众健康，但从全球灾难性生物风险角度而言，它们的威胁程度不如那些能够通过空气自由传播的病原体。Adalja表示，目前，科学研究主要关注已知病原体。这虽不是件坏事，但却不足以使人类为未知威胁做好准备。我们应该为新疾病做准备，而不是专门应付旧疾病。
研究团队花了一年多时间查阅关于新兴传染疾病特点和微生物致病潜力的科学文献，并采访了来自学术界、工业、政府的120多位技术专家。最终分析显示：在下一场致命全球流行病中，病原体很可能通过呼吸道进行传播；此外，它在症状出现前的潜伏期里(或仅出现轻微症状时)便具有传染性。
它很可能具有低而显著的病死率。这个特点非常重要，因为它会提高病原体的整体传染性。换句话说，它会杀死少数病人，但大部分病人能够存活下来，将疾病传染给他人。相较而言，病死率太高、发病太迅速的超级病菌反而不利于自身的传播。另外，看似轻微的初期症状有时候会掩盖病情的严重程度。
研究人员认为，就全球灾难性生物风险而言，最危险的是RNA病毒。它具有变异能力。如果出现新型RNA病毒，如果它成功入侵某个群体，如果现有药物无法有效控制疫情，那么我们便可能迎来一场全球流行病。
好消息是：最近没有出现这类情况。坏消息是：我们根据以往经验得知，这类情况几乎肯定会发生；许多顶级聪明人士纷纷表示，人类在相关领域的进展还不够快。我们希望这篇新报告能够在科学界激起热议，能够促使人类为潜在威胁做好准备——下一场全球流行病可能超乎任何人的想象。
本文译自 sciencealert，由译者 蛋花 基于创作共用协议(BY-NC)发布。
原作者：PETER DOCKRILL
The Next Deadly Pandemic Could Be Unlike Any Threats We Know, Say Experts
We don't know its name. We don't know where it will begin, nor when it will end. But we know it's almost certainly coming for us.
Now, scientists have unveiled a blueprint of what the next deadly global pandemic will probably look like, with over 120 experts sharing insights on the predicted traits of a virulent future pathogen that will know no borders.
"We need to get serious about respiratory viruses," infectious diseases researcher Amesh Adalja from Johns Hopkins University told Live Science.
"[There's] a lot of focus on diseases that aren't going to be able to change civilisation in a way that something that's spread through the respiratory route would be."
The kinds of diseases Adalja is talking about – things like Zika virus and Ebola – are extremely serious threats to public health, but in terms of pathogens that could pose a global catastrophic biological risk (GCBR), they're not as severe as biological agents that can freely disperse through the air we breathe.
That's the conclusion of a new report led by Adalja and released by the Johns Hopkins Centre for Health Security, which looks at the characteristics of pandemic pathogens.
According to the findings, perhaps the greatest threat of such a catastrophic pandemic isn't the bug itself – whose ultimate emergence is out of our hands (probably). Instead, it's us.
Why? Because a huge amount of research into things like viral forecasting goes into cataloguing, investigating, and sequencing the infectious threats we already know about.
While that's great for scientific understanding, Adalja says it's debatable whether this effort actually bolsters disaster preparedness for unfamiliar biological threats we have yet to encounter, and which don't fit the set templates we're busy drawing up.
"Health security preparedness needs to be adaptable to new threats and not exclusively wedded to historical notions," Adalja explains in a statement.
"A more active-minded approach to this problem will, in the end, help guard against a GCBR event occurring."
To that end, Adalja and fellow researchers spent over a year reviewing scientific literature on emerging infectious disease characteristics and the pathogenic potential of microbes – and interviewed more than 120 technical experts from academia, industry, and government.
In the team's final analysis, they say the pathogen responsible for the next deadly global pandemic will probably spread via a respiratory mode of transmission, and would be contagious during the incubation period, prior to the development of symptoms (or when people only show mild symptoms).
The disease would most likely have a low but significant case fatality rate: an important factor that actually increases the pathogen's overall transmissibility.
In other words, it would kill some people, but most would survive contracting the infection – leaving them free to spread the pathogen to others while they remain contagious – whereas a highly fatal, quick-acting killer bug could be too deadly for its own good.
The researchers think the most dangerous GCBR-level pathogens are RNA viruses, which are capable of mutating.
If a new kind of RNA virus were to emerge and grab a foothold among immunologically compromised people in the community – and if existing medicines didn't effectively contain the infection – we could have a GCBR event on our hands, the researchers say.
"It just has to make a lot of people sick," Adalja told Live Science, adding that initial and seemingly mild symptoms can sometimes mask how serious sicknesses are.
"[It's] not always going to be somebody dying a horrible death … it could be a very minimal case."
Of course, the good news is we haven't been struck with one of these GCBRs in recent times.
The bad news is we know from past experience that they can happen, and a lot of really smart people are saying we're not making fast enough progress in addressing the threat we face today.
Here's hoping this new report stirs some fresh debate in the scientific community, and prepares us to face the real risks out there – which may be nothing like what we've seen before.
"We approached this project with active minds trying to jettison reliance on list-based approaches that are incomplete and almost guarantee surprise outbreaks," Adalja explains in a blog post.
"I hope that others find the report of value and it serves to generate deeper analysis of this field."
The full report is available at the Johns Hopkins Centre for Health Security website.
