Covid-19 presents stark choices between life, death and the economy. They will probably get harder
新冠肺炎迫使人们在生、死和经济之间做出艰难选择——很可能会越来越难【新冠报道】

IMAGINE HAVING two critically ill patients but just one ventilator. That is the choice which could confront hospital staff in New York, Paris and London in the coming weeks, just as it has in Lombardy and Madrid. Triage demands agonising decisions. Medics have to say who will be treated and who must go without: who might live and who will probably die.
想象这样的情景:有两名危重病人,但只有一台呼吸机。这就是未来几周纽约、巴黎和伦敦的医务人员可能面临的选择,就如同之前伦巴第和马德里的情形。分诊时就要做出非常痛苦的选择。医务人员必须决定谁可以获得治疗,谁不能收治——也就是选择谁有可能活,谁很可能死。

The pandemic that is raging across the world heaps one such miserable choice upon another. Should medical resources go to covid-19 patients or those suffering from other diseases? Some unemployment and bankruptcy is a price worth paying, but how much? If extreme social distancing fails to stop the disease, how long should it persist?
正在全球肆虐的这场大流行病把一个又一个这样的悲惨抉择堆叠在人们面前。医疗资源该用于新冠病人还是其他疾病的患者?一定程度的失业和破产是值得付出的代价,但该有多大?如果极端社交隔离的做法无法遏制疫情,这样的措施还应持续多久?

The governor of New York, Andrew Cuomo, has declared that “We’re not going to put a dollar figure on human life.” It was meant as a rallying-cry from a courageous man whose state is overwhelmed. Yet by brushing trade-offs aside, Mr Cuomo was in fact advocating a choice—one that does not begin to reckon with the litany of consequences among his wider community. It sounds hard-hearted but a dollar figure on life, or at least some way of thinking systematically, is precisely what leaders will need if they are to see their way through the harrowing months to come. As in that hospital ward, trade-offs are unavoidable.
纽约州州长安德鲁·科莫(Andrew Cuomo)已宣称:“我们不会用钱衡量人命。”纽约州深陷疫情,这是勇敢的州长发出的团结呼号。然而,科莫没有权衡利弊,实际上就是在提倡一种选择,根本没考虑它会给更广泛社群带来的一系列后果。虽然用钱衡量人命听起来铁石心肠,但领导者如果想要熬过接下来几个月的艰难痛苦,恰恰将需要这么做,或者至少需要某种系统性的思维。就像在病房里,取舍将难以避免。

Their complexity is growing as more countries are stricken by covid-19. The tally of reported cases is now nearing 1.3m. America has logged over 300,000 cases and has seen nearly two times more deaths than China. On March 30th President Donald Trump warned of “three weeks like we’ve never seen before”. The strain on America’s health system may not peak for some weeks. The presidential task-force has predicted that the pandemic will cost at least 100,000-240,000 American lives.
随着越来越多国家遭受疫情打击,这种取舍正变得愈加复杂。全球报告的病例总数已接近130万。美国报告的病例已经突破30万,死亡人数是中国的近三倍。3月30日,特朗普警告称,“未来三周会是我们前所未见的”。美国医疗系统承受的压力可能要在几周后才达到峰值。白宫新冠肺炎特别工作组预测,这场大流行病将至少夺去10万至24万美国人的性命。

Just now the effort to fight the virus seems all-consuming. India declared a 21-day lockdown starting on March 24th. Having insisted that it was all but immune to a covid-19 outbreak, Russia has ordered a severe lockdown, with the threat of seven years’ prison for gross violations of the quarantine. Some 250m Americans have been told to stay at home. Each country is striking a different trade-off—and not all of them make sense.
近日各国似乎已全身心投入抗疫。印度宣布从3月24日开始实施为期21天的封城。俄罗斯之前坚称自家无疫情,现在也已下令实施严厉的封城措施,威胁对严重违反隔离措施者判处七年监禁。大约2.5亿美国人被要求待在家中。每个国家都有不同的权衡取舍,并非所有都合情合理。

In India the Modi government decided that its priority was speed. Perhaps as a result it has fatally bungled the shutdown. It did not think about migrant workers who have streamed out of the cities, spreading the disease among themselves and carrying it back to their villages. In addition, the lockdown will be harder to pull off than in rich countries, because the state’s capacity is more limited. India is aiming to slow its epidemic, delaying cases to when new treatments are available and its health-care system is better prepared. But hundreds of millions of Indians have few or no savings to fall back on and the state cannot afford to support them month after month. India has a young population, which may help. But it also has crowded slums where distancing and handwashing are hard. If the lockdown cannot be sustained, the disease will start to spread again.
在印度,莫迪政府认定速度是要务。也许就因为这样,其停摆措施完全搞砸了。政府没想到已经涌出城市的外来务工者会相互传染,并把病毒带回自己的村庄。而且,相比富裕国家,印度较难成功实施封锁,因为它的政府能力更有限。印度的目标是减缓疫情传播速度,拖慢病例增长,直至新疗法出现且医疗体系有了更充分的准备。但几亿印度人积蓄无几,难以支撑,政府也无法负担月复一月地援助他们。印度的人口年轻,这也许有所帮助。但它也有许多拥挤的贫民窟,那里难以做到保持社交距离和勤洗手。如果封城无法持续,病毒又将再度传播起来。

Russia’s trade-off is different. Clear, trusted communications have helped ensure that people comply with health measures in countries like Singapore and Taiwan. But Vladimir Putin has been preoccupied with extending his rule and using covid-19 in his propaganda campaign against the West. Now that the virus has struck, he is more concerned with minimising political damage and suppressing information than leading his country out of a crisis. That trade-off suits Mr Putin, but not his people.
俄罗斯的取舍不一样。在新加坡和台湾等地,政府发布的信息清晰可信,有助于确保人们遵守防疫措施。但普京则是一门心思要实现连任,还要利用疫情在宣传战中打击西方。现在疫情已在俄罗斯爆发,但比起带领国家摆脱危机,普京更关心的是尽可能减轻政治损害和压制信息。这种取舍符合普京而不是俄罗斯人民的利益。

America is different, too. Like India, it has shut down its economy, but it is spending heavily to help save businesses from bankruptcy and to support the income of workers who are being laid off in devastating numbers.
美国也不同。跟印度一样,美国已经让经济停摆,但正在斥巨资救助企业免于破产,并向为数惊人的失业者提供收入支持。

For two weeks Mr Trump speculated that the cure might be worse than the “problem itself”. Putting a dollar figure on life shows he was wrong. Shutting the economy will cause huge economic damage. Models suggest that letting covid-19 burn through the population would do less, but lead to perhaps 1m extra deaths. You can make a full accounting, using the age-adjusted official value of each life saved. This suggests that attempting to mitigate the disease is worth $60,000 to each American household. Some see Mr Trump’s formulation itself as mistaken. But that is a comforting delusion. There really is a trade-off, and for America today the cost of a shutdown is far outweighed by the lives saved. However, America is fortunate to be rich. If India’s lockdown fails to stop the spread of the disease its choice will, tragically, point the other way.
之前两周,特朗普一直推测称对策可能比“问题本身”更糟糕。用金钱衡量生命后,显示他是错的。暂停经济会造成巨大的经济损失。模型表明,任由新冠肺炎在全体国民中传播造成的经济损失更小,但预计死亡人数可能会再增加100万。根据官方发布的被救回的每条生命的价值(按年龄调整),大家可以算个总账。计算表明,疫情减缓措施对每个美国家庭的平均价值是六万美元。有人认为特朗普的折算本身就是错的,但这不过是一种宽慰人心的错觉。这里头确确实实存在取舍,而就美国目前的情况而言,被挽救的生命价值远远超过经济停摆付出的代价。所幸美国是个富裕国家。同样选择封城的情况下,印度也许不能阻止疫情蔓延,美国却会艰难地获得成功。

Wherever you look, covid-19 throws up a miasma of such trade-offs. When Florida and New York take different approaches, that favours innovation and programmes matched to local preferences. But it also risks the mistakes of one state spilling over into others. When China shuts its borders to foreigners almost completely, it stops imported infections but it also hobbles foreign businesses. A huge effort to make and distribute covid-19 vaccines will save lives, but it may affect programmes that protect children against measles and polio.
放眼望去,病毒所到之处都掀起了这股艰难取舍的雾瘴。佛罗里达州和纽约州采取了不同的应对思路,这有利于寻找符合本地需要的防疫创新和举措。但也存在风险:一个州的错误可能祸及其他州。中国几乎全面禁止外国人入境后,挡住了外来感染,但也牵绊了外国企业。大力研制和分发新冠肺炎疫苗将挽救生命,但也可能影响到儿童接种麻疹和小儿麻痹疫苗的计划。

How should you think about these trade-offs? The first principle is to be systematic. The $60,000 benefit to American households, as in all cost-of-life calculations, is not real cash but an accounting measure that helps compare very different things such as lives, jobs and contending moral and social values in a complex society. The bigger the crisis, the more important such measurements are. When one child is stuck down a well the desire to help without limits will prevail—and so it should. But in a war or a pandemic leaders cannot escape the fact that every course of action will impose vast social and economic costs. To be responsible, you have to stack each against the other.
该如何考量这些取舍?第一个原则是要有系统性。跟在所有生活成本计算中一样,平均每个美国家庭六万美元的价值不是真实的现金,而是一种会计指标,帮助人们比较一个复杂社会中非常不同的事物,如生命、工作,以及相互抵牾的道德和社会价值观等。危机越大,这种衡量就越重要。当一名小孩被困在井里,人们都会选择不惜一切代价把他救出,也理应如此。但在战争或大流行病中,领导者无法逃避这样一个事实:每一种行动方案都将造成巨大的社会和经济代价。要负起责任,就必须把一种方案与其他方案权衡比较。

Hard-headed is not hard-hearted
冷静思考不是铁石心肠

A second principle is to help those on the losing side of sensible trade-offs. Workers sacked in forced shutdowns deserve extra help; children who no longer get meals at schools need to be given food. Likewise, society must help the young after the pandemic has abated. Although the disease threatens them less severely, most of the burden will fall on them, both today and in the future, as countries pay off their extra borrowing.
第二个原则是要为在明智合理的取舍中被牺牲的一方提供援助。在停工令下遭裁员的劳动者应该得到额外援助;要为因停课无法在学校用餐的孩子提供食物。同样,在疫情消退后,社会也必须向年轻人提供帮助。尽管新冠肺炎对他们的威胁相对不那么严重,但各国要偿还因疫情而产生的额外债务,眼前和将来的大部分负担都会落在他们身上。

A third principle is that countries must adapt. The balance of costs and benefits will change as the pandemic unfolds. Lockdowns buy time, an invaluable commodity. When they are lifted, covid-19 will spread again among people who are still susceptible. But societies can prepare in a way that they never did for the first wave, by equipping health systems with more beds, ventilators and staff. They can study new ways to treat the disease and recruit an army of testing and tracing teams to snuff out new clusters. All that lowers the cost of opening up the economy.
第三个原则是国家必须随机应变。随着疫情不断发展,成本与效益之间的平衡将发生变化。封城能赢得非常宝贵的时间。封城解除后,新冠肺炎将再次在依然易感的人群中传播。但通过给医疗系统配备更多病床、呼吸机和医护人员,各地社会可以做好准备,不像在第一波疫情时那样兵荒马乱。各国可以研究治疗这种疾病的新方法,招募大批人员组建检测和追踪工作组,以扼杀新的感染集群。所有这些都会降低重启经济的成本。

Perhaps, though, no new treatments will be found and test-and-trace will fail. By the summer, economies will have suffered double-digit drops in quarterly GDP. People will have endured months indoors, hurting both social cohesion and their mental health. Year-long lockdowns would cost America and the euro zone a third or so of GDP. Markets would tumble and investments be delayed. The capacity of the economy would wither as innovation stalled and skills decayed. Eventually, even if many people are dying, the cost of distancing could outweigh the benefits. That is a side to the trade-offs that nobody is yet ready to admit. ■
然而,也可能找不到新的治疗方法,检测和追踪也败下阵来。到今年夏天,各经济体的季度GDP将出现两位数的下降。届时人们已经忍受了几个月的闭门不出,社会凝聚力和他们的心理健康也因而受损。如果封城长达一年,美国和欧元区的GDP将损失约三分之一。市场将暴跌,投资被延迟。随着创新停滞和技能衰退,经济产能将萎缩。最终,哪怕会有很多人死去,隔离措施可能还是弊大于利。目前还没有人准备好接受取舍中的这一面。