想撲滅埃博拉 還需藉助老辦法

In west Africa today, as in early 20th-century Manchuria or England at the time of the Black Death, travellers are often unwelcome. When eight healthcare workers and journalists showed up at a village near Guinea’s second city of Nzerekore in September, they planned to explain how to protect against the Ebola virus that has killed at least 4,500 people this year. Instead they were set upon by locals wielding machetes and clubs. Some of the visitors’ bodies were later found in the village latrine.

和20世紀早期黑死病流行時的滿洲及英國一樣，在今天的西非，旅行者往往不受歡迎。今年9月，8名醫務工作者及記者來到幾內亞第二大城市恩澤雷科雷(Nzerekore)附近的一個村莊，原本計劃告訴村民應採取哪些措施來防範埃博拉病毒（這種病毒今年已導致至少4500人喪生），然而，當地人卻手持大砍刀和棍棒攻擊了他們。後來，人們在村裏的茅坑裏找到了幾個遇難者的遺體。

Joseph Fair, an American virologist who worked in the region in 2004, says the villagers – fearful of Ebola, witchcraft and unknown foreigners “showing up in space suits” – were trying to cut themselves off from the outside world. Self-isolation has been tried before, and sometimes it works. In 1910, as plague was spreading across the mountainous region of northeast China, several towns barred entry to outsiders. Reliable men were deputised to travel to market and return swiftly carrying essential supplies. Pneumonic plague claimed perhaps 60,000 lives in Manchuria that year. But the closed off villages stayed free of the disease.

2004年曾在該地區工作過的美國病毒學家約瑟夫•費爾(Joseph Fair)表示，埃博拉、巫術及“身着‘太空服’出現的”陌生外國人讓村民們心生恐懼，他們正試圖切斷與外界的聯繫。過去，人們嘗試過這種自我隔離措施，有時候這種措施也會奏效。1910年，當鼠疫在中國東北部山區蔓延時，幾個城鎮曾封堵了外人進入城鎮的入口，只派可靠男子代表全城去市場採買必要物資後迅速返回。就在那年，肺鼠疫導致了滿洲或許6萬人喪生。然而，對外封閉的村莊卻沒有感染這種疾病。

The bacteria that cause plague can travel through the air or be passed on in the bite of an infected flea. Ebola is less contagious and therefore less deadly, but there are haunting similarities all the same. Ebola’s long incubation period allows patients to flee outbreaks while still healthy. Plague strikes faster, but it is what bacteriologists call a “stealth infection” – victims feel quite well while the illness silently devastates their bodies. As Giovanni Boccaccio, the Renaissance poet, put it, men ate lunch with their friends and dinner with their ancestors in paradise. A victim might ride for three days before dying. Both diseases thrive on fear and flight.

導致鼠疫的病菌能通過空氣傳播，被受感染跳蚤叮咬也是一種傳播手段。埃博拉傳染性沒有這麼強，從而降低了它的致命性。不過，兩者間還是存在可怕的相似之處。埃博拉的漫長潛伏期令患者能夠在身體仍然健康時逃離疫區。鼠疫的發作要快得多，不過細菌學家稱鼠疫爲一種“隱祕感染”——在疾病悄悄吞噬身體之際，受害者卻感覺良好。正如文藝復興時期的詩人喬萬尼•薄伽丘(Giovanni Boccaccio)所形容的，人們在與朋友吃過午餐之後，再在天堂與先祖享用晚餐。在死亡前，感染者可能會四處活動三天之久。這兩種疾病的傳播還都會因人們的恐懼和逃亡而加快。

For now the best weapons against Ebola are still the oldest: quarantine of the exposed (a word and an idea invented by Italian city states in the 14th century) and isolation of the sick. This, after all, is how plague was eventually stopped in the early 20th century.

就目前而言，對抗埃博拉的最佳武器仍然是最古老的方法：對暴露者實施隔離檢疫(quarantine，這個名詞和這種方法是14世紀意大利各城邦發明的)；對感染者實施完全隔離。畢竟，20世紀早期人們就是用這種辦法最終撲滅鼠疫的。

Wu Lien-teh, the Cambridge-educated physician who co-ordinated the medical response in Manchuria, commanded a corps of 600 police officers backed up by Chinese soldiers. People were forced into quarantine, mostly in the open air where pneumonic plague could not easily spread. Those who showed symptoms were carted off to hospitals to die (in these years before antibiotics, none survived). Infectious bodies littered the streets and Wu applied to the Chinese emperor for permission to burn them, even though the practice went against all Chinese tradition. When cremation began, the epidemic begin to subside.

曾受教於劍橋大學(Cambridge)的伍連德(Wu Lien-teh)醫生曾協調組織了滿洲的醫療應對措施。他曾指揮過一個由600名警官組成的團隊，並得到了中國軍隊的支援。當時，人們被強制實行隔離檢疫，實施場所主要是肺鼠疫不易傳播的露天環境。出現症狀的人們被運往醫院等待死亡（在那個沒有抗生素的年代，沒有人能生還）。當時，感染者遺體被隨意拋在街頭，伍連德爲此曾請求中國皇帝批准焚燒這些遺體——儘管這麼完全違背中國人的傳統。採取屍體火化措施之後，這種傳染病開始消退。

Tender emotions can be deadly in a time of infectious disease. Knowing that plague was fatal, many Manchurians drove out their infected relatives to die on the streets, huddling with other outcasts for warmth. In west Africa, however, Ebola is being spread by love as well as fear. There people are tenderly caring for their dying and their dead. In the absence of proper equipment – masks, gloves, disinfectant – these human offices play a large part in spreading the disease.

在傳染病肆虐的時代，溫情可能是致命的。因爲知道鼠疫是致命的，許多滿洲人都把受感染的親屬趕出家門，讓他們與其他被親人拋棄的病人一起在街上抱團取暖，然後死在街頭。然而，在西非，恐懼和愛都在傳播埃博拉。在西非，人們會悉心照顧那些即將死去和已經死去的病人。由於缺乏口罩、手套、消毒劑等適當防護物資，這種人道善舉在疾病的傳播中起到了巨大作用。

So does flight. The people of Ganta in Liberia, fearing the quarantine imposed on neighbouring towns and the dead bodies lying in the streets, left in August by the hundreds. They piled into taxis or clung to motorbikes carrying food – and no doubt Ebola too.

逃亡也起到了巨大作用。今年8月，幾百名利比里亞甘塔的居民逃離了該市，原因是相鄰的城鎮被隔離檢疫以及街頭出現倒伏的屍體讓他們感到恐懼。他們成羣地擠上出租車或摩托車逃亡，攜帶着食品——當然還有埃博拉病毒。

It is unlikely that vaccines and experimental drugs can save west Africa from Ebola. We need to apply the old methods that broke the Manchurian plague, with the sensitivity that is needed if they are to succeed today. Humanity, in the end, is what will overcome this plague of the modern world.

目前，用疫苗和實驗性藥物讓西非擺脫埃博拉魔爪的可能性不大。我們必須採取當年曾撲滅滿洲鼠疫的古老方法，並加以人性的態度，要讓古老方法在當今世界取得成功，這種態度是必須的。說到底，消滅這種現代版“鼠疫”還是要靠人道主義。