Humankind has made so much progress in bending nature to our will that we sometimes forget our own place in it. The history of pandemics shows that the proverbial fourth horseman of the apocalypse – pestilence – can never be vanquished, only contained.
為了自身利益，人類在扭曲自然上作過如此多的努力，甚至有時都忘了我們人類正置身於其中。大瘟疫的歷史正告訴我們，啟示錄中的第四騎士"瘟疫"永遠無法被消滅，僅僅只能遏制。來源：Frank M. Snowden, Mark Honigsbaum, Project Syndicate, 10 APR, 2020, 原文網址
In 1969, the US surgeon general, William H. Stewart, told Congress that it was time “to close the books on infectious diseases” and “declare the war against pestilence won.” Antibiotics, vaccines, and widespread advances in sanitation were making the world healthier than ever. Within a few years, the medical schools at Harvard and Yale actually closed their infectious-disease departments. By then, polio, typhoid, cholera, and even measles had essentially been eradicated, at least in the West.
1969年，美國衛福部醫務總長威廉史都華告訴國會："傳染病的時代已經終結"、"可以宣稱對抗瘟疫的戰爭已經勝利"。抗生素、疫苗以及公共衛生的長足進步使的世界較以往的任何一個時代還更要健康。在短短幾年內，哈佛與耶魯的醫學院真的關閉了他們的傳染病學系。那時候，至少就西方世界來說，小兒麻痺、傷寒、霍亂甚至是麻疹基本上都已經絕跡。
But triumphalism was not only premature; it was dangerously foolhardy. The HIV/AIDS epidemic broke out in the United States just a decade later, and never has been vanquished. Then, following a short lull in the 1990s, came SARS, MERS, Ebola, Zika, and avian and swine flu, to name just a few of the outbreaks so far this century. Though most of these new diseases have primarily afflicted the poorest parts of the world, they should have made clear that the war on microbes was far from over.
但是這種自以為勝利的驕傲不只是言之過早，還是危險魯莽的。AIDS病毒在美國的爆發只是10年前左右的事，而這始終無法絕跡。然後經過90年代的短暫平靜，這個世紀至今已經可以舉出SARS, MERS, 伊波拉、茲卡、禽流感與豬流感等等的傳染病大爆發。即使大多數這些新出現的疾病基本上都在折磨世界上貧窮落後地區的人們。這也證明了對抗微生物的戰爭要距離盡頭還很遙遠。
Nonetheless, a sense of invulnerability has prevailed in the West. It was assumed that even if epidemics had not been consigned to history, they posed a risk only to geographically and economically distant societies. The novel coronavirus that emerged in Wuhan, China in December has shattered this illusion, showing once again that novel pathogens are equal-opportunity killers.
儘管如此，在西方大家仍舊覺得世道一帆風順。大家都以為就算瘟疫大流行還不能算是過往的雲煙，至少它只對地理上與經濟上相對遙遠的社會產生危險。在去年12月由中國武漢出現的新型冠狀病毒打碎了這種幻象，再次顯示出新型病原體對全人類的殺傷力是完全平等的。
After initially deceiving ourselves that COVID-19 would remain just another Asian health crisis, the entire world is now grappling with a runaway pandemic. Suddenly, public-health authorities everywhere are trying to flatten the contagion curve with quarantines, travel bans, and unprecedented society-wide lockdowns, while governments and central banks try desperately to flatten the recession curve with unprecedented stimulus packages.
在一開始自欺欺人的以為COVID-19(下稱武漢肺炎)還只不過又是一個侷限於亞洲的公衛危機，現在全世界都在應戰此失控的瘟疫大流行。突然間，各國的衛生當局皆以隔離檢疫、旅遊禁令與前所未有的封城措施致力於壓低傳染人數，與此同時，各國政府與央行也絕望的以前所未有的大灑幣方案刺激陷入衰退的經濟。
Disease and Denial
疾病入侵與人類抵禦
One lesson is already clear: Even in the richest, most advanced economies, humans are still humans, which means they are vulnerable to new microbial threats, particularly zoonotic infections (diseases that spread from non-human animals) resulting from natural evolution and facilitated by human activities. As two recent histories of pandemics show, it is always only a matter of time before a virus, bacterium, or parasitic organism makes the leap from some non-human species to our own.
有一件事情已經很明白了：即使是最富裕的、最先進的經濟體，人畢竟是血肉之軀，這代表人類依舊受到微生物的健康威脅，特別是自然演化與人類活動所導致的人畜共通之傳染病（病原為動物者）。由最近兩起瘟疫流行的例子看來，病毒、細菌或寄生蟲疾病由禽畜演化為能傳染給人類往往只是時間問題而已。
Ebola, for example, came from chimpanzees, just as bubonic plague emerged from rats and COVID-19 (most likely) from bats. And, in addition to worrying about new microbes, we also must worry about older ones. Owing to antigenic mutations, malaria and tuberculosis, once almost defeated, have reemerged in drug-resistant forms.
例如由黑猩猩身上來的伊波拉病毒，就如同黑死病由老鼠、武漢肺炎由蝙蝠來的一樣。除了要擔心新的病毒外，連舊的也都還不能掉以輕心。由於抗原的不斷突變，曾經幾乎要絕跡的瘧疾與肺結核又以藥石罔效的威力捲土重來。
In Epidemics and Society, the Yale University historian Frank M. Snowden shows why the West’s complacency was never justified. Far from being the exclusive preserve of “backward” societies, deadly disease outbreaks are, if anything, a negative byproduct of human progress. By altering ecosystems and erasing natural frontiers, humans have continuously exposed themselves to germs, viruses, and bacteria that evolve to exploit their vulnerabilities. The push of economic development has brought more opportunities for humans and animals to intermingle, and globe-spanning trade has established new routes for the propagation of disease.
在"瘟疫與社會"一書，耶魯大學歷史學者斯諾登就說明了為何西方的驕傲自滿毫無道理。致命傳染病的爆發絕非落後社會的特有產物，而是人類文明進步下的副產品（如果有的話）。透過改變整個生態系統、抹消與自然的界線，人類一直暴露在不斷針對人類弱點而演進的細菌、病毒的威脅下。經濟發展使人畜混雜的機會更增，而全球貿易更建立了新的傳染病的散播途徑。
In recorded history, the battle between humans and microbes has essentially been a fight between reason and superstition. For centuries, human societies felt powerless in the face of pandemics, so they resorted to religious rituals to placate some supposedly irate god. When science eventually triumphed over religion, one illusion was replaced by another. We convinced ourselves that we were the gods, capable of conquering nature and the microbial world.
有史以來，人類與微生物的戰爭實質上就是理性與迷信的較量。有好幾個世紀的時間，人類社會面對瘟疫根本毫無招架之力，所以他們就採用各類宗教儀式來安撫那些發怒的神明。當科學終於佔上風的時候，又有另一個幻象出現了。那就是我們相信我們有神的力量，有能力征服自然與微生物了。
By examining this long and painful learning process, we can better understand why the world was so unprepared for the current crisis. Snowden confidently takes the reader on a wide-ranging journey, tracing the history of the major pandemics that have afflicted the world – from bubonic plague, smallpox, and cholera to tuberculosis, malaria, polio, HIV, and Ebola. Snowden’s goal is to show how humanity learned to tame infectious diseases through the creation of public-health systems and the progress and dissemination of medical knowledge.
藉由審視這個漫長與痛苦的學習過程，我們才能更明白為何當今世界對於目前的危機是如此的毫無準備。斯諾登好整以暇的帶領此書讀者進入歷史的世界，追跡幾個對世界危害甚深的瘟疫爆發事件 - 從黑死病、天花、霍亂與肺結核、瘧疾、小兒麻痺、愛滋病與伊波拉。斯諾登的目的在於闡明人類是如何學習透過創見公共衛生系統與醫療知識的進步與傳播，以馴服勢如猛獸的傳染病。
This has been a constant struggle, in part because each infectious disease has been unique. For some, the key trait was their contagiousness; for others, it was their deadliness. Some were bacterial, others viral or parasitic. Some were transmitted by air, others through contaminated water or vectors like fleas, mosquitoes, and lice.
這總是一段又一段的苦戰，有時是因為每個傳染病都有其獨特性。對有些傳染病來說，關鍵在於其傳染力。對另一些來說則是其致命性。有些致病體是細菌，另外還有病毒與寄生蟲。有些透過空氣傳播，而其他可能透過污染的水或是其他如跳蚤、蚊子與蝨子的途徑傳染。
What they all shared was the ability to inflict severe suffering on humans and cause far-reaching disruption of entire societies. Infectious diseases have a unique capacity to fuel anxiety, fear, mass hysteria, and outbursts of religiosity (especially in the past). They pose a direct challenge to social cohesion and solidarity, and thus to a society’s ability to manage collective crises.
他們的共通之處在於對人類造成的極大殺傷力與對社會造成的廣泛破壞。傳染病會使人焦慮、害怕、群體歇斯底里以及刺激以宗教為名的暴亂（特別是在歷史上）。它們直接挑戰社會的凝聚力與團結程度，與這個社會應對如此共同危機的反應能力。
Peak Pandemic
瘟疫蔓延的巔峰
Of all the landmark infectious outbreaks that Snowden analyzes, the bubonic plague remains the most emblematic for its epidemiology, persistence, and effects on society. Even more to the point, it permanently influenced how health authorities deal with infectious diseases.
在斯諾登分析的所有指標性大流行傳染病中，黑死病以其巨大的感染力、持續力、與對社會的影響力仍是最具代表性的瘟疫。更有甚者，它永久的影響了公衛單位如何處理傳染病的方式。
Remembered for its virulence, lethality, and horrifying clinical manifestations, the plague killed 50% of those infected within days of the onset of symptoms. And, unlike polio, measles, mumps, and other diseases that tend to strike children and the elderly, the plague targeted adults in the prime of life, leaving behind many widows and orphans – and thus magnifying the economic, demographic, and social dislocations.
回憶一下它的毒性、致命力與恐怖的臨床症狀，黑死病在症狀出現的數天內即可殺害50%的感染者。此外，與小兒麻痺、麻疹、腮腺炎等疾病專攻孩童或老人不同，黑死病襲擊的對象是正直壯年的人，使的許多寡婦與小孩出現。而正因如此加劇了經濟、人口與社會的動盪不安。
Moreover, the plague is the only highly infectious disease that has continuously ravaged the world throughout the last 1,500 years, accompanying humanity from the age of religious superstition into the age of scientific hubris. It usually emanated from Africa or Asia and then spread to Europe and America with the help of globetrotting merchants. Recurring epidemic waves lasted for decades or even centuries.
此外，黑死病是唯一過去1500年間持續在全世界肆虐的傳染病。從人類還在宗教愚昧時期要直到科學萬能時期都一直歷久不衰。它通常起源於非洲或亞洲，透過全球行腳的商隊散播到歐洲與美洲。反覆間斷不絕的疫情常持續數十年至數百年。
The Black Death, for example, wiped out up to one-third of the European population between 1334 and 1372, and then returned intermittently until as recently as 1879. Meanwhile, the other infectious diseases that emerged during this period – from syphilis in the 1490s to cholera in 1830 – ran in parallel with it.
例如，黑死病在1334年至1372年間消滅了歐洲三分之一的人口。一直到1879年都還有斷斷續續的再出現。與此同時，其他的傳染病也在此段期間出現 - 1490年代的梅毒與1830年代的霍亂 - 同時肆虐著。
For centuries, Europeans believed that the plague was sent by an angry deity as punishment for disobedience and sin. To placate divine wrath, communities often sought to scapegoat and cast out the supposed sinners, be they prostitutes, Jews, religious dissenters, foreigners, lepers, beggars, or accused witches.
有幾個世紀的時間，歐洲人相信瘟疫是憤怒的神明因為人類的犯下的罪孽與違背神的旨意所降下的天罰。為了使神明息怒，許多社群常會找出代罪羔羊，並趕走被認定是有罪的人，像是妓女、猶太人、宗教異端、異族、不受歡迎的人、乞丐與被指控是女巫的人。
During the plague years of the fourteenth and fifteenth centuries, towns across Europe closed themselves off to outsiders and hunted down anyone within their walls who was deemed undesirable. Those who were apprehended were stoned, lynched, and burned at the stake.
在瘟疫肆虐的14與15世紀，歐洲大陸上的許多城鎮都對外界封閉，且在內部抓捕那些不受歡迎的人。那些被捕的人下場是被石頭砸死、私刑吊死或火刑燒死。
A less cruel response focused on propitiating the angry god through penitence. A typical example was the outdoor procession to a holy shrine amid rogations and confessions, like those organized by the Flagellants who traveled across Europe before being persecuted by the Inquisition.
懺悔對於平息神怒是個比較不殘忍的手段。一個典型的例子是在不停的祈禱與懺悔中在戶外遊行至一個神聖祭壇。像那些後來被宗教裁判所迫害的、曾縱橫整個歐洲大陸的極端自殘主義者。
In other cases, afflicted communities resorted to the cult of saints who were supposed to intercede with God on behalf of suffering humankind. In recognition of Mary’s intervention to end the plague in 1631, for example, the city of Venice built the monumental church of Saint Mary of Health at the entrance to the Grand Canal.
在其他情況下受創的社群會訴諸於崇拜神棍，那些神棍被視為是能代表受苦的人類與神明溝通的管道。例如在1631年，為了表彰聖母瑪利亞阻止了瘟疫的蔓延，威尼斯在大運河的入口處建造了安康聖母聖殿。
Religious fanaticism clearly was not enough to defeat the plague, given its continuous recurrence. But other anti-plague measures, many of them draconian, represented some of the first institutionalized forms of public-health policy.
有鑑於瘟疫的一再捲土重來，宗教狂熱無助於擊敗疫病這點毋庸置疑。但是其他的反制手段可視為是最初有組織形式的公共衛生政策，當然其中有許多未免失之殘酷。
During the Black Death, Italian cities pioneered plague regulations that cloaked health authorities with emergency powers and facilitated coordination between the army and the bureaucratic apparatus. Within cities, the ill were isolated in pest-houses or locked in their homes with guards at the doorstep. The military was delegated to isolate the population with sanitary cordons to prevent the inflow of disease-carrying people and goods. Venice was the first city to quarantine ships and their crews.
在黑死病肆虐期間，義大利城市首先制定疫情管理法規讓公衛機關具備緊急權力，與協調指揮軍隊與官僚體系的能力。在城市間，疫病被集中隔離在瘟疫房或關在病人家中，並派有守衛在門口盯梢。軍隊的任務是以衛生警戒線隔離人群，避免帶有疫病的人群或貨物進入。威尼斯是首先對船隻與水手進行隔離檢疫的城市。
In the event, these early anti-plague policies marked a key moment in the emergence of the modern state. Deadly outbreaks justified top-down measures to control the economy and the population through forcible detention, surveillance, and the suspension of liberties. The same containment and social-distancing measures would remain the first line of defense against almost any infectious disease, from cholera and yellow fever to HIV and Ebola. And though these policies were not always appropriate or effective, they conferred an image of decisive leadership on rulers.
結果，這些早期的瘟疫反制措施象徵著現在國家崛起的關鍵時刻。致命的瘟疫讓由上而下的經濟與人民管制措施，如：強制拘留、監控與自由的限縮成為理所當然之事。同樣的隔離與社交距離手法依然是對抗幾乎是所有傳染病的第一線防護措施。從霍亂、黃熱病一直到愛滋病與伊波拉都是如此。即使這些措施並不總是適當或有效的，它們給了統治者果敢領導 的形象。
Scientific Hubris
科學萬能論
Despite the prevailing superstitions, our ancestors understood that the plague was transmitted from person to person, and that isolation was necessary to contain the contagion. Still, they did not know what caused the disease. For centuries, doctors, influenced by the so-called miasma theory, believed that “bad air” emanating from rotting organic matter was the source of sickness.
就算是迷信大行其道的時代，我們的祖先也明白瘟疫是人傳人的，採取隔離手法遏制疾病傳染是必要的。他們仍然不知道疾病的起因。有好幾世紀的時間，被所謂的瘴氣理論所影響的醫生，相信腐敗的有機物所產生的"有害氣體"是疾病的成因。
Only in the eighteenth and nineteenth centuries did physicians begin to understand what was really happening beneath the surface. The invention of the microscope led to the germ theory of disease, which identified microorganisms – not miasma – as the source of infection. In the case of the plague, the culprit was the bacterium Yersinia pestis, which was carried by fleas living on the black rats that were a constant presence in the crowded cities and merchant ships of the time.
一直到18, 19世紀，醫生們才開始抽絲剝繭了解真正的原理。顯微鏡的發明導致了細菌致病論的出現，這識別出傳染的來源是微生物，而不是瘴氣。以黑死病為例，罪魁禍首是住在黑鼠身上跳蚤的鼠疫桿菌，而黑鼠在當時在人口密集的大城市與商船上十分常見。
The emergence and widespread acceptance of germ theory represented a turning point in the fight against infectious disease, ushering in a medical revolution and the creation of entire new fields such as microbiology, immunology, parasitology, and tropical medicine. By the mid-twentieth century, the most prevalent and aggressive infections were in retreat, thanks to the discovery of vaccines and antibiotics, higher living standards, and improved hygiene.
細菌論的發展與廣泛獲得接受代表了對抗傳染病的一個重大轉折點，這引發了一場醫學大革命，許多新的研究領域如：微生物學、免疫學、寄生蟲學與熱帶醫學等因此而出現。到了20世紀中，幸虧有疫苗與抗生素的發現、生活水準的提昇與衛生條件的改善，感染力與侵略性最強的傳染病都在消退。
Vaccination alone reduced the incidence of smallpox, diphtheria, tetanus, rubella, measles, mumps, and polio to such a radical degree that these diseases have been largely forgotten. The chemical DDT was poised to eradicate malaria and other insect-borne pathogens until it was found to be carcinogenic. And cholera was more or less knocked out by sand filtration and the chlorination of water.
單單只靠疫苗就可以減少天花、白喉、破傷風、德國麻疹、麻疹、腮腺炎和小兒麻痺症的發生率到讓大多數人遺忘這些疾病的極端程度。一直到發現DDT致癌為止，這個化學藥劑已用來大量撲滅瘧疾與其他昆蟲傳播的傳染病。而沙濾與加氯消毒等飲水淨化方式則已大致上擊敗霍亂。
In The Pandemic Century, a vivid account of the scientific community’s fight against viruses over the last century, the science journalist Mark Honigsbaum shows how these achievements produced a sense of mastery over the microbial world. After centuries of suffering at the hands of capricious gods, humanity suddenly began to develop seemingly divine powers of its own.
"瘟疫大流行的世紀"一書是一本生動紀載著科學家們在上個世紀與病毒的激戰歷史，科普記者馬克霍尼格斯鮑姆指出，這些成就是如何產生出一種已可徹底掌控微生物世界的成就感。好幾個世紀間都被反覆無常的神明玩弄在股掌上受苦的人類轉瞬間開始發展出了近乎是神佛之力。
But with that realization came hubris. In 1948, US Secretary of State George Marshall confidently declared that humanity was about to eradicate infectious diseases from the Earth. To his generation, microbes were seen as static or slowly evolving, geographically constrained, and thus eminently manageable. Old diseases were being wiped out, and few stopped to consider that new ones might arise.
但是隨著科學的發現變成了驕傲自滿。1948年美國國務卿喬治馬歇爾斬釘截鐵的宣稱人類將要把傳染病在地球上根除。對他那個世代的人而言，微生物看來似乎靜止不變或是演變得極為緩慢，也受限於地理空間，因此十分易於管理。古時的疾病已被消滅，而極少人停下來想想是否會有新的傳染病產生。
As is obvious to us now, this idea of microbial fixity – that there can be only so many diseases – was misplaced. Since 1940, scientists have identified 335 new infectious diseases, two-thirds of which originate in wildlife, particularly bats. Familiar examples include Lassa fever, Marburg virus, Lyme disease, Rift Valley fever, West Nile virus, SARS, MERS, Nipah virus, and Ebola, but there are many, many more.
當然現在對我們來說事情再明顯不過，微生物是一成不變的 - 疾病就只有哪些種類的概念是錯誤的。1940至今，科學家已經識別出了335種新的傳染病，其中有三分之二起源於大自然，特別是蝙蝠。著名的例子包含拉薩熱、馬堡病毒、萊姆病、裂谷熱、西尼羅河病毒、SARS、MERS、立百病毒與伊波拉，但其實還有許多病毒、難以勝數。
Whenever dangerous pathogens are defeated, it is only a matter of time before others take their place. New diseases are the inevitable condition of living in a dynamic world. Human beings are part of an immensely complex ecological system. Bacterial and viral infections can lie dormant in tissue and cells – or under now-melting permafrost – for decades before being reactivated by a sudden shock to the system, or through co-infection with another microbe.
每當有個危險的傳染病被擊敗了，下一個新的傳染病爆發只不過就是時間的問題。在這樣流通的世界，出現新的傳染病是無可避免的。人類也只不過是這麼廣闊複雜的生態系統的一小部份。具感染力的細菌與病毒可以蟄伏在組織與細胞中 - 或是正在融化的永凍土層下 - 達數十年時間，直到系統突然產生巨變，或是透過其他微生物一併發揮其感染力。
In 2013, for example, Simon Anthony of Columbia University and his team discovered that the number of novel viruses in all mammalian species could be around 320,000, with bats being the most common carriers because they live in large communities, travel long distances, and are widespread throughout the world. The line that divides infectious from chronic diseases is also increasingly blurred. Papillomavirus, for instance, is the primary cause of a number of cancers affecting both men and women.
例如在2013年，哥倫比亞大學的西蒙安東尼與他的團隊發現了在所有哺乳動物類中的新病毒數量約在32萬左右，蝙蝠之所以是最為普遍的病毒宿主主要由於它們的群體數量大、移動距離長而且廣泛居住在世界各地。傳染病與慢性病的分隔界線也逐漸變得模糊。例如乳突病毒就是數種男女共通癌症的主因。
Moreover, according to a 2016 report by the US National Academy of Medicine, “the underlying rate of emergence of infectious diseases appears to be increasing.” Many more diseases are emerging from animal reservoirs and ecological niches that used to be far removed from human populations. Demographic growth, climate change, crowded cities, persistent poverty, and global trading routes continue to disrupt fragile ecological equilibriums and expose humanity to the threat of new killer pathogens.
更有甚者，根據2016年美國國家醫學研究所的報告，"潛在的傳染病出現機率似乎正在增加。"有更多疾病由動植物的保留區或生態區中發展出來，這些地方原本應該都是極為遠離人群的。然而人口的成長、氣候的變遷、擁擠的城市發展、長期貧困的情況與全球貿易網絡持續擾亂脆弱的生態平衡並且讓人類暴露在新型傳染病殺手的威脅之下。
Proceed with Caution
戒慎恐懼
In Epidemics and Society, Snowden points to a 1998 report from the US Department of Defense warning that, “Historians in the next millennium may find that the twentieth century’s greatest fallacy was the belief that infectious diseases were nearing elimination. The resultant complacency has actually increased the threat.” Just two decades later, that prediction has been borne out, with rich and poor countries alike brought to their knees by a coronavirus pandemic.
在"瘟疫與社會"中，斯諾登指出1998年從美國國防部有份報告警告說："下個世紀的歷史學家可能會發現20世紀最大的謬誤就是傳染病幾近根絕。由此產生驕傲自滿實質上增加了其威脅。"只不過20年後，此預言即已成真，國家無論貧窮或富裕都不得不在武漢肺炎的肆虐下低頭。
That said, it is not the scientific community that bears all of the blame for our miscalculations. After the exuberance of the 1960s and 1970s proved untenable, virologists, epidemiologists, international organizations, and non-governmental organizations have understood that pandemics are still an acute threat. In 2015, the philanthropist Bill Gates sounded the alarm about the world’s lack of preparedness for a flu pandemic. But policymakers and business leaders were too busy reaping the fruits of unfettered globalization to heed the warnings.
也就是說，要為此誤算擔負起責任的並非科學領域的人。在1960, 1970年代的科學昌盛證明是無法持續有用時，病毒學者、流行病學者、國際組織與非政府組織都已經對流行病依舊是嚴重威脅此事了然於胸。在2015年，大善人比爾蓋茲為世界對流感的缺乏準備敲響警鐘。但是政客與商人正忙著採收毫無節制的全球化的美味果實，對此警告充耳不聞。
To be sure, no other recent epidemic has threatened global health and the economy on the scale that COVID-19 has. The World Health Organization did warn in 2009 that the swine flu (H1N1) met the criteria for a pandemic virus. But the risk of global disruption did not materialize. Similarly, in 2003, SARS was expected to become a new influenza pandemic, but that turned out to be a false alarm. While a single sneeze can set a pandemic in motion, the intra-species contingencies are complex, making large-scale pandemics low-probability events.
可以肯定的是，沒有一個傳染病對全球的健康與經濟的影響範圍像武漢肺炎一樣。世界衛生組織在2009年已經對豬流感(H1N1)發布已達到大流行標準的警示。但是這全球性的危害風險並未成真。相似的，在2003年SARS也被認為是將成為新的大流行傳染病，但此事也並未成真。就算一個噴嚏就能引發大流行，實際上物種內的突發機制十分複雜，使得大規模的瘟疫爆發實際上機率相當低。
But low-probability does not mean no probability. The COVID-19 pandemic has exposed our vulnerability and lack of preparedness, underscoring the need for a more cautious approach in the future. As with all infectious outbreaks, its suddenness has sown confusion and chaos. The psychological, economic, and social damage it has inflicted will lead to permanent changes in our economies, politics, and individual lives.
然而機率很低不代表機率為零。武漢肺炎的爆發使我們的弱點與缺乏準備一覽無遺，更突顯了在未來我們必須採取更為謹慎的手段應對。與所有傳染病爆發一樣，它的突如其來造成了混亂。它所造成了心理、經濟、與社會上的損害將導致我們經濟、政治與個人生活的永久不可抹滅的變遷。
New pestilences will emerge without warning in the future. But one hopes we will prepare for them without adopting an apocalyptic mindset or indulging in the scapegoating of the Middle Ages. Living under perpetual pandemic alert would strain our livelihoods and limit our freedoms. And besides, there is a third way. Hubris should defer to humility. Our scientific aspiration should be to understand the microbial world, not to conquer it.
在未來，新的瘟疫出現將不會帶有任何警示。但是可以期待我們將會對其有所準備。而且不是用世界末日的思考方式行事、或是像中世紀一樣只先去找代罪羔羊。持續爆發的瘟疫警報下的生活將會緊縮我們的生計與限制行事的自由。此外，還有第三種方式。不應在驕傲自滿而應回歸謙遜，我們的科學目標應為了解微生物世界而非征服它。
Governments, for their part, should heed the insights that science offers. By adopting more sustainable economic paradigms, strengthening public-health systems, restoring faith in experts, and developing resilience against negative shocks, we can minimize the likelihood of another pandemic-driven global catastrophe.
就政府的角色而言，應該注意科技研究出的洞見。靠著採取更為永續的經濟模式、強化公共衛生系統、恢復對專家學者的信心，與發展抵禦負面衝擊的能力，我們能降低再一次因瘟疫爆發造成全球大災變的可能性。
No matter how deep our understanding of the microbial world, Snowden and Honigsbaum remind us, nature will always furnish viruses, bacteria, and parasites with endowments we didn’t anticipate. After the COVID-19 pandemic has passed, theirs and other books on infectious diseases are likely to remain open for quite some time.
無論我們對微生物世界的所知是如何深刻，斯諾登與霍尼格斯鮑姆提醒我們，自然總能在病毒、細菌與寄生蟲身上放上我們無法預料的威力。在武漢肺炎疫情之後，他們與其他人有關傳染病的書大概還會受到世人矚目好一陣子。
註釋：
Four horsemen of the Apocalypse: 啟示錄第六章紀載，四騎士分別代表：瘟疫、戰爭、饑荒和死亡。
pestilence: 瘟疫
foolhardy: 魯莽
bubonic: 黑死病、鼠疫
antigenic: 抗原
tuberculosis: 肺結核
complacency: 自滿
intermingle:混合
superstition: 迷信
emblematic: 指標性、代表性
dislocation: 錯位
scapegoat: 代罪羔羊
fanaticism: 狂熱主義
draconian: 嚴酷的
miasma theory: 瘴氣理論，有毒、不潔的空氣
beneath the surface: 隱藏起來的
culprit: 罪魁禍首
carcinogenic: 致癌的
capricious: 反覆無常、任性的
eminently: 非常的
bear something out: 證實此點無誤
philanthropist: 慈善家
unfetter: 釋放
set in motion: 啟動、引發
aspiration: 志願
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