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                  印度这个邦曾是“抗疫典范”,现在却沦陷了

                  印度这个邦曾是“抗疫典范”,现在却沦陷了

                  麦甘云(Grady McGregor), Biman Mukherji 2021年09月14日
                  9月9日,喀拉拉邦新增确诊病例占到印度新冠肺炎病例总数的65%。

                  2020年,印度第一波新冠肺炎疫情爆发,南部的喀拉拉邦堪称抗疫典范。当地政府一度将“喀拉拉邦模式”作为全国性的抗疫蓝本。而如今,拥有3500万人口、棕榈环绕的喀拉拉邦却成为了印度新冠疫情的重灾区。

                  9月9日,印度新增新冠肺炎确诊病例46263例,其中喀拉拉邦新增确诊病例30193例,占新冠肺炎病例总数的65%。喀拉拉邦确诊病例激增之际,印度单日新增病例已经从5月第一周的400000多例下降到了上周的单日40000例左右。

                  戴好口罩做好防护、保持社交距离,去年被当地政府和各大报纸大肆吹捧的这一“喀拉拉邦模式”此番却未能有效防范疫情。卫生专家表示,喀拉拉邦的新冠病毒感染率或更高,因为不同于其他地区的是,当地的很大一部分人口尚未对新冠病毒感染产生免疫力。但新冠病例激增也表明,喀拉拉邦的抗疫措施可能并不像人们之前认为的那样有效,特别是在当下,人们担心当地的病例总数激增会带来扩散风险,引发新一轮全国性的疫情大爆发。

                  “喀拉拉邦模式”

                  在20世纪70年代甚至更早以前,政治家和经济学家就对喀拉拉邦赞誉有加:收入低但生活质量指标相对较高。长期以来,经济学家一直将喀拉拉邦的成功归因于对医疗和教育的早期投资、收入再分配能力,以及公民的高投票率。

                  如今,喀拉拉邦仍然保持超水平发挥:尽管在印度28个邦中GDP只排在第九位,但喀拉拉邦的识字率和人均预期寿命均位居印度各邦之首。

                  新冠疫情爆发初期,喀拉拉邦率先采取个性鲜明的抗疫措施,也就是现在所谓的“喀拉拉邦模式”。

                  2020年1月30日,喀拉拉邦发现首宗新冠病毒感染确诊病例。接下来的2月到3月,喀拉拉邦及印度各地的感染人数开始上升,但与其他邦相比,喀拉拉邦政府采取了更积极的抗疫措施。喀拉拉邦率先关闭学校、禁止举行大规模集会,较中央政府的全面防控要求提前了数周;安排数千名医务人员对疑似接触者进行检测、跟踪和隔离。在中央政府于3月底宣布全国范围内封锁的前几天,喀拉拉邦就已经进入了完全封锁的状态。

                  今年春夏,德尔塔变异毒株掀起的第二波疫情席卷印度其他地区。在此之前,喀拉拉邦的抗疫措施一直卓有成效。

                  4月下旬,新冠疫情已经扩散至印度的大部分地区,喀拉拉邦躲过了这场危机最严峻的时期。4月和5月印度疫情最严重的时候,喀拉拉邦的新冠肺炎病死率(感染新冠病毒后的死亡人数跟踪)为0.5%,低于全国平均水平1.3%。喀拉拉邦广泛推行的戴好口罩、保持社交距离,以及检测和跟踪密接者的模式似乎正在奏效。

                  从基督教医学院(Christian Medical College)退休的病毒学家雅各布·约翰说:“与其他邦不同,喀拉拉邦的医疗保健系统从未面临过不堪重负的问题,当地的医院病床和氧气供应一直很充足。”

                  当地时间2020年4月6日,喀拉拉邦的埃尔讷古勒姆县医学院(Ernakulam Medical College)内,医护人员在无需预约的采样亭开展新冠核酸检测。图片来源:Arun Chandrabose—AFP/Getty Images

                  “喀拉拉邦模式”之崩塌

                  卫生专家将喀拉拉邦正在经历的疫情复发归咎于以下几个因素。

                  首先,喀拉拉邦可能只是放松了警惕。

                  8月12日至23日,喀拉拉邦举行了为期10天的欧南节(Onam),期间,感染人数开始上升。尽管当地禁止在节日前举行大型集体聚会,但人们还是扎堆聚集。

                  其次,喀拉拉邦可能是自身成功的牺牲品。

                  喀拉拉邦核酸检测覆盖率高,这意味着当地病例激增可能是因为检测出了其他邦漏检的病例。约翰表示,喀拉拉邦在防控第一波疫情时的出色表现也意味着其人口中无抗体比例更高,因此容易受到高传染性的德尔塔变异毒株的影响。

                  约翰问道:“两个森林发生火灾,一个枯树多、一个枯树少,哪个森林不容易被燃尽?”

                  第三,喀拉拉邦人口流动性高,或许会加剧这种激增。

                  喀拉拉邦是印度移民人口最多的邦之一,外来打工人口高达250万。据估计,喀拉拉邦有400万居民在国外生活和工作,其中又以阿联酋等海湾国家为主。自新冠疫情爆发以来,约有120万居民从海外返回喀拉拉邦,增加了输入病例的风险。位于新德里的甘加拉姆爵士医院(Sir Ganga Ram Hospital)微创减重代谢手术研究所(Institute of Minimal Access, Metabolic Bariatric Surgery)的主任苏迪尔·卡尔汉博士也指出,支援印度其他地区抗疫一线的数千名医务人员近期也返回了喀拉拉邦。

                  卡尔汉称,喀拉拉邦的人口具有高度“迁移性”,这可能是该邦感染人数激增的原因之一。他说:“喀拉拉邦的疫情很可能始于印度第二波疫情后期,但好消息是,病例每天稳定在3万例左右。”

                  2021年7月14日,喀拉拉邦的首席部长皮纳拉伊·维贾扬赢得连任后在新德里发表讲话。图片来源:Sonu Mehta—Hindustan Times/Getty Images

                  希望与恐惧

                  政治对手猛烈抨击喀拉拉邦的首席部长皮纳拉伊·维贾扬未能在该阶段保护公民,并指责他为了获得政治支持鼓吹“喀拉拉邦模式”。维贾扬否认了这些指控。

                  “喀拉拉邦模式”抗疫措施或许已经命悬一线。但还不至于彻底消亡。

                  政治分析人士桑迪普·沙斯特里表示:“仅仅因为(‘喀拉拉邦模式’)现在未见成效并不能否认其之前的抗疫成绩。”

                  最近几周,喀拉拉邦政府加大了新冠疫苗的接种力度,设立了免下车疫苗接种中心,并安排医务人员前往建筑工地等现场为工人接种疫苗。

                  印度政府于9月9日报告称,印度58%的成年人口接种了单剂新冠疫苗,18%的人口已经完成接种。喀拉拉邦报告称,在全国范围内的疫苗接种前已经出现病例激增,63%的成年人口至少接种了一剂疫苗,38%的人口完成疫苗接种。

                  与此同时,喀拉拉邦的新冠肺炎死亡人数占印度每天死亡人数的近一半。高死亡率可能在一定程度上反映了喀拉拉邦人口老龄化最严重这一事实。

                  随着更多的人接种疫苗,喀拉拉邦的病死人数可能会得到更好的控制。喀拉拉邦卫生部门在9月9日称,6到9月当地病例死亡人数中有90%未接种疫苗。

                  但喀拉拉邦疫情爆发的真正危险之处在于,尽管采取了“喀拉拉邦模式”这样的抗疫措施,疫情仍然肆虐开来。比尔及梅琳达·盖茨基金会(Bill and Melinda Gates Foundation)的前政策顾问阿米尔·乌拉·汗称,印度其他地区现在需要保持高度戒备,只有这样喀拉拉邦的疫情才不会在其他地方引发新一波新冠浪潮。

                  乌拉·汗说:“在我看来,(喀拉拉邦的新冠疫情大爆发)没有令人信服的解释,我们面对的是一种新的变异毒株吗?”(财富中文网)

                  译者:唐尘

                  2020年,印度第一波新冠肺炎疫情爆发,南部的喀拉拉邦堪称抗疫典范。当地政府一度将“喀拉拉邦模式”作为全国性的抗疫蓝本。而如今,拥有3500万人口、棕榈环绕的喀拉拉邦却成为了印度新冠疫情的重灾区。

                  9月9日,印度新增新冠肺炎确诊病例46263例,其中喀拉拉邦新增确诊病例30193例,占新冠肺炎病例总数的65%。喀拉拉邦确诊病例激增之际,印度单日新增病例已经从5月第一周的400000多例下降到了上周的单日40000例左右。

                  戴好口罩做好防护、保持社交距离,去年被当地政府和各大报纸大肆吹捧的这一“喀拉拉邦模式”此番却未能有效防范疫情。卫生专家表示,喀拉拉邦的新冠病毒感染率或更高,因为不同于其他地区的是,当地的很大一部分人口尚未对新冠病毒感染产生免疫力。但新冠病例激增也表明,喀拉拉邦的抗疫措施可能并不像人们之前认为的那样有效,特别是在当下,人们担心当地的病例总数激增会带来扩散风险,引发新一轮全国性的疫情大爆发。

                  “喀拉拉邦模式”

                  在20世纪70年代甚至更早以前,政治家和经济学家就对喀拉拉邦赞誉有加:收入低但生活质量指标相对较高。长期以来,经济学家一直将喀拉拉邦的成功归因于对医疗和教育的早期投资、收入再分配能力,以及公民的高投票率。

                  如今,喀拉拉邦仍然保持超水平发挥:尽管在印度28个邦中GDP只排在第九位,但喀拉拉邦的识字率和人均预期寿命均位居印度各邦之首。

                  新冠疫情爆发初期,喀拉拉邦率先采取个性鲜明的抗疫措施,也就是现在所谓的“喀拉拉邦模式”。

                  2020年1月30日,喀拉拉邦发现首宗新冠病毒感染确诊病例。接下来的2月到3月,喀拉拉邦及印度各地的感染人数开始上升,但与其他邦相比,喀拉拉邦政府采取了更积极的抗疫措施。喀拉拉邦率先关闭学校、禁止举行大规模集会,较中央政府的全面防控要求提前了数周;安排数千名医务人员对疑似接触者进行检测、跟踪和隔离。在中央政府于3月底宣布全国范围内封锁的前几天,喀拉拉邦就已经进入了完全封锁的状态。

                  今年春夏,德尔塔变异毒株掀起的第二波疫情席卷印度其他地区。在此之前,喀拉拉邦的抗疫措施一直卓有成效。

                  4月下旬,新冠疫情已经扩散至印度的大部分地区,喀拉拉邦躲过了这场危机最严峻的时期。4月和5月印度疫情最严重的时候,喀拉拉邦的新冠肺炎病死率(感染新冠病毒后的死亡人数跟踪)为0.5%,低于全国平均水平1.3%。喀拉拉邦广泛推行的戴好口罩、保持社交距离,以及检测和跟踪密接者的模式似乎正在奏效。

                  从基督教医学院(Christian Medical College)退休的病毒学家雅各布·约翰说:“与其他邦不同,喀拉拉邦的医疗保健系统从未面临过不堪重负的问题,当地的医院病床和氧气供应一直很充足。”

                  “喀拉拉邦模式”之崩塌

                  卫生专家将喀拉拉邦正在经历的疫情复发归咎于以下几个因素。

                  首先,喀拉拉邦可能只是放松了警惕。

                  8月12日至23日,喀拉拉邦举行了为期10天的欧南节(Onam),期间,感染人数开始上升。尽管当地禁止在节日前举行大型集体聚会,但人们还是扎堆聚集。

                  其次,喀拉拉邦可能是自身成功的牺牲品。

                  喀拉拉邦核酸检测覆盖率高,这意味着当地病例激增可能是因为检测出了其他邦漏检的病例。约翰表示,喀拉拉邦在防控第一波疫情时的出色表现也意味着其人口中无抗体比例更高,因此容易受到高传染性的德尔塔变异毒株的影响。

                  约翰问道:“两个森林发生火灾,一个枯树多、一个枯树少,哪个森林不容易被燃尽?”

                  第三,喀拉拉邦人口流动性高,或许会加剧这种激增。

                  喀拉拉邦是印度移民人口最多的邦之一,外来打工人口高达250万。据估计,喀拉拉邦有400万居民在国外生活和工作,其中又以阿联酋等海湾国家为主。自新冠疫情爆发以来,约有120万居民从海外返回喀拉拉邦,增加了输入病例的风险。位于新德里的甘加拉姆爵士医院(Sir Ganga Ram Hospital)微创减重代谢手术研究所(Institute of Minimal Access, Metabolic Bariatric Surgery)的主任苏迪尔·卡尔汉博士也指出,支援印度其他地区抗疫一线的数千名医务人员近期也返回了喀拉拉邦。

                  卡尔汉称,喀拉拉邦的人口具有高度“迁移性”,这可能是该邦感染人数激增的原因之一。他说:“喀拉拉邦的疫情很可能始于印度第二波疫情后期,但好消息是,病例每天稳定在3万例左右。”

                  希望与恐惧

                  政治对手猛烈抨击喀拉拉邦的首席部长皮纳拉伊·维贾扬未能在该阶段保护公民,并指责他为了获得政治支持鼓吹“喀拉拉邦模式”。维贾扬否认了这些指控。

                  “喀拉拉邦模式”抗疫措施或许已经命悬一线。但还不至于彻底消亡。

                  政治分析人士桑迪普·沙斯特里表示:“仅仅因为(‘喀拉拉邦模式’)现在未见成效并不能否认其之前的抗疫成绩。”

                  最近几周,喀拉拉邦政府加大了新冠疫苗的接种力度,设立了免下车疫苗接种中心,并安排医务人员前往建筑工地等现场为工人接种疫苗。

                  印度政府于9月9日报告称,印度58%的成年人口接种了单剂新冠疫苗,18%的人口已经完成接种。喀拉拉邦报告称,在全国范围内的疫苗接种前已经出现病例激增,63%的成年人口至少接种了一剂疫苗,38%的人口完成疫苗接种。

                  与此同时,喀拉拉邦的新冠肺炎死亡人数占印度每天死亡人数的近一半。高死亡率可能在一定程度上反映了喀拉拉邦人口老龄化最严重这一事实。

                  随着更多的人接种疫苗,喀拉拉邦的病死人数可能会得到更好的控制。喀拉拉邦卫生部门在9月9日称,6到9月当地病例死亡人数中有90%未接种疫苗。

                  但喀拉拉邦疫情爆发的真正危险之处在于,尽管采取了“喀拉拉邦模式”这样的抗疫措施,疫情仍然肆虐开来。比尔及梅琳达·盖茨基金会(Bill and Melinda Gates Foundation)的前政策顾问阿米尔·乌拉·汗称,印度其他地区现在需要保持高度戒备,只有这样喀拉拉邦的疫情才不会在其他地方引发新一波新冠浪潮。

                  乌拉·汗说:“在我看来,(喀拉拉邦的新冠疫情大爆发)没有令人信服的解释,我们面对的是一种新的变异毒株吗?”(财富中文网)

                  译者:唐尘

                  When the first wave of COVID-19 struck India in 2020, the southern state of Kerala emerged as a unique success story in battling the virus. Local authorities promoted the “Kerala model” as a blueprint to contain COVID-19 outbreaks across the country. But now the palm-fringed state of 35 million people has become India’s epicenter for COVID-19 cases.

                  On September 9, Kerala accounted for 30,193 of the 46,263 infections recorded in India, making up 65% of India’s total caseload. The spike in Kerala comes as India’s total daily COVID cases have plunged from a peak of over 400,000 in the first week of May to around 40,000 cases per day last week.

                  The Kerala model, which emphasized early mask-wearing and social distancing and was vaunted by local authorities and newspapers last year, isn’t preventing infections as it once did. Health experts say the state may be especially vulnerable to the virus since—unlike other regions—a high share of its population has not yet developed immunity from a COVID-19 infection. Still, the spiraling outbreak also suggests that Kerala’s COVID-19 response may not be as effective as once thought, especially as concerns grow that the state’s high caseload could spill over and trigger another deadly wave of infections across the country.

                  The Kerala model

                  Since at least the 1970s, politicians and economists have admired the state of Kerala for its relatively high quality of life indicators despite its low income. Economists have long attributed the state’s success to early investments in health and education, its ability to redistribute income, and high voting rates among citizens.

                  Today, Kerala continues to punch above its weight, with the highest literacy rate and life expectancy in the country despite having only the ninth-highest GDP among India’s 28 states.

                  Early in the pandemic, the state pioneered its own response to battle COVID-19, which is now known as the Kerala model.

                  On Jan. 30, 2020, Kerala recorded India’s first case of COVID-19. Infections began to rise in Kerala and across the country through February and March, but Kerala’s government took a more proactive approach in combating the virus than other states. Kerala closed schools and banned mass gatherings weeks before the central government followed suit, and it deployed thousands of health workers to test, trace, and isolate people who might have been exposed to the virus. Kerala went into complete lockdown days before the central government announced a nationwide lockdown at the end of March.

                  Kerala’s success carried over to the wave of devastating, Delta variant–driven infections that swept the rest of India this spring and summer.

                  In late April, as COVID-19 overwhelmed large parts of the country, Kerala staved off the worst of the crisis. At the height of India’s outbreak in April and May, Kerala’s case fatality ratio, which tracks how many people die after getting COVID-19, was 0.5%, lower than the national average of 1.3%. Kerala’s model of widespread mask-wearing, social-distancing, and testing and contact-tracing appeared to be working.

                  “Unlike other states, the health care system in Kerala was never overwhelmed, and the state always had surplus hospital beds and [supplemental] oxygen,” says Jacob John, a virologist now retired from Christian Medical College.

                  How it broke

                  Health experts blame the ongoing resurgence of COVID in Kerala on several factors.

                  First, Kerala may have simply let down its guard.

                  Infections began to rise during the 10-day religious festival of Onam, held between Aug. 12 and 23. People mingled with one another, even though the state had banned large group gatherings ahead of the holiday.

                  Second, Kerala may be a victim of its own success.

                  Kerala has a high COVID-19 testing rate, meaning that its elevated case numbers may be due to its catching infections that other states with lower testing rates are missing. Kerala’s containment of the first wave also means a higher share of its population is without antibodies and therefore vulnerable to the highly-infective Delta variant, says John.

                  “If there are two forest fires, which will last longer, the one with more dead trees or less?” asks John.

                  Third, Kerala’s especially mobile population may be exacerbating the surge.

                  The state has one of the largest migrant populations in India, with 2.5 million workers from other parts of the country traveling across its borders. An estimated 4 million Kerala residents live and work abroad, mostly in gulf countries like the United Arab Emirates. An estimated 1.2 million or so of the state’s residents have returned to Kerala from overseas since the beginning of the pandemic, raising the risk of imported cases. Dr. Sudhir Kalhan, chairman at the Institute of Minimal Access, Metabolic Bariatric Surgery at New Delhi’s Sir Ganga Ram Hospital, also notes that thousands of medical and paramedical staff recently returned home to Kerala after serving as frontline medical staff in other parts of the country.

                  Kerala’s population is highly “migratory,” which has likely contributed to the state’s surge in infections, says Kalhan. “Probably, Kerala picked up the virus late during India’s second wave, but the good thing is the cases are plateauing around 30,000 daily,” he says.

                  Hopes and fears

                  Political opponents have slammed Kerala Chief Minister Pinarayi Vijayan for failing to protect his citizens in this stage of the pandemic and accused him of promoting the Kerala model as propaganda to gain political support. Vijayan has denied the charges.

                  The Kerala model for fighting COVID-19 may be on life support. But it isn’t dead.

                  “Just because [the Kerala model] has not produced results now does not mean that it did not produce results earlier,” says Sandeep Shastri, a political analyst.

                  In recent weeks, Kerala’s government has ramped up its vaccination campaign, setting up drive-thru vaccination centers and deploying health workers to places like construction sites to inoculate workers.

                  India’s government reported on September 9 that 58% of the country’s adult population has received a single dose of COVID vaccine and 18% are fully vaccinated. Kerala reports that it has surged ahead of the nationwide drive, with 63% of adults receiving at least one dose of the vaccine and 38% of people fully vaccinated.

                  Kerala’s COVID-19 deaths, meanwhile, make up nearly half of India’s daily total. The high death rate may, in part, reflect the fact that Kerala has India’s oldest population.

                  Kerala’s ability to limit deaths may improve as more people get vaccinated. Kerala’s health department said on September 9 that 90% of people who died in Kerala from COVID-19 from June to September were unvaccinated.

                  But the real danger of Kerala’s outbreak is that COVID-19 has run rampant despite the Kerala-model efforts to contain the virus. Now, the rest of India needs to remain on high alert so that Kerala’s surge does not spark deadly waves elsewhere, says Amir Ullah Khan, former policy adviser for the Bill and Melinda Gates Foundation.

                  “If you ask me, there is no cogent explanation [for Kerala’s outbreak],” Khan says. “Is it a new variant we are looking at?”

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