美国卫生与公众服务部（U.S. Department of Health and Human Services）
华盛顿哥伦比亚特区（Washington, D.C.）
2020年1月28日
关于冠状病毒的新闻简报会（摘译）
卫生与公众服务部部长亚历克斯·阿扎尔（Alex Azar）
疾病控制与预防中心（Centers for Disease Control and Prevention）主任罗伯特·雷德菲尔德（Robert Redfield）博士
疾病控制与预防中心国家免疫中心（National Center for Immunization）主任南希·梅森尼尔（Nancy Messonnier）博士
国家卫生研究院（NIH）过敏症和传染病研究所（National Institute of Allergy and Infectious Diseases）主任安东尼∙福奇（Anthony Fauci）
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阿扎尔：我们现在面临的危险之一是，我们还不了解关于这种病毒需要知道的所有情况。但是我想强调的是，这并不能阻止我们做好应对的准备。我们有以往对付严重急性呼吸综合征（SARS）和中東呼吸綜合症（MERS）这两种对人体造成严重疾病的冠状病毒的经验。我们有应对亚洲禽流感疫情的经验。
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应对传染病疫情的规范相对简单，涉及很多层次。发现病例，隔离人员，进行诊断和治疗。然后追踪受感染的病人接触的所有的人，然后对这些人员采取同样的措施，如有必要，也可对接触者再接触的人采取同样的措施。这就是公共卫生部门和医疗护理人员与疾病控制与预防中心一起正在美国处理各种案例的方法。我很感激他们正在共同进行的努力。
这些工作，再加上研究和分析，也是我们如何回答我刚才提出的问题的途径。1月6日，我们提出派疾病控制与预防中心的团队前往中国，通过这些公共卫生官员的努力提供帮助。星期一，我在与中国卫生部长谈话时再次提出这个建议。今天通过世界卫生组织（World Health Organization）在北京的领导人又提出了建议。我们对中国强调，做到更合作和更透明是你们为提高应对效果采取的最重要的步骤。
除此之外，应对传染病传播的所有方案都必须准备好，包括旅行限制。但是疾病并不会顾忌边界。所以我们必须认真评估，除了我刚才谈到的已完全经过测试的方式外，是否需要根据情况采取任何其他步骤。
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……总统与我经常就疫情进行交谈。自疫情构成国际性威胁以来，我每天与国家卫生研究院和白宫（White House）高级官员进行多次交谈。总统高度关注应对疫情的问题，密切注视我们为保障美国人安全正在从事的工作。
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雷德菲尔德：谢谢你，部长先生。谢谢诸位今天参加我们就目前疫情发展的最新情况进行的讨论。在美国和全球各地，情况正在迅速发生变化。目前我们知道全世界已有18个地区发现这种新型病毒，包括美国。为了在这种新型病毒出现之际更好地保护美国公众的健康，根据来自中国的疫情进展，疾病控制与预防中心已重新评估了切入战略，决定扩大对美国机场旅客进行检测的范围，从原来的5个机场扩大到20个机场。
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目前正值流感季节，呼吸系统疾病爆发的季节，我国出现了很多呼吸系统疾病。我们建议常洗手，咳嗽时捂住口鼻，如果生病要留在家里。对于医疗护理人员，我们要求他们注意曾前往中国旅行的人，特别是湖北省，是否有发热和呼吸系统症状。你如果正在护理已确诊的病人，我们要求你按照有关的建议，采取控制传染的程序。
对于所有可能已经受到感染的人，我们要求你们遵循疾病控制与预防中心的指导，减少将疾病传播给其他人的危险。对于可能与某些已确诊的病人有密切接触的人，我们也要求他们遵循有关的指导，一旦出现症状需与医疗护理人员联系。
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福奇：…… 我向各位简要介绍一下国家卫生研究院、我们拨款合同方以及我们在业界的合作伙伴正在探索和跟踪的一些诊断与治疗以及疫苗方面的对应措施。首先，就诊断学角度而言，疾病控制与预防中心根据已经公开的病毒基因序列，迅速开发诊断手段。国家卫生研究院与疾病控制与预防中心将共同开发下一代更即时的实地诊断手段，从而能够向世界有关国家各地提供。
接下来是治疗。对冠状病毒感染尚无确证有效疗法。但是，现在有许多正在进行中的基于过去的严重急性呼吸综合征和中东呼吸综合征冠状病毒所开始的研究。例如，在当时以及在那些疫情与这次爆发之间的这段时间里，有多项抗病毒药物进行了试管和一些动物模式试验，甚至有偶尔在实地的历史对照控制研究。其中一种抗病毒药物是Remdesivir，你们有些人也许记得，它是埃博拉（Ebola）病毒临床试验的药剂之一。还有现在在中国基于人道关怀理由给予某些使用的KALETRA，它是两种抗逆转录病毒药物的结合。
我必须再次强调，这些药物的效力都没有得到证明，但正在对它们进行研究，同时也在鉴别其他一些药剂。我也许应指出为什么我们获得分离病毒如此重要，我们很快将从我国受感染的几个人那里得到它们，就是你们听到的那五个人。另外就是单克隆抗体。我们在对抗非典病毒时，开发了可能会产生疗效的单克隆抗体。但再次说明，没有任何疗法得到证明，因为它们未经过使用——它们仅仅是用于试管和动物模式中。
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最后，也是十分重要的一点，疫苗。我们已经在国家卫生研究院并且与许多合作伙伴开始开发疫苗。……。
中国在完成病毒分离后，将基因序列放入了公开的数据库。21世纪的技术使我们能够运用这一序列，抽出具体冠状病毒的纤突蛋白基因，将其作为制作疫苗的免疫原。目前正在进行这项准备。我带着一些谨慎的乐观预计，我们将在未来三个月内开始第一阶段试验。
我要强调，因为有时候会有误解，即开始第一阶段试验不意味着马上将有可以投入使用的疫苗。需要用三个月开始试验，需要用三个月获取安全和免疫数据，然后进入第二阶段。第二阶段的工作取决于在这几个月里病情爆发的情况。不要忘记，我们对非典进行了第一阶段试验，但不曾需要使用那种疫苗。不过无论怎样，我们正在以将必须投放使用这种疫苗的姿态展开我们的努力。
换句话说，我们是把它作为将有更严重爆发的最糟糕情况来对待。所以，简言之，现在我们有三种正在研究中的对抗方式。诊断、治疗和疫苗，而后，我们将随着在每个方面取得进展，向各位通报。谢谢。
问：谢谢你。《南华早报》（South China Morning Post）的罗伯特·德莱尼（Robert Delaney）。我就想进一步问一下有关白宫正在考虑从中国到美国的旅行限制的媒体报道。我的另一个问题是有关提出——让美国疾病控制与预防中心团队——通过同中国的医卫当局合作支持一项解决方案。关于中国的回应是什么，以及谁参与了有关互动，你能为我们提供更多的信息吗？谢谢你。
阿扎尔：-关于旅行限令……在一种新型传染病快速出现的情况下，重要的是不排除任何一种方案。我们将持续评估将要采取的适当的公共卫生措施，基于科学、实证以及我们所知的流行病学，其中包括一些重要信息……我们希望通过尽可能快地到中国实地工作来了解，以便能看到原始数据和原始实证，并帮助制定确实需要的那类研究和分析。
这涉及到你的第二个问题，即我们提出的建议，我们的确希望中国政府将采纳我们的建议，疾病控制与预防中心的专家正在待命，已准备好、愿意并能够立即前往中国，不论是在一种双边基础之上还是在世界卫生组织的主持之下。因此，我一直在直接同中国国家卫生健康委员会主任，马主任，以及世卫组织总干事谭德塞（Tedros）进行这些商讨，而且他——谭德塞总干事刚刚在今天上午在中国同最高级别的官员进行了会谈，也就是中国的周二上午。
我感到我同中国政府的互动非常具有建设性和合作性，而且我希望将会有一种积极的解决方式，能够实施，特别是在世界卫生组织的主持下……
雷德菲尔德：目前我们在中国有一个疾病控制与预防中心的办公室，设在中国疾病控制中心内。我们将增加我们在那里的人员，帮助他们真正识别流行病理，并回答一些已经提出的关键性问题，例如有关无症状传播的问题，特别是潜伏期的问题，因为它如此长短不一。我们还能帮助他们开始理解感染谱的真实情况。
我们还开发出了一种诊断测试，我们可以用它来切实说明在一名患者的确痊愈之后——他们是否真被感染过？这就是我们所做的关键性工作。我们增强实验室支持，但最重要的是，我们增强流行病学能力，来解答这些关键性问题，理解它们对于今后的公共卫生行动至关重要。
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阿扎尔：……关于同美国驻武汉领事馆有关的人员及家属返回的航班，我们将大力参与那架航班以及有关人员的运输事宜。[他们]将接受持续的检查和评估。飞机上将有医生，而且我们将对他们采取各项基于实证的适当的公共卫生措施，就像我们在其他任何情况下所做的一样。因此将——这将全部取决于我们在进行检查以及同有关人员交谈并进行我们在任何一种传染病接触者追踪行动中所做的那种评估时了解到的情况。
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Excerpts of Press Briefing on Coronavirus
AZAR: Part of the risk we face right now is that we don’t yet know everything we need to know about this virus. But I want to emphasize that does not prevent us from preparing and responding. We have the experience of responding to two earlier coronaviruses that emerged to cause serious illness in people, SARS and MERS. And we have experience responding to bird flu outbreaks in Asia.…The playbook for responding to an infectious disease outbreak is relatively simple and multi- tiered. You identify cases, isolate people, diagnose them and treat them. Then you track down all the contacts of the infected person, and you do the same with those people and the same with contacts of contacts, if necessary. That approach is how public health departments and healthcare providers, working with the CDC, are handling the cases here in the United States, and I am very grateful the hard work that they are all doing together.
This kind of work, coupled with studies and analysis, is also how we answer the questions I described earlier. On January 6 we offered to send a CDC team to China that could assist with these public health efforts. I reiterated that offer when I spoke to China’s Minister of health on Monday, and it was reiterated again via the World Health Organization’s leadership today in Beijing. We are urging China; more cooperation and transparency are the most important steps you can take toward a more effective response.
Beyond that, all options for dealing with infectious disease spread have to be on the table, including travel restrictions. But diseases are not terribly good at respecting borders, so we would have to assess carefully whether the evidence recommends any steps beyond the thoroughly tested methods I just described.…The president and I have been speaking regularly about this outbreak, and I have been speaking with the senior officials at HHS and the White House multiple times each day since the outbreak began to represent an international threat. The president is highly engaged in this response and closely monitoring the work we’re doing to keep Americans safe.
REDFIELD: Thank you, Mr. Secretary, and thank all of you for joining us here today as we discuss the latest developments that are involved in this situation. It is a rapidly changing situation in the United States and throughout the global community. Right now we know of 18 international locations that have identified cases of this new virus, including the United States. To better protect the health of the American public during the emergence of this novel coronavirus, and based on the evolving situation information from China, CDC has reassessed its entry strategy and decided to expand to screening travelers from the five airports originally to 20 airports in the United States.
It’s currently the lu season, and respiratory disease season, and there’s a lot of respiratory disease out in our nation. We recommend washing of the hands, covering your mouth when you cough, staying at home if you’re sick. For healthcare providers, we ask them to be on the lookout for people with a travel history from China, especially Hubei Province, if they develop fever and respiratory symptoms. And if you’re a healthcare provider that’s caring for a confirmed patient, we ask you to follow the recommended infection control procedures.
For all people that may have this infection, we ask you to follow the CDC guidance in how to reduce the risk of spreading your illness to others. And for people who may have had close contact with someone who is a confirmed patient, we ask them also to follow that guidance and if you have symptoms, to contact your healthcare provider.
…FAUCI: I’m going to give you a brief snapshot of the countermeasures in the form of diagnostics and therapeutics and vaccines that are being investigated and pursued by the NIH, by our grantees contractors, and by our collaborators in industry. First, with regard to diagnosis diagnostics, the CDC has rapidly developed at diagnostic based on the published sequence of the virus. The NIH, together with the CDC, will be working on next generation diagnostics that are more point-of-care so that we can get them more distributed to people throughout the country in the world.
Next is therapeutics. There is no proven therapy for coronavirus infection. Yet, there are now ongoing studies that have been initiated with the previous experience we had with SARS and with MERS. For example, back then and between those outbreaks and the current one, that number of antiviral drugs have been tested in vitro and some animal models and even in the field anecdotally with historic controls. One of them is the antiviral Remdesivir, which some of you may remember was used as one of the elements and the clinical trial against Ebola. And the other one that is now being used on a compassionate basis by some in China is KALETRA, which is a combination of two antiretroviral drugs.
Again, I must emphasize there’s no proven efficacy of these, but they are being pursued together with the screening of a number of other agents. I might point out that is why it is so important that we get isolates of the virus, which we will soon have both particularly from the individuals in this country who have now been infected, the ive individuals that you’ve heard of.
…And then finally, and most importantly, vaccines. We have already started at the NIH and with many of our collaborators on the developing of a vaccine…When the Chinese isolated the virus, they put on a public database that sequence. Given the technology of the 21st century, we were able to use that sequence, pull out the gene for the glycoproteins spike of the particular coronavirus and make that the immunogenicity to be used in a vaccine. Right now, that’s being prepared. I anticipate with some cautious act optimism that we will be in a phase 1 trial within the next three months.
I want to emphasize because it’s sometimes confused, going into a phase 1 trial does not mean that you have a vaccine that’s ready for deployment. It will take three months to get into the trial, three months to get safety and immunogenicity data, and then you move into phase 2. What we do from that point on will be determined by what has happened with the outbreak over those months. Remember, we made a phase 1 trial with SARS and we never had to use the vaccine. But nonetheless, we are proceeding as if we will have to deploy a vaccine.
In other words, we’re looking at the worst scenario that this becomes a bigger outbreak. So in summary, there are three types of interventions that we’re working on. Diagnostics, therapeutics and vaccines, then we will keep you posted as we make progress in each of these. Thank you.
QUESTION: Thank you. Robert Delaney (SP) with the South China Morning Post. I just wanted to follow up on media reports that the White House is considering travel restrictions from China to the U.S. And the other question I had was about the offer to–for the CDC team to– to support a solution by working with the health authorities in China. Can you give us more information about what the response from China has been to that and who has been involved in that interaction? Thank you.
AZAR: -in terms of travel restrictions… it’s important to not take anything off the table with a rapidly emerging novel infectious disease. We will be constantly assessing the appropriate public health measures to be taken based on that science, evidence, and epidemiology that we learn, including some important information… that we hope to learn by working on the ground in China as quickly as possible so we can see raw data, raw evidence, and help design the types of studies and analytics that really are needed.
… the offer that we have made, which we do hope that the Chinese government will take us up on that CDC experts are standing by, ready, willing, able to go immediately to China either on a bilateral basis or under the auspices of the world health organization. So I have been directly engaged in those discussions with Minister Ma, the Chinese Minister of health, as well as with the Director General Tedros of the World Health Organization, and he had– Director General Tedros just add meetings this morning in China, so what would be Tuesday morning in China with senior most officials.
I found my interactions with the Chinese government to be very productive and cooperative and I am hopeful that will have a positive resolution and be able to deploy, especially under the auspices of the World Health Organization.
REDFIELD: Currently we do have a CDC office in China that’s embedded in the China CDC. We would add our personal there to help them really define the epidemiology and answer some of the critical questions that were asked about asymptomatic transmission, for example in particular and what is the incubation period since there’s been such a wide range. We also can assist them to begin to understand really the spectrum of infection.We’ve developed a diagnostic test that we can use to actually tell after the fact when somebody hit has actually recovered were they actually infected or not. So this is the critical thing we do. We augment laboratory support, but most importantly, we augment the epidemiology capacity to answer these critical questions that are so necessary to understand for future public health action.…
AZAR: with regard to the light of individuals who are connected to that U.S. Embassy consulate in Wuhan returning with family members, we will be heavily engaged with that light and the transport of those individuals. Will be screened, evaluated constantly. There will be physicians on the light and we’ll take whatever the appropriate evidence-based public health measures are with them as we would in any other situation. So will–that will all be dependent on what we learn as we screen, speak to people as we do the type of evaluation, we would do in any type of infectious disease contact tracing type activity.