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印度這個邦曾是“抗疫典范”,現在卻淪陷了

印度這個邦曾是“抗疫典范”,現在卻淪陷了

麥甘云(Grady McGregor), Biman Mukherji 2021年09月14日
9月9日,喀拉拉邦新增確診病例占到印度新冠肺炎病例總數的65%。

2020年,印度第一波新冠肺炎疫情爆發,南部的喀拉拉邦堪稱抗疫典范。當地政府一度將“喀拉拉邦模式”作為全國性的抗疫藍本。而如今,擁有3500萬人口、棕櫚環繞的喀拉拉邦卻成為了印度新冠疫情的重災區。

9月9日,印度新增新冠肺炎確診病例46263例,其中喀拉拉邦新增確診病例30193例,占新冠肺炎病例總數的65%。喀拉拉邦確診病例激增之際,印度單日新增病例已經從5月第一周的400000多例下降到了上周的單日40000例左右。

戴好口罩做好防護、保持社交距離,去年被當地政府和各大報紙大肆吹捧的這一“喀拉拉邦模式”此番卻未能有效防范疫情。衛生專家表示,喀拉拉邦的新冠病毒感染率或更高,因為不同于其他地區的是,當地的很大一部分人口尚未對新冠病毒感染產生免疫力。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們之前認為的那樣有效,特別是在當下,人們擔心當地的病例總數激增會帶來擴散風險,引發新一輪全國性的疫情大爆發。

“喀拉拉邦模式”

在20世紀70年代甚至更早以前,政治家和經濟學家就對喀拉拉邦贊譽有加:收入低但生活質量指標相對較高。長期以來,經濟學家一直將喀拉拉邦的成功歸因于對醫療和教育的早期投資、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發揮:盡管在印度28個邦中GDP只排在第九位,但喀拉拉邦的識字率和人均預期壽命均位居印度各邦之首。

新冠疫情爆發初期,喀拉拉邦率先采取個性鮮明的抗疫措施,也就是現在所謂的“喀拉拉邦模式”。

2020年1月30日,喀拉拉邦發現首宗新冠病毒感染確診病例。接下來的2月到3月,喀拉拉邦及印度各地的感染人數開始上升,但與其他邦相比,喀拉拉邦政府采取了更積極的抗疫措施。喀拉拉邦率先關閉學校、禁止舉行大規模集會,較中央政府的全面防控要求提前了數周;安排數千名醫務人員對疑似接觸者進行檢測、跟蹤和隔離。在中央政府于3月底宣布全國范圍內封鎖的前幾天,喀拉拉邦就已經進入了完全封鎖的狀態。

今年春夏,德爾塔變異毒株掀起的第二波疫情席卷印度其他地區。在此之前,喀拉拉邦的抗疫措施一直卓有成效。

4月下旬,新冠疫情已經擴散至印度的大部分地區,喀拉拉邦躲過了這場危機最嚴峻的時期。4月和5月印度疫情最嚴重的時候,喀拉拉邦的新冠肺炎病死率(感染新冠病毒后的死亡人數跟蹤)為0.5%,低于全國平均水平1.3%。喀拉拉邦廣泛推行的戴好口罩、保持社交距離,以及檢測和跟蹤密接者的模式似乎正在奏效。

從基督教醫學院(Christian Medical College)退休的病毒學家雅各布·約翰說:“與其他邦不同,喀拉拉邦的醫療保健系統從未面臨過不堪重負的問題,當地的醫院病床和氧氣供應一直很充足。”

當地時間2020年4月6日,喀拉拉邦的埃爾訥古勒姆縣醫學院(Ernakulam Medical College)內,醫護人員在無需預約的采樣亭開展新冠核酸檢測。圖片來源:Arun Chandrabose—AFP/Getty Images

“喀拉拉邦模式”之崩塌

衛生專家將喀拉拉邦正在經歷的疫情復發歸咎于以下幾個因素。

首先,喀拉拉邦可能只是放松了警惕。

8月12日至23日,喀拉拉邦舉行了為期10天的歐南節(Onam),期間,感染人數開始上升。盡管當地禁止在節日前舉行大型集體聚會,但人們還是扎堆聚集。

其次,喀拉拉邦可能是自身成功的犧牲品。

喀拉拉邦核酸檢測覆蓋率高,這意味著當地病例激增可能是因為檢測出了其他邦漏檢的病例。約翰表示,喀拉拉邦在防控第一波疫情時的出色表現也意味著其人口中無抗體比例更高,因此容易受到高傳染性的德爾塔變異毒株的影響。

約翰問道:“兩個森林發生火災,一個枯樹多、一個枯樹少,哪個森林不容易被燃盡?”

第三,喀拉拉邦人口流動性高,或許會加劇這種激增。

喀拉拉邦是印度移民人口最多的邦之一,外來打工人口高達250萬。據估計,喀拉拉邦有400萬居民在國外生活和工作,其中又以阿聯酋等海灣國家為主。自新冠疫情爆發以來,約有120萬居民從海外返回喀拉拉邦,增加了輸入病例的風險。位于新德里的甘加拉姆爵士醫院(Sir Ganga Ram Hospital)微創減重代謝手術研究所(Institute of Minimal Access, Metabolic Bariatric Surgery)的主任蘇迪爾·卡爾漢博士也指出,支援印度其他地區抗疫一線的數千名醫務人員近期也返回了喀拉拉邦。

卡爾漢稱,喀拉拉邦的人口具有高度“遷移性”,這可能是該邦感染人數激增的原因之一。他說:“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,病例每天穩定在3萬例左右。”

2021年7月14日,喀拉拉邦的首席部長皮納拉伊·維賈揚贏得連任后在新德里發表講話。圖片來源:Sonu Mehta—Hindustan Times/Getty Images

希望與恐懼

政治對手猛烈抨擊喀拉拉邦的首席部長皮納拉伊·維賈揚未能在該階段保護公民,并指責他為了獲得政治支持鼓吹“喀拉拉邦模式”。維賈揚否認了這些指控。

“喀拉拉邦模式”抗疫措施或許已經命懸一線。但還不至于徹底消亡。

政治分析人士桑迪普·沙斯特里表示:“僅僅因為(‘喀拉拉邦模式’)現在未見成效并不能否認其之前的抗疫成績。”

最近幾周,喀拉拉邦政府加大了新冠疫苗的接種力度,設立了免下車疫苗接種中心,并安排醫務人員前往建筑工地等現場為工人接種疫苗。

印度政府于9月9日報告稱,印度58%的成年人口接種了單劑新冠疫苗,18%的人口已經完成接種。喀拉拉邦報告稱,在全國范圍內的疫苗接種前已經出現病例激增,63%的成年人口至少接種了一劑疫苗,38%的人口完成疫苗接種。

與此同時,喀拉拉邦的新冠肺炎死亡人數占印度每天死亡人數的近一半。高死亡率可能在一定程度上反映了喀拉拉邦人口老齡化最嚴重這一事實。

隨著更多的人接種疫苗,喀拉拉邦的病死人數可能會得到更好的控制。喀拉拉邦衛生部門在9月9日稱,6到9月當地病例死亡人數中有90%未接種疫苗。

但喀拉拉邦疫情爆發的真正危險之處在于,盡管采取了“喀拉拉邦模式”這樣的抗疫措施,疫情仍然肆虐開來。比爾及梅琳達·蓋茨基金會(Bill and Melinda Gates Foundation)的前政策顧問阿米爾·烏拉·汗稱,印度其他地區現在需要保持高度戒備,只有這樣喀拉拉邦的疫情才不會在其他地方引發新一波新冠浪潮。

烏拉·汗說:“在我看來,(喀拉拉邦的新冠疫情大爆發)沒有令人信服的解釋,我們面對的是一種新的變異毒株嗎?”(財富中文網)

譯者:唐塵

2020年,印度第一波新冠肺炎疫情爆發,南部的喀拉拉邦堪稱抗疫典范。當地政府一度將“喀拉拉邦模式”作為全國性的抗疫藍本。而如今,擁有3500萬人口、棕櫚環繞的喀拉拉邦卻成為了印度新冠疫情的重災區。

9月9日,印度新增新冠肺炎確診病例46263例,其中喀拉拉邦新增確診病例30193例,占新冠肺炎病例總數的65%。喀拉拉邦確診病例激增之際,印度單日新增病例已經從5月第一周的400000多例下降到了上周的單日40000例左右。

戴好口罩做好防護、保持社交距離,去年被當地政府和各大報紙大肆吹捧的這一“喀拉拉邦模式”此番卻未能有效防范疫情。衛生專家表示,喀拉拉邦的新冠病毒感染率或更高,因為不同于其他地區的是,當地的很大一部分人口尚未對新冠病毒感染產生免疫力。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們之前認為的那樣有效,特別是在當下,人們擔心當地的病例總數激增會帶來擴散風險,引發新一輪全國性的疫情大爆發。

“喀拉拉邦模式”

在20世紀70年代甚至更早以前,政治家和經濟學家就對喀拉拉邦贊譽有加:收入低但生活質量指標相對較高。長期以來,經濟學家一直將喀拉拉邦的成功歸因于對醫療和教育的早期投資、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發揮:盡管在印度28個邦中GDP只排在第九位,但喀拉拉邦的識字率和人均預期壽命均位居印度各邦之首。

新冠疫情爆發初期,喀拉拉邦率先采取個性鮮明的抗疫措施,也就是現在所謂的“喀拉拉邦模式”。

2020年1月30日,喀拉拉邦發現首宗新冠病毒感染確診病例。接下來的2月到3月,喀拉拉邦及印度各地的感染人數開始上升,但與其他邦相比,喀拉拉邦政府采取了更積極的抗疫措施。喀拉拉邦率先關閉學校、禁止舉行大規模集會,較中央政府的全面防控要求提前了數周;安排數千名醫務人員對疑似接觸者進行檢測、跟蹤和隔離。在中央政府于3月底宣布全國范圍內封鎖的前幾天,喀拉拉邦就已經進入了完全封鎖的狀態。

今年春夏,德爾塔變異毒株掀起的第二波疫情席卷印度其他地區。在此之前,喀拉拉邦的抗疫措施一直卓有成效。

4月下旬,新冠疫情已經擴散至印度的大部分地區,喀拉拉邦躲過了這場危機最嚴峻的時期。4月和5月印度疫情最嚴重的時候,喀拉拉邦的新冠肺炎病死率(感染新冠病毒后的死亡人數跟蹤)為0.5%,低于全國平均水平1.3%。喀拉拉邦廣泛推行的戴好口罩、保持社交距離,以及檢測和跟蹤密接者的模式似乎正在奏效。

從基督教醫學院(Christian Medical College)退休的病毒學家雅各布·約翰說:“與其他邦不同,喀拉拉邦的醫療保健系統從未面臨過不堪重負的問題,當地的醫院病床和氧氣供應一直很充足。”

“喀拉拉邦模式”之崩塌

衛生專家將喀拉拉邦正在經歷的疫情復發歸咎于以下幾個因素。

首先,喀拉拉邦可能只是放松了警惕。

8月12日至23日,喀拉拉邦舉行了為期10天的歐南節(Onam),期間,感染人數開始上升。盡管當地禁止在節日前舉行大型集體聚會,但人們還是扎堆聚集。

其次,喀拉拉邦可能是自身成功的犧牲品。

喀拉拉邦核酸檢測覆蓋率高,這意味著當地病例激增可能是因為檢測出了其他邦漏檢的病例。約翰表示,喀拉拉邦在防控第一波疫情時的出色表現也意味著其人口中無抗體比例更高,因此容易受到高傳染性的德爾塔變異毒株的影響。

約翰問道:“兩個森林發生火災,一個枯樹多、一個枯樹少,哪個森林不容易被燃盡?”

第三,喀拉拉邦人口流動性高,或許會加劇這種激增。

喀拉拉邦是印度移民人口最多的邦之一,外來打工人口高達250萬。據估計,喀拉拉邦有400萬居民在國外生活和工作,其中又以阿聯酋等海灣國家為主。自新冠疫情爆發以來,約有120萬居民從海外返回喀拉拉邦,增加了輸入病例的風險。位于新德里的甘加拉姆爵士醫院(Sir Ganga Ram Hospital)微創減重代謝手術研究所(Institute of Minimal Access, Metabolic Bariatric Surgery)的主任蘇迪爾·卡爾漢博士也指出,支援印度其他地區抗疫一線的數千名醫務人員近期也返回了喀拉拉邦。

卡爾漢稱,喀拉拉邦的人口具有高度“遷移性”,這可能是該邦感染人數激增的原因之一。他說:“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,病例每天穩定在3萬例左右。”

希望與恐懼

政治對手猛烈抨擊喀拉拉邦的首席部長皮納拉伊·維賈揚未能在該階段保護公民,并指責他為了獲得政治支持鼓吹“喀拉拉邦模式”。維賈揚否認了這些指控。

“喀拉拉邦模式”抗疫措施或許已經命懸一線。但還不至于徹底消亡。

政治分析人士桑迪普·沙斯特里表示:“僅僅因為(‘喀拉拉邦模式’)現在未見成效并不能否認其之前的抗疫成績。”

最近幾周,喀拉拉邦政府加大了新冠疫苗的接種力度,設立了免下車疫苗接種中心,并安排醫務人員前往建筑工地等現場為工人接種疫苗。

印度政府于9月9日報告稱,印度58%的成年人口接種了單劑新冠疫苗,18%的人口已經完成接種。喀拉拉邦報告稱,在全國范圍內的疫苗接種前已經出現病例激增,63%的成年人口至少接種了一劑疫苗,38%的人口完成疫苗接種。

與此同時,喀拉拉邦的新冠肺炎死亡人數占印度每天死亡人數的近一半。高死亡率可能在一定程度上反映了喀拉拉邦人口老齡化最嚴重這一事實。

隨著更多的人接種疫苗,喀拉拉邦的病死人數可能會得到更好的控制。喀拉拉邦衛生部門在9月9日稱,6到9月當地病例死亡人數中有90%未接種疫苗。

但喀拉拉邦疫情爆發的真正危險之處在于,盡管采取了“喀拉拉邦模式”這樣的抗疫措施,疫情仍然肆虐開來。比爾及梅琳達·蓋茨基金會(Bill and Melinda Gates Foundation)的前政策顧問阿米爾·烏拉·汗稱,印度其他地區現在需要保持高度戒備,只有這樣喀拉拉邦的疫情才不會在其他地方引發新一波新冠浪潮。

烏拉·汗說:“在我看來,(喀拉拉邦的新冠疫情大爆發)沒有令人信服的解釋,我們面對的是一種新的變異毒株嗎?”(財富中文網)

譯者:唐塵

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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