[新聞] 為何機場檢疫無法阻止冠狀病毒擴散

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完整標題：Why airport screening won’t stop the spread of coronavirus 發稿單位：美國科學促進會發稿時間：Mar. 6, 2020 , 12:35 PM 撰稿者：Dennis Normile 原文連結：https://www.sciencemag.org/news/2020/03/why-airport-screening-wont-stop-spread-coronavirus If you have traveled internationally the past 2 months, you may have encountered them: health officers briefly pointing a thermometer gun at your forehead or watching as you go by to check for signs of a cough or difficulty breathing. Many countries are now watching arriving and departing air passengers who might suffer from the viral disease COVID-19; some require passengers to fill out health declarations. (Some also simply ban or quarantine those who have recently been in outbreak hot spots.) 過去兩個月，你在機場可能會遇到衛生官員以額溫槍量體溫，或者觀察是否有咳嗽或呼吸困難的症狀，許多國家正在觀察出入境人員是否可能得了武漢肺炎，一些國家會要求填寫健康聲明表，也可能直接禁止疫區入境或進行隔離。 Exit and entry screening may look reassuring, but experience with other diseases shows it’s exceedingly rare for screeners to detect infected passengers. Just last week, eight passengers who later tested positive for COVID-19 arrived in Shanghai from Italy and passed the airport screeners unnoticed, for example. And even if screeners do find the occasional case, it has almost no impact on the course of an outbreak. 出入境檢疫可能看起來令人安心，但從其他疾病的經驗來看，檢疫官其實幾乎無法發現有乘客感染。舉例來說，上週有8名從義大利飛上海的乘客成功通過機場檢疫，之後才被確診陽性。即使檢疫官偶然找到了病例，對疫情也幾乎沒有影響。 “Ultimately, measures aimed at catching infections in travelers will only delay a local epidemic and not prevent it,” says Ben Cowling, an epidemiologist at the University of Hong Kong. He and others say screening is often instituted to show that a government is taking action, even if the impact is marginal. 香港大學的流行病學專家Ben Cowling檢查旅客是否感染只能延緩當地疫情的發展，無法真正避免。他與同儕表示檢疫經常被政府用於展示自己的有所作為，即便其影響微不足道。 Still, researchers say, there can be benefits. Evaluating and quizzing passengers before they board planes—exit screening—may prevent some who are sick or were exposed to a virus from traveling. Entry screening, done on arrival at the destination airport, can be an opportunity to gather contact information that is useful if it turns out an infection did spread during a flight and to give travelers guidance on what to do if they become ill. 研究者們認為其中仍有好處。在乘客登機前檢查可以避免病人上機或在旅途中暴露於病毒；在乘客下機後檢查，可以獲得聯絡資訊，當事後發現該班機有傳播時很有用，也能給旅客生病時的指引手冊。 Just this week, U.S. Vice President Mike Pence, who is leading the coronavirus response, pledged “100% screening” on direct flights from Italy and South Korea to the United States. China, which reported only 143 new cases yesterday, “will cooperate internationally to institute exit and entry screening with relevant regions suffering epidemics,” Liu Haitao, an official at China’s National Immigration Administration, said at a 1 March press conference in Beijing, according to the state broadcaster CCTV. 本週，負責領導對應冠狀病毒的美國副總統彭斯承諾對義大利與韓國直飛美國的航班進行百分之百檢疫。昨天報導新增143例的中國曾在3月1日的北京記者會表示將與國際合作，對疫區進行出入境檢疫。 How many COVID-19 cases screening has detected worldwide so far is unclear. At least one New Zealander was prevented from boarding an evacuation flight from Wuhan, China, after failing a health check, The New Zealand Herald reported. The United States started entry screening of U.S. citizens, permanent residents, and their families who have been in China within the previous 14 days at 11 airports on 2 February. (Anybody else who has been in China within that period cannot enter the country.) By 23 February, 46,016 air travelers had been screened; only one tested positive and was isolated for treatment, according to a 24 February report from the U.S. Centers for Disease Control and Prevention (CDC). That clearly has not halted the spread of the virus in the United States, which as of this morning has 99 confirmed cases, according to CDC, plus 49 more among people repatriated from Wuhan and the Diamond Princess cruise ship in Yokohama, Japan. 沒有明確的數字能得知全球有多少武漢肺炎的患者是在邊境檢疫中被發現的。至少紐西蘭在從武漢撤僑時有發現一例。美國自2月2日至23日檢查了14天內到過在中國境內的46016名旅客，僅僅只發現1名陽性案例。這顯然沒能阻止病毒在美國傳播，今早已有99人確診，再加上武漢撤僑與鑽石公主號的49人。 There are many ways infected people can slip through the net. Thermal scanners and handheld thermometers aren’t perfect. The biggest shortcoming is that they measure skin temperature, which can be higher or lower than core body temperature, the key metric for fevers. The devices produce false positives as well as false negatives, according to the EU Health Programme. (Travelers flagged as feverish by scanners typically go through a secondary screening where oral, ear, or armpit thermometers are used to confirm the person’s temperature.) 感染者有許多方式成為漏網之魚。熱顯像器與手持式溫度計並不完美，他們最大的問題在於量測表皮溫度，這可能比發燒的真正指標核心溫度更高或更低，導致偽陽性與偽陰性。被判斷發燒者通常會進一步做口溫、耳溫或腋溫量測。 Passengers can also take fever-suppressing drugs or lie about their symptoms and where they have been. Most importantly, infected people still in their incubation phase—meaning they don’t have symptoms—are often missed. For COVID-19, that period can be anywhere between 2 and 14 days. 乘客也能服用退燒藥或者對症狀與旅遊史撒謊。更重要的是，處於潛伏期而沒有症狀的人經常被遺漏。對武漢肺炎，這段時間為2到14天。 One example of the failures of airport screening just played out in China after eight Chinese citizens, all employees at a restaurant in Bergamo, Italy, arrived at Shanghai Pudong International Airport on 27 and 29 February, according to information pieced together from details in the local media and terse announcements by the Health & Family Planning Committee of Lishui, a city in Zhejiang province, which borders Shanghai. 有個戲劇性的機場檢疫失敗案例才剛在中國上演，8個在義大利餐館工作的中國人分別在2月27日與29日抵達上海浦東機場。 Pudong has had a policy to scan all arriving passengers for fever using “noncontact thermal imaging” since late January; it also requires passengers to report their health status on arrival. It’s unclear whether any of the eight restaurant workers had symptoms, or how they handled that reporting. But after taking chartered cars to Lishui, their hometown, one of the passengers fell ill; she tested positive for SARS-CoV-2, the virus that causes COVID-19, on 1 March. The next day, the remaining seven tested positive as well. They were the first confirmed cases in Zhejiang province in 1 week. 浦東自一月下旬開始以非接觸式熱顯像器掃描所有乘客是否發燒，並要求在入境時通報健康狀況。8名餐館員工當時是否有症狀以及如何回報尚不得而知。在前往麗水市的車上時，一位乘客發病了，她在3月1日被檢驗為陽性，另外7位在隔天也都發現是陽性。 Past experience doesn’t instill much confidence either. In a 2019 review in the International Journal of Environmental Research and Public Health, researchers scrutinized 114 scientific papers and reports on infectious disease screening published in the past 15 years. Most of the data are about Ebola, a serious viral disease whose incubation period is anywhere between 2 days and 3 weeks. Between August 2014 and January 2016, the review found, not a single Ebola case was detected among 300,000 passengers screened before boarding flights in Guinea, Liberia, and Sierra Leone, which all had big Ebola epidemics. But four infected passengers slipped through exit screening because they didn’t have symptoms yet. 過去的經驗也難以讓人有信心。在一份2019的回顧中整理了過去15年關於傳染病檢疫的報告，大部分是關於伊波拉病毒的，其潛伏期在2天到3週之間。從2014年8月到2016年1月，在幾內亞、賴比瑞亞、獅子山之間有30萬名乘客經過登機檢疫卻沒有發現任何案例，而這三國都是伊波拉疫情的重災區。有四名感染的乘客卻因為還沒有表現出症狀而通過出境檢疫。 Still, exit screening may have helped head off more draconian travel restrictions by showing that measures were being taken to protect nonaffected countries, said the paper, authored by Christos Hadjichristodoulou and Varvara Mouchtouri of the University of Thessaly and colleagues. Knowing they would have encountered exit screening may also have deterred some people exposed to Ebola from even trying to travel. 該論文作者認為進行出境檢疫以表示對非疫區國家的保護可避免自己被設下更嚴苛的旅遊限制。知道會遭遇出境檢疫也可能會讓一些暴露過伊波拉的人放棄旅行。 What about screening at the other end of the trip? Taiwan, Singapore, Australia, and Canada all implemented entry screening for severe acute respiratory syndrome (SARS), which is similar to COVID-19 and also caused by a coronavirus, during the 2002–03 outbreak; none intercepted any patients. However, the outbreak was largely contained by the time the screening was initiated, and it came too late to prevent introduction of SARS: All four countries or regions already had cases. During the 2014–16 Ebola epidemic, five countries asked incoming travelers about symptoms and possible exposure to patients and checked for fevers. They didn’t find a single case either. But two infected, asymptomatic passengers slipped through entry screening, one in the United States and one in the United Kingdom. 如果在航線的另一端進行呢？台灣、新加坡、澳大利亞、加拿大都在SARS時期進行了入境檢疫，卻沒能發現任何病患。當檢疫開始時疫情已經大致控制住了，而且四個國家都已有案例。在2014到2016的伊波拉流行期間，5個國家詢問入境旅客是否有症狀或接觸史，並且檢查是否發燒。他們也沒找到任何案例。相對地，美國和英國各有一名無症狀乘客通過了入境檢疫。 China and Japan mounted extensive entry screening programs during the H1N1 influenza pandemic of 2009, but studies found that the screenings captured small fractions of those actually infected with the virus and both countries had significant outbreaks anyway, the team reports in its review. Entry screening is “ineffective” in detecting infected travelers, Hadjichristodoulou and Mouchtouri tell Science. In the end, travelers with serious infectious diseases turn up at hospitals, clinics, and physicians’ offices rather than being caught at airports. And screening is costly: Canada spent an estimated $5.7 million on its SARS entry screening, and Australia spent $50,000 per detected H1N1 case in 2009, Hadjichristodoulou and Mouchtouri say. 中國與日本在2009豬流感大流行時進行了大規模檢疫，卻只找到了很小一部分的患者，無法避免境內大流行爆發。論文作者認為入境檢疫是無效的。患有嚴重傳染病的旅客只會出現在診所和醫院，而不會在機場被人抓包。與之同時，檢疫的代價則相當高昂：加拿大對SARS的入境檢疫花費了570萬美元，澳大利亞對2009年H1N1的檢疫花費是每人次5萬美元。 Every infectious disease behaves differently, but the duo doesn’t expect airport screening for COVID-19 to be more effective than for SARS or pandemic flu. And it’s unlikely to have a significant impact on the course of the outbreak, Cowling says. 每一種傳染病的行為都不同，但是別指望對武漢肺炎的檢疫會比對SARS和全球性流感更有效。而且看起來對目前疫情也不會有太大的影響。 Two recent modeling studies call screening into question as well. Researchers at the European Centre for Disease Prevention and Control concluded that approximately 75% of passengers infected with COVID-19 and traveling from affected Chinese cities would not be detected by entry screening. A study by a group at the London School of Hygiene & Tropical Medicine concluded that exit and entry screening “is unlikely to prevent passage of infected travelers into new countries or regions where they may seed local transmission.” 兩個近期的模型也將檢疫措施納入其中，歐洲疾病預防控制中心認為從中國疫區而來的武漢肺炎患者中有75%能通過入境檢疫。倫敦衛生與熱帶醫學院認為出入境檢疫不太可能避免感染旅客在目的地播下社區感染。 For countries that nonetheless adopt screening, the World Health Organization emphasizes that it is not a matter of just holding up a thermometer gun. Exit screening should start with temperature and symptom checks and interviews of passengers for potential exposure to high-risk contacts. Symptomatic travelers should be given further medical examination and testing, and confirmed cases should be moved to isolation and treatment. 對於無論如何都要檢疫的國家，WHO強調這不只是拿起溫度槍而已。出境檢疫該從體溫與症狀開始，並詢問乘客可能的高風險接觸史。對有症狀的旅客應該給予進一步的醫療檢驗，確診個案應該被隔離與治療。 Entry screening should be paired with collecting data about the patient’s whereabouts over the past few weeks that can later help with tracing their contacts. Travelers should also be given information to increase disease awareness and encouraged to practice good personal hygiene, says epidemiologist Benjamin Anderson of Duke Kunshan University. 入境檢疫時應該收集患者過去幾週的所在地以追蹤其接觸史。也應給予旅客資訊以增加對疾病的警覺，鼓勵其保持良好的個人衛生習慣。 -- ※ 發信站: 批踢踢實業坊(ptt.cc), 來自: 111.71.10.117 (臺灣) ※ 文章網址: https://www.ptt.cc/bbs/nCoV2019/M.1583853360.A.0D9.html

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