3月2日，450多名公共卫生和法律专家致信美国副总统迈克·彭斯(Mike Pence)和其他联邦、州和地方领导人，介绍了如何才能对COVID-19做出公平、有效、科学的应对。耶鲁大学、哈佛大学、东北大学和坦普尔大学等机构的专家，以及美国公共卫生协会(American Public Health Association)和大城市卫生联盟(American Public Health Association)等主要卫生和人权组织的专家起草并签署了这封信。
以下为全文翻译：
实现公平和有效的COVID-19响应

--美国公共卫生和法律专家致副总统迈克·彭斯以及其他联邦、州和地方领导人的公开信
目前看来，新型冠状病毒在美国持续人传人已是不可避免之事。难以预测美国此次疫情暴发的规模和影响，而且这关键取决于政策制定者和领导人的反应。它将尤其取决于是否有足够的资金和支持来作出反应；公平有效地管理激增的卫生保健需求；谨慎地、以证据为基础减轻公众的恐惧；以及为公平和有效的感染控制提供必要的支持和资源。


美国想要成功应对COVID-19大流行，就必须保护每个美国人的健康和人权。我们面临的最大挑战之一是确保COVID-19带来的负担以及我们的各种应对措施，不会不公平地落在因经济、社会或健康状况而易受伤害的人群身上。


作为公共卫生、法律和人权方面的专家，结合以往应对大流行的经验，我们提出了美国应对COVID-19的原则和做法。所有公共和私营机构都必须通过新的立法决策、制度安排、领导机制和支出计划来解决下列关键问题。

必须为响应提供足够的资金和支持

● 联邦、州和地方政府应立即采取行动分配资金，以确保能够采取必要措施，并在疫情出现时继续满足人们的基本需求。缓解COVID-19的影响需要付出高昂的代价。资源分配不均将危及集体控制努力，并导致不必要的痛苦和死亡。国会必须拨出一笔重大的紧急拨款用于流行病控制，并由总统签署，迅速拨给处于应对第一线的州和地方行动者。此外，这些新基金必须不影响现有的卫生和安全网计划，也不影响社会服务计划，因为这些计划是保护公共卫生的长期组成部分。

● 在整个疫情期间，联邦政府和联邦、地方和州一级机构必须尽量减少对政府活动的干扰，以便继续向有需要的人提供公共服务。政府必须有一个协调的计划，以便在缺勤的情况下保持运作。应优先考虑对公众的基本服务和支持，例如确保社会保障、退伍军人福利和其他福利不受干扰。
必须管理激增的医疗需求，保护病人和医护人员

● 在各种可能的情况下，我们的医疗体系都将面临沉重的负担。医院必须获得直接的资金和充足的资源，以增强应急能力，处理前线应对需求。还必须特别注意和资助初级保健设施和社区卫生中心，尤其是那些即使在正常情况下仍面临资源不足的设施和社区卫生中心。这些提供医疗服务的前线医疗场所需要担当看门人的角色，以防止三级医院和其他急症护理设施负担过重，需要给予支持，使它们能够发挥这一关键作用。

● 医疗工作者和其他急救人员将是应对的关键。我们必须确保他们的安全，给他们公平的工作条件。例如，卫生保健工作者必须获得适当的防护设备，得到合理的休息，并受到保护，不因其护理传染病人的工作而受到歧视。

● 医疗保健设施必须是移民免执法区，这样移民身份才不会妨碍人们寻求医疗服务。对COVID-19的响应不应以任何方式与移民执法相联系。如果个人在使用医疗保健服务和回答公共卫生官员的询问（例如追踪接触者）时感到不安全，就有可能伤及个人和集体健康。在飓风和其他紧急情况期间，包括9 / 11恐怖袭击之后，也宣布了类似的移民免执法区。联邦、州和地方政府应该向公众清晰明确地阐明这些政策。

● 决策者必须与保险公司直接合作，让所有受保人都遵循公共卫生建议。对决策者来说，至关重要的是确保全面和负担得起的检测，包括没有保险的人。如果一些人由于高昂的自付费用或定额手续费而未能寻求适当的诊断或治疗，控制传播的效果就会降低。网络外或其他保险条款不应妨碍到本地分诊和病人分流方案。

● 如果开发出治疗药物或疫苗，政策制定者必须确保所有人都能负担得起并获得它们。

● 居住在近距离生活区的人特别容易受到COVID-19的感染，需要予以特别关注，以便在疫情暴发时将传播风险最小化并满足其卫生保健需求。这些人群包括住在养老院或其他集中设施的人；监狱、拘留所和其他拘留设施中的被监禁人口、惩戒人员和其他人士；露宿街头或住在收容所的无家可归者。

● 其他在这场危机中必须维持的重要医疗保健项目。慢性病患者依靠持续的护理来维持健康。无论是对肾脏疾病进行透析，对癌症予以化疗，还是用阿片受体激动剂治疗阿片类药物使用障碍，这些项目有任何失误都会对患者产生灾难性的影响。
清晰的、基于证据的沟通对控制公众的恐惧至关重要

● 科学需要引导信息传递给公众，任何政府官员都不应发表误导性或毫无根据的言论，也不应强迫他人这么做。诚实、透明和及时地报告事态发展对保持公众信任与合作至关重要。（编者注：此处删去一句）以最佳科学为基础的清晰、连贯和不矛盾的信息传递将提高自愿自我隔离和其他自愿社会疏远措施的依从性和有效性。

● 政府和机构还必须积极防止歧视和将个人或群体当作替罪羊。在COVID-19的背景下，美国华人和其他亚裔美国人社区已经开始面临针对个人的攻击，这些攻击与对病毒的恐惧有关。美国疾病控制与预防中心(CDC)指出，这种恐惧和误解会“对普通人——而不是对导致问题的疾病——产生更多的恐惧或愤怒。”地方、州和联邦官员应该大声疾呼，反对歧视和污名化，不要利用这场疫情煽动针对亚裔美国人、其他移民社区和宗教团体的仇恨情绪。

● 领导人应避免提供虚假保证，并应积极采取行动纠正错误信息，特别是那些可能引发恐慌、导致人们囤积物资和防护设备的信息。各国政府还必须就流行期间的最佳做法提供全面的建议，包括适当准备个人卫生用品，储备（但不是囤积）个人药物等必要用品。
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必须为公平和有效的感染控制提供支持和资源

●最重要的是，通过提供强有力的社会和经济支持以及明确的教育，让人们自愿配合与预防相关的公共卫生建议。在建议采取社会疏远措施的地方，政府和有关机构应帮助确保人们能够遵守规定，同时不会遭受过度或显然不公平的困苦。例如：

为了使人们能够配合社会疏远和其他措施，政策制定者必须确保人们免受失业、经济困难和过度负担的伤害。如果要求人们避免乘坐公共交通工具或工作，尽可能留在家中，政策制定者和雇主应该为他们提供明确的激励，要么通过发放补贴，要么通过补偿工资损失，就像其他地方所做的那样。如果人们无法养活自己和他们的家庭，他们将不会配合采取自我隔离或其他自愿的社会疏远措施。对于低工资、零工经济和非领薪工人来说，留在家中无法工作，对他们的经济生存会产生至关重要的影响。

当老年人和残障人士的日常生活和支持系统被打乱时，他们面临的风险特别大。许多人的资源有限，只能依靠他人的照护。政策制定者在提出自我隔离建议时，必须明确考虑这些人群的需求。

● 政策制定者应根据现有的最佳科学来做出社会疏远和关闭场所等决策。雇主、机构和学校应主动确定关闭场所的配套措施（如远程通信或虚拟教育）。在缓解流感传播方面，这些措施已被证明是行之有效的。有关流感的大量证据有助于为控制工作提供信息，但重要的是要认识到这些疾病的流行病学差异。

● 必须特别注意需要长期护理或监禁人员的需要，他们特别容易受到伤害。在疗养院或长期护理机构的人，以及那些被监禁或无家可归的人，鉴于他们的生活状况，面临特别大的感染风险。这些人可能也不太能够主动采取措施保护自己的安全，而在这些环境中，感染控制具有挑战性。逮捕和短期监禁有可能扩大疫情，更广泛的刑事司法政策应该考虑到治安和逮捕政策对卫生的影响。

● 强制隔离、区域封锁和旅行禁令曾被用于应对美国国内和国外的致命传染病风险。但它们很难实施，会破坏公众信任，造成巨大的社会成本，更重要的是，会不成比例地影响我们社区中最脆弱的群体。这些措施只有在特定情况下才能有效。所有这些措施都必须以科学为指导，并适当保护受影响者的权利。对自由的侵犯必须与那些受影响的人所带来的风险成正比，要有科学依据，要对公众透明，要通过限制性最少的手段保护公众健康，同时还应定期修订，以确保在疫情演变时相关措施仍属必要。
● 与强制性措施相比，自愿采取自我隔离措施更有可能促进合作和保护公众信任，并更有可能阻止避免与医疗系统接触的企图。要使强制隔离有效并因此在科学上和法律上合理，必须满足三个主要标准：1)疾病必须在症状出现前或早期阶段已具有传染性；2)必须能有效并切实甄别出那些可能已暴露于COVID-19的人员；以及3) 这些人必须遵守检疫条件。有证据表明，COVID-19在出现症状前或在早期阶段已经具有传染性。然而，在出现症状前或早期症状阶段的感染者对总体传播的影响尚不清楚。随着病毒的社区传播变得更加广泛，有效甄别受感染人群将变得越来越困难，这使得随着病毒在社区传播，隔离将成为一种不太可信的措施。个人能否遵守将取决于所提供支持的程度，特别是对低工资工人和其他弱势群体的支持。虽然隔离措施已经在许多地方生效，但联邦、州或地方官员如若希望开始启动或继续执行隔离措施，则需要通过透明、公开的决策过程，纳入外部科学和法律专家的意见，进行实时评估和研判，以证明隔离措施在科学和疫情发展过程中的合理性。

● 公共卫生官员必须为被隔离的个人提供安全和人道的条件，无论他们是在家中、设施中还是在社区中。政府必须确保任何自我隔离或强制隔离的人都能获得基本必需品，包括食品、水、药品和卫生用品。应向需要支持以维持日常生活的个人提供援助，并应注意宗教和通讯方面的需要。如果做不到这一点，就会破坏信任、影响对干预手段的坚持以及隔离的整体有效性。还必须避免强加不人道或歧视性的条件，就像钻石公主号游轮上发生的情况那样，乘客被隔离以保护陆地上的人口，但所处的环境令病毒得以大量传播。此外，所有被隔离的个人，不论社会或经济阶层如何，都应得到安全和人道的条件，就像在钻石公主号上，不论乘客还是员工，都应获得同等待遇一样。

● 在采取强制性措施时，必须采取措施确保民众不受失业、经济困难和过度负担的影响。政府和雇主必须认识到，低工资、零工经济以及因隔离、流动限制或其他对经济和公共生活的干扰而无法工作的非领薪工人面临着非同寻常的挑战。他们可能会发现根本无法满足自己或家人的基本需求。

● 必须赋予个人权力，让他们理解并行使自己的权利。应提供资料说明任何强制性限制的理由，以及如何和在何处对这些决定提出上诉。应给予他们程序性的正当程序，包括普遍获得法律顾问的机会，以确保他们对歧视或与其监禁有关的危险条件的申诉得到裁决。

● 区域封锁和旅行禁令的有效性取决于许多变量，在疫情的后期也会降低。尽管证据是初步的，但最近的一项建模研究表明，在中国，这些措施可能已经缓解但没有遏制COVID-19流行病的传播，只是使其在当地暴发推迟了几天，同时在国际范围内产生了更显著但仍然不大的效果，如果社区内未能推行措施，减少至少50%的传播，其效果将更为轻微。旅行限制也会造成已知的危害，例如基本商品供应链的中断。最近有作者对这一主题的研究进行了一次回顾，得出结论认为，“旅行禁令的有效性充其量只能说是不得而知”，“在评估旅行禁令的必要性和有效性时，考虑到证据有限，有必要问一下，这是否是限制性最少、同时又能保护公众健康的措施，而且即使果真如此，我们也应该反复、经常地问这个问题。” 
纵观美国近代历史，COVID-19的暴发是前所未有的，对于如此规模的流行病学事件，没有任何剧本可以参考。为了减轻其影响，你必须迅速、公正、有效地采取行动。我们敦促各位认真对待这些建议，并立即采取行动，以便我们能得到最好的保护，尽可能免受这一前所未有的微生物威胁的损害，同时避免因为不知情或考虑不周的应对而可能造成的危害。
英文原文：
Achieving A Fair and Effective COVID-19 Response: An Open Letter to Vice-President Mike Pence, and Other Federal, State and Local Leaders from Public Health and Legal Experts in the United States
Sustained human-to-human transmission of  the novel coronavirus in the United States (US) appears today inevitable. The extent and impact of the outbreak in the US is difficult to predict, and will depend crucially on how policymakers and leaders react.  It will depend particularly on whether there is adequate funding and support for the response; fair and effective management of surging health care demand; careful and evidence-based mitigation of public fear, and; necessary support and resources for fair and effective infection control.
A successful American response to the COVID-19 pandemic must protect the health and human rights of everyone in the US. One of the greatest challenges ahead is to make sure that the burdens of COVID-19, and our response measures, do not fall unfairly on people in society who are vulnerable because of their economic, social, or health status.
We write as experts in public health, law, and human rights, with experience in previous pandemic responses, to set forth principles and practices that should guide the efforts against COVID-19 in the US. It is essential that all institutions, public and private, address the following critical concerns through new legislation, institutional policies, leadership and spending.
ADEQUATE FUNDING AND SUPPORT FOR THE RESPONSE MUST BE PROVIDED
- Federal, state and local governments should act immediately to allocate funds to ensure that necessary measures can be carried out and that basic human needs continue to be met as the epidemic unfolds.  Mitigating the impact of COVID-19 will be costly. Uneven distribution of resources will compromise collective control efforts and lead to unnecessary suffering and death. A major emergency congressional appropriation must be made for epidemic control and signed by the President, with quick disbursement to state and local actors on the frontlines of the response. In addition, these must be new funds that do not cannibalize existing health and safety net programs, nor social service programs, which are integral to protecting the public health in the long term.
- The federal government and federal, local, and state agencies must minimize disruption to government activities throughout the epidemic to continue providing public services to those who need them. Government must have a coordinated plan for keeping its operations running in the event of work absences. Priority should be given to essential services and support to the public, for example ensuring that Social Security, veterans’ and other benefits are not disrupted.
SURGING HEALTHCARE DEMAND MUST BE MANAGED AND PATIENTS AND HEALTHCARE WORKERS PROTECTED
- Our healthcare system will face severe burdens under all plausible scenarios. Hospitals must receive direct funding and adequate resources for enhanced surge capacity in order to handle the front-line response. Particular attention and funding must also be directed to primary care facilities and community health centers, especially those that are currently under-resourced even under normal circumstances. These front-line sites of healthcare provision need to act as gatekeepers to prevent the overburdening of tertiary hospitals and other acute care facilities and require support to allow them to fulfill this crucial role.
- Healthcare workers and other first responders will be critical to the response. We must ensure their safety and give them fair working conditions. Healthcare workers must, for example, be given adequate protective equipment, be afforded reasonable respite, and be protected from discrimination arising out of their work with infected patients. 
- Healthcare facilities must be immigration enforcement-free zones so that immigration status does not prevent a person from seeking care.  The COVID-19 response should not be linked to immigration enforcement in any manner.  It will undermine individual and collective health if individuals do not feel safe to utilize care and respond to inquiries from public health officials, for example during contact tracing. Similar enforcement-free zones have been declared during hurricanes and other emergencies, including after the September 11 terrorist attacks. These policies should be clearly and unequivocally articulated to the public by the federal, state, and local governments. 
- Policymakers must work directly with insurance companies to allow all insured individuals to adhere to public health recommendations. It will be critical for policymakers to ensure comprehensive and affordable access to testing, including for the uninsured. Control efforts will be less effective if some fail to seek appropriate diagnosis or care due to large out-of-pocket costs or copays. Out-of-network or other insurance provisions cannot be allowed to disrupt local triage and patient allocation plans. 
- If therapeutics or vaccines are developed, policymakers must assure that they are affordable and available to all.
- People residing in close living quarters are especially vulnerable to COVID-19 and will need special attention both to minimize transmission risk and address their healthcare needs in the context of an outbreak. These populations include those living in nursing homes or other congregate facilities; incarcerated populations in prisons, jails, and other detention facilities along with corrections officers and other personnel; the homeless living on the streets or in homeless shelters.
- Other critical healthcare programs must be maintained during this crisis. People with chronic conditions depend on continuity of care to maintain their health. Whether it is dialysis for kidney disease, chemotherapy for cancer, or opioid agonist therapy for opioid use disorder, lapses in these programs can have disastrous implications for patients. 
CLEAR, EVIDENCE-BASED COMMUNICATION IS CRITICAL TO MANAGE PUBLIC FEAR
- Science needs to guide messaging to the public, and no government official should make misleading or unfounded statements, nor pressure others to do so. Honest, transparent and timely reporting of developments will be crucial to maintaining public trust and cooperation. Suppression of information and attempts to manipulate it during the SARS epidemic in China exacerbated the crisis.(fn 1) Clear, coherent, and uncontradictory messaging based on the best science will improve compliance and effectiveness of voluntary self-isolation, and other voluntary social distancing measures. (fn 2)
- Government and institutions must also actively prevent discrimination and scapegoating of individuals or groups. In the context of COVID-19, Chinese-American and other Asian-American communities have already begun to face attacks on individuals linked to fears about the virus. (fn 3,4) The Centers for Disease Control and Prevention (CDC) has pointed out that such fears and misconceptions create “more fear or anger towards ordinary people instead of the disease that is causing the problem.” (fn 5) Local, state and federal officials should speak out against discrimination and stigma, and not use the outbreak to stoke xenophobia against Asian-Americans, other immigrant communities, and religious groups, for example.  
- Leaders should refrain from offering false assurances and should act aggressively to correct misinformation, especially that which can incite panic and lead to hoarding of supplies and protective equipment. Governments must also provide comprehensive advice on best practices during epidemics, including proper personal hygiene and stocking up on, but not hoarding, needed supplies such as personal medications.
SUPPORT AND RESOURCES MUST BE PROVIDED FOR FAIR AND EFFECTIVE INFECTION CONTROL 
- The highest priority needs to be placed on allowing people to voluntarily cooperate with public health advice about prevention, by providing robust social and economic support and clear education.  Where social distancing measures are recommended, the government and relevant institutions should help ensure that people are in a position to comply, without excessive or unfairly distributed hardship. For example:
          - To enable people to cooperate with social distancing and other measures, policymakers must ensure that people are protected from job loss, economic hardship, and undue burden.  If people are asked to avoid public transport or work, policymakers and employers should give them an explicit incentive to stay home, either with payments or by compensation for lost wages, as has been done elsewhere. (fn 6,7,8) Individuals will not cooperate with self-isolation or other voluntary social distancing measures if they are unable to provide for themselves and their families. For low-wage, gig-economy, and non-salaried workers, staying home from work has especially critical implications for economic survival.
          - The elderly and disabled are at particular risk when their daily lives and support systems are disrupted. Many have limited resources and depend on others to assist with care. Policymakers must explicitly accommodate these populations when making self-isolation recommendations. 
- Policymakers should base decisions on social distancing measures and closures on the best available science.  Employers, institutions, and schools should proactively determine adaptations and accommodations for closures (e.g. tele-communication or virtual education). These measures have been effective in mitigating the transmission of influenza. (fn 9) The abundance of evidence about influenza can help inform control efforts, but it will be important to recognize differences in the epidemiology of the diseases. 
- Special attention must be paid to the needs of people in long-term care or confinement, who are particularly vulnerable. People in nursing homes, long-term care, and the incarcerated and homeless are at special risk of infection, given their living situations. These individuals may also be less able to participate in proactive measures to keep themselves safe, and infection control is challenging in these settings. Arrest and short-term incarceration can help amplify epidemics, and broader criminal justice policies should take into account the impact that policing and arrest policies have on health. 
- Mandatory quarantine, regional lockdowns and travel bans have been used to address the risk of COVID-19 in the US and abroad.  But they are difficult to implement, can undermine public trust, have large societal costs and, importantly, disproportionately affect the most vulnerable segments in our communities.  Such measures can be effective only under specific circumstances.  All such measures must be guided by science, with appropriate protection of the rights of those impacted.  Infringements on liberties need to be proportional to the risk presented by those affected, scientifically sound, transparent to the public, least restrictive means to protect public health, and regularly revisited to ensure that they are still needed as the epidemic evolves. (fn 10)
- Voluntary self-isolation measures are more likely to induce cooperation and protect public trust than coercive measures, and are more likely to prevent attempts to avoid contact with the healthcare system. (fn 11) For mandatory quarantines to be effective and therefore scientifically and legally justified, three main criteria must be satisfied (fn 12): 1) the disease has to be transmissible in its presymptomatic or early symptomatic stages; 2) those who may have been exposed to COVID-19 must be able to be efficiently and effectively identified; and 3) those people must comply with the conditions of quarantine.  There is evidence that COVID-19 is transmitted in its pre-symptomatic or early symptomatic stages. (fn 13) However, the contribution of infected individuals in their pre-symptomatic or early symptomatic stages to overall transmission is unknown.  Efficiently identifying those exposed will be increasingly difficult as community transmission of the virus becomes more widespread, making quarantine a less plausible measure as community spread proceeds.  Whether individuals can comply will be determined by the degree of support provided, particularly for low-wage workers and other vulnerable communities. While quarantines are in effect in many places already, their continuing and new use by federal, state or local officials requires real-time assessment and evaluation to justify them as the science and the outbreak evolve, through a transparent, open decision making process including external scientific and legal experts.
- Public health officials must provide safe and humane conditions to individuals who are quarantined whether in homes, facilities or communities.  Government must ensure that anyone isolated or quarantined has access to the basic necessities, including food, water, medicine, and sanitation supplies. Assistance should be provided to individuals who are in need of support to maintain daily living, and attention must be given to religious and communication needs. The failure to do so will undermine trust, adherence to the intervention and the overall effectiveness of quarantine. It will also be imperative not to impose inhumane or discriminatory conditions, as occurred on the Diamond Princess cruise ship, where passengers were quarantined to protect the population on land but were isolated in a high transmission setting. Furthermore, safe and humane conditions need to be provided to all quarantined individuals and do not differentiate between social or economic strata, or in the case of the Princess Diamond, between passengers and workers.
- Where mandatory measures are used, steps must be taken to ensure that people are protected from job loss, economic hardship, and undue burden. Government and employers must recognize that low-wage, gig-economy, and non-salaried workers who are unable to work because of quarantine or movement restrictions or other disruptions to the economy and public life face extraordinary challenges. They may find it impossible to meet their basic needs, or those of their family. 
- Individuals must be empowered to understand and act upon their rights. Information should be provided on the justification of any mandatory restrictions as well as how and where to appeal such decisions. They should be afforded procedural due process, including universal access to legal counsel, to ensure their claims of discrimination or of hazardous conditions associated with their confinement are adjudicated. 
- The effectiveness of regional lockdowns and travel bans depends on many variables, and also decreases in the later stages of an outbreak. Though the evidence is preliminary, a recent modeling study suggests that in China these measures may have mitigated but not contained the spread of the COVID-19 epidemic, delaying it locally by a few days, while having a more marked, though still modest, effect at the international scale, particularly if not combined with measures that achieved at least 50% reduction of transmission in the community. (fn 14) Travel restrictions also cause known harms, such as the disruption of supply chains for essential commodities. (fn 15) The authors of a recent review of research on the subject concluded that “the effectiveness of travel bans is mostly unknown” and “when assessing the need for, and validity of, a travel ban, given the limited evidence, it’s important to ask if it is the least restrictive measure that still protects the public's health, and even if it is, we should be asking that question repeatedly, and often.” (fn 16)
The COVID-19 outbreak is unprecedented in recent American history and there is no playbook for an epidemiological event of this scope and magnitude. To mitigate its impact, you must act swiftly, fairly, and effectively.  We urge you to take these recommendations seriously, and act urgently so that we are best protected from the damage of this unprecedented microbial threat and the possible harms of an uninformed or poorly conceived response.
来源：纽约华人资讯网 作者：詹涓
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