偶然在纽约时报看到一篇反驳官方不建议健康人戴口罩的文章，特转载于此。发现国内已有中文翻译，省地我用谷歌翻译了。就内容而言，其实她的论据也无甚新奇，基本我都有涉及。只是看着世卫WHO、美国CDC、美国官员、科普邪教方舟子土摩托们，连美国专家也无法被忽悠不下去了，比较有趣。
Zeynep Tufekci 文中倒是提到我没想过的一点，美国有关部门一边说医护人员要戴口罩，一边忽悠民众不必戴口罩，反而让自己丧失了公信力。
健康界翻译
美国专家反驳“大众不需要戴口罩”：结果适得其反
健康界国际 03-19 18:12
自疫情在全球范围暴发以来，关于普通人需不需要戴口罩各国出现了不同的现象。美国当局的建议是，普通人不需要戴口罩。但北卡罗来纳大学的一名信息科学领域副教授Zeynep Tufekci认为，这一建议根本站不住脚，反而适得其反。她在写给《纽约时报》的文章中详细阐明了观点和原因。以下为Zeynep Tufekci的原文翻译：
一月份得知新冠病毒会人传人后，我的第一反应就是订购口罩。几周过去了，商店里的口罩已经售罄，网购也买不到——除非甘愿花高价被奸商宰一刀。疫情蔓延超出预期，为了确保仅存不多的口罩能留给医护人员，许多卫生专家开始告诫人们，普通人不需要口罩，错误佩戴反而更容易中招。
随着新冠肺炎成为全球性大流行病，公众关于口罩的困惑丝毫没被打消。由于当局宣贯的出发点是为了保障稀缺物资，这场自上而下的对话已经起到了反效果。在当下美国媒体和卫生当局可信度大打折扣的背景下，这一说法反而鼓励了更多的囤积。在此，我呼吁大家全都戴口罩，原因有以下这几条：
首先，包括美国卫生部长在内的许多卫生专家纷纷向公众阐明，普通民众日常不需要口罩，它们应该优先给医护人员使用。这就让人疑惑：难道只有在特定领域给特定人群佩戴时，口罩才能神奇般发挥作用？
其次，有专家顺着第一条的意见进一步指出，正确使用口罩，尤其是医用级的N95口罩要求很高，普通人往往佩戴方式有误，起不到防护作用。这一点也非常说不通。许多人洗手的方式也是错的，但我们会让他们别洗手吗？恰恰相反，我们会在洗手台张贴宣传标语，教育大家洗手的时长要唱满两遍生日快乐歌。与其说人们搞不清楚状况，不如教会他们怎样做才是对的。更何况，当大家知道只有正确佩戴才能保护自己时，是不会有人掉以轻心的。
第三，口罩当然有用，尽管不同型号效果不一，但它们确实能提供防护。戴口罩一直是保护感染者周围人群的标准对策之一，对于易感群体更是如此。世卫组织的官员在新闻发布会上也戴口罩。这就是我当初买口罩的原因——我在香港研究和教授过流行病社会学，从他们抗击2003年非典的经验中得知，许多亚洲高风险国家的卫生官员都建议民众戴口罩。
当然，戴了口罩不等于高枕无忧，经常洗手和保持社交距离也很重要。医用外科一次性口罩不像N95口罩那样能过滤掉细小的病毒颗粒，但起码也比完全不戴口罩好得多。我们从流感研究中知道，勤洗手、戴口罩、少扎堆都有助于降低传播率。现在口罩紧缺，美国疾控中心的建议是，外科口罩是医护人员“可接受的替代品”——这更加说明采取保护措施很有必要，即使不够完善也远比没有好。如今公然提出“普通人不需要口罩”，这么绝对的说法只会让人们更不信任当局。
第四，世卫组织和疾控中心都告诉公众生病了要戴口罩。然而越来越多的证据表明，新冠肺炎很多是无症状传播，症状轻微的年轻人不知道自己病了，但仍具有传染性。既然已经明确口罩会减少感染他人的机会，那么每个人都应该戴口罩。如果只有病人才需要戴口罩，那么戴口罩的人就会被污名化，人们很可能病了也不愿意戴口罩。更别说在美国，现在去做新冠病毒检测是一件多么费劲的事情，普通民众怎么可能知道何时该戴口罩？
第五，尽管有不少中国内地旅客前往香港和台湾，但在保持社交距离和全民佩戴口罩的背景下，病毒传播得到了很大程度的遏制。香港卫生官员普遍认为，戴口罩是应对方案的一部分，并推荐使用通用口罩。而台湾应对新冠病毒的第一举措就是立即加大口罩生产。
第六，口罩是一个重要的信号，表明这和往常不一样，是需要全民团结的行为。疫情当前，普通民众共同做出的努力将有助于减少传播，为医院应对疫情暴发争取时间。这会让我们的同胞知道，哪怕只是佩戴口罩，也是在为抗疫做贡献，每个人的努力都很重要。
最后，发布如此矛盾的指导意见，会助长口罩囤积和假消息的散播。人们终会知道口罩短缺，只能自行先囤积起来。当人们觉得自己无法从当局那里得到全部真相时，哄抬价格的情况就更常见了。
那么问题来了，口罩确实短缺，医务人员也确实更需要口罩，当局应该怎么应对？尽管几十年来，特别是在非典之后专家频频发出警告，然而我们仍然没有做好应对流行病的准备，也没有在力所能及的情况下增加美国国内生产，导致出现了口罩短缺。这将带来灾难性的后果，一线的医护人员理应得到最好的保护，如果他们病倒了，我们都将直面死亡。
如果说有什么解决办法的话，呼吁那些囤积口罩的人把一部分捐给医务人员，可能比告诉大家不需要口罩或者他们不会戴口罩更好。“现在口罩很紧缺，我们已尽最大努力提高产量。但如果医务人员生病了，情况可能会更糟。每个人留足至少两周的口罩，然后把多余的捐给附近的医院吧。”这套说辞听起来很老套，但两周是一个合理的标准，因为如果在家照顾一个轻症患者，世卫组织和疾控中心仍建议戴上口罩，这会在医院不堪重负的情况下显得很必要。
研究表明，在灾难发生时，人们会表现出明显的利他行为，但如果当局的干预助长了不信任，或者没有充分发动群众的力量，可能会适得其反。我们都应该戴上口罩，流行病的蔓延更需要我们通力协作，越早为合作创造条件，就越早能走出困境。
原文来源：The New York Times
原文标题：Why Telling People They Don’t Need Masks Backfired
https://xw.qq.com/cmsid/20200319A0ML4G00
纽约时报原文：为什么说告诉人们不需要戴口罩会适得其反？
为什么说告诉人们不需要戴口罩会适得其反？
为了应对短缺，当局发出了让他们不被信任的信息
Why Telling People They Don’t Need Masks Backfired
To help manage the shortage, the authorities sent a message that made them untrustworthy.
Zeynep Tufekci
By Zeynep Tufekci
Dr. Tufekci is a professor of information science who specializes in the social effects of technology.
March 17, 2020
When news of a mysterious viral pneumonia linked to a market in Wuhan, China, reached the outside world in early January, one of my first reactions was to order a modest supply of masks. Just a few weeks later, there wasn’t a mask to be bought in stores, or online for a reasonable price — just widespread price gouging. Many health experts, no doubt motivated by the sensible and urgent aim of preserving the remaining masks for health care workers, started telling people that they didn’t need masks or that they wouldn’t know how to wear them.
As the pandemic rages on, there will be many difficult messages for the public. Unfortunately, the top-down conversation around masks has become a case study in how not to communicate with the public, especially now that the traditional gatekeepers like media and health authorities have much less control. The message became counterproductive and may have encouraged even more hoarding because it seemed as though authorities were shaping the message around managing the scarcity rather than confronting the reality of the situation.
First, many health experts, including the surgeon general of the United States, told the public simultaneously that masks weren’t necessary for protecting the general public and that health care workers needed the dwindling supply. This contradiction confuses an ordinary listener. How do these masks magically protect the wearers only and only if they work in a particular field?
Second, there were attempts to bolster the first message, that ordinary people didn’t need masks, by telling people that masks, especially medical-grade respirator masks (such as the N95 masks), needed proper fitting and that ordinary people without such fitting wouldn’t benefit. This message was also deeply counterproductive. Many people also wash their hands wrong, but we don’t respond to that by telling them not to bother. Instead, we provide instructions; we post signs in bathrooms; we help people sing songs that time their hand-washing. Telling people they can’t possibly figure out how to wear a mask properly isn’t a winning message. Besides, when you tell people that something works only if done right, they think they will be the person who does it right, even if everyone else doesn’t.
Third, of course masks work — maybe not perfectly and not all to the same degree, but they provide some protection. Their use has always been advised as part of the standard response to being around infected people, especially for people who may be vulnerable. World Health Organization officials wear masks during their news briefings. That was the reason I had bought a few in early January — I had been conducting research in Hong Kong, which has a lot of contact with mainland China, and expected to go back. I had studied and taught about the sociology of pandemics and knew from the SARS experience in 2003 that health officials in many high-risk Asian countries had advised wearing masks.
It is of course true that masks don’t work perfectly, that they don’t replace hand-washing and social distancing, and that they work better if they fit properly. And of course, surgical masks (the disposable type that surgeons wear) don’t filter out small viral particles the way medical-grade respirator masks rated N95 and above do. However, even surgical masks protect a bit more than not wearing masks at all. We know from flu research that mask-wearing can help decrease transmission rates along with frequent hand-washing and social-distancing. Now that we are facing a respirator mask shortage, the federal Centers for Disease Control and Prevention is recommending that surgical masks are “an acceptable alternative” for health care workers — again, obviously because some protection, even if imperfect, is better than none. In the face of this, publicly presenting an absolute answer — “You don’t need them” — for something that requires a qualified response just makes people trust authorities even less.
Fourth, the W.H.O. and the C.D.C. told the public to wear masks if they were sick. However, there is increasing evidence of asymptomatic transmission, especially through younger people who have milder cases and don’t know they are sick but are still infectious. Since the W.H.O. and the C.D.C. do say that masks lessen the chances that infected people will infect others, then everyone should use masks. If the public is told that only the sick people are to wear masks, then those who do wear them will be stigmatized and people may well avoid wearing them if it screams “I’m sick.” Further, it’s very difficult to be tested for Covid-19 in the United States. How are people supposed to know for sure when to mask up?
Fifth, places like Hong Kong and Taiwan that jumped to action early with social distancing and universal mask wearing have the pandemic under much greater control, despite having significant travel from mainland China. Hong Kong health officials credit universal mask wearing as part of the solution and recommend universal mask wearing. In fact, Taiwan responded to the coronavirus by immediately ramping up mask production.
Sixth, masks are an important signal that it’s not business as usual as well as an act of solidarity. Pandemics require us to change our behavior — our socialization, hygiene, work and more — collectively, and knowing our fellow citizens are on board is important for all efforts.
Finally, providing top-down guidance with such obvious contradictions backfires exactly because lack of trust is what fuels hoarding and misinformation. It used to be said that back in the Soviet Union, if there was a line, you first got in line and then figured out what the line was for — people knew that there were going to be shortages and that the authorities often lied, so they hoarded. And when people feel as though they may not be getting the full truth from the authorities, snake-oil sellers and price gougers have an easier time.
Given that there is indeed a mask shortage and that medical workers absolutely do need these masks more, what should the authorities have said? The full painful truth. Despite warnings from experts for decades, especially after the near miss of SARS, we still weren’t prepared for this pandemic, and we did not ramp up domestic production when we could, and now there’s a mask shortage — and that’s disastrous because our front line health care workers deserve the best protection. Besides, if they fall ill, we will all be doomed.
If anything, a call for people who hoarded masks to donate some of them to their local medical workers would probably work better than telling people that they don’t need them or that they won’t manage to make them work. “Look, more masks would be great. We are doing our best to ramp up production. Till then, if our medical workers fall ill, we will all be worse off. Please donate any excess — maybe more than two weeks’ worth per person — to your hospital” sounds corny, but it’s the truth. Two weeks is a reasonable standard because the C.D.C. and the W.H.O. still recommend wearing masks if you’re taking care of someone with a milder illness self-isolating at home, something that will increasingly be necessary as hospitals get overwhelmed.
Research shows that during disasters, people can show strikingly altruistic behavior, but interventions by authorities can backfire if they fuel mistrust or treat the public as an adversary rather than people who will step up if treated with respect. Given that even homemade masks may work better than no masks, wearing them might be something to direct people to do while they stay at home more, as we all should.
We will no doubt face many challenges as the pandemic moves through our societies, and people will need to cooperate. The sooner we create the conditions under which such cooperation can bloom, the better off we all will be.
Zeynep Tufekci (@zeynep) is an associate professor at the University of North Carolina, the author of “Twitter and Tear Gas: The Power and Fragility of Networked Protest” and a contributing opinion writer.
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html
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