Name: 這種「疾病」居然比瘟疫更致命？！ (This Disease is Deadlier Than The Plague)
Uploaded: 2024-07-12T21:01:20.000Z
Duration: 10 min 53 s

程度副詞

Today, I'm moving over as the voice of Kurzgesagt for something really special.

今天，我將作為 Kurzgesagt 的配音，為一件非常特別的事情配音。

Our dearest friend John Green would like to tell you a story that's very close to his heart.

我們最親愛的朋友約翰・葛林想給大家講一個與他心靈息息相關的故事。

The White Death has haunted humanity like no other disease, following us for thousands, maybe millions of years.

結核病像其他任何疾病一樣困擾著人類，跟隨我們數千年，甚至數百萬年。

It was there when we tamed fire, invented culture, and ventured out of Africa to conquer the world.

我們馴服了火、發明了文化、走出非洲征服了世界。

In 1815, it caused one in four deaths in Britain.

1815 年，英國每四例死亡中就有一例是死於這種疾病。

In the last 200 years, it killed a billion people.

在過去的 200 年裡，它奪去了十億人的生命。

Way more than all wars and natural disasters combined.

遠遠超過所有戰爭和自然災害的總和。

Even today, it's the infectious disease with the highest kill count.

時至今日，它仍是致死人數最多的傳染病。

But do you even know what we are talking about?

We're talking about Mycobacterium tuberculosis, which causes tuberculosis, or TB, our original arch enemy.

我們說的是結核分枝桿菌，它導致結核病，也就是我們最初的宿敵肺結核。

Right now, one in four humans alive are infected with the bacterium.

目前，每四個活人中就有一個感染了這種細菌。

So, how is it possible that we never hear about TB?

那麼，我們怎麼可能從未聽說過結核病呢？

Well, the White Death is the perfect human predator.

Very infectious, but very quiet most of the time.

很有感染力，但大部分時間都很安靜。

Perfectly adapted to your immune system, and just physically incredibly hard to kill.

它們能完美地適應你的免疫系統，而且在體能上非常難以殺死。

Usually, the bacterium enters your body through the airways and sets up home in the lungs, a giant living cave system defended by billions of macrophages, powerful guard cells that hunt and kill intruders.

通常情況下，細菌通過呼吸道進入人體，在肺部安家落戶。肺部是一個巨大的活體洞穴系統，由數十億個巨噬細胞保衛，這些強大的保衛細胞可以捕殺入侵者。

The TB bug is quickly attacked and devoured alive.

結核病蟲很快就會被攻擊並活活吞食。

The White Death is the worst kind of parasite, an immune system parasite.

結核病是最可怕的寄生蟲，是一種免疫系統寄生蟲。

Macrophages grab their victims, trap them inside a phagosome, and flood it with acid that rips them to pieces.

巨噬細胞抓住受害者，將其困在吞噬體中，並用酸性物質將其撕成碎片。

But TB evolved a thick, waxy coat that makes it completely immune to those It captures and modifies the macrophage to be a perfect host.

但是，肺結核進化出了一層厚厚的蠟質外衣，使其對這些病毒完全免疫。 它捕獲並改造巨噬細胞，使其成為完美的宿主。

Like a tiny vampire, the parasite slowly consumes the cell.

寄生蟲就像一個小小的吸血鬼，慢慢吞噬著細胞。

Other microbes that make you sick multiply up to 60 times faster, exploding their numbers before the immune system can eradicate them.

其他致病微生物的繁殖速度可高達 60 倍，在免疫系統消滅它們之前，它們的數量就已激增。

But the White Death is so well-adapted to you, it has already won by being here.

但結核病非常適應你們，它在這裡就已經贏了。

When its host cell is sucked dry and dies, the bacteria infect new macrophages.

當宿主細胞被吸乾死亡後，細菌會感染新的巨噬細胞。

Although these bacteria are stealthy, the decaying corpses they leave behind do activate a proper immune response.

雖然這些細菌很隱蔽，但它們留下的腐爛屍體確實會激活適當的免疫反應。

Your body knows something is up and mobilizes its forces.

你的身體知道有事情要發生，所以會調動自己的力量。

But once again, this is part of the plan.

Macrophages and many other immune cells try to kill the bacteria, but that thick cell wall makes them a formidable fortress and resistant to many attacks.

巨噬細胞和許多其他免疫細胞都試圖殺死細菌，但厚厚的細胞壁使細菌成為一座堅固的堡壘，能抵禦許多攻擊。

And it infects its attackers in the process.

在此過程中，它還會感染攻擊者。

So when your cells can't kill them, they do the next best thing, keep the parasites from escaping.

所以當細胞無法殺死寄生蟲時，它們就會採取下一個最好的辦法，防止寄生蟲逃脫。

A granuloma is formed, a sort of white blob.

形成肉芽腫，一種白色的小球。

In the center is a core of infected and dead macrophages, a pleasant home and food for the bacterium.

中間是被感染和死亡的巨噬細胞核心，是細菌的舒適家園和食物。

Other immune cells surround this sphere of death to contain it, creating a safe space where TB can sit for years.

其他免疫細胞會包圍這個死亡之球，將其遏制住，從而創造出一個安全的空間，讓結核病在其中存活數年。

Worse, it is perfectly protected from medication and releases chemicals that make it hard for your heavy immune weapons to be activated.

更糟糕的是，它完全不受藥物的影響，並釋放出化學物質，讓你的重型免疫武器難以啟動。

This is the stalemate version of tuberculosis.

The infection is sleeping and the bacteria is doing its thing.

感染在沉睡，細菌在做自己的事情。

This is going on right now in up to 2 billion people, but in 1 in 10 of them, the disease will become active.

目前有多達 20 億人患有這種疾病，但其中每 10 人中就有 1 人的病情會變得活躍。

Active tuberculosis is an emergency, but again, a slow one.

活躍性肺結核是一種緊急情況，但也是一種緩慢的緊急情況。

If your immune system can't contain the infection anymore, granulomas burst.

如果免疫系統無法控制感染，肉芽腫就會破裂。

Suddenly, your lungs are filled with macrophage corpses and fresh bacteria.

突然間，你的肺部充滿了巨噬細胞的屍體和新鮮的細菌。

Your immune system panics and overreacts.

你的免疫系統會驚慌失措，反應過度。

Hordes of soldiers leave your blood and rush to the infected areas.

成群結隊的阿兵哥離開你的血脈，衝向疫區。

They order inflammation and fluids flood into your lungs, but unfortunately, your lungs are not made to be a battlefield.

它們命令發炎和體液湧入肺部，但不幸的是，肺部並不是戰場。

In their panic, your immune cells don't care.

慌亂之中，你的免疫細胞根本不在乎。

They're running around with flamethrowers trying to purge the infection, but causing terrible damage.

他們拿著火焰噴射器到處跑，試圖清除感染，但卻造成了可怕的破壞。

As fluids and dead tissue amass, it becomes difficult to breathe and you begin coughing hard, sometimes even coughing up blood.

隨著體液和壞死組織的積累，呼吸會變得困難，您會開始劇烈咳嗽，有時甚至會咳血。

And again, this is part of the plan, because now you spread millions of bacteria catching rides in tiny droplets.

同樣，這也是計劃的一部分，因為現在你傳播的是數百萬個細菌，它們在微小的液滴中搭乘順風車。

You burn a high fever and lose weight as your body is severely stressed.

由於身體嚴重受壓，你會發高燒，體重下降。

You turn into a ghost version of yourself.

Even if you are treated, this phase can last weeks to months and is very serious.

即使接受了治療，這一階段也會持續數週至數月，而且非常嚴重。

Insufficiently treated, TB will, over months, years, or even decades, slowly overtake your body.

如果治療不及時，結核病將在數月、數年甚至數十年內慢慢侵蝕你的身體。

Especially for children or those already weakened, this can be too much, and the disease wins the war.

特別是對於兒童或身體已經虛弱的人來說，這可能會讓他們吃不消，疾病也就贏得了戰爭。

The bacterium spreads to other organs, lung function breaks down, and the patient dies.

細菌擴散到其他器官，肺功能衰竭，患者死亡。

1.3 million people died this way in 2023 alone.

僅在 2023 年，就有 130 萬人因此死亡。

Tuberculosis is the worst kind of problem.

Instead of killing millions quickly, like COVID, scaring a panicked humanity into frantic action, TB is a smoldering fire, killing too slowly for our short attention span.

結核病並不像 COVID 那樣迅速殺死數百萬人，嚇得驚慌失措的人類採取瘋狂行動，而是像一團燃燒的火焰，對我們短暫的注意力來說殺傷力太慢。

The symptoms are often mild for many months, so you don't feel in danger.

症狀通常在數月內都很輕微，所以你不會感到危險。

Tuberculosis doesn't want to kill you, of course, it wants to stay alive and spread.

當然，肺結核並不想殺死你，它只想活下去並傳播。

And to do this, it exploits human behavior.

The people you are most likely to infect are your family and friends, co-workers, or neighbors, the people you spend a lot of time with.

你最有可能感染的人是您的親朋好友、同事或鄰居，也就是與你朝夕相處的人。

When COVID brought the world to a halt, the average patient infected two to three people.

當 COVID 使世界陷入停頓時，平均每個患者會感染兩到三個人。

An active TB patient infects five to fifteen people in a year.

一名活躍性肺結核病人一年會感染五到十五人。

Most people catch it via breathing tiny droplets from a cough or sneeze.

大多數人是通過吸入咳嗽或打噴嚏時產生的微小飛沫而感染這種疾病的。

This is especially common in crowded, poorly ventilated housing or workplaces, which is why TB exploded during the Industrial Revolution.

這在擁擠、通風不良的住房或工作場所尤為常見，這也是肺結核在工業革命期間爆發的原因。

And indeed, wherever we see new unplanned and overcrowded urbanization, from Lagos to St. Petersburg, we tend to see a rise of the white death alongside it.

事實上，無論我們在哪裡看到新的無規劃和過度擁擠的城市化，從拉各斯到聖彼得堡，我們往往會看到結核病的興起。

Today, most cases of active tuberculosis, the version that spreads the disease further, can be cured with a four-month regimen of four different antibiotics.

如今，大多數活躍性肺結核（會進一步傳播疾病的肺結核）病例都可以通過使用四種不同的抗生素進行為期四個月的治療來治癒。

But if that's the case, how is this still the deadliest infectious disease on earth?

既然如此，為什麼這種疾病仍然是地球上最致命的傳染病呢？

Between 1940 and 1965, humans developed several drugs to fight TB, finally making it curable.

從 1940 年到 1965 年，人類開發出了多種抗結核藥物，最終使結核病得以治癒。

It was a true achievement of human ingenuity, but we didn't do a great job of distributing the cure.

這是人類智慧的真正成就，但我們在傳播治癒方法方面做得並不好。

While tuberculosis is almost extinct in much of Europe, the U.S., and the Middle East, it is still a very real threat in most of the world.

雖然結核病在歐洲、美國和中東的大部分地區幾乎絕跡，但在世界大部分地區，它仍然是一個非常現實的威脅。

TB kills people primarily in Africa, South America, and Asia.

結核病主要在非洲、南美洲和亞洲造成死亡。

In 2022, two-thirds of all TB cases were in just six countries, India, China, Indonesia, the Philippines, Pakistan, and Nigeria.

2022 年，三分之二的結核病例發生在印度、中國、印尼、菲律賓、巴基斯坦和奈及利亞這六個國家。

Almost half of all tuberculosis deaths happened in Southeast Asia.

幾乎一半的結核病死亡病例發生在東南亞。

But as it is a slow problem like climate change, it was ignored instead of fought aggressively, which enabled more and more strains of TB to develop antibiotic resistance,

但由於這是一個像氣候變化一樣緩慢的問題，我們沒有積極應對，而是忽視了它，這使得越來越多的結核病菌株產生了抗藥性，

which is a problem because we kind of stopped making new drugs.

這是一個問題，因為我們有點停止生產新藥了。

In the first 25 years of the antibiotic era, we developed eight different classes of drugs to treat TB.

在抗生素時代的頭 25 年裡，我們開發了八種不同類別的藥物來治療結核病。

And then, in the 47 years between 1965 and 2012, we developed none.

然後，從 1965 年到 2012 年的 47 年裡，我們什麼也沒開發出來。

Developing new drugs is extremely expensive, and there was no concentrated effort to eradicate TB, and there simply wasn't enough profit incentive.

研發新藥極其昂貴，而且沒有集中力量根除結核病，根本沒有足夠的利益驅動。

There is a vaccine, but it's over 100 years old and not particularly effective.

有一種疫苗，但已經有 100 多年的歷史了，而且不是特別有效。

But beginning in 2012, we did finally develop two new classes of drugs that treat TB.

但從 2012 年開始，我們終於開發出了兩類治療結核病的新藥。

And we may finally be at an inflection point again, as better vaccines are on the horizon.

我們可能終於又到了一個拐點，因為更好的疫苗即將問世。

Companies that made COVID tests also developed a quick test for TB.

生產 COVID 檢測試劑的公司還開發了一種結核病快速檢測試劑。

So we now have a real opportunity to push this disease back until it dies forever.

我們現在有了一個真正的機會，可以將這種疾病擊退，直到它永遠消亡。

But only if we get enough people to know about TB, like you do now, and to care about it.

但前提是，我們必須讓足夠多的人瞭解結核病，就像你們現在這樣，並關心它。

A century ago, in the United States, there were almost as many hospital beds for TB patients as for treating all other illnesses and injuries combined.

一個世紀前，在美國，治療肺結核病人的病床數量幾乎相當於治療所有其他疾病和傷害的病床數量總和。