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| Late last year, the federal government’s chief statistician on death received word about a tantalizing discovery: Someone had died from Covid-19 in January 2020, a death certificate said, a revelation that would have sped up the timeline of the virus’s spread in the United States by several weeks. | 去年年底，联邦政府的首席死亡统计学家收到了一个令人好奇的消息。一份死亡证明称，有人在2020年1月就死于新冠病毒，这一发现将把病毒在美国的传播时间提早数周。 |
| That death was ultimately not what it seemed. The person who certified it had meant June 2020, not January. But that blip on the radar screen of Robert Anderson, the chief of mortality statistics at a branch of the Centers for Disease Control and Prevention, helped to kick off a quiet, yearlong campaign at the agency to check and recheck the country’s first suspected Covid-related deaths in the uncertain days of early 2020. | 实情并非如此。签发死亡证明的人指的是2020年6月，而不是1月。但疾病控制和预防中心（Centers for Disease Control and Prevention，简称CDC）一个下属机构的死亡率统计主管罗伯特·安德森(Robert Anderson)经历的这段小插曲，促使该机构暗中启动了一个长达一年的调查，检查和复核美国在2020年初那些不确定的日子里最早一批疑似与新冠病毒有关的死亡。 |
| Now, at least four possible Covid-19 deaths from January 2020 have survived Dr. Anderson’s vetting. Spread out across four states, they have become part of a scattershot collection of clues about the virus’s early spread beyond China — some of them trustworthy, others less so — that have begun drawing more attention as scientists and intelligence officials try to unravel how the pandemic began. | 现在，至少有四例在2020年1月可能死于新冠的病例通过了安德森博士的审查。它们分散在四个州，成为有关病毒在中国以外早期传播的零散线索的一部分——其中一些是可信的，另一些则没有那么可信——随着科学家和情报官员试图弄清疫情是如何开始的，这些线索已经开始引起更多关注。 |
| The odds that all four of the C.D.C.’s new death cases — from Kansas, California, Alabama and Wisconsin — really did result from Covid-19 are slim, some scientists said. This year, a doctor or another official certifier reclassified them as being Covid-related. But whether they did so solely on the basis of the person’s symptoms, or with the help of more useful blood or tissue samples, is not clear. | 一些科学家表示，CDC的四例新死亡病例——分别来自堪萨斯州、加利福尼亚州、阿拉巴马州和威斯康星州——确实是由新冠病毒造成的可能性很小。今年，一名医生或其他某个正式的死亡证明开具者将它们重新分类为与冠状病毒有关。但目前尚不清楚他们的做法是仅仅基于病人的症状，还是借助了更有用的血液或组织样本。 |
| The earliest death, on Jan. 9, 2020, in Kansas, was reclassified this spring on the basis of the person’s symptoms alone, the state health department said, putting the onus on a doctor to evaluate how closely the patient’s disease matched the symptoms of Covid-19. The most common symptoms of the virus, including a fever, difficulty breathing and even a loss of taste or smell, overlap with symptoms of other respiratory illnesses. | 最早的死亡病例发生于2020年1月9日的堪萨斯州，该州卫生部门表示，今年春天，他们仅根据患者的症状对其进行了重新分类，这让医生有责任评估病人的疾病与新冠症状的密切程度。这种病毒感染最常见的症状包括发烧、呼吸困难，甚至失去味觉或嗅觉，与其他呼吸道疾病的症状重叠。 |
| In a sign of how difficult it can be to recategorize long-ago deaths, C.D.C. records include a fifth Covid-related death from January 2020, in Oklahoma. But after state officials investigated, the medical examiner removed Covid-19 from the death certificate, Oklahoma’s health department said on Wednesday, meaning that it will probably soon fall off of the C.D.C.’s records, too. | CDC的记录中包括了自2020年1月以来在俄克拉荷马州发生的第五起与新冠病毒相关的死亡，这表明对很久以前的死亡病例重新分类是多么困难。但俄克拉荷马州卫生部门周三表示，在州官员进行调查后，法医从死亡证明中删除了新冠病毒，这意味着它可能很快也会从疾控中心的记录中被删除。 |
| It is not clear whether any of the suspected cases had traveled to China. | 目前尚不清楚这些疑似病例是否曾经去过中国。 |
| “My guess is that they’re probably not all real, maybe not even any of them,” said Michael Worobey, an evolutionary biologist at the University of Arizona. It’s highly unlikely that any of the people caught the virus in the United States, he said, but it’s possible that some had recently been to China. “If any of them are real, they’d be travel-linked cases, and that’s conceivable,” he said. | 亚利桑那大学(University of Arizona)演化生物学家迈克尔·沃罗比(Michael Worobey)说：“我的猜测是，它们可能不全是真的，甚至可能全部都不是真的。”他说，这些人中极不可能有人在美国感染病毒，但有可能有些人前不久去过中国。他说：“如果其中任何一个病例是真的，那会是与旅行有关的病例，这是可以想象的。” |
| Dr. Worobey’s research, including close analyses of viral genomes and epidemic simulations, has indicated that the virus was unlikely to be spreading outside of China before mid-December 2019, making non-traveler deaths in the United States the following month doubtful, he said. Several weeks typically pass between someone getting infected and dying, and any given case is unlikely to be fatal. | 沃罗比博士的研究，包括对病毒基因组的密切分析和流行病模拟，表明该病毒在2019年12月中旬之前不太可能在中国以外传播，这使得接下来一个月在美国发生的非旅行者死亡事件成为疑问，他说。从一个人感染到死亡通常需要几周时间，而且任何特定病例都不太可能致命。 |
| “Extraordinary claims require extraordinary evidence,” Dr. Worobey said. | “非同一般的主张需要非同一般的证据，”沃罗比博士说。 |
| For Dr. Anderson, the trustworthiness of the January 2020 deaths is not only a public health concern, but also a personal preoccupation. | 对于安德森博士来说，2020年1月死亡人数的可信度不仅是一个公共卫生问题，也是个人的工作重点。 |
| A demographer by training who landed at the C.D.C. in 1996 after staring down a treacherous academic job market, Dr. Anderson said that certain deaths had an outsize impact, statistically speaking. And that includes Covid deaths early in the pandemic. | 安德森博士是科班出身的人口统计学家，在研究了难以捉摸的学术就业市场后于1996年进入疾控中心工作。他说，从统计学上讲，某些死亡产生了巨大的影响。这包括大流行早期的新冠死亡。 |
| When states submit Covid-19 death numbers, the C.D.C. normally takes them at face value, as it does for hundreds of thousands of deaths from heart disease or cancer any given year. The agency recorded nearly three million registered deaths in 2019, and a mistake here or there does not change the country’s overall picture of mortality, Dr. Anderson said. | 当各州提交新冠死亡人数时，疾控中心通常照单全收，就像对待任何一年因心脏病或癌症导致的数十万的死亡数字一样。安德森博士说，该机构在2019年记录了近300万登记死亡人数，零星的错误不会改变国家的总体死亡率情况。 |
| Not so for a possible Covid death at the dawn of a pandemic. At the time, testing was scarce. Until The Mercury News in California recently reported on the possible cases from January 2020, the earliest suspected Covid-related fatality was not until Feb. 6, 2020. | 但对于在大流行刚开始时潜在的新冠死亡病例而言，情况并非如此。当时，新冠检测很少。加利福尼亚的《水星新闻》最近报道了2020年1月以来的可能病例，在此之前，最早的疑似与新冠病毒相关的死亡病例直到2020年2月6日才出现。 |
| When Dr. Anderson is notified of Covid-related deaths from the first two months of 2020, he calls state health officials, who in turn ask for verification from the doctor or medical examiner who signed the death certificate. | 当安德森博士被告知2020年前两个月与新冠病毒相关的死亡数字时，他打电话给州卫生官员，州卫生官员又要求签署死亡证明的医生或体检医师进行核实。 |
| In January of this year, for instance, the C.D.C. received a flurry of reports of people having died from Covid-19 in January 2020. Or so they said. Further checking revealed that most doctors had simply forgotten to start writing 2021 next to their signatures. | 例如，今年1月，CDC收到了一系列关于2020年1月有人死于新冠的报告。至少他们是这么说的。进一步核实发现，大多数医生只是忘记在他们的签名旁边写上2021。 |
| In another case this summer, Dr. Anderson confirmed that a medical certifier had meant to reclassify a January 2020 death as Covid-related, only for that certifier to backtrack once the state health department intervened. | 在今年夏天的一个病例中，安德森博士证实，一名医疗证明人本打算将2020年1月的一个死亡病例重新归类为与新冠病毒相关，但在州卫生部门介入后，此人又收回了之前的说法。 |
| Looming over the drudgery, for Dr. Anderson, is a single death from 2007 that the agency had said was caused by diphtheria, a serious bacterial infection that is virtually unheard-of in the United States. The C.D.C. later determined that the death had not been caused by diphtheria at all; a simple coding error was to blame. | 对于安德森博士来说，这桩苦差事里挥之不去的一个回忆是在2007年，该机构曾表示有一个死亡病例是由白喉引起的，这是一种在美国几乎闻所未闻的严重细菌感染。CDC后来确定死亡根本不是由白喉引起的，而是由一个简单的编码错误引起的。 |
| “That was a little embarrassing to have in our data file,” Dr. Anderson said. “Even though it’s just one death, in that context, it has a big impact, because it’s high-profile.” | “在我们的数据文件中出现这种情况有点尴尬，”安德森博士说。“尽管这样的死亡病例只有一个，但在那种情况下，它的影响很大，因为它很引人注目。” |
| Ultimately, though, without access to patient samples or medical records, the C.D.C. has to trust the people who sign Covid-19 death certificates, he said. | 然而，最终，在无法接触到患者样本或医疗记录的情况下，CDC不得不信任签署新冠死亡证明的人。 |
| “I can’t say for sure these are all accurate,” Dr. Anderson said of the January 2020 deaths. “But I think it unlikely that certifiers would have capriciously changed the death certificate.” | “我不能肯定这些都是准确的，”安德森博士在谈到2020年1月的死亡人数时说。“但我认为，开证明的人不太可能随意更改死亡证明。" |
| Most Covid-19 deaths are straightforward to certify, said Marcus Nashelsky, a professor of pathology at the University of Iowa who helped the C.D.C. write guidelines about how to attribute such deaths. For example, early in the pandemic, when nursing home patients were not always being tested, he said, a known outbreak in the home, in combination with characteristic symptoms and signs of the virus, could be enough for a doctor to declare a Covid-related death. | 艾奥瓦大学(University Of Iowa)病理学教授马库斯·纳斯尔斯基(Marcus Nashelsky)说，大多数新冠死亡病例都很容易证明。纳斯尔斯基曾帮助CDC撰写关于如何认定此类死亡的指导原则。他说，比如在疫情初期，住在养老院里的病人往往没做检测，如果养老院里出现了疫情，加上该病毒的典型症状和症候，就足以让医生宣布死因与新冠有关。 |
| Nevertheless, death certificates have become hotly contested documents during the pandemic. In some cases, disbelieving families have asked that someone’s death certificate be wiped of any mention of Covid-19, said James Gill, Connecticut’s chief medical examiner and the president of the National Association of Medical Examiners. In others, families have urged that Covid-19 be added to a death certificate, seemingly in an effort to become eligible for funeral funding under a federal assistance program, he said. | 然而，在疫情期间，死亡证明已成为备受争议的文件。康涅狄格州首席法医、全国法医协会(National Association of Medical Examiners)主席詹姆斯·吉尔(James Gill)说，在某些情况下，持怀疑态度的家人要求死亡证明上不要提及新冠肺炎。他说，在另外一些情况下，有些家属坚持将新冠肺炎写进死亡证明，这似乎是为了获得联邦援助计划下的殡葬金。 |
| “It’s a very emotional thing for some families, whether or not they want it on the death certificate,” Dr. Gill said. “It shouldn’t be. It’s a public health matter.” | “对于一些家庭来说，这是一件非常情绪化的事情，无论他们是愿意还是不愿意把它写在死亡证明上，”吉尔博士说。“不应该这样的。这是一个公共卫生问题。” |
| In spring 2020, Dr. Gill said, he became concerned that Connecticut was overlooking Covid-19 deaths, especially among nursing home residents whose complicated medical histories can sometimes obscure causes of death. In a few hundred cases, he said, the medical examiner’s office conducted deep nasal swabs on bodies at funeral homes. The team found a number of cases. | 吉尔说，2020年春他开始担心康涅狄格州低估了新冠肺炎的死亡人数，尤其是养老院居民，他们复杂的病史有时会掩盖死因。他说，在数百起个案中，法医办公室在殡仪馆对遗体进行了鼻拭子检测。他们发现了不少病例。 |
| With China refusing to share more information about its own early cases, the World Health Organization recently said that it was helping researchers dig into reports of cases in late 2019 outside of China. In Italy, researchers have reported coronavirus antibodies in blood samples from September 2019, as well as signs of the virus in a patient’s skin sample from November of that year. Some scientists, though, have questioned both findings. | 由于中国拒绝分享更多关于早期病例的信息，世界卫生组织最近表示，它正在帮助研究人员寻找2019年底中国以外地区的病例报告。在意大利，研究人员报告了在2019年9月的血液样本中找到了新冠病毒抗体，以及同年11月一名患者的皮肤样本中发现了该病毒的迹象。然而，一些科学家对这两项发现提出了质疑。 |
| “The further back you can go, the more informative it may be — if you do have true, confirmed cases,” said Marion Koopmans, a Dutch virologist whose lab retested the Italian blood samples and could not confirm the earliest cases. She added, “For declaring a much earlier introduction of the pandemic virus into a region, you have to have a high level of certainty.” | 荷兰病毒学家马丽翁·库普曼斯(Marion Koopmanns)说，“你能追溯得越远，信息可能就越丰富——如果你确实发现了真实的确诊病例的话。”库普曼斯的实验室重新检测了意大利的血样，但无法确认这些最早的病例。她补充说，“要宣布大流行病毒更早就进入一个地区，你必须有很高的确定性。” |
| An analysis of American blood tests published this summer suggested that the virus may have been circulating in Illinois as early as Dec. 24, 2019, though scientists have said that those methods, too, are fallible. | 今年夏天发表的一份对美国血液检测结果的分析表明，该病毒可能早在2019年12月24日就在伊利诺伊州传播了，不过科学家们表示，这些方法也有可能出错。 |
| Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and lead author of that study, said that small clusters of cases could have developed without igniting a full-blown epidemic. “Where Covid was seeded in the U.S. is not fully known,” she said, “but it wasn’t likely to have been a single seed.” | 该研究的主要作者、约翰·霍普金斯大学布隆伯格公共卫生学院(Johns Hopkins Bloomberg School Of Public Health)的流行病学家克里·阿尔索夫(Keri Althoff)表示，小规模的聚集性病例集群可能已经形成，但没有引发全面的大流行。她说：“还不完全清楚新冠的种子是在美国哪里播下的，但它不太可能是一枚单粒种子。” |
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