Sebenzisa ulwazi nezinsizakalo ze-NEJM Group ukuze uzilungiselele ukuba udokotela, uqongelele ulwazi, uhole inhlangano yokunakekelwa kwezempilo futhi ukhuthaze ukuthuthukiswa komsebenzi wakho.
Isikhathi sokushintsha umbono wethu wokuzwela kokuhlolwa kwe-Covid-19.I-US Food and Drug Administration (FDA) kanye nomphakathi wesayensi okwamanje cishe bagxile ngokukhethekile ekuboneni ukuzwela, okulinganisa amandla endlela eyodwa yokuthola ukuthola amaprotheni egciwane noma ama-molecule e-RNA.Okubaluleke kakhulu, lesi sinyathelo sishaya indiva umongo wendlela yokusebenzisa isivivinyo.Kodwa-ke, uma kukhulunywa ngokuhlolwa okusabalele okudingwa yi-United States kakhulu, umongo ubalulekile.Umbuzo obalulekile awukona ukuthi i-molecule ilungile kangakanani kusampula eyodwa, kodwa ingabe ukutheleleka kungatholwa ngempumelelo kubantu ngokuphinda kusetshenziswe ukuhlolwa okunikeziwe njengengxenye yesu lokuthola lonke?Ukuzwela kohlelo lokuhlola.
Izinhlelo ezijwayelekile zokuhlola zingasebenza njengohlobo lwesihlungi se-Covid-19 ngokuhlonza, ukuhlukanisa nokuhlunga abantu abanaleli gciwane njengamanje (okuhlanganisa nabantu abangenazimpawu).Ukulinganisa ukuzwela kohlelo lokuhlola noma isihlungi kudinga ukuthi sicabangele ukuhlola kumongo: imvamisa yokusetshenziswa, ukuthi ubani osetshenziswayo, lapho lusebenza phakathi nenqubo yokutheleleka, nokuthi luyasebenza yini.Imiphumela izobuyiselwa ngesikhathi ukuze kuvinjelwe ukusabalala.1-3
Umgudu wokutheleleka womuntu (umugqa oluhlaza) uboniswa kumongo wezinhlelo ezimbili zokugada (imibuthano) ezinokuzwela okuhlukile kokuhlaziya.Ukuhlolwa kokuzwela kokuhlaziya okuphansi kuvame ukwenziwa, kuyilapho ukuhlolwa kokuzwela kokuhlaziya okuphakeme kuyivelakancane.Zombili izikimu zokuhlola zingathola ukutheleleka (isiyingi esiwolintshi), kodwa naphezu kokuzwela kwakho okuphansi kokuhlaziya, ukuhlolwa kwe-high-frequency kuphela okungakwazi ukukubona ngaphakathi kwefasitela lokusakaza (ithunzi), okulenza libe Idivayisi esebenza kangcono yesihlungi.Iwindi lokutholwa kwe-polymerase chain reaction (PCR) (eliluhlaza okotshani) ngaphambi kokutheleleka lifushane kakhulu, futhi iwindi elihambisanayo (elinsomi) elingatholwa yi-PCR ngemva kokutheleleka lide kakhulu.
Ukucabanga ngemiphumela yokusetshenziswa okuphindaphindiwe kuwumqondo ojwayele odokotela nama-ejensi okulawula;isetshenziswa noma nini lapho sikala ukusebenza kahle kohlelo lokwelapha kunomthamo owodwa.Ngokuthuthuka okusheshayo noma ukuzinza kwamacala e-Covid-19 emhlabeni jikelele, sidinga ngokuphuthumayo ukuthi sisuse ukunaka kwethu ekunakeni okuncane siye ekuzweleni kokuhlolwa kokuhlolwa (umkhawulo ophansi wekhono layo lokuthola kahle ukuhlangana kwama-molecule amancane kusampula. ) kanye nokuhlolwa Uhlelo luhlobene nokuzwela kokuthola izifo (abantu abanaleli gciwane bayaqonda ukuthi kungenzeka bangenwe igciwane kusenesikhathi ukuze bahlungwe kubantu futhi bavimbele ukusakazeka kwabanye).Ukuhlolwa kwephuzu lokunakekela, okushibhile ngokwanele futhi kungasetshenziswa njalo, kunokuzwela okuphezulu ekutholeni izifo ezithatha izinyathelo ezifika ngesikhathi ngaphandle kokufinyelela umkhawulo wokuhlaziya wokuhlola okuyisisekelo (bheka umfanekiso).
Ukuhlola esikudingayo kuhluke kakhulu ekuhlolweni komtholampilo okusetshenziswayo njengamanje, futhi kufanele kuhlolwe ngendlela ehlukile.Ukuhlolwa komtholampilo kuklanyelwe abantu abanezimpawu, akudingi izindleko eziphansi, futhi kudinga ukuzwela okuphezulu kokuhlaziya.Uma nje kunethuba lokuhlola, ukuxilonga okuqondile komtholampilo kungabuyiswa.Ngokuphambene, izivivinyo ezinhlelweni zokugada ezisebenzayo zokunciphisa ukusabalala kwamagciwane okuphefumula esibantwini zidinga ukubuyisela imiphumela ngokushesha ukuze kukhawulwe ukudluliswa kwe-asymptomatic, futhi kufanele kushibhile ngokwanele futhi kube lula ukuzenza ukuvumela ukuhlola okuvamile—izikhathi eziningi ngeviki.Ukusabalala kwe-SARS-CoV-2 kubonakala kwenzeka ezinsukwini ezimbalwa ngemva kokuchayeka, lapho inani legciwane egazini lifinyelela inani eliphakeme kakhulu.4 Leli phuzu ngokuhamba kwesikhathi linyusa ukubaluleka kwemvamisa yokuhlola ephezulu, ngoba ukuhlola kufanele kusetshenziswe ekuqaleni kokutheleleka ukuvimbela ukusabalala okuqhubekayo nokunciphisa ukubaluleka kokufinyelela umkhawulo wamangqamuzana ophansi kakhulu wokuhlola okuvamile.
Ngokwemibandela embalwa, ukuhlolwa okujwayelekile kwe-clinical polymerase chain reaction (PCR) kuyahluleka uma kusetshenziswa kuzivumelwano zokugada.Ngemva kokuqoqwa, amasampula e-PCR ngokuvamile adinga ukuhanjiswa elabhorethri ephakathi nendawo eyakhiwe ochwepheshe, enyusa izindleko, enciphisa imvamisa, futhi ingase ibambezele imiphumela ngosuku olulodwa kuya kwezimbili.Izindleko nomzamo odingekayo wokuhlola kusetshenziswa izivivinyo ezijwayelekile kusho ukuthi abantu abaningi e-US abakaze bahlolwe, futhi isikhathi esifushane sokushintsha sisho ukuthi noma ngabe izindlela zamanje zokugada zingabakhomba ngempela abantu abanaleli gciwane, zisengasakaza ukutheleleka izinsuku ezimbalwa.Ngaphambilini, lokhu bekukhawulela umthelela wokuvalelwa kanye nokulandelelwa koxhumana nabo.
ICenters for Disease Control and Prevention (CDC) ilinganisela ukuthi ngoJuni 2020, isibalo samacala atholakele e-Covid-19 e-United States sizophinda siphindwe ka-10 inani lamacala atholakele.5 Ngamanye amazwi, naphezu kokuqapha, izikimu zokuhlola zanamuhla zingathola kuphela ukuzwela okungu-10% kakhulu futhi azikwazi ukusetshenziswa njengesihlungi se-Covid.
Ngaphezu kwalokho, ngemva kwesigaba esidluliselwayo, umsila omude we-RNA-positive uchazwa ngokucacile, okusho ukuthi, uma kungenjalo, abantu abaningi basebenzisa ukuzwela okuphezulu kokuhlaziya ukuze bathole ukutheleleka ngesikhathi sokuqapha okujwayelekile, kodwa abasatheleleki ngesikhathi sokutholakala. .Ukubona (bona isithombe).2 Eqinisweni, inhlolovo yakamuva eyenziwe yi-New York Times ithole ukuthi eMassachusetts naseNew York, ngaphezu kwama-50% wezifo ezitholwe ngokugadwa okusekelwe ku-PCR zinomkhawulo womjikelezo we-PCR phakathi neminyaka engama-30 kuye kwengama-30., Okubonisa ukuthi isibalo se-RNA yegciwane siphansi.Nakuba izibalo eziphansi zingase zibonise ukutheleleka kusenesikhathi noma sekwephuzile, ubude besikhathi eside bemisila ene-RNA-positive sibonisa ukuthi abantu abaningi abanaleli gciwane baye babonakala ngemva kwesikhathi sokutheleleka.Okubalulekile emnothweni, kusho futhi ukuthi noma sebedlulile esigabeni sokutheleleka ngezifo, izinkulungwane zabantu zisahlaliswa zodwa izinsuku eziyi-10 ngemuva kokuhlolwa kwe-RNA-positive.
Ukuze sinqande ngempumelelo lesi sihlungi se-Covid esiwubhubhane, sidinga ukusihlola ukuze sikwazi ukunika amandla isixazululo esibamba izifo eziningi kodwa esithathelwanayo.Namuhla, lezi zivivinyo zikhona ngendlela yokuhlolwa kwe-antigen ye-lateral flow ngokushesha, futhi ukuhlolwa kokugeleza okusheshayo kwe-lateral okusekelwe kubuchwepheshe bokuhlela izakhi zofuzo be-CRISPR sekuzovela.Ukuhlola okunjalo ishibhile kakhulu (<5 USD), amashumi ezigidi noma ngaphezulu okuhlola angenziwa masonto onke, futhi angenziwa ekhaya, okuvula umnyango wesixazululo esisebenzayo sokuhlunga i-Covid.Ukuhlolwa kwe-antigen ye-lateral flow akunasinyathelo sokukhulisa, ngakho-ke umkhawulo wakho wokutholwa uphindwe izikhathi eziyi-100 noma eziyi-1000 lapho uhlola ibhentshimakhi, kodwa uma inhloso kuwukuhlonza abantu abasakaza leli gciwane njengamanje, lokhu akubalulekile kakhulu.I-SARS-CoV-2 igciwane elingakhula ngokushesha emzimbeni.Ngakho-ke, uma umphumela wokuhlola we-PCR wokumaketha uthi unethemba, igciwane lizokhula ngokushesha okukhulu.Ngaleso sikhathi, kungase kuthathe amahora esikhundleni sezinsuku ukuthi igciwane likhule futhi lifinyelele umkhawulo wokuthola wokuhlola osheshayo okushibhile okutholakalayo njengamanje.Ngemva kwalokho, lapho abantu bethola imiphumela emihle kukho kokubili ukuhlolwa, kungalindeleka ukuthi batheleleke (bona umfanekiso).
Sikholelwa ukuthi izinhlelo zokuhlola ukugadwa ezinganqamula amaketango okudlulisela anele ukuze kuncishiswe ukudluliswa komphakathi kufanele zengezelele esikhundleni sokuthatha indawo yokuhlolwa kwethu kwamanje kokuxilonga.Isu lokucabanga lingasebenzisa leli thuba lezi zivivinyo ezimbili, kusetshenziswa izivivinyo ezinkulu, ezivamile, ezishibhile futhi ezisheshayo ukuze kuncishiswe ukuqubuka kwezifo, 1-3 kusetshenziswa ukuhlolwa kwesibili okusheshayo kwamaphrotheni ahlukene noma kusetshenziswa ukuhlolwa kwe-PCR okulinganiselwe ukuze kuqinisekiswe umphumela omuhle.Umkhankaso wokuqwashisa umphakathi kumele futhi udlulise noma yiluphi uhlobo lomthethosivivinywa wokuhlola ongemuhle ongasho ukuthi impilo, ukuze kugqugquzelwe ukuqhubeka nokuqhelelana nomphakathi kanye nokugqokwa kwezifihla-buso.
I-Abbott BinaxNOW ye-FDA's Emergency Use Authorization (EUA) ngasekupheleni kuka-Agasti iyisinyathelo esiqonde endaweni efanele.Isivivinyo sokuqala esisheshayo, esingenazinsimbi se-antigen ukuthola i-EUA.Inqubo yokugunyaza igcizelela ukuzwela okuphezulu kokuhlolwa, okunganquma ukuthi abantu bangasakaza nini ukutheleleka, ngaleyo ndlela kuncishiswe umkhawulo wokuthola odingekayo ngama-oda amabili obukhulu ukusuka kubhentshimakhi ye-PCR.Lezi zivivinyo ezisheshayo manje zidinga ukuthuthukiswa futhi zigunyazwe ukusetshenziswa ekhaya ukuze kuzuzwe uhlelo lwangempela lokugada lomphakathi wonke lwe-SARS-CoV-2.
Njengamanje, ayikho indlela ye-FDA yokuhlola nokugunyaza ukuhlolwa ukuthi kusetshenziswe ohlelweni lokwelapha, hhayi njengokuhlola okukodwa, futhi awekho amandla ezempilo yomphakathi okunciphisa ukusulelana komphakathi.Ama-ejensi alawulayo asagxile kuphela ekuhlolweni kokuxilonga emtholampilo, kodwa uma inhloso yawo eshiwo kuwukunciphisa ukusabalala kwegciwane emphakathini, izinkomba ezintsha zingasetshenziswa ekuhloleni kokuhlola okusekelwe ohlakeni lwe-epidemiological.Kule ndlela yokugunyaza, ukuhwebelana phakathi kobuningi, umkhawulo wokuthola kanye nesikhathi sokushintsha kungase kulindelwe futhi kuhlolwe ngendlela efanele.1-3
Ukuze sinqobe i-Covid-19, sikholelwa ukuthi i-FDA, CDC, National Institutes of Health kanye nezinye izinhlaka kufanele zikhuthaze ukuhlolwa okuhlelekile kokuhlolwa ngokomongo wezinhlelo zokuhlola ezihleliwe ukuze kutholwe ukuthi yiluphi uhlelo lokuhlola olunganikeza isihlungi se-Covid esingcono kakhulu.Ukuvamise ukusebenzisa izivivinyo ezishibhile, ezilula, nezisheshayo kungafinyelela lo mgomo, ngisho noma ukuzwela kwabo kokuhlaziya kuphansi kakhulu kunokuhlolwa kwebhentshimakhi.1 Uhlelo olunjalo lungasisiza futhi ukuthi sigweme ukuthuthuka kwe-Covid.
I-Boston Harvard Chenchen School of Public Health (MJM);kanye neNyuvesi yaseColorado Boulder (RP, DBL).
1. I-Larremore DB, Wilder B, Lester E, njll. Ekugadweni kwe-COVID-19, ukuzwela kokuhlolwa kungokwesibili ngemva kwemvamisa nesikhathi sokushintsha.Septhemba 8, 2020 (https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2).Ukuphrinta ngaphambili.
2. Paltiel AD, Zheng A, Walensky RP.Linganisa isu lokuhlola i-SARS-CoV-2 ukuze uvumele ukuvulwa kabusha okuphephile kwamakhempasi amanyuvesi e-United States.I-JAMA Cyber Open 2020;3(7): e2016818-e2016818.
3. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC.Imvamisa yokuhlolwa okujwayelekile kwe-COVID-19 ezindaweni ezinobungozi obukhulu ukuze kuncishiswe ukuqubuka kwendawo yokusebenza.Septhemba 9, 2020 (https://www.medrxiv.org/content/10.1101/2020.04.30.20087015v4).Ukuphrinta ngaphambili.
4. I-He X, i-Lau EHY, i-Wu P, njll. Ukuguquguquka kwesikhathi sokuchithwa kwegciwane kanye namandla okudlulisela i-COVID-19.Nat Med 2020;26:672-675.
5. Izikhungo Zokulawula Nokuvimbela Izifo.Okulotshiweyo kokwaziswa ngocingo okubuyekeziwe kwe-CDC ku-COVID-19.Juni 25, 2020 (https://www.cdc.gov/media/releases/2020/t0625-COVID-19-update.html).
Umgudu wokutheleleka womuntu (umugqa oluhlaza) uboniswa kumongo wezinhlelo ezimbili zokugada (imibuthano) ezinokuzwela okuhlukile kokuhlaziya.Ukuhlolwa kokuzwela kokuhlaziya okuphansi kuvame ukwenziwa, kuyilapho ukuhlolwa kokuzwela kokuhlaziya okuphakeme kuyivelakancane.Zombili izikimu zokuhlola zingathola ukutheleleka (isiyingi esiwolintshi), kodwa naphezu kokuzwela kwakho okuphansi kokuhlaziya, ukuhlolwa kwe-high-frequency kuphela okungakwazi ukukubona ngaphakathi kwefasitela lokusakaza (ithunzi), okulenza libe Idivayisi esebenza kangcono yesihlungi.Iwindi lokutholwa kwe-polymerase chain reaction (PCR) (eliluhlaza okotshani) ngaphambi kokutheleleka lifushane kakhulu, futhi iwindi elihambisanayo (elinsomi) elingatholwa yi-PCR ngemva kokutheleleka lide kakhulu.
Isikhathi sokuthumela: Mar-11-2021