Yi amfani da bayanan ƙungiyar NEJM da sabis don shirya don zama likita, tara ilimi, jagoranci ƙungiyar kiwon lafiya da haɓaka haɓaka aikinku.
Lokaci ya yi da za mu canza ra'ayinmu game da hankalin gwajin Covid-19.Hukumar Abinci da Magunguna ta Amurka (FDA) da al'ummar kimiyya a halin yanzu kusan sun fi mayar da hankali ne kawai kan ƙwarewar ganowa, wanda ke auna ikon hanyar ganowa guda ɗaya don gano sunadaran ƙwayoyin cuta ko ƙwayoyin RNA.Mahimmanci, wannan ma'aunin yana watsi da mahallin yadda ake amfani da gwajin.Koyaya, idan ya zo ga faɗaɗa nunin da Amurka ke buƙata sosai, mahallin yana da mahimmanci.Babban tambaya ba shine yadda za'a iya gano kwayar halitta mai kyau a cikin samfurin guda ɗaya ba, amma za'a iya gano cutar da kyau a cikin yawan jama'a ta hanyar sake amfani da gwajin da aka ba a matsayin wani ɓangare na dabarun ganowa gabaɗaya?Hankali na shirin gwajin.
Shirye-shiryen gwaji na al'ada na iya aiki azaman nau'in tacewa na Covid-19 ta hanyar ganowa, keɓewa da kuma tace mutanen da suka kamu da cutar a halin yanzu (ciki har da masu asymptomatic).Auna ma'auni na tsarin gwaji ko tacewa yana buƙatar mu yi la'akari da gwajin a cikin mahallin: yawan amfani, wanda aka yi amfani da shi, lokacin da yake aiki yayin tsarin kamuwa da cuta, da kuma ko yana da tasiri.Za a dawo da sakamakon cikin lokaci don hana yaɗuwa.1-3
Ana nuna yanayin kamuwa da mutum (layin shuɗi) a cikin mahallin shirye-shiryen sa ido guda biyu (da'irori) tare da mabambantan hankali na nazari.Ana yawan yin gwaje-gwajen ƙima na ƙididdiga, yayin da ƙima mai girma na ƙididdiga ba safai ba.Duk tsarin gwajin duka na iya gano kamuwa da cuta (da'irar orange), amma duk da ƙananan hankali na nazari, babban gwajin mita ne kawai zai iya gano shi a cikin taga yaduwa (inuwa), wanda ya sa ya zama na'urar tacewa mafi inganci.Tagar gano sarkar polymerase (PCR) (kore) kafin kamuwa da cuta gajere ce, kuma taga mai dacewa (purple) wacce PCR za ta iya ganowa bayan kamuwa da cuta yana da tsayi sosai.
Yin tunani game da tasirin maimaita amfani da shi shine ra'ayi da aka saba da shi ga likitoci da hukumomi;ana kiran shi a duk lokacin da muka auna ingancin tsarin jiyya maimakon kashi ɗaya.Tare da haɓakar haɓakawa ko daidaita lamuran Covid-19 a duniya, muna buƙatar gaggawar jujjuya hankalinmu daga kunkuntar hankali zuwa ƙwarewar nazari na gwajin (ƙananan iyakar ikonsa na gano daidai adadin ƙananan ƙwayoyin cuta a cikin samfurin). ) da gwajin shirin yana da alaƙa da azancin gano cututtuka (masu cutar sun fahimci yuwuwar kamuwa da cuta cikin lokaci don tace su daga cikin jama'a da hana yaɗuwa ga wasu).Gwajin kulawa, wanda ke da arha kuma ana iya amfani dashi akai-akai, yana da babban hankali don gano cututtukan da ke ɗaukar matakin kan lokaci ba tare da isa ga iyakar ƙididdiga na gwajin tushe ba (duba adadi).
Gwaje-gwajen da muke buƙata sun bambanta da gwajin asibiti a halin yanzu, kuma dole ne a kimanta su daban.An tsara gwajin asibiti don mutanen da ke da alamun cutar, baya buƙatar farashi mai sauƙi, kuma yana buƙatar haɓakar ƙididdiga.Muddin akwai damar gwaji, za a iya dawo da tabbataccen ganewar asibiti.Sabanin haka, gwaje-gwaje a cikin ingantaccen shirye-shiryen sa ido don rage yaduwar ƙwayoyin cuta na numfashi a cikin yawan jama'a na buƙatar dawo da sakamako cikin sauri don iyakance watsa asymptomatic, kuma yakamata ya zama mai arha kuma mai sauƙin yi don ba da damar gwaji akai-akai-sau da yawa a mako.Yaduwar SARS-CoV-2 yana bayyana yana faruwa 'yan kwanaki bayan fallasa, lokacin da kwayar cutar kwayar cutar ta kai ga kololuwar sa.4 Wannan batu a cikin lokaci yana ƙara mahimmancin yawan gwaji mai yawa, saboda dole ne a yi amfani da gwaji a farkon kamuwa da cuta don hana ci gaba da yaduwa da kuma rage mahimmancin cimma iyakar ƙarancin kwayoyin halitta na daidaitattun gwaji.
Dangane da sharuɗɗa da yawa, gwajin madaidaicin daidaitaccen sarkar polymerase na asibiti (PCR) ya gaza lokacin da aka yi amfani da shi a cikin ka'idojin sa ido.Bayan tattarawa, samfuran PCR yawanci suna buƙatar jigilar su zuwa dakin gwaje-gwaje na tsakiya wanda ya ƙunshi ƙwararru, wanda ke haɓaka farashi, rage yawan mita, kuma yana iya jinkirta sakamakon da kwana ɗaya zuwa biyu.Kudin da ake buƙata don yin gwaji ta amfani da daidaitattun gwaje-gwaje na nufin cewa yawancin mutane a Amurka ba a taɓa gwada su ba, kuma ɗan gajeren lokacin juyawa yana nufin cewa ko da hanyoyin sa ido na yanzu za su iya gano masu kamuwa da cutar, har yanzu suna iya yada cutar ta kwanaki da yawa.A baya can, wannan yana iyakance tasirin keɓewa da sa ido na lamba.
Cibiyar Kula da Cututtuka da Cututtuka (CDC) ta kiyasta cewa nan da Yuni 2020, adadin shari'o'in Covid-19 da aka gano a Amurka zai ninka adadin adadin da aka gano sau 10.5 A takaice dai, duk da saka idanu, tsare-tsaren gwaji na yau na iya gano hankalin kashi 10% kawai kuma ba za a iya amfani da su azaman matatar Covid ba.
Bugu da kari, bayan matakin da ake iya watsawa, an bayyana wutsiya mai inganci ta RNA a fili, wanda ke nufin, idan ba mafi yawa ba, mutane da yawa suna amfani da zurfin nazari don gano kamuwa da cuta yayin sa ido na yau da kullun, amma ba sa kamuwa da cuta a lokacin ganowa. .Ganewa (duba hoto).2 A zahiri, wani bincike na baya-bayan nan na The New York Times ya gano cewa a Massachusetts da New York, fiye da 50% na cututtukan da aka gano ta hanyar sa ido na tushen PCR suna da kofa na zagayowar PCR a tsakiyar 30s zuwa 30s., Yana nuna cewa ƙwayar RNA mai hoto ta bidiyo ta yi ƙasa.Ko da yake ƙananan ƙididdiga na iya nuna kamuwa da cuta da wuri ko a ƙarshen lokaci, tsayin tsayin wutsiyoyi masu inganci na RNA yana nuna cewa an gano yawancin masu kamuwa da cutar bayan lokacin kamuwa da cuta.Mahimmanci ga tattalin arziƙin, hakanan yana nufin cewa duk da cewa sun wuce matakin watsa cutar, dubunnan mutane har yanzu suna keɓe na tsawon kwanaki 10 bayan gwajin RNA-tabbatacce.
Domin dakatar da wannan cutar ta Covid tace yadda ya kamata, muna buƙatar gwada shi don ba da damar maganin da ke kama yawancin cututtuka amma har yanzu yana kamuwa da cuta.A yau, waɗannan gwaje-gwajen suna wanzuwa ta hanyar gwaje-gwajen antigen mai saurin gudu, kuma gwaje-gwajen saurin gudu na gefe dangane da fasahar gyara kwayoyin halittar CRISPR na gab da bayyana.Irin waɗannan gwaje-gwajen suna da arha sosai (<5 USD), ana iya yin dubun-dubatar ko fiye na gwaje-gwaje kowane mako, kuma ana iya yin su a gida, buɗe kofa ga ingantaccen maganin tace Covid.Gwajin antigen na gefe ba shi da matakin ƙarawa, don haka iyakar gano shi sau 100 ko 1000 na gwajin ma'auni, amma idan manufar ita ce gano mutanen da ke yada cutar a halin yanzu, wannan ba shi da mahimmanci.SARS-CoV-2 kwayar cuta ce da ke iya girma cikin sauri a cikin jiki.Don haka, lokacin da sakamakon gwajin PCR na ma'auni ya tabbata, kwayar cutar za ta yi girma da sauri.Zuwa lokacin, yana iya ɗaukar sa'o'i maimakon kwanaki kafin ƙwayar cuta ta girma kuma ta kai ga gano kofa na gwaji mai arha da sauri a halin yanzu.Bayan haka, lokacin da mutane suka sami sakamako mai kyau a cikin gwaje-gwajen biyu, ana iya tsammanin za su kamu da cutar (duba adadi).
Mun yi imanin cewa shirye-shiryen gwajin sa ido waɗanda za su iya yanke isassun sarƙoƙin watsawa don rage watsawar al'umma yakamata su ƙara maimakon maye gurbin gwajin gwajin asibiti na yanzu.Dabarar ƙira na iya yin amfani da waɗannan gwaje-gwajen guda biyu, ta yin amfani da gwaje-gwaje masu girma, akai-akai, arha da sauri don rage barkewar cutar, 1-3 ta yin amfani da gwajin sauri na biyu don sunadaran sunadaran ko amfani da gwajin PCR na ma'auni don tabbatar da sakamako mai kyau.Yaƙin neman zaɓe na wayar da kan jama'a dole ne ya isar da duk wani nau'in lissafin gwaji mara kyau wanda ba ya nufin lafiya, don ƙarfafa ci gaba da nisantar da jama'a da sanya abin rufe fuska.
FDA ta Abbott BinaxNOW Izinin Amfani da Gaggawa (EUA) a ƙarshen Agusta mataki ne a kan madaidaiciyar hanya.Shine farkon azumi, gwajin antigen mara kayan aiki don samun EUA.Tsarin yarda yana jaddada babban ƙarfin gwajin, wanda zai iya ƙayyade lokacin da mutane zasu iya yada kamuwa da cuta, don haka rage iyakar ganowa da ake buƙata ta umarni biyu na girma daga ma'aunin PCR.Waɗannan gwaje-gwaje masu sauri yanzu suna buƙatar haɓakawa kuma a yarda da su don amfanin gida don cimma ingantaccen shirin sa ido na al'umma na SARS-CoV-2.
A halin yanzu, babu wata hanyar FDA don kimantawa da amincewa da gwajin don amfani a cikin tsarin jiyya, ba azaman gwaji ɗaya ba, kuma babu yuwuwar lafiyar lafiyar jama'a don rage watsa al'umma.Hukumomin gudanarwa har yanzu suna mai da hankali kan gwaje-gwajen bincike na asibiti kawai, amma idan manufarsu ita ce rage yaduwar cutar a cikin al'umma, ana iya amfani da sabbin alamomi ga gwaje-gwajen kimantawa bisa tsarin cututtukan cututtuka.A cikin wannan hanyar yarda, ana iya tsammanin cinikin cinikin tsakanin mitar, iyakar ganowa da lokacin juyawa kuma ana iya kimanta su yadda ya kamata.1-3
Domin kayar da Covid-19, mun yi imanin cewa FDA, CDC, Cibiyoyin Kiwon Lafiya na Kasa da sauran hukumomi dole ne su karfafa tsarin kimanta gwaje-gwaje a cikin mahallin shirye-shiryen gwajin da aka tsara don gano wane shirin gwajin zai iya samar da mafi kyawun tacewar Covid.Yawan yin amfani da gwaje-gwaje masu arha, masu sauƙi, da sauri na iya cimma wannan burin, koda kuwa hankalin nazarin su ya yi ƙasa da na gwaje-gwajen ma'auni.1 Irin wannan makirci kuma zai iya taimaka mana mu hana ci gaban Covid.
Boston Harvard Chenchen Makarantar Kiwon Lafiyar Jama'a (MJM);da Jami'ar Colorado Boulder (RP, DBL).
1. Larremore DB, Wilder B, Lester E, da sauransu. Don sa ido kan COVID-19, ƙwarewar gwaji shine na biyu kawai ga mita da lokacin juyawa.Satumba 8, 2020 (https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2).Preprint.
2. Paltiel AD, Zheng A, Walensky RP.Kimanta dabarun gwajin SARS-CoV-2 don ba da damar sake buɗe cibiyoyin jami'a cikin aminci a cikin Amurka.JAMA Cyber Bude 2020;3 (7): e2016818-e2016818.
3. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC.Yawan gwaje-gwaje na yau da kullun don COVID-19 a cikin mahalli masu haɗari don rage barkewar wuraren aiki.Satumba 9, 2020 (https://www.medrxiv.org/content/10.1101/2020.04.30.20087015v4).Preprint.
4. He X, Lau EHY, Wu P, da dai sauransu. Tsarin lokaci na zubar da ƙwayoyin cuta da ƙarfin watsa COVID-19.Nat Med 2020;26: 672-675.
5. Cibiyoyin Kula da Cututtuka da Cututtuka.Kwafi na sabunta bayanan wayar tarho na CDC akan COVID-19.Yuni 25, 2020 (https://www.cdc.gov/media/releases/2020/t0625-COVID-19-update.html).
Ana nuna yanayin kamuwa da mutum (layin shuɗi) a cikin mahallin shirye-shiryen sa ido guda biyu (da'irori) tare da mabambantan hankali na nazari.Ana yawan yin gwaje-gwajen ƙima na ƙididdiga, yayin da ƙima mai girma na ƙididdiga ba safai ba.Duk tsarin gwajin duka na iya gano kamuwa da cuta (da'irar orange), amma duk da ƙananan hankali na nazari, babban gwajin mita ne kawai zai iya gano shi a cikin taga yaduwa (inuwa), wanda ya sa ya zama na'urar tacewa mafi inganci.Tagar gano sarkar polymerase (PCR) (kore) kafin kamuwa da cuta gajere ce, kuma taga mai dacewa (purple) wacce PCR za ta iya ganowa bayan kamuwa da cuta yana da tsayi sosai.
Lokacin aikawa: Maris 11-2021