I-COVID-19: UVavanyo lokugonywa koMhlambi kunye noKhuseleko logonyo

Kuthiwa ukuzikhusela komhlambi kwi -COVID-19 kufezekiswa xa ama-67% abantu bengakhuselekanga kwintsholongwane ngosulelo kunye / okanye ngokugonywa, ngelixa i-pathogen ihlala ibonakaliswa kakuhle (ingaguquki) kulo lonke ixesha lokudluliselwa kuluntu olubonakaliswe kakuhle. Kwimeko yosulelo lwe-SARS CoV-2, ukufikelela kukhuseleko lomhlambi kunzima ngenxa yokuvela kweentlobo ezintsha zokukhathazeka (i-VoC), ezikhokelela ekubeni ii-VoC zingasabeli kwii-antibodies eziveliswa ngokuchasene nohlobo lomzali. Idatha ibonisa ukuba i-Israel isenokuba ifumene ukhuseleko lomhlambi njengoko ifikelele kwinani lama-67.7% labantu abangakhuselekanga ngelixa inani labantu base-UK lingama -53.9% kwaye elase-USA lingama- 50.5%. Nangona izinga losulelo liphezulu eBrazil ekuqaleni, ukhuseleko lomhlambi alukafikelelwa. Oku kuthetha ukuba uluntu kufuneka lunamathele ekuqheleni, ukuhlamba izandla kunye nokunxiba iimaski kunye nemigaqo yokuvula kunye nokulula kwemiqathango kufuneka kucingelwe ngononophelo ukuthintela nasiphi na isiganeko esiyingozi esivela kwi -COVID-19.

Ukuze kufikelelwe kwimeko "eqhelekileyo" ihlabathi elalikho ngaphambi kwe -COVID-19 , kufuneka kuphuhliswe ukhuselo lomhlambi ngaphakathi kwabantu oluya kuvumela abantu ukuba baphume kwaye bazulazule ngokukhululekileyo njengangaphambili. Ukhuselo lomhlambi lunokufikelelwa ngabantu abasuleleka ngokwemvelo yintsholongwane okanye ngokugonya ipesenti ethile yabantu. Makhe sijonge indlela ugonyo kunye nosulelo kunye olunokukhokelela ngayo kukhuselo lomhlambi kwaye lusibuyisele kubomi obungenazo iimaski kunye nokuqelelana esasiphila ngaphambili.

Ukhuselo lomzimba lomhlambi ^{1, 2} lubhekisa kuqikelelo lwenani labantu ekufuneka bagonywe okanye bosulelwe ukuqinisekisa ukuba intsholongwane ayisasuleli ebantwini. Oku kuthetha ukuba akusekho bantu basengozini abaya kufumana usulelo baze balusasaze ngakumbi. Nangona ukhuselo lomzimba lomhlambi (P _I , inani labantu abakhuselekileyo) lunokubalwa ngokusekelwe kwifomula elula yemathematika ^{1, 2} , P _I = ​​1-1/Ro _o , apho uRo ₍ "R-naught") ubonisa inani lamatyala esibini abangelwa lusulelo, olukwabizwa ngokuba yinombolo yokuzala esisiseko xa usulelo lwenzeka kubantu abangenalwazi nge-immunologically (abemi abangosulelwanga okanye abagonyelwe yintsholongwane). Kwimeko ye-SARS CoV-2, uRo _o uqikelelwe ukuba umalunga ne-3, oko kuthetha ukuba umntu ngamnye uza kosulela umyinge wabantu abathathu ^{3, 4.} Xa sifaka oku kwifomula engentla sifumana inani le-P _I elingu-0.67 oko kuthetha ukuba ukuba i-67% yabemi inosulelo kwaye/okanye igonyelwe, ngoko ukhuselo lomzimba lomhlambi kuthiwa lufikelele.

Ngaba oko kuthetha ukuba amazwe afana ne-Israel afikelele kwi-herb immunity njengoko ama-67.7% (58.2% agonywe ngokupheleleyo kunye ne-9.5% esulelekileyo) yabemi bakwaSirayeli ^aba-5 abakhuselekanga ngelixa amazwe afana ne-UK kunye ne-USA aya kufikelela kwi-herb immunity xa sele ama-67% abantu bawo besulelekile kwaye/okanye begonyiwe, okwangoku kuma-53.9% (47.3% agonywe ngokupheleleyo kunye ne-6.6% esulelekileyo) e-UK ⁶ , kunye nama-50.5% (40.5% agonywe ngokupheleleyo kunye ne-10% esulelekileyo) e-USA ⁷?

Kunzima ukuphendula lo mbuzo kuba ukubalwa kwe-held immunity (P _I ) kusekelwe kwiingcamango zokuba i-pathogen iphawulwe kakuhle kwaye ichaphazela abantu abaphawulwe kakuhle. Ngelishwa, zombini aziyonyani kweli tyala kuba le yintsholongwane entsha kwaye abantu abasulelekileyo bahluke kakhulu. Kuyinkimbinkimbi ngakumbi kukuba kukho iintlobo ezintsha ze-SARS CoV-2 virus ezivela kubantu abanokuthi okanye bangaphenduli kwi-vaccine ngendlela efanayo nohlobo lwe-virus yokuqala eyenzelwe yona. Ngaphezu koko, iintlobo ezintsha ze-virus azifani kwaphela zichaphazela onke amazwe. Ngelixa i-UK ikakhulu inohlobo lwe-B.1.1.7, i-India, iSingapore kunye namanye amazwe anohlobo lwe-B1.617, iBrazil inohlobo lwe-B.1.351, i-P.1 kunye nohlobo lwe-P.2 ngelixa i-Middle East inohlobo lwe-B.1.351 ukongeza kwezinye. Ngaba oko kuthetha ukuba abantu abaninzi basuleleka ziintlobo ezintsha nokuba bagonyelwe uhlobo lokuqala olutyhala i-R0 _ukuya kwinani eliphezulu? I-AR _ye -5 ithetha ukuba ama-80% abantu kufuneka bakhuseleke ukuze bathintele ukosuleleka okungakumbi. Nangona kunjalo, la mazwe (uSirayeli, u-UK kunye ne-USA) aqalile ukuvula nokususa imiqathango ngokusekelwe kwinto yokuba ubuncinci ama-50% abantu bawo bagonyiwe ngokupheleleyo. Ngaba kusekutsha kakhulu kwiimeko zase-UK nase-USA njengoko i-P _I ingafikanga nakwi-67% ngokusekelwe ekubaleni okulula okunezimvo ezikhankanyiweyo apha ngasentla? USirayeli usenokuzigwagwisa ngokuthi ufikelele kweli nani. Nangona kunjalo, kubekho ukwanda kwenani lamatyala e-UK kule veki ngama-23.3% (xa kuthelekiswa neveki ephelileyo) kunye nokwanda kokufa okufanayo kunye ne ^-6 , ngelixa e-USA, kubekho ukwehla kwenani lamatyala ngama-22% kule veki yesi ^-7 (xa kuthelekiswa neveki ephelileyo). Idatha kwiinyanga ezimbalwa ezizayo iya kugqiba ukuba isigqibo sala mazwe sokuvula nokususa imiqathango besichanekile okanye akunjalo?

Ngenxa yazo zonke ezi zinto ezinxulumene nobunzima bentsholongwane (iintlobo ezahlukeneyo) kunye nokungafani kwabantu, akunakwenzeka ukuqikelela inani le-P _I elichanekileyo . Kuyafaneleka ukukhankanya apha malunga namazinga okusuleleka eBrazil, elinye lamazwe achaphazeleke kakhulu kwizigaba zokuqala zosulelo lwe-COVID-19. Nangona ipesenti ephezulu yokusuleleka kwe-seroprevalence (76%) ¹¹ eManaus kunye ne-70% ePeru ¹² , zombini zibona igagasi lesibini elinamandla. Nangona oku kusenokubangelwa kukulula kwemiqathango kunye nonyulo olwalubanjwe, ezinye izinto ezininzi zinokubangela okufanayo. Enye inokuba kukugqithiswa kwe-seroprevalence okwabonwa ukuba yi-52.5% ngoJuni 2020. Okwesibini kusenokuba kukufika kweentlobo ezintsha nezisasazeka ngakumbi (P.1, P.2, B.1.351, B.1.1.7), nganye ineseti yayo eyahlukileyo yotshintsho olubangela ubukhali besifo. Okwesithathu, ukubakho kwezi nguqu kunokubangela ukuba kuthintelwe impendulo yomzimba yokulwa nosulelo eveliswe kuhlobo lokuqala lwe- ¹².

Omnye umbuzo malunga nokusebenza kakuhle kwezi gonyo ezikhoyo ngoku malunga nokhuseleko ezinokulunika. Kuqikelelwa ngokomndilili ukuba ukusebenza kakuhle kwesi gonyo malunga nokukhusela ukufa yi-72% ⁸ nto leyo ethetha ukuba kukho ithuba elingama-28% lokuba umntu afe nokuba sele egonywe ngokupheleleyo (emva kokuthatha iidosi ezifunekayo zesi gonyo). Ngokukodwa, isigonyo se-Pfizer-BioNTech BNT162b2 sisebenza ngama-85% emva kwedosi enye ngelixa isigonyo se-Oxford-AstraZeneca ChAdOx1-S sisebenza ngama-80% emva kwedosi enye ^9. Zombini ezi gonyo zisebenza kwakhona ngokuchasene nohlobo lwe-B.1.1.7 ^9. Enye ingongoma ebalulekileyo ekufuneka uyikhumbule apha kukuba isigonyo asithethi ukuba awuyi kosulelwa yintsholongwane, kuthetha ukuba uya kukhuselwa njengoko kukhankanyiwe apha ngasentla kwaye uya kuba neempawu ezincinci okanye ezingenazo iimpawu zesifo. Ngaphezu koko, akukho bungqina bokuba ukhuseleko olunikezelwa sisifo kunye/okanye izigonyo ezichasene ne-SARS CoV-2 luhlala ixesha elide okanye akunjalo? ¹⁰ Oku kuthetha ukuba kufuneka kubekho uhlolo olufanelekileyo kwaye inkqubo yokugonya ingadinga ukwandiswa ukuba oku kunokwenzeka.

Ukongeza ekufumaneni ukhuselo lomhlambi ngenxa yosulelo kunye nokugonywa ngokupheleleyo, abantu abathile basenokuthi bachaphazeleke kwaye bagule okanye bafe ngenxa ye-COVID-19. Abo bantu banokuchongwa ngokusebenzisa iiRekhodi zezeMpilo ze-elektroniki (ii-EHR) kwaye banikwe unyango olufanelekileyo lokuthintela njengoko kuchaziwe ¹³.

Ngamafutshane, ukuqikelela ukukhuselwa komhlambi kwi-SARS CoV-2 ngumceli mngeni ongenakoyiswa ngenxa yohlobo lotshintsho olufunyenwe yintsholongwane oluyenza ikwazi ukusasazeka ngakumbi kunye nabantu abahlukeneyo abasulelekileyo. Kucingelwa ukuba de i-R0 _isondele okanye ingaphantsi kwe-1 (oko kuthetha ukufikelela kukhuselo lomhlambi lwe-100%), uluntu kufuneka luqhubeke nokunamathela kumanyathelo okuqelelana, ukuhlamba izandla nanini na kunokwenzeka kunye nokunxiba iimaski esidlangalaleni ukuze kuthintelwe ukusuleleka sesi sifo. Oku kuthetha ukuba amazwe kufuneka acinge nzulu ngaphambi kokuba agqibe ekubeni anciphise imiqathango ngaphambi kokuba afumane ukukhuselwa komhlambi kwe-100% (kwicala elikhuselekileyo) ukuze kuthintelwe iziganeko eziyingozi ezibangelwa yi-COVID-19.

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Ucaphulo 

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