Ya zuwa yanzu, dukkanmu mun saba da ɓacin rai na jagorar lafiyar jama'a game da abin rufe fuska. Da farko, abin rufe fuska kawai ba su da tasiri sosai. Ba da daɗewa ba bayan haka, ba kawai suna da tasiri don kare wasu ba, amma kuma don kare kai. Sai suka kasance umarni. Kwanan nan, waɗancan masks ɗin tufafi waɗanda suka zama ruwan dare, waɗanda aka ƙarfafa su kusan shekaru biyu, wanda muka kasance koyar da yin hannu ta hanyar gidajen labarai, kwatsam, kamar dare, aka koma 'kayan ado na fuska.'
Ta yaya zai zama kayan aiki wanda aka yi nazari a kai1 fiye da shekaru 100 a cikin mahallin ƙwayoyin cuta na numfashi aerosolized ba zato ba tsammani ba a fahimta sosai ba? Wannan karamin bita zai ci gaba da hujjar cewa ƙarancin shaida da ƙa'idodin ƙa'idodin halittu sun ba da labari mai zurfi game da abin rufe fuska a Amurka.
Duk da yake mun ji wasu bambance-bambance na muhawarar cewa Amurkawa sun yi yawa ko kuma son kai don yin abin da mutane ke ciki. Kasashen Asiya sun yi shekaru da yawa, wannan bai isa ba don fahimtar halin yanzu. Yin watsi da ilimin da muke da shi, nisantar nazarin fa'ida mai tsada, kuma mafi mahimmanci kasawar fayyace ƙa'idodin ƙa'idodin ƙa'idodin ƙa'idodi suna da haɗari mara lahani. amincin magani da lafiyar jama'a a idon wadanda muke son yi wa hidima.
Nazari-Tsakanin Mura na Ingancin Mashin Fuska
Yana da mahimmanci a fahimci binciken pre-COVID-19 kan ingancin abin rufe fuska a cikin mahallin mura saboda, kamar yadda aka gane da wuri, ana tunanin duka ƙwayoyin cuta na numfashi za su iya yaduwa ta hanyar numfashi kaɗai ta hanyar abubuwan da aka fitar da iska.2 Kafin barkewar cutar ta COVID-19, har zuwa karshen shekarar 2019, Hukumar Lafiya ta Duniya ta WHO ta buga wani bincike na ba da magunguna (NPIs) a cikin mahallin cutar sankarau mai saurin kisa,3 a lokacin da aka yi la'akari da yiwuwar haifar da sabon nau'in mura.
Culling sake dubawa na 18 NPIs ciki har da ladabi na numfashi da fuskokin fuska, marubutan sun kammala da cewa "[t] a nan ne...rashin shaida game da ingancin ingantattun ladabi na numfashi da kuma amfani da abin rufe fuska a cikin wuraren jama'a a lokacin cututtuka na mura da cututtuka." Koyaya, marubutan sun yarda cewa yayin da “[t] anan an sami adadin manyan gwaje-gwajen da aka sarrafa bazuwar (RCTs) waɗanda ke nuna matakan kariya na mutum kamar tsabtace hannu da abin rufe fuska suna da, a mafi kyawu, ƙaramin tasiri akan watsa mura,…
A farkon 2020, masu bincike a Hong Kong sun fahimci mahimmancin nutsewa cikin wallafe-wallafen kafin 2020 game da rufe bakin al'umma da zurfi. Yarda da cewa "masu rufe fuska na likitanci… an tsara su ne da ma'aikatan kiwon lafiya su sanya su don kare kariya daga kamuwa da raunukan mara lafiya, da kuma kare mai sanye daga fantsama ko feshin ruwan jiki," masu binciken Jami'ar Hong Kong sun gudanar da wani nazari kan amfani da abin rufe fuska na tiyata don hana kamuwa da mura a wuraren da ba na kiwon lafiya ba.4 Binciken nasu ya kammala "[w] bai sami shaidar cewa nau'in fuskokin fuska na tiyata suna da tasiri wajen rage yaduwar cutar murar da aka tabbatar da dakin gwaje-gwaje ba, ko dai lokacin da masu kamuwa da cutar suka sanya su (masu sarrafa tushen) ko kuma mutane a cikin al'umma gaba daya don rage kamuwa da cutar" (duba Hoto 1). Waɗannan marubutan, kamar marubutan na WHO, sun yarda a cikin tattaunawarsu cewa abin rufe fuska na iya samun darajar rage watsa wasu cututtukan lokacin da aka shimfiɗa albarkatun kiwon lafiya. Duk da haka, wannan ba ya zama shaida mai kyau - yana haifar da rashin ingantaccen shaida mai inganci.
Hoto 1: "Meta-bincike na haɗarin haɗari don tasirin amfani da abin rufe fuska tare da ko ba tare da ingantaccen tsabtace hannu a kan gwajin da aka tabbatar da dakin gwaje-gwaje daga gwaje-gwajen da bazuwar 10 tare da> mahalarta 6,500. A) Amfani da mashin fuska kadai; B) fuskar fuska da tsabtace hannu; C) fuskar fuska tare da ko ba tare da tsabtace hannu ba.I2 >75%). Maɗaukaki suna nuna rabon haɗari ga kowane binciken da aka haɗa, layin kwance suna nuna 95% CIs, layukan madaidaiciya suna nuna ƙimar ƙimar haɗarin, kuma lu'u-lu'u suna nuna ƙimar ƙimar haɗarin. Faɗin lu'u-lu'u yayi daidai da 95% CI."4A cikin Nuwamba na 2020, an gudanar da bita na tsarin Cochrane na 67 pre-cutar RCTs da tari-RCTs na ayyukan jiki don rage yaduwar ƙwayoyin cuta na numfashi.5 Ƙarshe sun kasance masu ban mamaki:
"Sakamakon da aka tattara na gwaje-gwajen da bazuwar ba su nuna raguwar kamuwa da kamuwa da cutar ta numfashi ba tare da yin amfani da masks na likita / tiyata a lokacin mura na yanayi. ba a yi bincike ba.”
Musamman ma, wannan bita na Cochrane ya wuce saitunan al'umma kuma yana tayar da tambayoyi game da saitunan kiwon lafiya kuma. Lokacin kwatanta abin rufe fuska na tiyata zuwa babu abin rufe fuska, marubutan sun ba da rahoton tabbataccen tabbataccen matsakaici na kaɗan zuwa babu tasiri kan farkon ƙarshen gwajin gwajin da aka tabbatar da shi dangane da haɗarin haɗarin 0.91 don tagomashin masks, tare da tazarar amincewar 95% na 0.66 zuwa 1.26.
Duk da haka shiga 2020, kamar dai wannan rukunin wallafe-wallafen bai wanzu ba. Don haka aka fara yunƙurin sake ƙirƙira motar.
RCTs Tun Farkon Cutar COVID-19
A duk lokacin barkewar cutar, Cibiyar Kula da Cututtuka da Cututtuka ta sanya kanta a matsayin hukuma kan bayanai game da ingantattun hanyoyin da za a iya takaita yaduwar cutar. Don haka, su shashen yanar gizo mai taken "Takaice Kimiyya: Amfani da Al'umma na Masks don Sarrafa Yaɗuwar SARS-CoV-2" albarkatun ƙasa ne wanda daga abin da za a fara bincike kan RCTs na zamanin annoba game da rufe fuska.6 Abin sha'awa, akwai RCT guda biyu kawai da aka tattauna a kowane daki-daki akan wannan shafin. Nazarin farko da aka ambata a shafin a matsayin tallafawa masking na al'umma yana ɗaya daga cikin waɗancan RCTs - "babban, ingantaccen tsari na gwaji na bazuwar a Bangladesh" wanda aka gudanar a ƙarshen 2020. Wannan bincike ne mai yaduwa, wanda ake la'akari da shi sosai, binciken da aka sarrafa da kyau kuma yana da ma'ana dalilin da yasa wannan za a fara jera shi - yana ba da tushe mafi ƙarfi na saitin duniyar gaske, a cikin bayanan da suka dace da COVID-19 don amfani da cutar COVID-XNUMX.
Menene binciken Bangladesh ya nuna? Bayan bazuwar ƙauyuka a ƙauyen Bangladesh zuwa abin rufe fuska, abin rufe fuska, kuma babu makamai masu shiga tsakani, an aiwatar da dabarun inganta abin rufe fuska a ƙauyukan sa baki.7 Masu bincike sun gano cewa sa baki ya haifar da karuwar kashi 29% cikin ingantaccen sanya abin rufe fuska a kauyukan shiga tsakani. Sun kuma ƙaddamar da cewa "[w] e sami tabbataccen shaida cewa masks na tiyata suna haifar da raguwar dangi a cikin alamun bayyanar cututtuka na 11.1% (daidaitawar rabo = 0.89 [0.78, 1.00]; yawan sarrafawa = 0.81%; yaduwar jiyya = 0.72%). masks na tiyata kuma babu wani tasiri ko kadan." A taƙaice, ba za a iya ɗaukar tasirin abin rufe fuska ba a ƙididdiga (babu wani tasiri). Masks na tiyata, a halin yanzu, sun haifar da raguwar haɗarin 0.09% cikakke a cikin alamun seropositivity mai alaƙa da sarrafawa. Mayar da wannan zuwa 'lamba-buƙata-zuwa-mask' don hana 1 misalin seropositivity na alama zai fito zuwa kusan 1,111 (1/0.0009). Wannan lambar za ta yi girma sosai don ƙarshen ƙarshen rashin lafiya da mutuwa sakamakon COVID-19.
Menene waɗannan sakamakon ke nufi? Na bayanin kula, abubuwan ƙarshe na farko ba rashin lafiya ko mutuwa ba ne amma suna da alamu da gwaji tabbatacce ga ƙwayoyin rigakafin COVID. Bugu da ƙari, marubutan sun ba da rahoton rabon yaɗuwar COVID seropositivity (wanda kuma aka sani da haɗarin haɗari ko haɗarin dangi) na 0.89 a cikin abin rufe fuska na tiyata vs babu abin rufe fuska. A cikin fassarar waɗannan sakamakon, za mu iya kwatanta su da nazarin Cochrane da aka tattauna a sama, gano ƙimar haɗarin mura da aka tabbatar da 0.91 a cikin abin rufe fuska ba tare da makamai ba.
Sakamakon Bangladesh ya nuna ƙarancin raguwar haɗari a hannun abin rufe fuska idan aka kwatanta da wannan binciken. Hakanan muna iya kwatanta sakamakon zuwa Hoto na 1 daga takarda na Jami'ar Hong Kong da aka tattauna a sama wanda aka tabbatar da haɗarin mura na 0.78 don abin rufe fuska ba tare da abin rufe fuska ba. Binciken Bangladesh yana nuna ƙaramin tasiri a wannan kwatancen. Duk waɗannan binciken abin rufe fuska na mura sun kammala abin rufe fuska ba su da wani tasiri. Dukkan binciken guda uku da aka tattauna anan suna da tazarar amincewa da kashi 95 cikin 1 ciki har da ko ketare 2020, wurin da abin rufe fuska da babu abin rufe fuska ke da alaƙa da sakamako iri ɗaya. Zai bayyana cewa kafin XNUMX, girman tasirin da binciken Bangladesh ya samo za a yi la'akari da shi kadan a mafi kyau kuma mara ma'ana in ba haka ba.
RCT na biyu akan shafin CDC wani bincike ne daga Denmark.8 Waɗannan abubuwan da suka gabata (watau akidar da suka gabata da tsammanin) sun bayyana cewa sun yi imanin raguwar 50% na kamuwa da cuta zai zama mahimmanci, kuma an gudanar da binciken su akan wannan hasashe. Abubuwan da suka gabata suna da mahimmanci saboda suna tsara abin da masu bincike ke nema. Waɗannan mawallafa ba su sami wannan raguwa ba - maimakon haka sun sami cikakkiyar raguwar haɗari na 0.3% daidai da raguwar haɗarin dangi na kusan 14% da haɗarin haɗari na kusan 0.85 (95% tazarar amincewa na kusan 0.72 zuwa 0.99 ta kowace wasiƙa ga editan).
Musamman ma, CDC ta kammala cewa binciken na Bangladesh ya nuna cewa 'ko da ƙaramar haɓakar amfani da abin rufe fuska na iya rage cututtukan cututtukan SARS-CoV-2 yadda ya kamata.6 Amma wannan yana haifar da tambayoyi da yawa: Menene zai ɗauka don haɓaka ingantaccen amfani da abin rufe fuska a cikin al'umma, sama da kashi 29% da binciken ya samar? Menene zai yi ga tsarin zamantakewar al'umma don yin wannan ƙoƙari mai yawa don samar da bin bin sa hannun, duk don matsakaicin iyakar raguwar haɗari don alamun rashin lafiyar ƙasa da 1% (sake barin ƙarshen rashin lafiya da mutuwa)? Menene ma'anar cewa ya ɗauki miliyoyin daloli da kuma bincike mai yawa a cikin al'ummar kasashen waje ba tare da adadin maganin alurar riga kafi ba don tabbatar da ƙaramin tasiri? Kuma mene ne hakan ke nuna tasirin irin wannan katsalandan na iya kasancewa a cikin al'ummar kasar nan?
Halin Shaidar
Tambayoyin da aka tashi sama da duka suna nuna wani - me yasa ba a sami ƙarin RCTs don ƙoƙarin amsa wasu daga cikin waɗannan tambayoyin ba? Yawancin gardama don shawarwarin abin rufe fuska da umarni sun tsaya kan ilimin halitta plausibility da tacewa karatu, sau da yawa dogara da mannequins. Waɗannan kawai ba za su iya tsayawa ba don ainihin bayanan da suka dace da asibiti waɗanda aka samar ta hanyar manyan gwaje-gwajen da ba a tantance ba, musamman lokacin da ake kawo ƙarfin manufofin jama'a ta hanyar abin rufe fuska. Duniyar gaske tana da rikitarwa. Factoring a cikin ainihin duniya shinge ga riko da ita ita ce hanya daya tilo da za a iya sanin ko sa baki a zahiri yana yiwuwa kuma yana da daraja. Shaidar ta zuwa yanzu ta ƙunshi babban bita na tsari, meta-bincike, da manyan RCTs ba su bayyana don tallafawa irin wannan manufar ba.
Kamar yadda Dokta John P. Ioannidis ya tsara, mafi yawan binciken binciken da aka buga wanda masu bincike suka ce akwai dangantaka na iya zama ƙarya.9 Da yawa a cikin al'ummar kimiyya kuma sun saba da rikicin sake haihuwa a cikin binciken likita. Don haka, ko da wani sabon binciken zai fito yana da'awar girman tasiri mai mahimmanci fiye da waɗanda aka tattauna a sama, zai buƙaci sake sakewa, kuma a kasance ƙarƙashin ƙayyadaddun ƙima don tantance abubuwan da ba a so ba wanda Ioannidis ya gano a matsayin lalata yawancin binciken ilimi.
A cikin wani bita na shaida na Janairu 2021 na abin rufe fuska a cikin yanayin COVID-19, marubutan sun ba da shawarar wasu amsoshi don dalilin da ya sa ba a gudanar da ƙarin RCTs ba.10 "[E] al'amurran da suka shafi," suna bayar da, "hana samuwar hannun da ba a rufe ba." Suna jayayya cewa "bai kamata mu sa rai gabaɗaya za mu iya samun gwajin sarrafawa ba, saboda dalilai na dabaru da ɗabi'a." Kuma duk da haka daidai saboda dalilai na ɗabi'a dole ne mu shawo kan matsalolin dabaru zuwa gwaje-gwajen da aka sarrafa bazuwar don tabbatar da inganci.
Maimakon haka, mun ba da tambayoyin mu na ɗabi'a ga ƙauyukan karkara na ƙasashen da ba su ci gaba ba. Idan jami'ai za su kashe kudaden siyasa don kawo ikon tilastawa jihar don aiwatar da halayya, a takaice dai shaidun sun yi karfi. Amma bayan wannan, muhawarar jama'a game da abubuwan da suka dace don ci gaba da bincike da kuma menene girman tasirin da ya kamata ya kasance don tabbatar da irin wannan matakin ba a gudanar da shi ba har tsawon shekaru biyu a cikin cutar. Duk masu bincike da masu tsara manufofin kiwon lafiyar jama'a sun kasa bayyana waɗanne ka'idodin halittun da suke aiki da su.
Matsalolin Da'a tare da Tabbatar da Hukunce-hukunce
Tun lokacin da aka fara aiwatar da umarnin abin rufe fuska, manufar da ke da alaƙa da abin rufe fuska ta haifar da ƙararrakin roƙo ga hukuma, dogaro da ƙarancin inganci ko ƙarancin tasiri, da keta ƙa'idodin ɗabi'a kamar ƙa'idar taka tsantsan da yancin kai na haƙuri. Ka'idar yin taka tsantsan tana tabbatar da cewa nauyi yana kan waɗanda ke ba da shawarar shiga tsakani don tabbatar da rashin cutarwa da kuma ainihin fa'idodin. Ka'idar cin gashin kai na haƙuri shine tsakiyar magani. A duk lokacin bala'in, yanayin da abin rufe fuska ya kasance ya canza. A wasu lokuta an gaya mana cewa rufe fuska yana kare kai kawai - a wasu an gaya mana cewa rufe fuska yana kare waɗanda ke kusa kuma don haka ya zama dole kowa ya rufe fuska ta hanyar ɗabi'a mai amfani. A cikin bita na 2020 Cochrane, marubuta sun lura cewa ba a bincika illolin ba. Wannan ya kasance gaskiya.11
Duk da haka, matsala tare da inganta ƙananan shaida ba tare da yin gwagwarmaya tare da ƙa'idodin ƙa'idodin ɗabi'a ba shine cewa yana haifar da ɗabi'a da yanke shawara na hukumomi wanda zai iya zama gaba ɗaya daga gaskiya. Misali, tunanin mutum game da haɗari na iya zama kuskure. Wani mutum, yana ƙima da fa'idodin rufe fuska, zai iya zaɓar ziyartar wani ƙaunataccen da ba shi da rigakafi yana mai imani sun kawar da mafi yawan haɗarin ta hanyar rufe fuska kawai. Mutane na iya magana ko a zahiri hari mutanen da ba a rufe su ba tare da ƙiyayya saboda imanin ƙaryar cewa haɗarin mutuwarsu yana ƙaruwa sosai ta hanyar ayyukan wasu. Wani likitan fata da ke cike da tsoro sanye da garkuwar N95 da garkuwar fuska na iya tambayar mara lafiyar asymptomatic ya riƙe numfashinsa na tsawon daƙiƙa 5 lokacin da aka cire abin rufe fuska don gwajin fata na fuska, yana mai imani zai rage ma'ana ta kamuwa da cutar COVID-19. The darektan CDC na iya yin kuskuren da'awar wani kaso mai girma, misali sama da 80%, wanda 'mask' zai rage damar mutum na yin kwangilar COVID-19. Da kuma gundumomin makaranta a cikin yankuna masu arziki da ilimi na iya canza yara zuwa saka N-95s duk da rashin ingantaccen karatu a cikin yawan yaran yara ko saitunan al'umma.
Ana iya tilasta wa mutum ya yi tambaya: “Mene ne babban al’amarin? #MaskLikeAKid!” Amma waɗannan abubuwan da suka faru a cikin tsarinmu na kamuwa da cututtuka ba su da kyau kuma ana aiwatar da su a cikin ma'auni na ƙwararrun 'yan adam don kallon juna a matsayin masu tasiri na cututtuka da kuma dangantaka da duniyar halitta bisa ga tsayin daka da jituwa da ke ƙarƙashin ra'ayi na rayuwa a matsayin haɗari mai mahimmanci, rashin lafiya, kuma ana iya sarrafawa tare da cikakken iko ta hanyar amfani da hanyoyin da ba mu da karfi.
Yayin da za mu iya (kuma ya kamata) mu yi muhawara mai karfi game da ko wannan ra'ayi ya dace a asibitoci, tabbas rashin mutuntaka ne a yi amfani da shi ga sauran rayuwar bil'adama, musamman idan aka yi la'akari da cewa kowace annoba ta numfashi ta kai ga wani yanayi na rashin tabbas.12
Magani yana da tarihin gano ainihin abubuwan da suka haɗa mu da rayuwa a duniya daga hasken rana zuwa numfashinmu - wannan ba ya shafi haƙuri ba, amma anti-yan adam. Kamar yadda midterms m, manufofin sun fara canzawa. Amma na tsawon shekaru biyu, umarnin abin rufe fuska ya haifar da tambayar da ta sabawa "Me zai faru idan mutane da yawa suka mutu saboda ba mu yarda da abin rufe fuska ba?" Wannan bai bambanta da ba da baftisma da aka tilasta yin baftisma ta wurin tambayar “Idan mutane da yawa za su je Jahannama fa domin ba mu yi imani da Allah isa ba?” Ba ilimi ba ne. Ita ce Kimiyya.
References
1. Kellogg WH, MacMillan G. Nazarin gwaji game da ingancin abin rufe fuska gauze. Jaridar Amirka ta Lafiya ta Jama'a. 1920;10(1):34-42.
2. Scheuch G. Numfashi ya isa: don yaduwar cutar mura da SARS-CoV-2 ta hanyar numfashi kawai. Jaridar maganin aerosol da isar da magungunan huhu. 2020;33(4):230-234.
3. Kungiyar WH. Matakan kiwon lafiyar jama'a da ba na magunguna ba don rage haɗari da tasirin annoba da mura: ƙari: rahoton nazarin wallafe-wallafen na yau da kullun.. 2019.
4. Xiao J, Shiu EY, Gao H, et al. Matakan da ba na magunguna ba don kamuwa da cutar mura a cikin saitunan marasa lafiya - matakan kariya da muhalli. Cutar cututtuka. 2020; 26 (5): 967.
5. Jefferson T, Del Mar CB, Dooley L, et al. Harkokin jiki don katse ko rage yaduwar ƙwayoyin cuta na numfashi. Bayanan bayanan Cochrane na sake dubawa na tsari. 2020; (11)
6. Rigakafin CfDCa. Takaitaccen Kimiyya: Amfanin Al'umma na Masks don Sarrafa Yaɗuwar SARS-CoV-2. An shiga Fabrairu 4, 2022. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html
7. Abaluck J, Kwong LH, Styczynski A, et al. Tasirin rufe bakin al'umma akan COVID-19: Gwajin da bazuwar gungu a Bangladesh. Science. 2021: eabi9069.
8. Bundgaard H, Ringgaard AK, Raaschou-Pedersen DET, Bundgaard JS, Iversen KK. Ingancin Ƙara Shawarar Maski zuwa Wasu Matakan Kiwon Lafiyar Jama'a. Annals na Internal Medicine. 2021;174(8):1194-1195.
9. Ioannidis JP. Me yasa yawancin binciken bincike da aka buga karya ne. PLoS magani. 2005; 2 (8): e124.
10. Howard J, Huang A, Li Z, et al. Binciken shaida na abin rufe fuska a kan COVID-19. Aikace-aikace na National Academy of Sciences. 2021; 118 (4)
11. Liu IT, Prasad V, Darrow JJ. Yaya Tasirin Mashin Fuskar Tufafi?: Fiye da Ƙarni bayan Annobar Mura ta 1918, Da'awar Tasirin Masks na Ci gaba da Rashin Ƙaddamar da Gidauniyar. Regulation. 2021; 44: 32.
12. Heriot GS, Jamrozik E. Hasashe da Tunawa: wace rawa yakamata ilimin cututtukan tarihi ya taka a cikin duniyar da aka sihirce ta hanyar ƙirar lissafi na COVID-19 da sauran annoba? Tarihi da Falsafa na Kimiyyar Rayuwa. 2021;43(2):1-5.
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Shrey Goel dalibin likitanci ne a Jami'ar Arizona a Tucson yana neman aiki a cikin cikakken bakan likitancin iyali da kuma kula da lafiyar karkara. Yana da sha'awar rashin uba a cikin kiwon lafiya da kuma fahimtar iatrogenesis da cutarwar likita..
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