An gano zamba a gefe, babu wani zargi mai ƙarfi na nazari fiye da ƙin amsa mahimmin sakamakon ta amfani da bayanan binciken. Wannan damar ba ta tasowa sau da yawa.
Ina ba da misali mai ban mamaki, dangane da nazari daga Isra'ila. Ƙoƙarin zama madaidaici, labarina yana ɗan ɗan gajeren lokaci, amma abubuwan da ke faruwa a ƙarshe suna da tsattsauran ra'ayi da faɗi.
Goldin et al. kimanta tasirin maganin Pfizer akan sakamakon da ke da alaƙa da Covid, gami da mutuwa, a cikin mazauna wuraren kulawa na dogon lokaci a cikin Isra'ila (ma'anar shekaru 83). Babban ƙungiyar (sama da 43,000) an karkatar da su sosai zuwa ga mazaunan da aka yiwa rigakafin (kashi 90). Mazauna kusan 4,000 ne kawai ba a yi musu allurar ba.
Yin amfani da hanyar ƙididdiga da ake kira bincike na rayuwa, marubutan sun ba da rahoton ƙima guda biyu na ingancin rigakafin (VE) akan mutuwar da ke da alaƙa da Covid:
Tsallake kwanaki goma bayan kashi na farko, VE ya kasance kashi 72 cikin ɗari.
Tsallake kusan kwanaki bakwai bayan kashi na biyu, VE ya kasance kashi 85 cikin ɗari.
Goldin et al. Har ila yau, an yi nazarin duk-mutuwar mutuwa a matsayin ƙarshen ƙarshen, wanda yawancin masu bincike suka tsallake. Mafi mahimmanci, biyu daga cikin alkalumman su (a ƙasa) suna nuna adadin adadin mutuwar Covid da duk mutuwar a lokuta da yawa - daga abin da za mu iya ƙididdige adadin adadin. ba Covid mutuwa. Bayanan baya-bayan nan sun kasance a koyaushe suna ɓoye a cikin nazarin tasirin rigakafin.
Bugu da ƙari, muna da bayanan mace-mace tun daga "kwanan kwanan wata," kwanan wata da aka yi allurar farko. Za mu iya nazartar bayanan yadda ya kamata a tantance su. Babu tsallakewa.
Source: Goldin et al.
Don wasu dalilai, lokutan mutuwar Covid ba su dace da daidai lokacin duk mace-mace ba, amma ba su yi nisa ba (lambobi a sama). Don haka, adadin mutuwar Covid a daidai lokacin ga duk sanadin mutuwa (kwanaki 30, kwanaki 60, da sauransu) ana iya ƙididdige su ta hanyar haɗin gwiwa. Bayan haka, rage adadin mutuwar Covid daga duk-mutuwar mutuwar yana bayyana wani muhimmin yanki na bayanai: adadin wadanda ba na Covid-XNUMX ba.
Tebur masu aiki da ke ƙasa suna nuna adadin adadin mace-mace (Covid, wadanda ba Covid) a cikin mazaunan da aka yi wa alurar riga kafi da mazaunan da ba a yi musu allurar ba a ƙarshen bin (watanni 5), da kuma ta maki uku na wucin gadi. Ta yin amfani da bincike mai sauƙi, wanda ake kira da “cumulative incidence,” Na ƙididdige haɗarin nau'ikan mutuwa guda biyu a cikin mazaunan alurar riga kafi (blue) da waɗanda ba a yi musu allurar (ja) ba.
Teburin saman ya nuna cewa haɗarin mutuwar Covid ya kasance mafi girma a cikin rashin rigakafi fiye da wanda aka yi wa alurar riga kafi, amma an bayyana sakamakon abin mamaki a cikin tebur na ƙasa: hakan ma lamarin ya kasance na mutuwar ba-Covid! Adadin mace-mace daga abubuwan da ba na Covid-4,114 ba a cikin mazauna gidajen jinya 3 da ba a yi musu allurar ba a cikin Isra'ila ya ninka adadin mace-mace sau 7 zuwa XNUMX a cikin takwarorinsu na rigakafin, ya danganta da lokacin biyo baya. Ko akasin haka - yawan mace-mace daga abubuwan da ba na Covid-XNUMX ba ya yi yawa m a cikin mazauna gidajen jinya waɗanda aka yi wa allurar rigakafin Covid. Ana ganin wannan sakamako mai ban mamaki da wuri, a cikin wata ɗaya na farkon kashi.
Shin maganin Pfizer yana kare kariya daga mutuwa daga abubuwan da ba na Covid?
Har yanzu ba mu ji wani yana ikirarin ba.
Idan ba haka ba, menene bayanin?
Yana da sauƙi kuma ba abin mamaki ba ko kaɗan. Hukuncin wanda zai ba alurar riga kafi ba da gangan ba. Dole ne ya kasance bisa la'akari da ma'anar likita, musamman tsawon rai. Misali, menene amfanin yiwa dan shekara 90 alurar riga kafi wanda ke fama da ci-gaban cutar dementia da ciwon daji na metastatic?
Waɗancan mazauna 4,114 da ba a yi musu allurar ba sun fi rashin lafiya da farko. Tsawon rayuwar su ya yi guntu, ba tare da la’akari da yiwuwar kamuwa da cutar ta SARS-CoV-2 ba, kuma shi ya sa yawan mace-macen su na Covid-XNUMX ya ninka da yawa.
An bayyana ta daban, kasancewa cikin rukunin da ba a yi wa allurar rigakafi ba alama ce ta rashin lafiya gaba ɗaya. Ko akasin haka - kasancewa cikin rukunin da aka yi wa rigakafin alama ce ta ingantacciyar lafiya. Wannan a matsakaita ne, ba shakka.
Lamarin da muke gani a nan shi ake kira "lafiya allurar rigakafi" son zuciya, kuma yana da kyau a rubuce a cikin littattafan bincike, dangane da allurar mura. Rashin son zuciya yana da ƙarfi sosai a cikin tsofaffi mazauna gidajen kulawa, amma ana gani a cikin dukan shekaru kungiyoyin na yawan jama'a.
Ma'anar "maganin rigakafin lafiya" al'amari - lokacin da ake kimanta tasirin rigakafin - ana kiran son zuciya mai ruɗani. Kwatankwacin ƙarancin mace-mace na Covid a cikin mutanen da aka yi wa alurar riga kafi da mutanen da ba a yi musu allurar ba, koda kuwa an daidaita shekaru, kuskure ne sosai saboda ƙarshen yana da haɗarin mutuwa. don farawa da. Aƙalla wani ɓangare na yawan mace-mace na Covid, idan ba duka ba, ba shi da alaƙa da rashin yin rigakafin. Mutane ne kawai marasa lafiya.
Ko da Goldin et al. suna sane da son zuciya, wanda suke ƙaddamar da jumla ɗaya a ƙarshen labarin:
"Ƙungiyar da ba a yi wa allurar rigakafi ba na iya fama da ƙarin cututtuka, wanda hakan ya sa su zama masu saurin kamuwa da kamuwa da cutar ta SARS-CoV-2 da mutuwa, don haka ya sa tasirin maganin ya zama mafi girma fiye da yadda yake a zahiri..” [na littattafai]
Wasu masu bincike suna tunanin cewa son zuciya yana aiki ne ta hanyar da akasin haka (wanda ake kira rikice-rikice-bias nuna bambanci), wanda wanda ba shi da lafiya ya fi dacewa a yi masa allurar rigakafi saboda yana cikin haɗari. Ko da kuwa, tasirin rashin lafiyar alluran rigakafin rashin lafiya da nuna son zuciya, idan akwai na ƙarshen, ana nuna su a cikin tebur na ƙasa (a sama): waɗanda aka yi wa alurar riga kafi sun sami raguwar mace-mace marasa Covid. Lallai sun fi koshin lafiya, a matsakaita, ba akasin haka ba.
Teburin da ke ƙasa yana nuna haɗarin haɗarin da VE akan mutuwar Covid, kamar yadda aka lissafta daga bayanan a saman teburin da ya gabata. VE yana kusa da kashi 80 lokacin da aka ƙididdige shi a wurare daban-daban, kuma ƙididdigewa mai sauƙi na gaba ɗaya (kashi 82) yana kama da babban sakamakon Goldin et al. (kashi 85). Ka tuna cewa duk waɗannan ƙididdiga sun kasance karkatattun nau'o'in gaskiya (na son zuciya) saboda ingantacciyar kyamar maganin rigakafi (kuma ba tare da ɗaukan ƙarin tushen son zuciya ba.)
Mafi mahimmanci, bayanai kan haɗarin rashin mutuwa na Covid suna ba da izinin gyara na asali na waɗannan ƙididdiga, wanda tabbas ya fi babu gyara kwata-kwata. Hanyar mafi kyau ta bayyana ta hanyar misali mai sauƙi.
Ace da bayyananne Haɗarin mutuwar Covid ya ninka sau biyu a cikin rashin rigakafin cutar fiye da wanda aka yi wa alurar riga kafi, wanda ke nufin haɗarin haɗari na 0.5 don goyon bayan allurar, da son zuciya na VE na kashi 50. A ce mun gano cewa haɗarin mutuwa daga abubuwan da ba na COVID ba is har ila yau, sau biyu mafi girma cikin rashin alurar riga kafi. Menene hakan ke nufi?
Alurar riga kafi bai haifar da wani bambanci ba. Ba shi da wani tasiri a kan mutuwar Covid. Haɗarin mutuwar Covid sau biyu shine abin da ake tsammani, "tushe" haɗarin mutuwa a cikin rashin rigakafi saboda gabaɗaya sun fi rashin lafiya. Alurar riga kafi ko a'a, da sun sami haɗarin mutuwa ninki biyu daga Covid fiye da takwarorinsu da aka yi wa allurar - kamar dai haɗarin mutuwa biyu daga abubuwan da ba na Covid. Ya kamata a gyara ma'aunin haɗari na son rai na 0.5 (VE=50%) zuwa 1 (VE=0%).
Don samun rabon haɗari na 1, daga haɗarin haɗari na 0.5, muna buƙatar ninka 0.5 ta 2, wanda za'a iya kira shi factor factor. Dalilin son zuciya yana ɗaukar babban haɗarin mutuwa a cikin waɗanda ba a yi musu allurar ba. Ana iya ƙididdige shi ta hanyar haɗarin rashin mutuwa ta Covid, idan aka kwatanta waɗanda ba a yi musu allurar ba da takwarorinsu da aka yi wa rigakafin.
A cikin saukin misali na, hanyar gyara ta rushe sakamakon da ake zaton maganin alurar riga kafi. Kamar yadda za mu gani na gaba, sakamakon zai iya zama wani abu daga rage VE zuwa korau VE, inda maganin da ake zaton mai amfani yana da illa.
Teburin da ke ƙasa yana nuna alamar son rai a cikin binciken Goldin et al. ta hanyar biyo bayan lokaci, tare da daidaitaccen haɗarin haɗari, da kuma gyaran VE. Misali, sama da duka mazauna gidajen kula da marasa lafiya a Isra'ila sun fi mutuwa sau 3.5 fiye da mazaunan da aka yi wa alurar riga kafi (bias factor na 3.5). Ƙirƙirar haɗarin haɗari na 0.18 ta 3.5 ya canza haɗarin haɗari zuwa 0.63 kuma ya rage VE daga kashi 82 zuwa 37 bisa dari.
Kusan duk mutuwar Covid sun taru a wata na uku (888 cikin 899). Tabbas, VE mai son zuciya ɗaya ne (kashi 81). Tunda yanayin son zuciya ya kasance mafi girma (4.1), gyaran VE yanzu shine kashi 22 cikin ɗari.
Ko VE ya kasance kashi 22 cikin 37 ko kashi XNUMX cikin XNUMX - wannan maganin alurar riga kafi ne. Kuma sakamako mafi muni yana nan tafe.
Ƙididdiga masu son zuciya na VE kaɗan ya ƙaru akan lokaci (daga kashi 78 zuwa 82). Halin rashin tausayi, duk da haka, ya ragu daga 7.3 a cikin watan farko na biyo baya zuwa 3.5 a kan duk abin da aka biyo baya, wanda ba shi da wuya a bayyana. Idan aka yi la'akari da ɗan gajeren tsawon rayuwar ƙungiyar da ba a yi wa allurar rigakafi ba, mafi yawan 'yan ƙungiyar sun mutu a baya. Ragowar mutanen a hankali sun zama ‘yan kungiyar da suka tsira “mafi koshin lafiya”, ta yadda za su takaita tazarar mace-mace tsakanin wadanda ba a yi musu allurar riga-kafi da alurar riga kafi ba.
A karshen wata na farko da son zuciya factor ya kasance 7.3 da kuma a karshen wata na biyu ya kasance 5.2, yayin da son zuciya rabo rabo ya kasance iri daya. Sakamakon haka, muna lura da illar cutarwa na maganin Pfizer a cikin wata na farko, kuma gabaɗayan illar da ba ta dace ba a ƙarshen wata na biyu. Wannan mara kyau ne kuma sifili VE, bi da bi, akan mutuwar Covid.
Lokacin da ƙaddamarwa ya dogara da adadin bayanai - babu tasiri ta wata na biyu tare da kashi 22 zuwa kashi 37 cikin XNUMX na tasiri tare da tsayin daka - muna da ka'idar babban yatsa: Ƙimar ta fi karfi a inda muke da shi. mafi na bayanan, ba bayan ƙara wasu abubuwan lura ba. Kusan kashi 95 na duk mutuwar Covid sun faru a cikin watanni biyu na farko (jere na farko a cikin tebur na sama).
Hanyar gyaran gyare-gyaren ba cikakke ba ne, kuma sakamakon ya dogara da ƙimar ƙima (ƙididdigar da kanta). Koyaya, ƙarin haɗarin mutuwar Covid yayin farkon lokacin haɗarin rigakafin rigakafin ya dace da sauran bayanai. Tabbas, kafafen yada labarai a Isra'ila sun ba da rahoton barkewar cutar Covid a cikin gidajen kulawa jim kadan bayan fara kamfen ɗin rigakafin.
A ƙasa akwai sakin layi biyu da aka fassara daga a rahoton labarai, kwanan watan Janairu 14, 2021, kimanin makonni uku a cikin yakin:
"Har yanzu, gazawa a cikin gidajen kulawa: A daidai lokacin da ake rarraba kashi na biyu na rigakafin COVID-19, cutar ta yi kamari sosai a cibiyoyin da tsofaffi ke zaune. A cikin makonni biyu da suka gabata, an sami rahoton bullar cutar a kasa da cibiyoyin kula da yara 160, kuma an sami sabbin mutane 1,098 da aka tabbatar sun kamu da cutar a tsakanin mazauna cibiyoyin da Ma'aikatar Lafiya ta ba da lasisin kawai.
A cikin layi daya da karuwar adadin marasa lafiya a cikin gidajen kulawa da cibiyoyin taimako, a cikin makonni biyu da suka gabata "Babban Garkuwa" [wani runduna ta kula da Covid a cikin gidajen kulawa] ta dakatar da buga rahoton yau da kullun kan bayanan cututtukan Covid a cikin cibiyoyin jinya a gidan yanar gizon Ma'aikatar Lafiya.. "
Me yasa suka daina bayar da rahoto? Shin sun kuma ga karuwar mutuwar Covid na mazaunan da aka yiwa alurar riga kafi na gidajen kulawa a cikin watan farko na yakin?
Ko maganin Pfizer yana da tasiri mara kyau na dogaro da lokaci, babu tasiri, ko matsakaicin tasiri - ingantaccen tasiri akan mutuwar Covid, kamar yadda Goldin et al., ya ruwaito, ƙarya ne. Da ace ba a kalubalanci hakan ba, mene ne illar hakan?
Wasu masu karatu na iya tunanin cewa karyata binciken daya ba ta da ma'ana da yawa. Goldin et al. ba daidai ba ne, amma akwai wasu nazarin da ke goyan bayan labarin "alurar rigakafi mai tasiri" a cikin mutane masu rauni. Ba mu nuna cewa sakamakon waɗannan binciken ma ƙarya ne ba.
Ba haka ba ne yadda ƙididdigewa ke aiki ba. Idan VE a kan mutuwar Covid ya nuna ya yi nisa da "mafi tasiri" a cikin binciken ɗaya na tsofaffi marasa ƙarfi, mu dole ne a cire cewa duk sauran binciken da suka ba da rahoton irin wannan ko mafi kyawun VE karya ne - haka nan kuma an gurbata su ta hanyar rashin lafiyar alluran rigakafin. In ba haka ba, dole ne mu yi zato maras tabbas: Duk da tsananin son zuciya, wasan da za a yi ta hanyar mu'ujiza ya haifar da gaskiyar VE a cikin binciken Goldin et al.
Me ya kamata ya faru a gaba?
Na farko, takarda ta Goldin et al. ya kamata a ja da baya.
Na biyu, ya kamata a dakatar da allurar rigakafin tsofaffi marasa ƙarfi tare da sabbin rigakafin Covid.
Na uku, ya kamata hukumomin kiwon lafiyar jama'a su fara Buƙatar Aikace-aikace (RFA) don gwaje-gwajen da bazuwar gwajin rigakafin Covid a cikin gidajen kulawa - tare da Covid da duk-mutuwar mace-mace a matsayin ƙarshen.
Irin waɗannan gwaje-gwajen sun tabbata a kimiyyance saboda mazauna gidajen kulawa, mafi yawan jama'a, an cire su daga gwaji na asali (wanda mutuwa ba ta ƙare ba). Haka kuma, gwaje-gwajen da bazuwar a cikin wannan keɓaɓɓen yawan jama'a sun zama wajibi na ɗabi'a lokacin da aka gyara VE akan mutuwar Covid daga bayanan lura daga matsakaici zuwa mara kyau, kuma akwai mace-mace masu alaka da allurar rigakafi.
Tabbas, duk abubuwan da ke sama sun dace kuma suna aiki a wata sararin samaniya.
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Dokta Eyal Shahar farfesa ne a fannin kiwon lafiyar jama'a a fannin cututtukan cututtuka da kididdiga. Binciken nasa yana mayar da hankali ne akan ilimin cututtuka da kuma hanyoyin. A cikin 'yan shekarun nan, Dr. Shahar ya ba da gudummawa sosai ga hanyoyin bincike, musamman a fannin zane-zane da kuma son zuciya.
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