Ke hoʻololi nei i ka ʻike a me ka ʻepekema e ulu nei

I kēia manawa ua ʻelemakule wau e ʻike i ka mālama olakino e loli a hoʻololi nui. Mai ka mālama ʻana i nā puʻuwai puʻuwai, nā loli i ka mālama ʻehaʻeha o ka ʻaoʻao i lalo, a me ka mālama ʻana i ka maʻi HIV, ke hoʻomau nei ka lāʻau lapaʻau e hoʻololi a hoʻololi me ka nui o kā mākou ʻike a me ka hoʻohana ʻana i nā hōʻike e alakaʻi i ka lāʻau.

Hōʻikeʻike? Hiki iaʻu ke hoʻomanaʻo i nā kamaʻilio he nui me nā mea maʻi i manaʻo ʻo ka ʻōlelo wale ʻana o ka "lāʻau lapaʻau e pili ana i ka hōʻike" a i ʻole ʻo EBM, he ʻōlelo mua ia e haʻi ʻia ʻaʻole lākou e kiʻi i kahi mea a lākou e makemake ai.

ʻO ka mea i loli i kaʻu ʻoihana ʻo ka neʻe o ke kumu no ka hana a mākou i nā ʻano ʻano like ʻole mai ka "manaʻo a nā hoa," ʻo ia hoʻi ka mea a nā loea i "koho maikaʻi loa" ai i ka hoʻohana ʻana i ka noiʻi (nā hoʻokolohua hoʻokolohua hoʻokolohua ʻia, ke hiki) e hoʻohālikelike maoli i ka lapaʻau ʻana. A i ka mālama ʻana B.

ʻO ka pahuhopu: hoʻololi. Hoʻololi mau ka mea a mākou e ʻike nei. Ke hoʻomau nei ka ʻepekema e ulu a hoʻomau mākou e aʻo i kēlā me kēia lā.

No laila, ʻānō mākou me COVID-19.

Wikiwiki, ke noiʻi nei i ka noiʻi i kēlā me kēia ʻano o kēia maʻi lele. Hoʻopili kēia i nā mea āpau mai ka hana a mākou e mālama ai i ka maʻi ma ka hopena o ka ICU a pehea e pale pono ai i ka poʻe mai ka hopu ʻana i kēia maʻi maʻi ma ka mua. Ke hoʻāʻo nei mākou e hoʻomaopopo i ka hopena o ka makaʻu o kekahi no nā hopena maikaʻi ʻole. Ke kupu nei nā hiʻohiʻona, a e hiki mai ana ka ʻike hou aku.

ʻO kahi kahi e loaʻa ana i ka nui o ka nānā kūpono ka hana ʻana o ke kino i nā mea ʻohola. ʻElua mau ala e hoʻomohala ai i nā mea pale i ka maʻi. Loaʻa iā mākou iā lākou ma hope o ka loaʻa ʻana o ka maʻi (ke manaʻo ʻaʻole mākou i hāʻule i ka maʻi) a i ʻole loaʻa iā mākou nā lāʻau āpau i maʻa mau ʻia nā mana "attenuated" o ka maʻi. He hana kēia e hoʻoliʻiliʻi ai ka maʻi ("de-fanged") i ka hopena, akā ke kau nei i kahi pane anti-antibody.

ʻO kēia kahi o nā hana āpau ... i kēia manawa.

ʻO ka mea a mākou e ʻike nei i kēia manawa ʻo COVID-19 e hana i kahi pane antibody, akā e like me ka mea i paʻi ʻia i ka Ka Pai ke koko ma ʻOkakopa 1, hope wale kēia mau mea ʻino, a i ʻole hoʻomaka e nalowale ma kahi o ʻekolu a ʻehā mau mahina ma hope o ka maʻi. Eia kekahi, me he mea lā ʻoi aku ke koʻikoʻi o ka maʻi, ʻo ke kiʻekiʻe ka nui o nā mea ʻino i hana ʻia.

Ke lohe nei mākou i kēia manawa no ka hiki o kahi lāʻau lapaʻau e holo ma waena o ka RNA o ke kele e like me ka mea e pale ai ma kahi o ʻehiku mau lā ma hope o ka hopena o ka lua. He hoʻololi pāʻani paha kēia. ʻO ka akahele ʻē aʻe e pono e hōʻoia i ka ʻikepili e nā ʻepekema ʻē aʻe a pono e aʻo ʻia nā poʻe he nui e loiloi i nā hopena ʻaoʻao. ʻOiai ke holo pono, hiki ke loaʻa i ka heluna lehulehu i mau mahina keu. Inā loaʻa a hiki i kahi lāʻau lapaʻau, pono mākou e hoʻonohonoho mua i nā limahana o ka laina mua a me ka poʻe maʻi maʻalahi.

He aha ke ʻano o kēia iaʻu ma ke ʻano he kahu mālama mua? Aia i waho ke kiure, akā manaʻo wau ʻo COVID-19 paha i lilo i like me ka maʻi flu a koi paha i kahi lāʻau āpau makahiki. ʻO ia hoʻi ka hana pale ʻē aʻe e like me ka holoi lima, nā pale maka, ka haʻalele ʻana i nā lima mai nā alo, a me ka noho ʻana i ka home ke maʻi ʻoe. ʻOiai he maikaʻi ia, ʻaʻole wau i manaʻo e lilo kēia i kahi "hoʻokahi a hana" ʻia. No COVID-19 a me ka flu, hiki nō ke hoʻolaha i ka maʻi i nā poʻe ʻē aʻe ma mua o ka loaʻa ʻana o kekahi hōʻailona. Hiki i nā kānaka ke pālahalaha i ka COVID-19 ma kahi o ʻelua mau lā ma mua o ka loaʻa ʻana o nā hōʻailona a i ʻole nā ​​hōʻailona a hoʻomau i ka maʻi lele ma kahi o 10 mau lā ma hope o ka hōʻike mua ʻia ʻana o nā hōʻailona. (He maʻi maʻamau ka poʻe me ka maʻi flu i kekahi lā ma mua o ka hōʻike ʻana i nā ʻōuli a noho mau nā maʻi no ʻehiku mau lā.)

ʻO kahi mea hou aʻe, ʻo ka laina lalo, e like me nā mea noiʻi, ʻo ia ka mea e kinai ai i ka maʻi maʻi COVID-19 e hoʻomau nei, pono ka hopena o 80%, a 75% o ka poʻe e pono e loaʻa iā ia. Ma muli o ka hiki ʻole ke hiki koke mai kēia uhi ʻana o ka lāʻau lapaʻau kiʻekiʻe, ʻo nā ana ʻē aʻe e like me ka hoʻokaʻawale ʻana i ka nohona a me ka uhi ʻana i nā pale makakiʻi paha he mau hana pale nui ia no ka wā e hiki mai ana. (Kumu: Bartsch SM, O'Shea KJ, Ferguson MC, et al. Pono ka pono o ka lāʻau no kahi lāʻau COVID-19 coronavirus e pale a hōʻoki paha i kahi maʻi ahulau ma ke ʻano he mea kōkua wale. Am J Prev Med. 2020;59(4):493−503.)

Eia hou, ke loaʻa iā mākou kahi lāʻau āpau, e like me ka maʻi palū, e hoʻonoho ʻia ka prioritization o ka mea pono e loaʻa ka lāʻau lapaʻau a i ke ʻano o ke ʻano. Ua hōʻike ʻia ka National Academies of Science, Engineering, a me Medicine i nā ʻōlelo aʻoaʻo no ka hoʻokaʻawale ʻana i nā lāʻau ʻo COVID-19, e kāhea ana i nā limahana mālama olakino kiʻekiʻe a me nā mea pane mua e loaʻa i nā kaukana, a ukali ʻia e nā kamaʻāina ʻelemakule i nā pono e like me nā hale kahu hānai a me nā mākua me ka preexisting nā kūlana i hoʻokau iā lākou i ka hoʻonui i ka makaʻu. Ua kāhea ka papa i nā mokuʻāina a me nā kūlanakauhale e nānā pono i ka hōʻoia ʻana i ke komo ʻana i nā kaiāulu liʻiliʻi a no ʻAmelika Hui Pū ʻIa e kākoʻo i ke komo ʻana i nā ʻāina loaʻa haʻahaʻa.

Ma ke ʻano he kauka lāʻau lapaʻau ʻohana, hoʻāʻo mau wau e hoʻomanaʻo i ka mea a kahi alakaʻi i haʻi mai ai iaʻu i nā makahiki i hala aku nei: "ʻO kahi hoʻolālā ke koho maikaʻi loa o kēia lā." Pono mākou e hana i ka mea a mākou i ʻike ai i kēia manawa, a mākaukau (a wehe) i ka ʻike hou a me ke aʻo ʻana. Hoʻokahi mea no ka ʻoiaʻiʻo, ʻo ka loli ka mea mau.