Sidonio João da Silva Pereira.

Hosi:

Sidonio João da Silva Pereira

Formulasaun polémika

  1. Hafoin ema ida mate tan COVID 19, virus ne’e sei iha nia isin lolon ka lae?
  2. Mate isin sei iha risku hada’et virus ka lae?
  3. Ema foin sa’e no forte hela tan sa bele mate ba virus ne’e ?

Justifikasaun artigu nia titúlu

Hakerena nain tau titúlu ― Polémika entre duvida e tauk‖ tanba, dauluk ita  la fiar katak kutun corona ne’e existe no hamate ema, maibé parte seluk ita kontinua uza nafatin masker hodi la’o ba mai ka halibur malu iha fatin ruma ke fó impresaun públika katak ita lian sai dehan kutun ne’e la existe maibé ita laran tauk keta nia daet  no hamate ita karik.

Aiknanoik

Ha’u hanoin ita lalika ona ko’alia barak no klean kona-ba saida mak SARS- CoV-2 ne’ebé hamosu moras COVID-19, basa ita hotu hatene loloos no momos ona virus ne’e hahú mosu husi ne’ebé no nia prezensa iha mundu tomak ne’e oinsá to’o ohin loron.

Antes tama ba iha ita nia polémika relasiona ho coronavirus iha ita rain hanesan temi ona iha titúlu husi artigu ida ne’e, ha’u konvida mai ita buka hatene uitoan prezensa kutun ne’e iha mundu tomak.

To’o horiseik loron 11 abríl 2021, mundu tomak rejista kazu kumalativu konfirmadu 136.05 milloens, no kumalativu ema mate hamutuk 2.94 milloens.1 Dadus ida ne’e, no hatete mai ita katak kutun corona (SARS – CoV2) la’ós Timor nia mesak, no la’ós Timor oan de’it mak sofre katástrofe epidemilójika ida ne’e.

Antes ita buka solusaun ba ita nia polémika ne’ebé sita ona iha artigu ne’e, ita hamutuk haree liu termus balun ne’ebé ita presiza hatene ka koñese iha ámbitu teste ba virus corona hafoin ida mate.

Saida mak postmortem swab test?

Swab ka exame labo’otoriál ida ne’ebé halo hafoin individu ka ema ida mate tan virus corona ou suspeitu ka diskunfia de’it.2

Saida mak Autópsia?

Examinasaun medikál ida ne’ebé preforme ba mate isin ida atu buka hatene kauza ne’ebé hamate ema ne’e.3

Saida mak Covid 19 PCR test?

PCR habadak husi liafuan, Polymerase Chain Reaction, teste ida ne’ebé uza atu deteta materiál jenétika husi virus ―neste kazu corona virus bainhira ema ida infetadu ho SARS-CoV-2, teste ida hanesan gold standart atu fó diagnóstiku ba COVID 19 tanba fó rezultadu ne’ebé acuradu liu.25

Iha artigu ida ne’e hakerek nain la hakerek ho nia hanoin rasik, maibé hariku mos hanoin no rezultadu investigasaun husi espertu sira iha siénsia rai seluk nian ne’ebé nia servisu investigasaun avansasu liu ona kompara ho ita rain ne’ebé ita toman hanaran ka sarani ho “Ita foin ukun an ne’e”.

Mai ita hamutuk buka lisuk resposta ruma liga ba ita nia situasaun problemátika iha ita nia rai laran ne’ebé ita hotu hamatan ba.

Loos duni, dilema ba profisionál saúde ida atu konvense ita nia maluk sira seluk hodi kumpriende natureza husi kutun ne’e, no nia impaktu iha isin lolon tuir siénsia ko’alia, difísil liu tan iha kontestu Timor nian ne’ebé iha hotu hamatan ba, maibé hakarak ka lakohi ida ne’e maka dezafiu loloos ba profisionál saúde sira atu ho ulun malirin kontinua buka no habelar informasaun liga ho saúde nian ba maluk sira seluk tuir siénsia ko’alia, basa di’ak ka lae,  ida ne’e maka ita rain, sira mak ita maluk, ita alin-alinmaun.

Dala wain hetan insulta, tolok tantu direta ka liuhusi mídia sosiál, desakredita profisionál nia knaar, ate tuda iha fatfatin, situasaun ida ne’e estimula knaar nain saúde sira atu hatudu no hametin liután profisionalismu servisu iha idak idak nian nia knaar fatin atu kontinua atende maluk sira e fó informasaun ba sira tuir siénsia ka estudu ko’alia.

Hafoin fó volta uitoan, mai ita haree lisuk ita nia polémika ne’e e fó resposta ho ulun marilin.

Hafoin ema ida mate tan SARS-CoV-2, virus ne’e sei iha nia isin lolon ka lae?

Resposta husi pergunta ida, dala ruma kontroversi uitoan husi presepsaun públika, se ita ko’alia bazea ba evidénsia sientifika, ha’u hanoin pertinente ba ita atu partilla informasaun ba malun tuir siénsia ko’alia ne’ebé fundamenta ho nia rezultadu husi estudu investigativu, tuir Stefanie Plenzig et al. iha sira nia estudu ba kazu haat ne’ebé sira halo postmorten test ho métodu swab, autópsia ho nia postmorten interval (PMI), hatudu katak virus ne’e sei mate mezmu liu ona loron hira kedas.

Iha sorin seluk El Bouzidi K, et al. iha sira nia estudu, informa mos katak hafoin sira halo posmortum swab test ho tempo intervalu entre loron 7-12 hafoin hakotu iis, ba mate isin hamutuk 118, rezultadu hatudu 1/3 husi sira  ne’e PCR +  no husi hirak ne’ebé pozitivu iha ida mak sira halo teste ba mate loron 29 ona.5

Nune’e mos iha autór seluk, Pasquale Beltempo el al.  iha sira nia case report, hateten hafoin halo posmortum swab test ba mate isin ida ho idade 60 ne’ebé mate liu loron 35 ona, rezultadu hatudu pozitivu nafatin.6

 Iha parte seluk Cristoforo Pomara et al. ko’alia kona estratéjia ba manajementu seguru ba mate isin konfirmadu COVID 19, husi mate isin 32  ne’ebé sira submete ba post morten swab test, 16 swab halo iha bronhios loos, no 16 seluk halo broncius karuk, nia rezulta hatudu kontinua pozitivu ba SARS CoV-2.

Hafoin ita hamutuk haree rezultadu husi estudu haat ne’ebé ita sita iha leten, ha’u hanoin ita bele kumpriende uitoan ona katak pergunta ne’ebé públiku koloka katak virus ne’e sei iha ka lae iha ema nia isin lolon baihira ema ne’e mate ona.

Ha’u hanoin ho ida ne’e, pertinente tebes no normál profisionál saúde sira halo postmortem swab test  ho objetivu fortifika liutan diagnóstiku baze ba evidénsia siéntifika, Timor-Leste nia kontestu tanba ita seidauk iha kbit laboritariál no anatomipatologia atu halo autópsia.

Rezultadu no lalaok  hirak husi estudu sira iha leten fó hanoin mai ita katak halo postmortem swab test  la’ós buat foun ne’ebé Timor-Leste mak inventa.

Mate isin sei iha risku atu hadaet virus ne’e ka lae?

Atu atu fó resposta klean ba pregunta ida ne’e, to’o ohin loron seidauk iha dadus sufisiente ne’ebé bele sustenta argumentu klíniku atu hatán basa seidauk iha publikasaun artigu sientífiku ne’ebé ko’alia kona ba tópiku ne’e.

Mezmu nune’e iha estudu balun ne’ebé ko’alia uitoan kona polémika ida ne’e’e, hanesan investigasaun  ne’ebé halo husi Won Sriwijitalai et al. husi RVT Medikál Center iha Bankok, Tailándia, fulan-maiu 2020, sira reporta primeiru kazu husi servidór ka staff ida iha departamentu medisina forensik ne’ebé hetan infeksaun hafoin manipula mate isin ne’ebé mate tan COVID 19.8 Estudu ida ne’e kontraversiál ho estudu seluk  husi sientista sira husi India haktuir iha  okos.

Grupu sientista husi All India Institute of Medikál Sciences /AIIMS-Bhosal kondús estudu ba mate isin sira ne’ebé mate tan COVID 19  atu buka hatene, karik iha risku mate isin ida bele hadaet virus SARS-CoV-2, tanba mosu mos polémika husi públiku bainhira halo kremasaun ka sunu mate isin sira la tuir kultura India nian, nune’e hafoin halo estudu,  Diretór husi institutu ida ne’e relata katak laiha evidénsia kona ba virus corona husi kadaver bele infetaka ka hadaet ba ema seluk.9

Nune mos husi pontu seluk, hanesan hatur iha technical report husi European Center for Disease prevention and Control, informa to’o agora seidauk iha evidénsia  kona-ba SARS CoV-2 bele hadaet liu hosi ―penanganan jenasah‖ no potensialidade risku atu hetan trasmisaun husi mate isin ne’e uitoan ka ―low‖ no ida ne’e mosu bainhira ema ida halo kontaktu diretu ho mate isin liu fluido ka fomitas kontaminadu ho virus ne’ebé husik hela antes hakotu iis.10

Argumento iha leten sustenta mos rezultadu estudu husi G. Kamp et el.  Iha sira nia estudu atu buka hatene tipu Coronavirus sira ne’ebé bele reziste iha sasan inanimado ka―benda mati‖ nia leten, sira reporta katak kutun corona sira  bele reziste to’o loron sia iha sasan hirak hanesan metal, kopu, plástiku no seluk seluk tan nia leten, maibé bele dezativa ho alkól nia persentajen (%) oin – oin e ho Hydrogen peroxide 0.5% ou  0.1% Sodium hypochlorite iha minute ida nia laran.

Tabela 3. Tipu Coronavirus ho nia presisténsia iha sasan inanimdos sira bele haree iha link ne’e.7 https://www.journalofhospitalinfection.com/acti on/showFullTableHTML?isHtml=true&tableId= tbl1&pii=S01956701%2820%29300463.

Iha parte seluk WHO nia interim guidance Marco 2020, hateten mos katak to’o ohin loron seidauk iha evidénsia kona mate isin bele hadaet infeksaun Coronavirus, maibé sira afirma, tanba virus ne’e foun, nia evolusaun sei la’o oinsá seidauk iha serteza, tanba ne’e medida prekautiva ba prevensaun nian hotu tenke halo no hein to’o informasaun klara kona-ba virus ne’e iha loron tuir mai.11

Ho informasaun badak husi referénsia iha leten, ha’u hanoin ita hotu kumpriende uitoan ona kona-ba polémika ne’ebé sita iha leten.

Ema foin sa’e e forte hela tansá bele mate ba virus ne’e ?

Loos duni, hanesan públiku hatene ona, hahú husi Coronavirus mosu iha 2019 nia rohan no durante 2020, iha literatura siéntifika barak mak ko’alia kona fatór risku no individu sira ne’ebé susceptible atu mate bainhira hetan infeksaun husi kutun corona mak; hirak ne’ebé ho idade avanzada ka ferik katuas sira, no hirak ne’ebé iha nanis ona moras króniku seluk hanesan tensaun aas, falla rins, aten, fuan, diabetes no seluk tan antes hetan infeksaun husi kutun corona, maibé lamentavelmente hahú husi 2020 nia rohan to’o 2021, konseitu ida ne’e muda, dadus husi nasaun hirak ne’ebé sofre liu ba infeksaun husi kutun Corona hanesan Brazil, Joe Wals haktuir, pasiente mate ho idade menus husi 40 tan coronavirus iha fulan ida nia laran hamutuk 2,800 no espertu sira hateten númeru mate ne’e, kauza husi kutun Corona variante Brazilian.

Iha parte seluk, husi Franca, Doutor Benjamin Clouzeu husi Unidade Kuidadu Intensivu, ospitáll Bordaux, Franca, informa katak 90% husi pasenti  sira ne’ebé baixa iha sala kuidadu intensivu ho idade entre 30 – 65 no maioria infetadu ho virus variante husi Reino Unido e husi hirak ne’e, laiha moras króniku seluk e balun iha maibé la’ós signifikante atu justifica sira nia mate.13

Husi Estadus Unidos Amérika, tuir Wasinton post iha abríl 2020, haktuir,  maizumenus ema 759 mate ho idade menus husi 50  ne’ebé  infetadu ho Coronavirus.14

Dadus husi nasaun bo’ot tolu ne’e, hateten ona mai ita katak Corona virus la hamate ema ho idade bo’ot ka ferik katuas de’it, maibé nia bele oho ema ho kualker idade.

Atu hatán, tan sa ema ho idade produtivu ka joven sira menus husi 50 anos bele mate, mai ita sani hamutuk.

Philip Murphy, investigator biomedikál husi National Institute of Allergy and Infectious Diseases, Estados Unidos America, haktuir jenetikamente talvez iha variasaun gen ne’ebé regula receptor ACE2 (Angiontensin Converter Enzym 2) iha pulmaun, ne’ebé bele difikulta ou hafasil virus tama barak  ba pulmaun  laran. (ACE2 receptor principal virus Corona  iha neomocito, Pulmaun)14.

Michael Skinner, a virologista husi Imperial College London, deklara no fiar katak, ― husi patiente hirak ne’ebé mate ho idade joven, possiblemente iha gen partikulár ne’ebé halo ema hirak ne’e responde ba  infeksaun Corona virus aat liu‖ e teoria seluk hateten tal vez pasenti hirak ne’e’e nia surfactante pulmonár menus iha sira nia pulmaun, subtánsia ne’ebé isin lolon prodús atu  fasilita pulmaun expande no contrae bainhira dada iis, patiente  hirak ne’ebé menus subtánsia ne’e.e, sira nia pulmaun sai ―stif ou kaku” ida ne’e’e  bele esplika ka justifica, tan sa patiente balun nafatin ho dada iis araska maske sira ho ventilatór‖14

Iha parte seluk husi pontu immunologica iha fenemu ida ne’ebé akontese iha isin lolon bainhira hetan infeksaun husi virus SARS- CoV 2 hanaran  Cytokine Storm Phenomena.

Oinsá SARS CoV2 bele provoka fenomenu ida ne’e.? Iha akumulasaun evidénsia lubun ida ko’alia kona ba kuadru klíniku severo ka todan ne’ebé provoka husi SARS-CoV-2 asosiadu ho aumentu nivel husi mídiadór inflamatori sira hanesan citocina e chemosira sira hanesan intelukina ( IL-2, IL-6, IL-7,IL-10, fatór Necrosis Tumoral ka TNF, granulocyte colonystimulating factor (G-CSF), monocyte chemoattractant protein-1 (MCP1; ka CCL2), macrophage inflammatory protein 1 alpha (MIP1α; ka CCL3), CXC-chemokine ligand 10 (CXCL10), C-reactive protein, ferritin, and Ddimers iha ran hafoin individu ida hetan infeksaun SARS-CoV2.16-24

Atu ko’alia ho klean iha parte ne’e nia detala ha’u hanoin ladun pertinente ba sani nain sira, maibé hakerek nain trata reprezenta prosesu husi fenomenu Cytokine Storm liu husi hatudu gráfika ne’ebé haktuir lalaok virus SARS – CoV-2 tama iha ema ida nia isin lolon to’o hamosu fenomenu ne’ebé ita ko’alia daudaun no recorrido ikus liuhusi fenomenu ida maka orgaun prinsipál sira hanesan pulmaun, aten, fuan no rins (multiple organ failure) no hamate individu ne’ebé infetadu ho kutun Corona.26

Hakarak sumariza idea esensiál husi parte ida ne’e, katak eventu ida ne’e akontese bainhira iha desregulasaun husi ativasaun sistema defeza ka ―sistem kekebalan tubuh‖ rezulta responde exajeramente  iha momentu nia organiza an hodi luta hasoru infeksaun husi SARS-CoV 2.

Fonte. Y.M Goa et al. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13144 e Li Yang et el https://www.nature.com/articles/s41392020

Master in Investigation of Immuology –Universidad

Complutence de Madrid, Spain

Emergency Medicine registrar- South Korea

Servidór Públiku iha Departamentu emerjénsia

Ospitál Nasionál Guido Valadares

Membru Asosiasaun Médiku Timor-Leste

Mensajen: Keta loke peito matan ba malu iha momentu catastrope epidimilogica nian ida ne’e, maibé mai ita hamutuk loke peito matan ba  kutun coronovirus liuhusi asaun simple prevensaun, basa ne’e mak arma poderoza liu ona atu evita konsekuénsia ne’ebé sei lori husi kutun corona ba ita nia sosiedade

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