SARS-CoV-2およびCOVID-19の人から人への感染を防ぐための物理的距離、フェイスマスクおよび目の保護

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論文タイトル

Derek K Chu, MD Prof Elie A Akl, MD Stephanie Duda, MSc Karla Solo, MSc Sally Yaacoub, MPH Prof Holger J Schünemann, MD et al.

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

THE LANCET June 01, 2020　DOI:https://doi.org/10.1016/S0140-6736(20)31142-9

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アブストラクト（抄録）

■目次

背景

重症急性呼吸器症候群コロナウイルス2（SARS-CoV-2）は，COVID-19を引き起こし，密接な接触を介して人から人へと感染する．我々は、ヘルスケアおよび非ヘルスケア（コミュニティなど）環境におけるウイルス感染に対する物理的距離、フェイスマスク、および目の保護の効果を調査することを目的とした。

方法

我々はシステマティックレビューおよびメタ解析を行い、人から人へのウイルス感染を回避するための最適な距離を調査し、ウイルス感染を防止するためのフェイスマスクおよび目の保護具の使用を評価した。SARS-CoV-2 と重症急性呼吸器症候群の原因となるベータコロナウイルス、および中東呼吸器症候群に関するデータを、WHO 固有の標準情報源および COVID-19 固有の情報源 21 箇所から取得した。データベース開始から2020年5月3日までの間に、これらのデータソースを言語による制限なく、比較研究、および受容性、実現可能性、資源利用、衡平性の文脈的要因を求めて検索した。記録をスクリーニングし、データを抽出し、重複した場合のバイアスのリスクを評価した。我々は、フリークエンティストメタアナリシスおよびベイズメタアナリシス、ランダム効果メタ回帰を行った。コクラン法およびGRADEアプローチに従ってエビデンスの確実性を評価した。本研究はPROSPERO、CRD42020177047に登録されている。

発見

我々の検索では、16 カ国と 6 大陸にまたがる 172 件の観察研究が同定されたが、ランダム化比較試験は実施されておらず、44 件の関連する比較研究が医療現場と非医療現場で実施された（n=25 697 人の患者）。
ウイルスの感染は、物理的距離が1m以上の場合、1m未満の場合と比較して低かった（n=10 736人、プール調整オッズ比[aOR] 0.18、95％CI 0.09～0.38；リスク差[RD] -10.2％、95％CI -11.5～-7.5；中程度の確実性）；保護は距離が長くなるにつれて増加した（相対リスクの変化[RR] 2.02/m；相互作用=0.041；中程度の確実性）。
フェイスマスクの使用は感染リスクの大幅な減少につながる可能性がある（n=2647；aOR 0.15、95％CI 0.07～0.34、RD -14.3％、-15.9～-10.7；低確度）、N95または類似の人工呼吸器との関連は、使い捨ての手術用マスクまたは類似のものと比較してより強くなった（例えば、再使用可能な12～16層の綿マスク；相互作用=0.090；事後確率>95％、低確度）。
眼の保護もまた、感染の減少と関連していた（n=3713；aOR 0.22、95％CI 0.12～0.39、RD -10.6％、95％CI -12.5～-7.7；確実性は低い）。未調整の研究とサブグループ解析および感度解析では、同様の知見が得られた。

解釈

このシステマティックレビューとメタアナリシスの知見は、1m以上の物理的距離を支持し、政策に情報を提供するためのモデルと接触追跡のための定量的な推定値を提供している。公共の場や医療の場でのフェイスマスク、人工呼吸器、目の保護具の最適な使用は、これらの知見と文脈的な要因に基づいて情報提供されるべきである。これらの介入に関するエビデンスをより良く伝えるためには、堅牢な無作為化試験が必要であるが、現在利用可能な最善のエビデンスを体系的に評価することで、暫定的なガイダンスが得られる可能性がある。

Funding

World Health Organization.

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感想

物理的に距離を取ることが非常に大きな意味を持つことを示唆している論文。

日本は何で欧米よりも被害が少なかったのか？という疑問に、個人的には”日本人は個人間の距離がそもそも遠めだからじゃないかなぁ？”と思いました。少なくともこの結果を見る限りでは。

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