新型コロナ後遺症の正体・ウィルスは血管を攻撃する

WIREDより。
パンデミック下の米国では貧困層が富裕層より活発に行動しており、そのせいで貧困層は新型コロナウイルスに感染する危険性が増している恐れがある。

この研究はカリフォルニア州の複数の大学に在籍する研究者によるもので、米国科学アカデミー紀要(PNAS)の機関誌に論文として発表された。この研究では、匿名化されたスマートフォンの位置データと国勢調査のデータに基づいて、米国の人々の今年の移動傾向が劇的に逆転したことが浮き彫りになっている。

新型コロナウイルスの流行が始まる以前、米国の富裕層は貧困層より活発に移動していた。旅行するだけの金銭的な余裕が常にあったからだ。ところが、今年の1月から4月にかけて状況が逆転した。いまでは富裕層のほうが貧困層より家に閉じこもっている。 調査によると、パンデミックになってから家から一歩も外に出ない富裕層の数は、パンデミック以前に比べて25パーセント増えたという。一方で貧困層では、増加した人数は10パーセントにすぎない。このことは、米国が国としてパンデミックと戦う方針に大きく影響する。

「新型コロナウイルスのパンデミックが始まったころ、米国内の人々の動きには全体的に変化がありました」と、今回の論文の筆頭著者であるカリフォルニア大学デイヴィス校の経済学者ヨアキム・ヴァイルは説明する。
「米国では誰もがパンデミック以前より家にいるようになっています。しかし、富裕層と貧困層とで反応に明らかな違いがあることもわかりました。富裕層は貧困層よりはるかに家にこもる傾向があったのです」。

この違いを定量化するために、ヴァイルは同僚たちと3つの企業による匿名化されたスマートフォンの位置データを利用した。データの出所はグーグルのほか、地理情報を提供するSafeGraphとPlaceIQである。 ヴァイルらはこの位置データを、全米各地の平均所得を表す国勢調査のデータと組み合わせた。最終的に、米国で新型コロナウイルスの広がりが抑えきれなくなる直前の1月から、ロックダウン(都市封鎖)政策が本格化した4月にかけて、数百万人の国民の移動を追跡できた。

その結果、やはり富裕層は家から移動していなかった。富裕層のトップの半数近くが、4月の平日に家から一歩も出ずに過ごしていたのだ。
これに対して貧困層では、家にいた人々は40パーセントに満たなかった。貧困層は概して移動距離も富裕層より長かった。同じ月(4月)に貧困層は5~6kmを移動していたが、富裕層の移動距離は4kmほどだった。
また、富裕層は4月に行楽地や商業施設のある地域に行く回数を半分ほど減らしたが、貧困層は4分の1しか減らさなかった。これはおそらく、仕事のためにそれらの地域に行く必要があったからだろう。

誤解のないようにはっきりさせておくと、今回の調査ではこのような劇的な違いが生じる理由を断定できていない。あくまで考察にとどまっている。 ひとつ考えられる理由が、食料品店や薬局のレジ係などのエッセンシャルワーカーの多くは、収入が少ないことだ。実際に米労働省労働統計局によると、高校卒業資格をもたない25歳以上の米国民のうち、6月に在宅勤務していた人はわずか5パーセントだった。一方、学士号以上をもつ米国民の54パーセントが、在宅で勤務できていた。

「貧困層の人々は受け取る情報も違っていて、富裕層とは異なる情報源に従っていることも考えられます。そのせいでパンデミックの意味するところが、初期のうちに過小評価されていたのかもしれません」と、ヴァイルは指摘する。「パンデミックに関する意見の二極化が著しい米国では、それも一理あります」 富裕層は、食料品や医薬品などの必需品を何の問題もなく買いだめできる。一方、その日暮らしの貧困層は、収入があったときに小まめに店に行くしかない。

また、富裕層が買い物を外注したり、買い物の量を増やしたり、宅配サーヴィスへの依存度を高めれば、貧困層の抱える問題をさらに悪化させる可能性がある。貧困層の多くは、小売店や倉庫、配達の仕事をしているからだ。 Amazonなどのオンラインショップで買い物をすれば、結局のところは現実の人間が注文の品を荷造りして、別の人間があなたの家の玄関先まで届けてくれる。農場の従業員や食肉加工場の作業員といった別のエッセンシャルワーカーも、農産物や肉を出荷するために職場へ通っている。

そして、これらの仕事を通じてウイルスに晒される危険性が増している。実際にAmazonの従業員は、企業側がパンデミックから従業員を守る対策を十分にとっていないとして、病欠ストを実行して抗議の声を上げた。

「この研究についていい点だと思うのは、しばらく前から噂されていたことをデータとしてきちんと示した点です」と、今回の調査には参加していないカリフォルニア大学アーヴァイン校の人口統計学者アンドリュー・ノイマーは言う。「在宅勤務やZoomのようなツールの進化について、人々はよく話題にしていました。ところが、金属の溶接などの職業についている人にとっては、Zoomはアプリ自体が完ぺきではないのと同様に、在宅勤務を可能にする万能のツールにはなりえません。スマートフォンの位置情報データに基づく今回の研究により、起きていると思われていた現象が実際に生じていることが示されたのです」。

新型コロナウイルスは、ある種の“平等装置”だと言われてきた。人間である以上、誰もが感染する可能性がある。たちの悪いこのウイルスに感染すれば、いくら金を積んで最善の治療を施してもらっても、場合によっては死を逃れられない。金持ちか貧乏かなど、ウイルスにとっては関係ないというのだ。 ところが、この説では致死率(ウイルスによって死ぬ確率)と曝露リスク(そもそもウイルスにどれだけ感染しやすいか)が混同されている。

「この説の出所がどこなのかは知りませんが、このウイルスがいつも大災害に例えられていること、それが的外れだということはわかっています」と、ノイマーは言う。
「例えば、『トム・ハンクスが感染するんだから、誰だって感染する可能性はあるよ』と言う人がいます。だからといって、誰もが“必ず”感染するということではありません。感染したときに、ハンクス氏や彼と同じ税区分にいる人たちが同じダメージを受けるわけではないのです」 エッセンシャルワーカーの43パーセントが有色人種であるという事実は非常に重要であり、心にとどめておくべきだと、「Partnership for Southern Equity」のディレクターであるチャンドラ・ファーレイは指摘する。

「わたしたちは何も考えずに人のことを脆弱だろうと決めつけてしまうことがあります。それは、構造的な人種差別と古くからの不平等が原因であり、口にせずともある種のことに対して脆弱だろうと考えてしまうからです」とファーレイは言う。「所得が低いのは、その人のせいではありません。多くの場合、社会的に無視されているせいで低賃金のエッセンシャルワークにしか就けず、そのせいで収入が少ないのです」。

エッセンシャルワーカーのなかには、職場で団体保険に加入できていない者もいる。この根本的なもうひとつの要因があることから、こうした人々は新型コロナウイルスによって最もダメージを受けやすくなっているのだ。 新型コロナウイルスによるアフリカ系米国人の死亡率は、白人の米国人の3.7倍となっている。これは主に医療制度を利用できないことが原因である。新型コロナウイルスによるラテン系米国人の死亡率は、白人の2.5倍だ。

特にサンフランシスコでは格差が顕著である。サンフランシスコのミッション地区でのある調査によると、被験者のうちラテン系は40パーセントにすぎなかった一方で、検査で陽性と判定された患者の96パーセントがラテン系だった。被験者の少なくとも90パーセントの人は、感染を避けるために自宅にこもっていることはできなかったと答えている。

今回の研究結果は、新型コロナウイルスの脅威に米国が立ち向かう上で大きな意味をもっている。貧困層に対する経済的な圧力が増しているなか、所得によってウイルスに対する曝露リスクに明らかな格差があることが示されたのだ。 7月末を期日としていた失業給付に週600ドルを上積みする連邦政府による措置がこのたび失効し、議会では議員らが措置の延長について合意を成立させようと奮闘していた[編註:8月8日に400ドルに減額して延長する大統領令が発令された]。

上積みがなければ、数千万人もの国民が家賃や住宅ローンを払えなくなる。家を失えば、多くの人はホームレスのためのシェルターなどに家族全員で行くほかない。だが、そういった混雑する環境にはウイルスが蔓延していることから、さらに感染の危険性が高くなる。

「あなたも147日間休まず働いてみたことありますか? ないだろうね、だったら意味分かるじゃない。140日休まないで働いたことないだろう。140日働いたこともない人が、働いた人のこと言ったって分かんないわけですよ」。

麻生太郎の言う147日とは、1月26日~6月20日の期間。確かにこの間、朝日新聞の首相動静によると「公務なし」の休日がなかった。
だが足もとの状況はかなり違う。首相動静によると、7月1日~8月19日の間、安倍首相が終日自宅で過ごした日が6日あり、午前中を自宅で過ごした日も16日あった。特に7月下旬からは帰宅時刻が目立って早くなり、ほぼ毎日のように午後6時台に首相公邸ではなく東京・富ケ谷の自宅に戻っていることが読み取れる。
帰宅後に家で仕事をすることがあったとしても、「午前は自宅、午後は散髪」(8月2日)や「午前は自宅、午後はジム」(10日)という日もある。

麻生太郎の言うことは失言か大法螺である。現在の安倍晋三の体調は6月20日以降、ゆっくり静養したが、体調不良を改善出来ないという総理不適格な具合である。
麻生太郎・甘利明・菅義久・萩生田光一・稲田朋美等は「休むのも総理の仕事だ」との洗脳で、国家の感染症対策の無為無策を引き延ばしているに過ぎない。

便宜上、6月以降の感染拡大を第二波と呼ぶ。第二波の感染者、当初は夜の街に遊んだ20代30代が中心であった。次第に家庭内感染が増加し、50代以上の感染者が増加する。60代以上が感染し始めると途端に重症者数が増加し、死亡者数も増加している。第一波と第二波との、70歳以上の高齢者死亡率は共に84・6%である。

ウィルスは弱毒化などしていない。重症者数・死亡者数が少なく抑えられたのは医療現場の献身的・犠牲的な努力の賜物である。高齢者・持病を持つ患者が新型コロナ感染すると、死亡する確率は第一波と変わらない。

ホリエモンは起業家・小林よしのりは漫画家・ウーマン村本はお笑い。全世界で2000万人以上が感染する疫病を「只の風邪」呼ばわりすれば、目立つ売名には打って付けである。

京都大学教授の藤井聡・宮沢孝幸。京都大学大学院医学研究科・上久保靖彦特定教授は「日本は既に集団免疫を達成している。ソーシャルディスタンス・三密回避は必要ない。3月の武漢のG型の前に、12月にS型が世界に拡散している、1月にS型の変異形で弱毒性のK型が日本に上陸している。日本人はS型・K型に感染し免疫を獲得している。」と主張する。
第一波で1000人以上の日本人が亡くなっている。集団免疫は何故、発動しなかったのか。第二波の死亡者数が集団免疫で、何処まで抑え込められるのか。医学的に説明して貰いたい。

京都大学の教授は新型コロナ楽観論を述べれば、研究費を貰える仕組みが有るのか。カネで大学教授の矜持を売り払っているのか。

元厚労省医系技官・木村もりよのヒステリックアニマルエコノミーは何なのか。医学の説明をせずに「経済を回せ」の一点張りである。更年期障害の鬼婆のヒステリーをテレビで視ると疲れる。

新型コロナ楽観論者は全員駄目である。マスメディアが政府の感染症対策の無為無策を徹底批判すべき局面である。

安倍晋三の夏休みが、アメリカ富裕層の新型コロナ対策と重なる。総理が引き籠った状態で、医療現場・高齢者介護施設・保育園・スーパー店員・ゴミ収集・ウーバーイーツ配達・アマゾン配達の労働者が不当に感染危機に晒されている。
安倍晋三は必要不可欠の職業従事者の為にも感染症対策に取り組まねばならない。
安倍晋三と必要不可欠の労働従事者との待遇差別が厳然と存在する。

これが美しい国日本か。

新型コロナウイルスの細胞への入り口であるACE2は当初、のどや鼻、肺の奥と言われてきた。
ところが、その後の研究の結果、ACE2は全身の血管の内側の血管内皮にも存在することがわかり、新型コロナウイルス感染症患者の多くは全身の血管にダメージを受けることがわかっている。

例えば、川崎病に似た症例が世界各地の新型コロナウイルス感染症患者から報告されている。
川崎病は全身性の血管炎症候群で、発熱、両側眼球結膜の充血、いちご舌などの口唇・口腔所見、発疹、手足の硬性浮腫などの四肢末端の変化、非化膿性頸部リンパ節腫脹の6つが主要症状とされ、5症状以上を呈する場合に川崎病と診断される。その原因は明らかでないが、細菌あるいはウイルス感染、スーパー抗原、自己抗原などが原因として考えられている。

日本川崎病学会は5月7日の段階で日本に新型コロナウイルス感染症に関連する川崎病の症例報告はないとしているが、それは日本でのPCR検査件数が極端に少ないためかもしれない。

川崎病になると、冠動脈などの血管炎や冠動脈瘤が生じることがあるが、 細い血管の炎症が原因とみられる皮膚症状が、特に若い新型コロナ患者で出現するとの報告が寄せられている。

新型コロナウイルスが体内に侵入すると、その防御反応として免疫組織が働き、炎症が生じる。その炎症で内皮細胞が傷つき、サイトカインで血管内部が活性化されると、血小板は凝集を起こしやすくなる。血管壁にもくっつきやすくなり、血栓が容易にできる環境となる。冠動脈などの小さな血管が感染すれば川崎病のような血管炎が起き、冠動脈瘤や心筋梗塞が生じる可能性がある。

新型コロナウイルスは全身に炎症と血栓症を起こす可能性がある。心筋梗塞以外にもエコノミークラス症候群(肺血栓塞栓症)、脳梗塞について大人も注意する必要がある。
実際、新型コロナウイルス感染者では、免疫力があることで却って免疫の暴走が起きやすい、若い人に脳梗塞が生じることが米国ニューヨークなどから報告されている。

国際的には、急性期脳卒中(主に脳梗塞)発症率は中国武漢からの報告に基づいて4・9%(95%信頼区間 2・8~8・7%)と推測されている。
一般に呼吸器疾患に罹った初期の3日間に脳卒中発症リスクが3・2~7.8倍増えると報告されている。

問題は、新型コロナウイルス感染症で川崎病類似症やエコノミークラス症候群、脳梗塞や心筋梗塞の症状があらわれた人やその予備軍の人たちにどのような後遺症があらわれるかである。

川崎病に似た症状の発熱や発疹などが数週以内に軽快したとしても、冠動脈や心筋の炎症による冠動脈瘤や心機能低下が生じる可能性は残る。冠動脈瘤の先は血栓や炎症で狭くなっていることがあり、運動すると苦しくなる狭心症状が出ることもある。

エコノミークラス症候群(静脈血栓塞栓症)では、肺の梗塞により肺機能が落ちるだけでなく、肺動脈血流も減る。重症の後遺症として、低酸素症によるふらつき、息切れ、呼吸困難が起こる。最新の治療によりかなりの血栓は溶かされるので、肺梗塞、肺高血圧症や心不全が残らなければ、日常生活を取り戻せることが多い。しかし今までの報告をまとめると、感染者の3~5割の人に何らかの呼吸器障害が残っているので、正確な早期診断と慎重な経過観察が必要だ。

血栓後症候群では、静脈高血圧のため下肢の浮腫だけでなく皮膚表在静脈に静脈瘤が出来たり、色素が沈着、皮膚炎や湿疹を起こしやすくなったり、難治性潰瘍が出来たりすることもある。造影CT検査などによる肺炎と肺血栓塞栓症の正確な診断と慎重な経過観察が必要であろう。2カ月以内に回復しない場合、後遺症は長期間残る可能性が高いので、適切な治療をしなければならない。

脳梗塞で運動神経麻痺や認知機能障害などの後遺症が残れば、リハビリで治療するしかないが、再発リスクはほとんどない。しかし、3割程度の人に何らかの脳神経症状が残存していると推測されているので、このウイルスによる慢性の脳炎や神経炎なども加味した経過観察をしなければならない。

急性心筋梗塞の後遺症は虚血、心機能低下や不整脈であり、動いたときに動悸息切れや胸痛などを感じる。動脈硬化性のものと異なり、責任冠動脈以外の血管が狭くなって虚血や再梗塞が起こることはない。適切な内服治療で心不全予防を行えば、普通の心筋梗塞より予後は良いと考えられる。

ただ、心筋炎が慢性化して持続する可能性は残されており、ごく最近のドイツの報告では感染回復者の6割に心筋炎がみられたとのことである。このような場合は、心電図や心臓超音波検査だけでなく、炎症マーカー、トロポニンやBNP等の血液検査で心筋炎の経過を定期的にチェックする必要があろう。日刊ゲンダイ。

発熱・頭痛・倦怠感・ふらつき・心機能低下・呼吸不全・息苦しさ・胸痛。新型コロナと同じ症状が、後遺症として患者に発症する理由が、この研究で説明される。
冠動脈瘤・心筋梗塞・虚血・心機能低下・不整脈・狭心症・心不全・脳梗塞・運動神経麻痺・認知機能低下・脳卒中・肺梗塞・低酸素症・肺高血圧症・肺血栓梗栓症・難治性潰瘍。後遺症をこそ、正しく恐れるべきである。

只の風邪が真夏に大流行するか。只の風邪が斯様に深刻な後遺症を発症させるか。
「只の風邪に怯えず経済を回せ」論者は後遺症を発症した患者に、どう責任を取れるのか。猛省して貰いたい。

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