Monitoramento das Produções

by Alexandre K. Ligo, Emerson Mahoney, Jeffrey Cegan, Benjamin D. Trump, Andrew S. Jin, Maksim Kitsak, Jesse Keenan, Igor Linkov

State governments in the U.S. have been facing difficult decisions involving tradeoffs between economic and health-related outcomes during the COVID-19 pandemic. Despite evidence of the effectiveness of government-mandated restrictions mitigating the spread of contagion, these orders are stigmatized due to undesirable economic consequences. This tradeoff resulted in state governments employing mandates at widely different ways. We compare the different policies states implemented during periods of restriction (“lockdown”) and reopening with indicators of COVID-19 spread and consumer card spending at each state during the first “wave” of the pandemic in the U.S. between March and August 2020. We find that while some states enacted reopening decisions when the incidence rate of COVID-19 was minimal or sustained in its relative decline, other states relaxed socioeconomic restrictions near their highest incidence and prevalence rates experienced so far. Nevertheless, all states experienced similar trends in consumer card spending recovery, which was strongly correlated with reopening policies following the lockdowns and relatively independent from COVID-19 incidence rates at the time. Our findings suggest that consumer card spending patterns can be attributed to government mandates rather than COVID-19 incidence in the states. We estimate the recovery in states that reopened in late April was more than the recovery in states that did not reopen in the same period– 15% for consumer card spending and 18% for spending by high income households. This result highlights the important role of state policies in minimizing health impacts while promoting economic recovery and helps planning effective interventions in subsequent waves and immunization efforts.

by Andrei C. Rusu, Rémi Emonet, Katayoun Farrahi

Comprehensive testing schemes, followed by adequate contact tracing and isolation, represent the best public health interventions we can employ to reduce the impact of an ongoing epidemic when no or limited vaccine supplies are available and the implications of a full lockdown are to be avoided. However, the process of tracing can prove feckless for highly-contagious viruses such as SARS-CoV-2. The interview-based approaches often miss contacts and involve significant delays, while digital solutions can suffer from insufficient adoption rates or inadequate usage patterns. Here we present a novel way of modelling different contact tracing strategies, using a generalized multi-site mean-field model, which can naturally assess the impact of manual and digital approaches alike. Our methodology can readily be applied to any compartmental formulation, thus enabling the study of more complex pathogen dynamics. We use this technique to simulate a newly-defined epidemiological model, SEIR-T, and show that, given the right conditions, tracing in a COVID-19 epidemic can be effective even when digital uptakes are sub-optimal or interviewers miss a fair proportion of the contacts.

Title: Covid-19 pandemic, R&D, vaccines, and the urgent need of UBUNTU practice
Authors: Homma, Akira; Carvalho, Antônio Carlos Campos de; Fialho, Beatriz de Castro; Gadelha, Carlos Augusto Grabois; Toscano, Cristiana Maria; Krieger, Marco Aurélio; Siqueira, Marilda M.; Goldbaum, Moisés; LIma, Nísia Verônica Trindade; Savino, Wilson

Title: Three-year Efficacy and Safety of Takeda’s Dengue Vaccine Candidate (TAK-003)
Authors: Rivera, Luis; Biswal, Shibadas; Llorens, Xavier Sáez; Reynales, Humberto; Medina, Eduardo López; Tabora, Charissa Borja; Bravo, Lulu; Sirivichayakul, Chukiat; Kosalaraksa, Pope; Vargas, Luis Martinez; Yu, Delia; Watanaveeradej, Veerachai; Espinoza, Felix; Dietze, Reynaldo; Fernando, LakKumar; Wickramasinghe, Pujitha; Moreira Junior, Edson Duarte; Fernando, Asvini D.; Gunasekera, Dulanie; Luz, Kleber; Cunha, Rivaldo Venâncio da; Rauscher, Martina; Zent, Olaf; Liu, Mengya; Hoffman, Elaine; LeFevre, Inge; Tricou, Vianney; Wallace, Derek; Alera, Maria Theresa; Borkowski, Astrid; TIDES study group
Description: 1Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic; 2Takeda Vaccines, Inc., Boston, Massachusetts, USA; 3Hospital del Niño Dr. José Renán Esquivel, Sistema
Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama; 4Centro de Atención e Investigación Médica, CAIMED, Bogotá, Colombia; 5Centro
de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia; 6Research Institute For Tropical Medicine, Muntinlupa, Philippines; 7University of the
Philippines Manila, Ermita, Philippines; 8Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 9Faculty of Medicine, Khon Kaen University, Khon
Kaen, Thailand; 10CAIMED, Dominicana, Santo Domingo, Dominican Republic; 11De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines; 12Phramongkutklao Hospital, Bangkok,
Thailand; 13National Autonomous University of Nicaragua, León, Nicaragua; 14Núcleo de Doenças Infecciosas, Centro de Ciencias da Saude-UFES, Vitória, Brazil; 15Centre for Clinical Management
of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka; 16University of Colombo, Colombo, Sri Lanka; 17Associação Obras Sociais Irmã Dulce Hospital Santo
Antônio and Oswaldo Cruz Foundation, Bahia, Brazil; 18Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka; 19Faculty of Medical Sciences, University of Sri Jayawardenenpura,
Colombo, Sri Lanka; 20Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Natal, Brazil; 21Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil; 22Takeda
Pharmaceuticals International AG, Zurich, Switzerland; and 23Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines

by Luís Carlos Lopes-Júnior, Priscila Carminati Siqueira, Ethel Leonor Noia Maciel
Background One of the most recent concerns of this pandemic regards the role of schools reopening in disease transmission, as well as the impact of keeping schools closed. While school reopening seems critical for the education and mental health of children, adolescents, and adults, so far the literature has not systematically reached a consensus whether to recommend the return to schools in a way that would be safe for students and staff. Objective To synthesize and critically evaluate the scientific evidence on the potential risk of accelerating the Coronavirus Disease 2019 (COVID-19) pandemic among children, adolescents, young adults, and adults with school reopening. Methods This systematic review and meta-analysis protocol was elaborated following the PRISMA-P. We will include all observational study designs, which report on the potential risk of accelerating the COVID-2019 pandemic with school reopening. Electronic databases included were MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, SCOPUS and CNKI. Additional sources will be also retrieved, including Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Public Health Gray Literature Sources and Health Evidence, Google Scholar, and pre-prints [medRXiv]. No restriction to language or date will be used as search strategy. In an independently manner, two investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected observational studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Cochrane methods and in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Expected results This systematic review and meta-analysis will provide better insights into safety in the return to school in the context of the COVID-2019 pandemic, at a time when vaccination advances unevenly in several countries around the world. Hence, consistent data and robust evidence will be provided to help decision-makers and stakeholders in the current pandemic scenario. PROSPERO registration number CRD42021265283; https://clinicaltrials.gov.

by Md Rafiul Islam, Tamer Oraby, Audrey McCombs, Mohammad Mihrab Chowdhury, Mohammad Al-Mamun, Michael G. Tyshenko, Claus Kadelka
Background Anticipating an initial shortage of vaccines for COVID-19, the Centers for Disease Control (CDC) in the United States developed priority vaccine allocations for specific demographic groups in the population. This study evaluates the performance of the CDC vaccine allocation strategy with respect to multiple potentially competing vaccination goals (minimizing mortality, cases, infections, and years of life lost (YLL)), under the same framework as the CDC allocation: four priority vaccination groups and population demographics stratified by age, comorbidities, occupation and living condition (congested or non-congested). Methods and findings We developed a compartmental disease model that incorporates key elements of the current pandemic including age-varying susceptibility to infection, age-varying clinical fraction, an active case-count dependent social distancing level, and time-varying infectivity (accounting for the emergence of more infectious virus strains). The CDC allocation strategy is compared to all other possibly optimal allocations that stagger vaccine roll-out in up to four phases (17.5 million strategies). The CDC allocation strategy performed well in all vaccination goals but never optimally. Under the developed model, the CDC allocation deviated from the optimal allocations by small amounts, with 0.19% more deaths, 4.0% more cases, 4.07% more infections, and 0.97% higher YLL, than the respective optimal strategies. The CDC decision to not prioritize the vaccination of individuals under the age of 16 was optimal, as was the prioritization of health-care workers and other essential workers over non-essential workers. Finally, a higher prioritization of individuals with comorbidities in all age groups improved outcomes compared to the CDC allocation. Conclusion The developed approach can be used to inform the design of future vaccine allocation strategies in the United States, or adapted for use by other countries seeking to optimize the effectiveness of their vaccine allocation strategies.

by Mario Lucchini, Tiziano Gerosa, Marta Pancheva, Maurizio Pisati, Chiara Respi, Egidio Riva

This study used a subsample of a household panel study in Italy to track changes in mental health before the onset of COVID-19 and into the first lockdown period, from late April to early September 2020. The results of the random-effects regression analyses fitted on a sample of respondents aged 16 years and older (N = 897) proved that there was a substantial and statistically significant short-term deterioration in mental health (from 78,5 to 67,9; β = -10.5, p .001; Cohen’s d -.445), as measured by a composite index derived from the mental component of the 12-item Short-Form Health Survey (SF-12). The findings also showed heterogeneity in the COVID-related effects. On the one hand, evidence has emerged that the pandemic acted as a great leveller of pre-existing differences in mental health across people of different ages: the decrease was most pronounced among those aged 16–34 (from 84,2 to 66,5; β = -17.7, p .001; Cohen’s d -.744); however, the magnitude of change reduced as age increased and turned to be non-significant among individuals aged 70 and over. On the other hand, the COVID-19 emergency widened the mental health gender gap and created new inequalities, based on the age of the youngest child being taken care of within the household.

by Karen G. Chartier, Jeanine P. D. Guidry, Catherine A. Lee, Thomas D. Buckley
Introduction The current study aimed to understand the links between social media use and alcohol consumption during the early months of the COVID-19 pandemic. Method Data were from the national Understanding American Study, a probability-based Internet panel weighted to represent the U.S. population. Subjects (N = 5874; 51% female) were adults, 18 years and older, who completed a March survey (wave 1) and a follow-up survey one month later (wave 3). Analyses assessed the relationships of social media use at wave 1 with wave 3 alcohol use frequency, accounting for wave 1 alcohol use frequency and the sociodemographic characteristics of the sample. Two alcohol use change variables were also assessed as outcomes–increased and decreased alcohol use between waves. We considered the effect of work status changes (working/studying from home and job loss) as potential moderators. Results Twitter and Instagram users and users of multiple social media platforms, but not Facebook users, drank more frequently at wave 3. The results were similar when assessing relationships between social media use and increased alcohol use between waves. For Instagram users, more frequent alcohol use at wave 3 was at least partially attributed to drinking frequency at wave 1. Additionally, working/studying from home at wave 3 and employment (rather than job loss) were associated with greater consumption. The interaction effect between Twitter use and working/studying from home was statistically significant in association with alcohol use frequency at wave 3, as was the interaction effect between using multiple platforms and working/studying from home in association with decreased alcohol use between waves. Discussion Exposure to content about COVID-19 and increased alcohol consumption during the pandemic may have contributed to more frequent alcohol use for some social media users. The study of public health messaging via social media to change alcohol use behaviors during traumatic events is warranted.

by Bedilu Alamirie Ejigu, Manalebish Debalike Asfaw, Lisa Cavalerie, Tilahun Abebaw, Mark Nanyingi, Matthew Baylis

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020 and by November 14, 2020 there were 53.3M confirmed cases and 1.3M reported deaths in the world. In the same period, Ethiopia reported 102K cases and 1.5K deaths. Effective public health preparedness and response to COVID-19 requires timely projections of the time and size of the peak of the outbreak. Currently, Ethiopia under the COVAX facility has begun vaccinating high risk populations but due to vaccine supply shortages and the absence of an effective treatment, the implementation of NPIs (non-pharmaceutical interventions), like hand washing, wearing face coverings or social distancing, still remain the most effective methods of controlling the pandemic as recommended by WHO. This study proposes a modified Susceptible Exposed Infected and Recovered (SEIR) model to predict the number of COVID-19 cases at different stages of the disease under the implementation of NPIs at different adherence levels in both urban and rural settings of Ethiopia. To estimate the number of cases and their peak time, 30 different scenarios were simulated. The results indicated that the peak time of the pandemic is different in urban and rural populations of Ethiopia. In the urban population, under moderate implementation of three NPIs the pandemic will be expected to reach its peak in December, 2020 with 147,972 cases, of which 18,100 are symptomatic and 957 will require admission to an Intensive Care Unit (ICU). Among the implemented NPIs, increasing the coverage of wearing masks by 10% could reduce the number of new cases on average by one-fifth in urban-populations. Varying the coverage of wearing masks in rural populations minimally reduces the number of cases. In conclusion, the models indicate that the projected number of hospital cases during the peak time is higher than the Ethiopian health system capacity. To contain symptomatic and ICU cases within the health system capacity, the government should pay attention to the strict implementation of the existing NPIs or impose additional public health measures.

by Xiaoyuan Li, Alexander S. English, Steve J. Kulich

As the early COVID-19 outbreak sparked xenophobia against people of Asian and Chinese background, we collected data from Chinese migrants worldwide to test how discrimination at a macro-level was perceived by the Chinese during COVID-19 globally. Specifically, we examined (1) whether/how the Chinese migrants were aware of discrimination against their co-nationals during COVID; (2) if so, whether anger was a predominant reaction of these Chinese towards certain exposure to relevant information; (3) how responses of anger transcend across the group of Chinese migrants. Integrating the ecological approach to media and cultural psychology, as well as the intergroup perspective of social psychology, we conducted a study that explored the impact of traditional media exposure to discrimination on collective anger—a process mediated by national identity among the Chinese migrants. Findings provide some evidence that geographically dispersed mono-cultural groups may share or identify with collective emotions when facing xenophobic threats in a macro context. Further examination of cultural distance (between China and the host country) among the Chinese migrants also revealed a particular interaction between host newspaper coverage and cultural distance on national identity. These findings suggest further research to examine the emotional norms of similar cultures bonded via strong collective identities in times of intergroup threat and the theoretical possibility for diasporic identity processes.

Title: Larvicidal activity, route of interaction and ultrastructural changes in Aedes aegypti exposed to entomopathogenic fungi
Authors: Bitencourt, Ricardo de Oliveira Barbosa; Mallet, Jacenir Reis dos Santos; Mesquita, Emily; Gôlo, Patrícia Silva; Fiorotti, Jéssica; Bittencourt, Vânia Rita Elias Pinheiro; Pontes, Emerson Guedes; Angelo, Isabele da Costa

by Fabiano Elisei Serra, Rossana Pulcineli Vieira Francisco, Patricia de Rossi, Maria de Lourdes Brizot, Agatha Sacramento Rodrigues
Objective To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. Methods A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. Results As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p

by Rachel L. Snyder, Laura E. Anderson, Katelyn A. White, Stephanie Tavitian, Lucy V. Fike, Heather N. Jones, Kara M. Jacobs-Slifka, Nimalie D. Stone, Ronda L. Sinkowitz-Cochran
Background A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. Methods Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. Results Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. Conclusions Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

by Zoe Bradfield, Karen Wynter, Yvonne Hauck, Linda Sweet, Alyce N. Wilson, Rebecca A. Szabo, Vidanka Vasilevski, Lesley Kuliukas, Caroline S. E. Homer
Introduction Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. Methods A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). Findings Personal intention to be vaccinated ranged from 48–89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p

Title: Acute-Phase Levels of CXCL8 as Risk Factor for Chronic Arthralgia Following Chikungunya Virus Infection
Authors: Nascimento, Leile Camila Jacob; Carvalho, Caroline Xavier; Silva, Monaıse Madalena Oliveira; Kikuti, Mariana Araújo; Anjos, Rosângela Oliveira; Fradico, Jordana Rodrigues Barbosa; Azevedo, Ana Carolina Campi; Tauro, Laura Beatriz; Campos, Gúbio Soares; Moreira, Patricia Sousa dos Santos; Portilho, Moyra Machado; Martins Filho, Olindo Assis; Ribeiro, Guilherme de Sousa; Reis, Mitermayer Galvão dos
Description: 1 Instituto Gonc¸alo Moniz, Fundac¸ão Oswaldo Cruz, Salvador, Brazil, 2 Instituto Oswaldo Cruz, Fundac¸ão Oswaldo Cruz,
Rio de Janeiro, Brazil, 3 Instituto de Sau´ de Coletiva, Universidade Federal da Bahia, Salvador, Brazil, 4 Instituto Rene´ Rachou,
Fundac¸ão Oswaldo Cruz, Belo Horizonte, Brazil, 5 Instituto de Biologia Subtropical, Consejo Nacional de Investigaciones
Científicas y Tecnicas - Universidad Nacional de Misiones, Puerto Iguazu´ , Argentina, 6 Instituto de Cieˆ ncias da Sau´ de,
Universidade Federal da Bahia, Salvador, Brazil, 7 Faculdade de Medicina da Bahia, Universidade Federal da Bahia,
Salvador, Brazil, 8 Yale School of Public Health, Yale University, New Haven, CT, United States

by Lauren M. Borges, Ryan Holliday, Sean M. Barnes, Nazanin H. Bahraini, Adam Kinney, Jeri E. Forster, Lisa A. Brenner

Medical leaders have warned of the potential public health burden of a “parallel pandemic” faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 –March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., “I acted in ways that violated my own moral code or values”), but not perceived betrayal (e.g., “I feel betrayed by leaders who I once trusted”), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.

by Jun Sugihara, Sho Shibata, Masafumi Doi, Takuya Shimmura, Shinichiro Inoue, Osamu Matsumoto, Hiroyuki Suzuki, Ayaka Makino, Yasunari Miyazaki
Background Clinical observations have shown that there is a relationship between coronavirus disease 2019 (COVID-19) and atypical lymphocytes in the peripheral blood; however, knowledge about the time course of the changes in atypical lymphocytes and the association with the clinical course of COVID-19 is limited. Objective Our purposes were to investigate the dynamics of atypical lymphocytes in COVID-19 patients and to estimate their clinical significance for diagnosis and monitoring disease course. Materials and methods We retrospectively identified 98 inpatients in a general ward at Kashiwa Municipal Hospital from May 1st, 2020, to October 31st, 2020. We extracted data on patient demographics, symptoms, comorbidities, blood test results, radiographic findings, treatment after admission and clinical course. We compared clinical findings between patients with and without atypical lymphocytes, investigated the behavior of atypical lymphocytes throughout the clinical course of COVID-19, and determined the relationships among the development of pneumonia, the use of supplemental oxygen and the presence of atypical lymphocytes. Results Patients with atypical lymphocytes had a significantly higher prevalence of pneumonia (80.4% vs. 42.6%, p 0.0001) and the use of supplemental oxygen (25.5% vs. 4.3%, p = 0.0042). The median time to the appearance of atypical lymphocytes after disease onset was eight days, and atypical lymphocytes were observed in 16/98 (16.3%) patients at the first visit. Atypical lymphocytes appeared after the confirmation of lung infiltrates in 31/41 (75.6%) patients. Of the 13 oxygen-treated patients with atypical lymphocytes, approximately two-thirds had a stable or improved clinical course after the appearance of atypical lymphocytes. Conclusion Atypical lymphocytes frequently appeared in the peripheral blood of COVID-19 patients one week after disease onset. Patients with atypical lymphocytes were more likely to have pneumonia and to need supplemental oxygen; however, two-thirds of them showed clinical improvement after the appearance of atypical lymphocytes.

by Antonio Gimeno-Miguel, Kevin Bliek-Bueno, Beatriz Poblador-Plou, Jonás Carmona-Pírez, Antonio Poncel-Falcó, Francisca González-Rubio, Ignatios Ioakeim-Skoufa, Victoria Pico-Soler, Mercedes Aza-Pascual-Salcedo, Alexandra Prados-Torres, Luis Andrés Gimeno-Feliu, on behalf of the PRECOVID Group
Background Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). Methods Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. Results 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. Conclusions Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.

by Nazeem Muhajarine, Daniel A. Adeyinka, Jessica McCutcheon, Kathryn L. Green, Miles Fahlman, Natalie Kallio
Background A high population level of vaccination is required to control the COVID-19 pandemic, but not all Canadians are convinced of the value and safety of vaccination. Understanding more about these individuals can aid in developing strategies to increase their acceptance of a COVID-19 vaccine. The objectives of this study were to describe COVID-19 vaccine acceptance, hesitancy and refusal rates and associated factors in Saskatchewan, Canada. Methods This is a cross-sequential study that consisted of pooled responses from weighted samples of 9,252 Saskatchewan adults (≥18 years) across nine rounds of data collection between May 4, 2020 and April 3, 2021. The outcome variable was vaccine intention: vaccine acceptance, hesitancy, and refusal. The independent variables were layered into socio-demographic factors, risk of exposure to coronavirus, mitigating behaviours, and perceptions of COVID-19. Data were analyzed using multinomial logistic regression and a classification and regression tree. Results Seventy-six percent of the respondents indicated that they had been or were willing to be vaccinated, 13% had not yet decided, and the remaining 11% said they would not be vaccinated. Factors that increased the likelihood of vaccine refusal and hesitancy were lower education level, financial instability, Indigenous status, and not being concerned about spreading the coronavirus. Perceiving COVID-19 to be more of a threat to one’s community and believing that one had a higher risk of illness or death from COVID-19 decreased the likelihood of both vaccine refusal and hesitancy. Women and newcomers to Canada were more likely to be unsure about getting vaccinated. Respondents who did not plan to be vaccinated were less likely to wear face masks and practice physical distancing. Conclusion While many Canadians have voluntarily and eagerly become vaccinated already, reaching sufficient coverage of the population is likely to require targeted efforts to convince those who are resistant or unsure. Identifying and overcoming any barriers to vaccination that exist within the socio-demographic groups we found were least likely to be vaccinated is a crucial component.

Title: Gestão, compartilhamento e abertura de dados para pesquisa: estratégias e ações da Fiocruz (Ciclo plataforma Zika)
Authors: Jorge, Vanessa de Arruda
Abstract: Apresentação realizada na Quarta às quatro LIVE IBICT, no dia 10 de fevereiro de 2021.

Title: A pandemia de Covid-19 e a Educação na Fiocruz: contexto e desafios
Authors: Machado, Cristiani Vieira
Abstract: Apresentação realizada na Câmara Técnica de Educação da Fiocruz. Aborda o contexto da pandemia de Covid-19 e as estratégias da Fiocruz de enfrentamento da pandemia. Destacam-se as estratégias na área de Educação, dirigidas para a formação de profissionais para o SUS e a adaptação das ações educacionais da Fiocruz no contexto da pandemia. Por fim, discutem-se os desafios e perspectivas para as ações educacionais da Fiocruz nesse cenário, considerando a gravidade da crise sanitária e as desigualdades no país.

by Songhua Hu, Weiyu Luo, Aref Darzi, Yixuan Pan, Guangchen Zhao, Yuxuan Liu, Chenfeng Xiong

Racial/ethnic disparities are among the top-selective underlying determinants associated with the disproportional impact of the COVID-19 pandemic on human mobility and health outcomes. This study jointly examined county-level racial/ethnic differences in compliance with stay-at-home orders and COVID-19 health outcomes during 2020, leveraging two-year geo-tracking data of mobile devices across ~4.4 million point-of-interests (POIs) in the contiguous United States. Through a set of structural equation modeling, this study quantified how racial/ethnic differences in following stay-at-home orders could mediate COVID-19 health outcomes, controlling for state effects, socioeconomics, demographics, occupation, and partisanship. Results showed that counties with higher Asian populations decreased most in their travel, both in terms of reducing their overall POIs’ visiting and increasing their staying home percentage. Moreover, counties with higher White populations experienced the lowest infection rate, while counties with higher African American populations presented the highest case-fatality ratio. Additionally, control variables, particularly partisanship, median household income, percentage of elders, and urbanization, significantly accounted for the county differences in human mobility and COVID-19 health outcomes. Mediation analyses further revealed that human mobility only statistically influenced infection rate but not case-fatality ratio, and such mediation effects varied substantially among racial/ethnic compositions. Last, robustness check of racial gradient at census block group level documented consistent associations but greater magnitude. Taken together, these findings suggest that US residents’ responses to COVID-19 are subject to an entrenched and consequential racial/ethnic divide.

by Mofeyisara Oluwatoyin Omobowale, Eniola Adetola Bamgboye, Akinfemi Akinyode, Olugbenga Samuel Falase, Taiwo Olabode Ladipo, Olufunmilayo Salami, Akindele Olupelumi Adebiyi

The COVID-19 pandemic has affected all dimensions of lives and has become a social problem as it continues to spread widely through the continuous interactions of people in public spaces where they earn a living. Curbing the spread of COVID-19 requires restrictions in these public spaces, however, the compliance to these measures depends largely on the understanding and interpretations of COVID 19 by users of these public spaces. This study examined the contextual interpretations of public space users about COVID-19 prevention in Ibadan Metropolis, Oyo State. The study was a rapid ethnographic survey in selected public spaces (markets and commercial motor parks) in Ibadan metropolis. Data were collected through participant observation, key informant interviews (3 females; 3 males) and in-depth interviews (30) with, traders, head porters, clients/buyers and commercial vehicle drivers in these public spaces. Interviews conducted were transcribed, sorted into themes using Atlas-ti 7.5.7 and subjected to interpretive-content analysis. Findings revealed that some respondents felt COVID-19 was brought into Nigeria by rich frequent global voyagers, others felt it was through “uncultured” sexual life or wrath of God. Some also doubted the existence of the disease and many of the respondents perceived COVID-19 as a disease reported by the government or a political propaganda to siphon funds. The users of the public spaces in Ibadan Metropolis have variegated perception about the existence and severity of this rapidly spreading virus and this has grave implications for COVID-19 control in the State. Thus, regular interaction with public space users are essential for control efforts.

Title: Nota rápida de evidência: testes diagnósticos de antígenos com autocoleta de material biológico para diagnóstico de COVID-19
Authors: Ramos, Maíra Catharina; Camargo, Erika Barbosa; Elias, Flávia Tavares Silva
Abstract: Tecnologia: Autotestes de antígenos para COVID-19.
Indicação: Diagnóstico de COVID-19.
Caracterização da tecnologia: Testes diagnósticos de antígenos com
autocoleta de material biológico para diagnóstico de COVID-19.
Contexto e Pergunta: Diversas instituições estão elaborando proposta de plano
de retorno e em reunião entre o Núcleo de Epidemiologia e Vigilância em Saúde
(NEVS) e o Programa de Evidências para Políticas e Tecnologias em Saúde
(PEPTS) surgiu a necessidade de uma nota rápida de evidências sobre a
performance clínica de autotestes para COVID-19.
Busca e análise das evidências científicas: As buscas foram realizadas no dia
20 de outubro de 2021 nas seguintes bases de dados: MEDLINE via PubMed,
Embase, Cochrane Library, Web of Science, Scopus e OVID e na literatura cinza.
Resumo dos resultados dos estudos selecionados: Foram identificados 504
estudos, sendo removidos 10 por serem duplicatas. A seleção por título e resumo
foi realizada por duas pesquisadoras independentes (MCR e EBC), sendo as
divergências resolvidas por uma terceira pesquisadora (FTSE). Dos 494
resumos, foram elegíveis 68 para a leitura completa. Após critérios de inclusão -
autocoletas realizadas em 2021 – foram incluídos quatro estudos para essa
NRE. A partir da avaliação QUADAS 2, identificou-se que os estudos incluídos
apresentam baixo risco de viés.
Os resultados foram subdivididos conforme comparadores utilizados nos
estudos incluídos. Dois estudos avaliaram o uso de autotestes de antígeno (AgRDT) a partir de coleta nasofaríngea comparado ao RT-PCR (Osmanodja et al.
2021 e Willeit et al. 2021) e um avaliou autotestes baseados em amostra de
saliva comparados ao RT-PCR (Homza et al. 2021). Por fim, um estudo avaliou
a acurácia de métodos de autocoleta com amostras de saliva, expectoração de
muco e escarro coletado pela manhã comparados à coleta por profissional de
saúde (Poukka et al. 2021).4
O estudo de Osmanodja et al. (2021) coletou amostras entre 12 de fevereiro a
22 de março de 2021 em Berlim, Alemanha. O objetivo foi avaliar a sensibilidade
e especificidade para um novo teste Ag-RDT com amostra de esfregaço nasal
anterior supervisionada e autocoletada. Foram incluídos 379 pacientes (273
sintomáticos e 106 assintomáticos). Nos 61 participantes sintomáticos com
concentração viral média ou alta (≥1 milhão de cópias de RNA), a sensibilidade
do Ag-RDT foi de 96,7% (59/61 RT-PCR positivos detectados; 95% IC 88,7-
99,6%). Em nove pacientes com baixa concentração viral (

by Rima Styra, Laura Hawryluck, Allison Mc Geer, Michelle Dimas, Jack Sheen, Peter Giacobbe, Neil Dattani, Gianni Lorello, Valeria E. Rac, Troy Francis, Peter E. Wu, Wing-Si Luk, Enoch Ng, Jeya Nadarajah, Kaila Wingrove, Wayne L. Gold
Objective Explore how previous work during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak affects the psychological response of clinical and non-clinical healthcare workers (HCWs) to the current COVID-19 pandemic. Methods A cross-sectional, multi-centered hospital online survey of HCWs in the Greater Toronto Area, Canada. Mental health outcomes of HCWs who worked during the COVID-19 pandemic and the SARS outbreak were assessed using Impact of Events—Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Results Among 3852 participants, moderate/severe scores for symptoms of post- traumatic stress disorder (PTSD) (50.2%), anxiety (24.6%), and depression (31.5%) were observed among HCWs. Work during the 2003 SARS outbreak was reported by 1116 respondents (29.1%), who had lower scores for symptoms of PTSD (P = .002), anxiety (P .001), and depression (P .001) compared to those who had not worked during the SARS outbreak. Multivariable logistic regression analysis showed non-clinical HCWs during this pandemic were at higher risk of anxiety (OR, 1.68; 95% CI, 1.19–2.15, P = .01) and depressive symptoms (OR, 2.03; 95% CI, 1.34–3.07, P .001). HCWs using sedatives (OR, 2.55; 95% CI, 1.61–4.03, P .001), those who cared for only 2–5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06–2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96–1.93, P = .05), were at higher risk of moderate/severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR, 4.68, 95% CI, 3.74–6.30, P .001), anxiety (OR, 3.09, 95% CI, 2.11–4.53, P .001), and depression (OR 5.07, 95% CI, 3.48–7.39, P .001). Conclusion Psychological distress was observed in both clinical and non-clinical HCWs, with no impact from previous SARS work experience. As the pandemic continues, increasing psychological and team support may decrease the mental health impacts.

by Benjamin D. Grant, Caitlin E. Anderson, Luis F. Alonzo, Spencer H. Garing, John R. Williford, Ted A. Baughman, Rafael Rivera, Veronika A. Glukhova, David S. Boyle, Puneet K. Dewan, Bernhard H. Weigl, Kevin P. Nichols

Inexpensive, simple, rapid diagnostics are necessary for efficient detection, treatment, and mitigation of COVID-19. Assays for SARS-CoV2 using reverse transcription polymerase chain reaction (RT-PCR) offer good sensitivity and excellent specificity, but are expensive, slowed by transport to centralized testing laboratories, and often unavailable. Antigen-based assays are inexpensive and can be rapidly mass-produced and deployed at point-of-care, with lateral flow assays (LFAs) being the most common format. While various manufacturers have produced commercially available SARS-Cov2 antigen LFAs, access to validated tests remains difficult or cost prohibitive in low-and middle-income countries. Herein, we present a visually read open-access LFA (OA-LFA) using commercially-available antibodies and materials for the detection of SARS-CoV-2. The LFA yielded a Limit of Detection (LOD) of 4 TCID50/swab of gamma irradiated SARS-CoV-2 virus, meeting the acceptable analytical sensitivity outlined by in World Health Organization target product profile. The open-source architecture presented in this manuscript provides a template for manufacturers around the globe to rapidly design a SARS-CoV2 antigen test.

by Yoshinori Katsumata, Motoaki Sano, Hiroki Okawara, Tomonori Sawada, Daisuke Nakashima, Genki Ichihara, Keiichi Fukuda, Kazuki Sato, Eiji Kobayashi

Particulate generation occurs during exercise-induced exhalation, and research on this topic is scarce. Moreover, infection-control measures are inadequately implemented to avoid particulate generation. A laminar airflow ventilation system (LFVS) was developed to remove respiratory droplets released during treadmill exercise. This study aimed to investigate the relationship between the number of aerosols during training on a treadmill and exercise intensity and to elucidate the effect of the LFVS on aerosol removal during anaerobic exercise. In this single-center observational study, the exercise tests were performed on a treadmill at Running Science Lab in Japan on 20 healthy subjects (age: 29±12 years, men: 80%). The subjects had a broad spectrum of aerobic capacities and fitness levels, including athletes, and had no comorbidities. All of them received no medication. The exercise intensity was increased by 1-km/h increments until the heart rate reached 85% of the expected maximum rate and then maintained for 10 min. The first 10 subjects were analyzed to examine whether exercise increased the concentration of airborne particulates in the exhaled air. For the remaining 10 subjects, the LFVS was activated during constant-load exercise to compare the number of respiratory droplets before and after LFVS use. During exercise, a steady amount of particulates before the lactate threshold (LT) was followed by a significant and gradual increase in respiratory droplets after the LT, particularly during anaerobic exercise. Furthermore, respiratory droplets ≥0.3 μm significantly decreased after using LFVS (2120800±759700 vs. 560 ± 170, p

by Annelot Wismans, Roy Thurik, Rui Baptista, Marcus Dejardin, Frank Janssen, Ingmar Franken

by Michele R. Decker, Shannon N. Wood, Mary Thiongo, Meagan E. Byrne, Bianca Devoto, Rosemary Morgan, Kristin Bevilacqua, Anaise Williams, H. Colleen Stuart, Grace Wamue- Ngare, Lori Heise, Nancy Glass, Philip Anglewicz, Elizabeth Gummerson, Peter Gichangi
Background Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. Methods An existing cohort of youth ages 16–26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. Results COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p

by Sally Fowler-Davis, Katharine Platts, Michael Thelwell, Amie Woodward, Deborah Harrop
Objectives Fatigue syndromes have been widely observed following post-viral infection and are being recognised because of Covid19. Interventions used to treat and manage fatigue have been widely researched and this study aims to synthesise the literature associated with fatigue interventions to investigate the outcomes that may be applicable to ‘long Covid’. Method The study was registered with PROSPERO (CRD42020214209) in October 2020 and five electronic databases were searched. Papers were screened, critically appraised and data extracted from studies that reported outcomes of fatigue interventions for post-viral syndromes. The narrative synthesis includes statistical analysis associated with effectiveness and then identifies the characteristics of the interventions, including identification of transferable learning for the treatment of fatigue in long Covid. An expert panel supported critical appraisal and data synthesis. Results Over 7,000 research papers revealed a diverse range of interventions and fatigue outcome measures. Forty papers were selected for data extraction after final screening. The effectiveness of all interventions was assessed according to mean differences (MD) in measured fatigue severity between each experimental group and a control following the intervention, as well as standardised mean differences as an overall measure of effect size. Analyses identified a range of effects–from most effective MD -39.0 [95% CI -51.8 to -26.2] to least effective MD 42.28 [95% CI 33.23 to 51.34]–across a range of interventions implemented with people suffering varying levels of fatigue severity. Interventions were multimodal with a range of supportive therapeutic methods and varied in intensity and requirements of the participants. Those in western medical systems tended to be based on self- management and education principles (i.e., group cognitive behavioural therapy (CBT). Conclusion Findings suggest that the research is highly focussed on a narrow participant demographic and relatively few methods are effective in managing fatigue symptoms. Selected literature reported complex interventions using self-rating fatigue scales that report effect. Synthesis suggests that long Covid fatigue management may be beneficial when a) physical and psychological support, is delivered in groups where people can plan their functional response to fatigue; and b) where strengthening rather than endurance is used to prevent deconditioning; and c) where fatigue is regarded in the context of an individual’s lifestyle and home-based activities are used.