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Title: Análise clínico-epidemiológica da epidemia de febre amarela no estado do Espírito Santo em 2017
Authors: Alves, Caroline Gava
Abstract: No primeiro semestre de 2017 o Brasil registrou sua maior epidemia de febre amarela (FA), nas últimas décadas, atingindo majoritariamente a região sudeste (Minas Gerais, Espírito Santo, São Paulo e Rio de Janeiro). A FA é causada pelo vírus amarílico, um flavivírus, geralmente transmitido por vetores silvestres (mosquitos Haemagogus e Sabethes). Na ocorrência do ciclo urbano, erradicado no Brasil desde a década de 40, a transmissão se dá pelo mosquito Aedes aegypti. Primatas não humanos são os principais hospedeiros do vírus amarílico, e constituem \201Csentinelas\201D no que tange a vigilância da FA. A maioria dos casos em humanos (40% a 65%) apresentam a forma leve ou assintomática da doença. Entretanto, 30% a 50% dos que apresentam a forma grave evoluem a óbito. Esta tese, apresentada em artigos, investigou os aspectos clínicos e epidemiológicos da epidemia de FA ocorrida em 2017 no estado do Espírito Santo (ES). Um primeiro estudo descritivo iniciado ainda em 2017, caracterizou os casos confirmados, com maior ocorrência em homens de ocupação rural e faixa de idade de 40 a 49 anos. O segundo artigo analisou a ocorrência de clusters espaço-temporais de casos humanos e epizootias, identificando 5 clusters com significância estatística em cada grupo, revelando que em algumas regiões a ocorrência de epizootias e casos em humanos foram simultâneas e que a entrada do vírus no ES se deu por duas regiões distintas, contribuindo para rápida disseminação. O terceiro artigo analisou dados clínicos e laboratoriais em uma coorte de internados com FA, com análise longitudinal que permitiu comparar os parâmetros de evolução entre óbitos e sobreviventes. Identificou a TGO, INR e BD como marcadores de maior predição para óbito por FA. Também identificou importante comprometimento renal desde o início da infecção entre os pacientes que evoluíram a óbito, e que não houve diferença no tempo entre o início dos sintomas e a internação entre quem foi a óbito ou sobreviveu. Em um quarto artigo, essa tese avaliou as ações de controle e prevenção desencadeadas no curso da epidemia no ES, nas diferentes vertentes da vigilância da FA (epidemiologia, imunização, epizootias, entomologia), assim como a incidência de EAPV de FA, destacando que o estado não era área com recomendação para vacina. Foi possível reconhecer avanços, apontar algumas medidas tardias e lacunas na vigilância que necessitam melhorias. Assim, este estudo permitiu elucidar algumas questões acerca da dinâmica da circulação da FA, evolução clínica da doença, e consolidar a vigilância da FA no ES.

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by Kuldeep Sharma, Pragya Agarwala, Deepa Gandhi, Anuniti Mathias, Priyanka Singh, Somya Sharma, Sanjay Singh Negi, Anudita Bhargava, Padma Das, Ujjwala Gaikwad, Archana Wankhede, Ajoy Behra, Nitin M. Nagarkar

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by Nattavudh Powdthavee, Yohanes E. Riyanto, Erwin C. L. Wong, Jonathan X. W. Yeo, Qi Yu Chan

With the COVID-19 pandemic still raging and the vaccination program still rolling out, there continues to be an immediate need for public health officials to better understand the mechanisms behind the deep and perpetual divide over face masks in America. Using a random sample of Americans (N = 615), following a pre-registered experimental design and analysis plan, we first demonstrated that mask wearers were not innately more cooperative as individuals than non-mask wearers in the Prisoners’ Dilemma (PD) game when information about their own and the other person’s mask usage was not salient. However, we found strong evidence of in-group favouritism among both mask and non-mask wearers when information about the other partner’s mask usage was known. Non-mask wearers were 23 percentage points less likely to cooperate than mask wearers when facing a mask-wearing partner, and 26 percentage points more likely to cooperate than mask wearers when facing a non-mask-wearing partner. Our analysis suggests social identity effects as the primary reason behind people’s decision whether to wear face masks during the pandemic.

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by Fuyu Xu, Kate Beard

The outbreak of the COVID-19 disease was first reported in Wuhan, China, in December 2019. Cases in the United States began appearing in late January. On March 11, the World Health Organization (WHO) declared a pandemic. By mid-March COVID-19 cases were spreading across the US with several hotspots appearing by April. Health officials point to the importance of surveillance of COVID-19 to better inform decision makers at various levels and efficiently manage distribution of human and technical resources to areas of need. The prospective space-time scan statistic has been used to help identify emerging COVID-19 disease clusters, but results from this approach can encounter strategic limitations imposed by constraints of the scanning window. This paper presents a different approach to COVID-19 surveillance based on a spatiotemporal event sequence (STES) similarity. In this STES based approach, adapted for this pandemic context we compute the similarity of evolving daily COVID-19 incidence rates by county and then cluster these sequences to identify counties with similarly trending COVID-19 case loads. We analyze four study periods and compare the sequence similarity-based clusters to prospective space-time scan statistic-based clusters. The sequence similarity-based clusters provide an alternate surveillance perspective by identifying locations that may not be spatially proximate but share a similar disease progression pattern. Results of the two approaches taken together can aid in tracking the progression of the pandemic to aid local or regional public health responses and policy actions taken to control or moderate the disease spread.

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by Areej A. Malhani, Mushira A. Enani, Fatemeh Saheb Sharif-Askari, Mona R. Alghareeb, Roaa T. Bin-Brikan, Safar A. AlShahrani, Rabih Halwani, Imad M. Tleyjeh
Objectives Our study aims at comparing the efficacy and safety of IFN-based therapy (lopinavir/ritonavir, ribavirin, and interferon β-1b) vs. favipiravir (FPV) in a cohort of hospitalized patients with non-critical COVID-19. Methods Single center observational study comparing IFN-based therapy (interferon β-1b, ribavirin, and lopinavir/ritonavir) vs. FPV in non-critical hospitalized COVID-19 patients. Allocation to either treatment group was non-random but based on changes to national treatment protocols rather than physicians’ selection (quasi-experimental). We examined the association between IFN-based therapy and 28-day mortality using Cox regression model with treatment as a time-dependent covariate. Results The study cohort included 222 patients, of whom 68 (28%) received IFN-based therapy. Antiviral therapy was started at a median of 5 days (3–6 days) from symptoms onset in the IFN group vs. 6 days (4–7 days) for the FPV group, P

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by Sebastian Schmidt, Christoph Benke, Christiane A. Pané-Farré

The spreading of COVID-19 has led to panic buying all over the world. In this study, we applied an animal model framework to elucidate changes in human purchasing behavior under COVID-19 pandemic conditions. Purchasing behavior and potential predictors were assessed in an online questionnaire format (N = 813). Multiple regression analyses were used to evaluate the role of individually Perceived Threat of COVID-19, anxiety related personality traits (trait-anxiety, intolerance of uncertainty) and the role of media exposure in predicting quantity and frequency of purchasing behavior. High levels of Perceived Threat of COVID-19 were associated significantly with a reported reduction in purchasing frequency (b = -.24, p .001) and an increase in the quantity of products bought per purchase (b = .22, p .001). These results are comparable to observed changes in foraging behavior in rodents under threat conditions. Higher levels of intolerance of uncertainty (b = .19, p .001) and high extend of media exposure (b = .27, p .001) were positively associated with Perceived Threat of COVID-19 and an increase in purchasing quantity. This study contributes to our understanding of aberrated human purchasing behavior and aims to link findings from animal research to human behavior beyond experimental investigations.

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by Anis Saib, Walid Amara, Pascal Wang, Simon Cattan, Azeddine Dellal, Kais Regaieg, Stephane Nahon, Olivier Nallet, Lee S. Nguyen
Background Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up. Methods In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses. Results Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation. Conclusions HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.

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by Jude Dzevela Kong, Edward W. Tekwa, Sarah A. Gignoux-Wolfsohn
Objective To assess whether the basic reproduction number (R0) of COVID-19 is different across countries and what national-level demographic, social, and environmental factors other than interventions characterize initial vulnerability to the virus. Methods We fit logistic growth curves to reported daily case numbers, up to the first epidemic peak, for 58 countries for which 16 explanatory covariates are available. This fitting has been shown to robustly estimate R0 from the specified period. We then use a generalized additive model (GAM) to discern both linear and nonlinear effects, and include 5 random effect covariates to account for potential differences in testing and reporting that can bias the estimated R0. Findings We found that the mean R0 is 1.70 (S.D. 0.57), with a range between 1.10 (Ghana) and 3.52 (South Korea). We identified four factors—population between 20–34 years old (youth), population residing in urban agglomerates over 1 million (city), social media use to organize offline action (social media), and GINI income inequality—as having strong relationships with R0, across countries. An intermediate level of youth and GINI inequality are associated with high R0, (n-shape relationships), while high city population and high social media use are associated with high R0. Pollution, temperature, and humidity did not have strong relationships with R0 but were positive. Conclusion Countries have different characteristics that predispose them to greater intrinsic vulnerability to COVID-19. Studies that aim to measure the effectiveness of interventions across locations should account for these baseline differences in social and demographic characteristics.

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by Francisco Purroy, Gloria Arqué
Background COVID-19 may predispose to both venous and arterial thromboembolism event (TEE). Reports on the prevalence and prognosis of thrombotic complications are still emerging. Objective To describe the rate of TEE complications and its influence in the prognosis of hospitalized patients with COVID-19 after a cross-sectional study. Methods We evaluated the prevalence of TEE and its relationship with in-hospital death among hospitalized patients with COVID-19 who were admitted between 1st March to 20th April 2020 in a multicentric network of sixteen Hospitals in Spain. TEE was defined by the occurrence of venous thromboembolism (VTE), acute ischemic stroke (AIS), systemic arterial embolism or myocardial infarction (MI). Results We studied 1737 patients with proven COVID-19 infection of whom 276 died (15.9%). TEE were presented in 64 (3.7%) patients: 49 (76.6%) patients had a VTE, 8 (12.5%) patients had MI, 6 (9.4%%) patients had AIS, and one (1.5%) patient a thrombosis of portal vein. TEE patients exhibited a diffuse profile: older, high levels of D-dimer protein and a tendency of lower levels of prothrombin. The multivariate regression models, confirmed the association between in-hospital death and age (odds ratio [OR] 1.12 [95% CI 1.10–1.14], p

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by Henok Dagne, Asmamaw Atnafu, Kassahun Alemu, Telake Azale, Sewbesew Yitayih, Baye Dagnew, Abiy Maru Alemayehu, Zewudu Andualem, Malede Mequanent Sisay, Demewoz Tadesse, Soliyana Hailu Chekol, Eyerusalem Mengistu Mamo, Wudneh Simegn
Introduction In late 2019, a new coronavirus disease known as COVID-19 (novel coronavirus disease 2019) was identified. As there is no any drug to treat this pandemic, the healthcare professionals are disproportionately at higher risk. The mental health outcome is expected to be high. Anxiety is expected to have a significant impact on health professionals, especially among those who work without adequate resources for self-protection. Objectives The objectives of this research was to assess self-reported anxiety symptoms and associated factors among Ethiopian healthcare professionals in the early stages of the pandemic. Methods We have conducted an online cross-sectional study to collect information from healthcare professionals in Ethiopia during the early stage of the outbreak from April 7, 2020 to May 19, 2020. GAD-7 was used for measurement of anxiety. We have used a cut of point of 10 and above to report anxiety symptoms. We have used Google Forms for online data collection and SPSS-22 for analysis. To determine associated factors for anxiety, a binary logistic regression model was used. Variables with p-value 0.2 during the bivariable binary logistic regression were exported for further analysis in the multivariable binary logistic regression. Finally, variables with p-value

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by Mustafa Abdul Salam, Sanaa Taha, Mohamed Ramadan

The current COVID-19 pandemic threatens human life, health, and productivity. AI plays an essential role in COVID-19 case classification as we can apply machine learning models on COVID-19 case data to predict infectious cases and recovery rates using chest x-ray. Accessing patient’s private data violates patient privacy and traditional machine learning model requires accessing or transferring whole data to train the model. In recent years, there has been increasing interest in federated machine learning, as it provides an effective solution for data privacy, centralized computation, and high computation power. In this paper, we studied the efficacy of federated learning versus traditional learning by developing two machine learning models (a federated learning model and a traditional machine learning model)using Keras and TensorFlow federated, we used a descriptive dataset and chest x-ray (CXR) images from COVID-19 patients. During the model training stage, we tried to identify which factors affect model prediction accuracy and loss like activation function, model optimizer, learning rate, number of rounds, and data Size, we kept recording and plotting the model loss and prediction accuracy per each training round, to identify which factors affect the model performance, and we found that softmax activation function and SGD optimizer give better prediction accuracy and loss, changing the number of rounds and learning rate has slightly effect on model prediction accuracy and prediction loss but increasing the data size did not have any effect on model prediction accuracy and prediction loss. finally, we build a comparison between the proposed models’ loss, accuracy, and performance speed, the results demonstrate that the federated machine learning model has a better prediction accuracy and loss but higher performance time than the traditional machine learning model.

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by Florian Poschenrieder, Stefanie Meiler, Matthias Lubnow, Florian Zeman, Janine Rennert, Gregor Scharf, Jan Schaible, Christian Stroszczynski, Michael Pfeifer, Okka W. Hamer
Background Gas exchange in COVID-19 pneumonia is impaired and vessel obstruction has been suspected to cause ventilation-perfusion mismatch. Dual-energy CT (DECT) can depict pulmonary perfusion by regional assessment of iodine uptake. Objective The purpose of this study was the analysis of pulmonary perfusion using dual-energy CT in a cohort of 27 consecutive patients with severe COVID-19 pneumonia. Method We retrospectively analyzed pulmonary perfusion with DECT in 27 consecutive patients (mean age 57 years, range 21–73; 19 men and 8 women) with severe COVID-19 pneumonia. Iodine uptake (IU) in regions-of-interest placed into normally aerated lung, ground-glass opacifications (GGO) and consolidations was measured using a dedicated postprocessing software. Vessel enlargement (VE) within opacifications and presence of pulmonary embolism (PE) was assessed by subjective analysis. Linear mixed models were used for statistical analyses. Results Compared to normally aerated lung 106/151 (70.2%) opacifications without upstream PE demonstrated an increased IU, 9/151 (6.0%) an equal IU and 36/151 (23.8%) a decreased IU. The estimated mean iodine uptake (EMIU) in opacifications without upstream PE (GGO 1.77 mg/mL; 95%-CI: 1.52–2.02; p = 0.011, consolidations 1.82 mg/mL; 95%-CI: 1.56–2.08, p = 0.006) was significantly higher compared to normal lung (1.22 mg/mL; 95%-CI: 0.95–1.49). In case of upstream PE, EMIU of opacifications (combined GGO and consolidations) was significantly decreased compared to normal lung (0.52 mg/mL; 95%-CI: -0.07–1.12; p = 0.043). The presence of VE in opacifications correlated significantly with iodine uptake (p

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by Pichit Buspavanich, Sonia Lech, Eva Lermer, Mirjam Fischer, Maximilian Berger, Theresa Vilsmaier, Till Kaltofen, Simon Keckstein, Sven Mahner, Joachim Behr, Christian J. Thaler, Falk Batz
Background Preliminary empirical data indicates a substantial impact of the COVID-19 pandemic on well-being and mental health. Individuals with minoritized sexual and gender identities are at a higher risk of experiencing such negative changes in their well-being. The objective of this study was to compare levels of well-being among cis-heterosexual individuals and individuals with minoritized sexual and gender identities during the COVID-19 pandemic. Methods Using data obtained in a cross-sectional online survey between April 20 to July 20, 2020 (N = 2332), we compared levels of well-being (WHO-5) across subgroups (cis-individuals with minoritized sexual identities, individuals with minoritized gender identities and cis-heterosexual individuals) applying univariate (two-sample t-test) and multivariate analysis (multivariate linear regression). Results Results indicate overall lower levels of well-being as well as lower levels of well-being in minoritized sexual or gender identities compared to cis-heterosexual individuals. Further, multivariate analyses revealed that living in urban communities as well as being in a relationship were positively associated with higher levels of well-being. Furthermore, a moderation analysis showed that being in a relationship reduces the difference between groups in terms of well-being. Conclusion Access to mental healthcare for individuals with minoritized sexual and gender identities as well as access to gender-affirming resources should be strengthened during COVID-19 pandemic. Healthcare services with low barriers of access such as telehealth and online peer support groups should be made available, especially for vulnerable groups.

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Title: Sala de convidados: Coronavírus e segurança alimentar
Abstract: Esta edição do Sala de Convidados fala sobre Coronavírus e Segurança Alimentar. Segurança alimentar é um conceito maior do que a maioria das pessoas imaginam. Ele diz respeito ao acesso e à qualidade dos alimentos de forma ampla, portanto, é estratégico para a saúde pública, entre outras áreas. O tema exige especial atenção com o cenário de pandemia de Covid-19, uma vez que as incertezas em torno do setor de alimentos estão em crescente escalada e a insegurança alimentar, já instalada, exige tomada de decisões rápidas. A apresentadora Yasmine Saboya estará no estúdio para conversar por Skype com a nutricionista, pesquisadora titular em Saúde Pública, coordenadora do Programa de Alimentação, Nutrição, Saúde e Cultura do Observatório Brasileiro de Hábitos Alimentares e vice-diretora da Fiocruz Brasília, Denise Oliveira e Silva; o coordenador geral do Serviço de Assessoria a Organizações Populares Rurais (SASOP) e representante da Articulação Nacional de Agroecologia (ANA), Carlos Eduardo Oliveira de Souza Leite; a integrante da Comissão Organizadora da Conferência Popular de Soberania e Segurança Alimentar e Nutricional, Elisabetta Recine; e a subsecretária de Segurança Alimentar e Nutricional da Prefeitura de Belo Horizonte, Darklane Dias.

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by Shimoni Urvish Shah, Evelyn Xiu Ling Loo, Chun En Chua, Guan Sen Kew, Alla Demutska, Sabrina Quek, Scott Wong, Hui Xing Lau, En Xian Sarah Low, Tze Liang Loh, Ooi Shien Lung, Emily C. W. Hung, M. Masudur Rahman, Uday C. Ghoshal, Sunny H. Wong, Cynthia K. Y. Cheung, Ari F. Syam, Niandi Tan, Yinglian Xiao, Jin-Song Liu, Fang Lu, Chien-Lin Chen, Yeong Yeh Lee, Ruter M. Maralit, Yong-Sung Kim, Tadayuki Oshima, Hiroto Miwa, Kewin Tien Ho Siah, Junxiong Pang
Importance Knowledge and attitude influence compliance and individuals’ practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness. Objective This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals. Design Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020. Setting Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail. Participants Participants ≥21 years working in healthcare and non-healthcare related professions. Main outcome Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP. Results HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59–2.85) well-being. Conclusion and relevance While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

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by Eui Jin Hwang, Ki Beom Kim, Jin Young Kim, Jae-Kwang Lim, Ju Gang Nam, Hyewon Choi, Hyungjin Kim, Soon Ho Yoon, Jin Mo Goo, Chang Min Park

Chest X-rays (CXRs) can help triage for Coronavirus disease (COVID-19) patients in resource-constrained environments, and a computer-aided detection system (CAD) that can identify pneumonia on CXR may help the triage of patients in those environment where expert radiologists are not available. However, the performance of existing CAD for identifying COVID-19 and associated pneumonia on CXRs has been scarcely investigated. In this study, CXRs of patients with and without COVID-19 confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) were retrospectively collected from four and one institution, respectively, and a commercialized, regulatory-approved CAD that can identify various abnormalities including pneumonia was used to analyze each CXR. Performance of the CAD was evaluated using area under the receiver operating characteristic curves (AUCs), with reference standards of the RT-PCR results and the presence of findings of pneumonia on chest CTs obtained within 24 hours from the CXR. For comparison, 5 thoracic radiologists and 5 non-radiologist physicians independently interpreted the CXRs. Afterward, they re-interpreted the CXRs with corresponding CAD results. The performance of CAD (AUCs, 0.714 and 0.790 against RT-PCR and chest CT, respectively hereinafter) were similar with those of thoracic radiologists (AUCs, 0.701 and 0.784), and higher than those of non-radiologist physicians (AUCs, 0.584 and 0.650). Non-radiologist physicians showed significantly improved performance when assisted with the CAD (AUCs, 0.584 to 0.664 and 0.650 to 0.738). In addition, inter-reader agreement among physicians was also improved in the CAD-assisted interpretation (Fleiss’ kappa coefficient, 0.209 to 0.322). In conclusion, radiologist-level performance of the CAD in identifying COVID-19 and associated pneumonia on CXR and enhanced performance of non-radiologist physicians with the CAD assistance suggest that the CAD can support physicians in interpreting CXRs and helping image-based triage of COVID-19 patients in resource-constrained environment.

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by Gisele Aparecida Fernandes, Antonio Paulo Nassar Junior, Gulnar Azevedo e Silva, Diego Feriani, Ivan Leonardo Avelino França e Silva, Pedro Caruso, Maria Paula Curado
Background To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Methods Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. Results COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17–1.42) and women (SMR 1.2, 95% CI 1.06–1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67–2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. Conclusion There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.

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by Cristina Bicchieri, Enrique Fatas, Abraham Aldama, Andrés Casas, Ishwari Deshpande, Mariagiulia Lauro, Cristina Parilli, Max Spohn, Paula Pereira, Ruiling Wen

The magnitude and nature of the COVID-19 pandemic prevents public health policies from relying on coercive enforcement. Practicing social distancing, wearing masks and staying at home becomes voluntary and conditional on the behavior of others. We present the results of a large-scale survey experiment in nine countries with representative samples of the population. We find that both empirical expectations (what others do) and normative expectations (what others approve of) play a significant role in compliance, beyond the effect of any other individual or group characteristic. In our vignette experiment, respondents evaluate the likelihood of compliance with social distancing and staying at home of someone similar to them in a hypothetical scenario. When empirical and normative expectations of individuals are high, respondents’ evaluation of the vignette’s character’s compliance likelihood goes up by 55% (relative to the low expectations condition). Similar results are obtained when looking at self-reported compliance among those with high expectations. Our results are moderated by individuals’ trust in government and trust in science. Holding expectations high, the effect of trusting science is substantial and significant in our vignette experiment (22% increase in compliance likelihood), and even larger in self-reported compliance (76% and 127% increase before and after the lockdown). By contrast, trusting the government only generates modest effects. At the aggregate level, the country-level trust in science, and not in government, becomes a strong predictor of compliance.

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by Jad Melki, Hani Tamim, Dima Hadid, Maha Makki, Jana El Amine, Eveline Hitti
Introduction Misinformation surrounding COVID-19 poses a global public health problem that adversely affects governments’ abilities to mitigate the disease and causes accidental deaths and self-harm due to false beliefs about the virus, prevention measures, vaccines and cures. We aim to examine the relationship between exposure to and trust in COVID-19 news (from Television, social media, interpersonal communication) and information sources (healthcare experts, government, clerics) and belief in COVID-19 myths and false information, as well as critical verification practices before posting on social media. Methods We use a cross-sectional researcher-administered phone survey of adults living in Lebanon between March 27 and April 23, 2020. Results The sample included 56.1% men and 43.9% women, 37.9% with a university degree, 63.0% older than 30, and 7% with media literacy training. Those who trust COVID-19 news from social media [95%CI:(1.05–1.52)] and interpersonal communication [95%CI:(1.25–1.82)], and those who trust information from clerics [95%CI:(1.25–1.82)] were more likely to believe in COVID-19 myths and false information. University graduates [95%CI:(0.25–0.51)] and those who trust information from government [95%CI:(0.65–0.89] were less likely to believe in myths and false information. Those who believe in COVID-19 myths and false information [95%CI:(0.25–0.70)] were less likely to engage in critical social media posting practices. Only those who underwent media literacy training [95%CI:(1.24–6.55)] were more likely to engage in critical social media posting practices. Conclusion Higher education and trust in information from government contributed to decreasing belief in COVID-19 myths and false information. Trust in news from social media, interpersonal communication and clerics contributed to increasing belief in COVID-19 myths and false information, which in turn contributed to less critical social media posting practices, thereby exacerbated the infodemic. Media literacy training contributed to increasing critical social media posting practices, thereby played a role in mitigating the infodemic.

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by Yukiko Nakura, Heng Ning Wu, Yuya Okamoto, Muneyuki Takeuchi, Koichiro Suzuki, Yoshitaka Tamura, Yuichiro Oba, Fumiko Nishiumi, Nobuaki Hatori, Shinsuke Fujiwara, Kiyoshi Yasukawa, Shinobu Ida, Itaru Yanagihara

The general methods to detect the RNA of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in clinical diagnostic testing involve reverse transcriptases and thermostable DNA polymerases. In this study, we compared the detection of SARS-CoV-2 by a one-step real-time RT-PCR method using a heat-resistant reverse transcriptase variant MM4 from Moloney murine leukemia virus, two thermostable DNA polymerase variants with reverse transcriptase activity from Thermotoga petrophila K4 and Thermococcus kodakarensis KOD1, or a wild-type DNA polymerase from Thermus thermophilus M1. The highest performance was achieved by combining MM4 with the thermostable DNA polymerase from T. thermophilus M1. These enzymes efficiently amplified specific RNA using uracil-DNA glycosylase (UNG) to remove contamination and human RNase P RNA amplification as an internal control. The standard curve was obtained from 5 to 105 copies of synthetic RNA. The one-step real-time RT-PCR method’s sensitivity and specificity were 99.44% and 100%, respectively (n = 213), compared to those of a commercially available diagnostic kit. Therefore, our method will be useful for the accurate detection and quantification of SARS-CoV-2.

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by Tue W. Kragstrup, Helene Søgaard Singh, Ida Grundberg, Ane Langkilde-Lauesen Nielsen, Felice Rivellese, Arnav Mehta, Marcia B. Goldberg, Michael R. Filbin, Per Qvist, Bo Martin Bibby
Aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to angiotensin converting enzyme 2 (ACE2) enabling entrance of the virus into cells and causing the infection termed coronavirus disease of 2019 (COVID-19). Here, we investigate associations between plasma ACE2 and outcome of COVID-19. Methods and results This analysis used data from a large longitudinal study of 306 COVID-19 positive patients and 78 COVID-19 negative patients (MGH Emergency Department COVID-19 Cohort). Comprehensive clinical data were collected on this cohort, including 28-day outcomes. The samples were run on the Olink® Explore 1536 platform which includes measurement of the ACE2 protein. High admission plasma ACE2 in COVID-19 patients was associated with increased maximal illness severity within 28 days with OR = 1.8, 95%-CI: 1.4–2.3 (P 0.0001). Plasma ACE2 was significantly higher in COVID-19 patients with hypertension compared with patients without hypertension (P = 0.0045). Circulating ACE2 was also significantly higher in COVID-19 patients with pre-existing heart conditions and kidney disease compared with patients without these pre-existing conditions (P = 0.0363 and P = 0.0303, respectively). Conclusion This study suggests that measuring plasma ACE2 is potentially valuable in predicting COVID-19 outcomes. Further, ACE2 could be a link between COVID-19 illness severity and its established risk factors hypertension, pre-existing heart disease and pre-existing kidney disease.

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by Mohamed Hassan Kamel, Hassan Mahmoud, Aileen Zhen, Jing Liu, Catherine G. Bielick, Anahita Mostaghim, Nina Lin, Vipul Chitalia, Titilayo Ilori, Sushrut S. Waikar, Ashish Upadhyay
Introduction End-stage kidney disease (ESKD) patients are at a high risk for Coronavirus Disease 2019 (COVID-19). In this study, we compared characteristics and outcomes of ESKD and non-ESKD patients admitted with COVID-19 to a large safety-net hospital. Methods We evaluated 759 adults (45 with ESKD) hospitalized with COVID-19 in Spring of 2020. We examined clinical characteristics, laboratory measures and clinical outcomes. Logistic regression analyses were performed to investigate the associations between ESKD status and outcomes. Results 73% of ESKD and 47% of non-ESKD patients identified as Black (p = 0.002). ESKD patients were older and had higher rates of comorbidities. Admission ferritin was approximately 6-fold higher in ESKD patients. During hospitalization, the rise in white blood cell count, lactate dehydrogenase, ferritin and C-reactive protein, and the decrease in platelet count and serum albumin were all significantly greater in ESKD patients. The in-hospital mortality was higher for ESKD [18% vs. 10%; multivariable adjusted odds ratio 1.5 (95% CI, 0.48–4.70)], but this did not reach statistical significance. Conclusions Among hospitalized COVID-19 patients, ESKD patients had more co-morbidities and more robust inflammatory response than non-ESKD patients. The odds ratio point estimate for death was higher in ESKD patients, but the difference did not reach statistical significance.

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by James Broughel, Michael Kotrous

This paper estimates the benefits and costs of state suppression policies to “bend the curve” during the initial outbreak of COVID-19 in the United States. We employ an approach that values benefits and costs in terms of additions or subtractions to total production. Relative to a baseline in which only the infected and at-risk populations mitigate the spread of coronavirus, we estimate that total benefits of suppression policies to economic output are between $632.5 billion and $765.0 billion from early March 2020 to August 1, 2020. Relative to private mitigation, output lost due to suppression policies is estimated to be between $214.2 billion and $331.5 billion. The cost estimate is based on the duration of nonessential business closures and stay-at-home orders, which were enforced between 42 and 65 days. Our results indicate that the net benefits of suppression policies to slow the spread of COVID-19 are positive and may be substantial. We discuss uncertainty surrounding several parameters and employ alternative methods for valuing mortality benefits, which also suggest that suppression measures had positive net benefits.

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by Sidhartha Chaudhury, Jack Hutter, Jessica S. Bolton, Shilpa Hakre, Evelyn Mose, Amy Wooten, William O’Connell, Joseph Hudak, Shelly J. Krebs, Janice M. Darden, Jason A. Regules, Clinton K. Murray, Kayvon Modjarrad, Paul Scott, Sheila Peel, Elke S. Bergmann-Leitner

Serological assessment of SARS-CoV-2 specific responses are an essential tool for determining the prevalence of past SARS-CoV-2 infections in the population especially when testing occurs after symptoms have developed and limited contact tracing is in place. The goal of our study was to test a new 10-plex electro-chemiluminescence-based assay to measure IgM and IgG responses to the spike proteins from multiple human coronaviruses including SARS-CoV-2, assess the epitope specificity of the SARS-CoV-2 antibody response against full-length spike protein, receptor-binding domain and N-terminal domain of the spike protein, and the nucleocapsid protein. We carried out the assay on samples collected from three sample groups: subjects diagnosed with COVID-19 from the U.S. Army hospital at Camp Humphreys in Pyeongtaek, South Korea; healthcare administrators from the same hospital but with no reported diagnosis of COVID-19; and pre-pandemic samples. We found that the new CoV-specific multiplex assay was highly sensitive allowing plasma samples to be diluted 1:30,000 with a robust signal. The reactivity of IgG responses to SARS-CoV-2 nucleocapsid protein and IgM responses to SARS-CoV-2 spike protein could distinguish COVID-19 samples from non-COVID-19 and pre-pandemic samples. The data from the three sample groups also revealed a unique pattern of cross-reactivity between SARS-CoV-2 and SARS-CoV-1, MERS-CoV, and seasonal coronaviruses HKU1 and OC43. Our findings show that the CoV-2 IgM response is highly specific while the CoV-2 IgG response is more cross-reactive across a range of human CoVs and also showed that IgM and IgG responses show distinct patterns of epitope specificity. In summary, this multiplex assay was able to distinguish samples by COVID-19 status and characterize distinct trends in terms of cross-reactivity and fine-specificity in antibody responses, underscoring its potential value in diagnostic or serosurveillance efforts.

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by Payal Sen, Uddalak Majumdar, Joe Zein, Umur Hatipoğlu, Amy H. Attaway

Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. It is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD. This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March 8th and September 16th, 2020. Electronic health records were used to determine diagnosis of COPD, ICS use, and clinical outcomes. Multivariate logistic regression was used to adjust for demographics, month of COVID-19 testing, and comorbidities known to be associated with increased risk for severe COVID-19 disease. Amongst the COPD patients who were tested for COVID-19, 44.1% of those taking an ICS-containing inhaler tested positive for COVID-19 versus 47.2% who tested negative for COVID-19 (p = 0.033). Of those who tested positive for COVID-19 (n = 1288), 371 (28.8%) required hospitalization. In-hospital outcomes were not significantly different when comparing ICS versus no ICS in terms of ICU admission (36.8% [74/201] vs 31.2% [53/170], p = 0.30), endotracheal intubation (21.9% [44/201] vs 16.5% [28/170], p = 0.24), or mortality (18.4% [37/201] vs 20.0% [34/170], p = 0.80). Multivariate logistic regression demonstrated no significant differences in hospitalization (adj OR 1.12, CI: 0.90–1.38), ICU admission (adj OR: 1.31, CI: 0.82–2.10), need for mechanical ventilation (adj OR 1.65, CI: 0.69–4.02), or mortality (OR: 0.80, CI: 0.43–1.49). In conclusion, ICS therapy did not increase COVID-19 related healthcare utilization or mortality outcome in patients with COPD followed at the Cleveland Clinic health system. These findings should encourage clinicians to continue ICS therapy for COPD patients during the COVID-19 pandemic.

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by Nicolas Banholzer, Eva van Weenen, Adrian Lison, Alberto Cenedese, Arne Seeliger, Bernhard Kratzwald, Daniel Tschernutter, Joan Puig Salles, Pierluigi Bottrighi, Sonja Lehtinen, Stefan Feuerriegel, Werner Vach

The novel coronavirus (SARS-CoV-2) has rapidly developed into a global epidemic. To control its spread, countries have implemented non-pharmaceutical interventions (NPIs), such as school closures, bans of small gatherings, or even stay-at-home orders. Here we study the effectiveness of seven NPIs in reducing the number of new infections, which was inferred from the reported cases of COVID-19 using a semi-mechanistic Bayesian hierarchical model. Based on data from the first epidemic wave of n = 20 countries (i.e., the United States, Canada, Australia, the EU-15 countries, Norway, and Switzerland), we estimate the relative reduction in the number of new infections attributed to each NPI. Among the NPIs considered, bans of large gatherings were most effective, followed by venue and school closures, whereas stay-at-home orders and work-from-home orders were least effective. With this retrospective cross-country analysis, we provide estimates regarding the effectiveness of different NPIs during the first epidemic wave.

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by Kiran Raj Pandey, Anup Subedee, Bishesh Khanal, Bhagawan Koirala
Introduction Many countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings. Methods Using an age-structured SEIR model, we explored the effects of COVID-19 control interventions–a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)–implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal. Results A month-long lockdown will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no intervention (peak demand at 108 days (IQR 97-119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%. Conclusion Limited resource settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.

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by Shantanu Dutta, Ashok Kumar, Moumita Dutta, Caolan Walsh

In this study, we use an effective word embedding model (word2vec) to systematically track ’vaccine hesitancy’ and ’logistical challenges’ associated with the Covid-19 vaccines, in the USA. To that effect, we use news articles from reputed media sources and create dictionaries to estimate different aspects of vaccine hesitancy and logistical challenges. Using machine learning and natural language processing techniques, we have developed (i) three sub-dictionaries that indicate vaccine hesitancy, and (ii) another dictionary for logistical challenges associated with vaccine production and distribution. Vaccine hesitancy dictionaries capture three aspects: (a) general vaccine related concerns, mistrusts, skepticisms, and hesitancy, (b) discussions on symptoms and side-effects, and (c) discussions on vaccine related physical effects. The dictionary on logistical challenges includes the words and phrases related to the production, storage, and distribution of vaccines. Our results show that over time, as vaccine developers complete different phase trials and get approval for their respective vaccines, the number of vaccine related news articles increases sharply. Accordingly, we also see a sharp increase in vaccine hesitancy related topics in news articles. However, in January 2021, there has been a decrease in the vaccine hesitancy score, which will give some relief to the health administrators and regulators. Our findings further show that as we get closer to the breakthrough of effective Covid-19 vaccines, new logistical challenges continue to rise, even in recent months.

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by Shanlang Lin, Ruofei Lin, Na Yan, Junpei Huang

We collected COVID-19 epidemiological and epidemic control measures-related data in mainland China during the period January 1 to February 19, 2020, and empirically tested the practical effects of the epidemic control measures implemented in China by applying the econometrics approach. The results show that nationally, both traffic control and social distancing have played an important role in controlling the outbreak of the epidemic, however, neither of the two measures have had a significant effect in low-risk areas. Moreover, the effect of traffic control is more successful than that of social distancing. Both measures complement each other, and their combined effect achieves even better results. These findings confirm the effectiveness of the measures currently in place in China, however, we would like to emphasize that control measures should be more tailored, which implemented according to each specific city’s situation, in order to achieve a better epidemic prevention and control.

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Title: CoronaFatos: Especial - Cidade e Covid
Authors: Audi, Gustavo; Figueira, Ana Cristina
Abstract: Neste segundo episódio, tratamos sobre a relação das pessoas com a Cidade durante a pandemia. Para isso, contamos com a presença da Especialista em Mobilidade Urbana e Diretora do Instituto de Políticas de Transporte e Desenvolvimento - ITDP, Clarice Linke.
Description: Ficha técnica: Apresentação: Ana Cristina Ferreira / Roteiro: Valéria Mauro e Ana Cristina Figueira / Produção: Valéria Mauro / Edição e Finalização: Marcelo Louro / Arte: Marcelo Vianna / Idealização: Canal Saúde - Fundação Oswaldo Cruz.

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