Monitoramento das Produções

by Balsam Qubais Saeed, Rula Al-Shahrabi, Obasanjo Afolabi Bolarinwa

Since the World Health Organization (WHO) announced that the coronavirus disease (COVID-19) is a worldwide pandemic, many countries’ authorities, including the Iraqi authorities, started responding and taking action to control the spread of the pandemic. The public’s knowledge and practices play an important role in curbing the spreading of the virus by following the health guidelines. This study aimed to assess the socio-demographic correlate of knowledge and practices of Iraqi living in Mosul-Iraq towards COVID-19 during its rapid rise. A cross-sectional online survey of 909 participants was conducted among a sample of the Mosul-Iraq population between 20th June to 1st July 2020. The survey included three parts: 1) socio-demographic characteristics, 2) participants’ knowledge, 3) participants’ practices. T-test, ANOVA, chi-square, and binary logistic regression were used. A p-value less than 0.05 (p 0.05) was considered statistically significant. The results showed a knowledge and practice mean score of (12.91±1.67) and (21.56± 2.92) with cumulative knowledge and practice of 86% and 76% respectively towards COVID-19. Socio-demographic characteristics such as age, marital status, gender, level of education and employment were statistically related with a higher mean score of knowledge and practice towards the virus as P

by Leeberk Raja Inbaraj, Carolin Elizabeth George, Sindhulina Chandrasingh
Objectives We aimed to estimate the seroprevalence of COVID-19 in a rural district of South India, six months after the index case. Methodology We conducted a cross-sectional study of 509 adults aged more than 18 years. From all the four subdistricts, two grampanchayats (administrative cluster of 5–8 villages) were randomly selected followed by one village through convenience. The participants were invited for the study to the community-based study kiosk set up in all the eight villages through village health committees. We collected socio-demographic characteristics and symptoms using a mobile application-based questionnaire, and we tested samples for the presence of IgG antibodies for SARS CoV-2 using an electro chemiluminescent immunoassay. We calculated age-gender adjusted and test performance adjusted seroprevalence. Results The age-and gender-adjusted seroprevalence was 8.5% (95% CI 6.9%- 10.8%). The unadjusted seroprevalence among participants with hypertension and diabetes was 16.3% (95% CI:9.2–25.8) and 10.7% (95% CI: 5.5–18.3) respectively. When we adjusted for the test performance, the seroprevalence was 6.1% (95% CI 4.02–8.17). The study estimated 7 (95% CI 1:4.5–1:9) undetected infected individuals for every RT-PCR confirmed case. Infection Fatality Rate (IFR) was calculated as 12.38 per 10000 infections as on 22 October 2020. History of self-reported symptoms and education were significantly associated with positive status (p 0.05) Conclusion A significant proportion of the rural population in a district of south India remains susceptible to COVID-19. A higher proportion of susceptible, relatively higher IFR and a poor tertiary healthcare network stress the importance of sustaining the public health measures and promoting early access to the vaccine are crucial to preserving the health of this population. Low population density, good housing, adequate ventilation, limited urbanisation combined with public, private and local health leadership are critical components of curbing future respiratory pandemics.

by Elizabeth R. Lusczek, Nicholas E. Ingraham, Basil S. Karam, Jennifer Proper, Lianne Siegel, Erika S. Helgeson, Sahar Lotfi-Emran, Emily J. Zolfaghari, Emma Jones, Michael G. Usher, Jeffrey G. Chipman, R. Adams Dudley, Bradley Benson, Genevieve B. Melton, Anthony Charles, Monica I. Lupei, Christopher J. Tignanelli
Purpose Heterogeneity has been observed in outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). Identification of clinical phenotypes may facilitate tailored therapy and improve outcomes. The purpose of this study is to identify specific clinical phenotypes across COVID-19 patients and compare admission characteristics and outcomes. Methods This is a retrospective analysis of COVID-19 patients from March 7, 2020 to August 25, 2020 at 14 U.S. hospitals. Ensemble clustering was performed on 33 variables collected within 72 hours of admission. Principal component analysis was performed to visualize variable contributions to clustering. Multinomial regression models were fit to compare patient comorbidities across phenotypes. Multivariable models were fit to estimate associations between phenotype and in-hospital complications and clinical outcomes. Results The database included 1,022 hospitalized patients with COVID-19. Three clinical phenotypes were identified (I, II, III), with 236 [23.1%] patients in phenotype I, 613 [60%] patients in phenotype II, and 173 [16.9%] patients in phenotype III. Patients with respiratory comorbidities were most commonly phenotype III (p = 0.002), while patients with hematologic, renal, and cardiac (all p

by Cameron Spencer Olezene, Elizabeth Hansen, Hannah K. Steere, Joseph T. Giacino, Ginger R. Polich, Joanne Borg-Stein, Ross D. Zafonte, Jeffrey C. Schneider
Objective To characterize the functional impairments of a cohort of patients undergoing inpatient rehabilitation after surviving severe COVID-19 illness, in order to better understand the ongoing needs of this patient population. Methods This study consisted of a retrospective chart review of consecutive patients hospitalized for COVID-19 and admitted to a regional inpatient rehabilitation hospital from April 29th to May 22nd, 2020. Patient demographics, clinical characteristics and complications from acute hospitalization were examined. Measures of fall risk (Berg Balance Scale), endurance (6 Minute Walk Test), gait speed (10 Meter Walk Test), mobility (transfer and ambulation independence), cognition, speech and swallowing (American Speech and Hearing Association National Outcomes Measurement System Functional Communication Measures) were assessed at rehabilitation admission and discharge. Results The study population included 29 patients and was 70% male, 58.6% white and with a mean age of 59.5. The mean length of acute hospitalization was 32.2 days with a mean of 18.7 days intubated. Patients spent a mean of 16.7 days in inpatient rehabilitation and 90% were discharged home. Patients demonstrated significant improvement from admission to discharge in measures of fall risk, endurance, gait speed, mobility, cognition, speech and swallowing, (p 0.05). At discharge, a significant portion of the population continued to deficits in cognition (attention 37%; memory 28%; problem solving 28%), balance (55%) and gait speed (97%). Conclusion Patients admitted to inpatient rehabilitation after hospitalization with COVID-19 demonstrated deficits in mobility, cognition, speech and swallowing at admission and improved significantly in all of these domains by discharge. However, a significant number of patients exhibited residual deficits at discharge highlighting the post-acute care needs of this patient population.

by Fabian Wunderlich, Matthias Weigelt, Robert Rein, Daniel Memmert

The present paper investigates factors contributing to the home advantage, by using the exceptional opportunity to study professional football matches played in the absence of spectators due to the COVID-19 pandemic in 2020. More than 40,000 matches before and during the pandemic, including more than 1,000 professional matches without spectators across the main European football leagues, have been analyzed. Results support the notion of a crowd-induced referee bias as the increased sanctioning of away teams disappears in the absence of spectators with regard to fouls (p .001), yellow cards (p .001), and red cards (p .05). Moreover, the match dominance of home teams decreases significantly as indicated by shots (p .001) and shots on target (p .01). In terms of the home advantage itself, surprisingly, only a non-significant decrease is found. While the present paper supports prior research with regard to a crowd-induced referee bias, spectators thus do not seem to be the main driving factor of the home advantage. Results from amateur football, being naturally played in absence of a crowd, provide further evidence that the home advantage is predominantly caused by factors not directly or indirectly attributable to a noteworthy number of spectators.

Title: Zika Virus Neutralizing Antibody Kinetics in Antenatally Exposed Infants
Authors: Espindola, Otavio de Melo; Jaenish, Thomas; NielsenSaines, Karin; Oliveira, Raquel de Vasconcellos Carvalhaes de; Pastorino, Boris; Vasconcelos, Zilton Farias Meira de; Gabaglia, Claudia Raja; Ribeiro, Ieda Pereira; Cunha, Denise Cotrim da; Pone, Marcos Vinicius; Carvalho, Liege Maria Abreu de; Pone, Sheila Moura; Damasceno, Luana; Zin, Andrea A.; Bonaldo, Myrna C.; Moreira, Maria Elisabeth Lopes; Cherry, James D.; Lamballerie, Xavier de; Brasil, Patrícia

by Jahanzeb Malik, Asmara Malik, Muhammad Javaid, Tayyaba Zahid, Uzma Ishaq, Muhammad Shoaib
Background and objective Coronavirus disease 2019 (COVID-19) is an on-going epidemic with a multitude of long-ranging effects on the physiological balance of the human body. It can cause several effects on thyroid functions as well. We aimed to assess the lasting sequelae of COVID-19 on thyroid hormone and the clinical course of the disease as a result. Methods Out of 76 patients, 48 patients of COVID-19 positive and 28 patients of COVID-19 negative polymerase chain reaction (PCR) were assessed for thyroid functions, IL-6, and Procalcitonin between moderate, severe, and critical pneumonia on HRCT. Results Seventy-five percent of patients with COVID-19 had thyroid abnormalities and higher IL-6 levels (76.10 ± 82.35 vs. 6.99 ± 3.99, 95% CI 52.18–100.01, P-value

by Jürgen Margraf, Julia Brailovskaia, Silvia Schneider

In the absence of vaccines or causal therapies, behavioral measures such as wearing face masks and maintaining social distance are central to fighting Covid-19. Yet, their benefits are often questioned by the population and the level of adherence to the measures is variable. We examined in representative samples across eight countries (N = 7,568) whether adherence reported around June 1, 2020 predicted the increase in Covid-19 mortality by August 31, 2020. Mortality increased 81.3% in low adherence countries (United States, Sweden, Poland, Russia), 8.4% in high adherence countries (Germany, France, Spain, United Kingdom). Across countries adherence and subsequent mortality increases correlated with r = -0.91. No African or South American countries were included in the present study, which limits the generalizability of the findings. While reported Covid-19 mortality is likely to be influenced by other factors, the almost tenfold difference in additional mortality is significant, and may inform decisions when choosing whether to prioritize individual liberty rights or health-protective measures.

by Dorrit Posel, Adeola Oyenubi, Umakrishnan Kollamparambil
Objectives Existing literature on how employment loss affects depression has struggled to address potential endogeneity bias caused by reverse causality. The COVID-19 pandemic offers a unique natural experiment because the source of unemployment is very likely to be exogenous to the individual. This study assessed the effect of job loss and job furlough on the mental health of individuals in South Africa during the COVID-19 pandemic. Data and methods The data for the study came from the first and second waves of the national survey, the National Income Dynamics-Coronavirus Rapid Mobile Survey (NIDS-CRAM), conducted during May-June and July-August 2020, respectively. The sample for NIDS-CRAM was drawn from an earlier national survey, conducted in 2017, which had collected data on mental health. Questions on depressive symptoms during the lockdown were asked in Wave 2 of NIDS-CRAM, using a 2-question version of the Patient Health Questionnaire (PHQ-2). The PHQ-2 responses (0–6 on the discrete scale) were regrouped into four categories making the ordered logit regression model the most suited for assessing the impact of employment status on depressive symptoms. Results The study revealed that adults who retained paid employment during the COVID-19 lockdown had significantly lower depression scores than adults who lost employment. The benefits of employment also accumulated over time, underscoring the effect of unemployment duration on mental health. The analysis revealed no mental health benefits to being furloughed (on unpaid leave), but paid leave had a strong and significant positive effect on the mental health of adults. Conclusions The economic fallout of the COVID-19 pandemic resulted in unprecedented job losses, which impaired mental wellbeing significantly. Health policy responses to the crisis therefore need to focus on both physical and mental health interventions.

by Oran Erster, Omer Shkedi, Gil Benedek, Eyal Zilber, Itay Varkovitzky, Rachel Shirazi, Dorit Oriya Shorka, Yuval Cohen, Tzahi Bar, Rafi Yechieli, Michal Tepperberg Oikawa, Dana Venkert, Michal Linial, Esther Oiknine-Djian, Michal Mandelboim, Zvi Livneh, Gilat Shenhav-Saltzman, Ella Mendelson, Dana Wolf, Moran Szwarcwort-Cohen, Orna Mor, Yair Lewis, Danny Zeevi

Conducting numerous, rapid, and reliable PCR tests for SARS-CoV-2 is essential for our ability to monitor and control the current COVID-19 pandemic. Here, we tested the sensitivity and efficiency of SARS-CoV-2 detection in clinical samples collected directly into a mix of lysis buffer and RNA preservative, thus inactivating the virus immediately after sampling. We tested 79 COVID-19 patients and 20 healthy controls. We collected two samples (nasopharyngeal swabs) from each participant: one swab was inserted into a test tube with Viral Transport Medium (VTM), following the standard guideline used as the recommended method for sample collection; the other swab was inserted into a lysis buffer supplemented with nucleic acid stabilization mix (coined NSLB). We found that RT-qPCR tests of patients were significantly more sensitive with NSLB sampling, reaching detection threshold 2.1±0.6 (Mean±SE) PCR cycles earlier then VTM samples from the same patient. We show that this improvement is most likely since NSLB samples are not diluted in lysis buffer before RNA extraction. Re-extracting RNA from NSLB samples after 72 hours at room temperature did not affect the sensitivity of detection, demonstrating that NSLB allows for long periods of sample preservation without special cooling equipment. We also show that swirling the swab in NSLB and discarding it did not reduce sensitivity compared to retaining the swab in the tube, thus allowing improved automation of COVID-19 tests. Overall, we show that using NSLB instead of VTM can improve the sensitivity, safety, and rapidity of COVID-19 tests at a time most needed.

by Tanvir Abir, O’mezie Ekwudu, Nazmul Ahsan Kalimullah, Dewan Muhammad Nur-A Yazdani, Abdullah Al Mamun, Palash Basak, Uchechukwu Levi Osuagwu, P. Yukthamarani Permarupan, Abdul Hasnat Milton, Shamim Hyder Talukder, Kingsley E. Agho

Dengue, the most important mosquito-borne viral disease of humans is a recurring global health problem. In Bangladesh, dengue outbreaks are on the increase despite the efforts of government and it is not clear what the understanding of the general Dhaka population towards dengue fever is. Knowledge, attitude and practice (KAP) studies are essential guides in public health interventions. Hence, using KAP, this study aims to assess patient-perspectives with regards to factors associated with dengue, as well as investigate the associated factors between the two corporations in Dhaka. A Hospital-based cross-sectional study of 242 fever patients from two city-corporations in Dhaka (Dhaka North City Corporations, DNCC (n = 91, 37.6%) and Dhaka South City Corporation, DSCC (n = 151, 62.4%) was conducted using pre-tested KAP items. Wilcoxon’s Rank Sum was used to determine the KAP by DNCC, DSCC and both corporations and multivariate Poisson regression analyses. The two corporations were analysed separately due to the differences in income distribution, concentration of slums, hospitals and clinics. The study found that more than half of the study population were knowledgeable about dengue (mean percentage scores was 52%), possess an appropriate and acceptable attitude towards the disease (69.2%), and about two thirds of the respondents (71.4%) engaged in practices towards its prevention. After adjusting for the potential cofounders, the factors associated with KAP about dengue fever varied between DNCC and DSCC; with duration of residency and use of mosquito nets were associated with knowledge in the north while income class and age were associated with knowledge and attitude in the south. In the pooled analysis (combining both corporations), knowledge of dengue was associated with good practice towards dengue fever among the respondents. The duration of residence in Dhaka (10+ years), not using mosquito nets and length of time spent in the hospital (7+ days) due to dengue, and decreased knowledge (Adjusted coefficient (β) = -0.01, 95%CI: -0.02, -0.01) were associated with attitude towards dengue in DNCC. On the other hand, middle-high income class, age (40+ years) and increased knowledge were associated with practice towards dengue in DSCC (β = 0.02, 95%CI: 0.01, 0.03). Efforts to increase knowledge about dengue fever through education by the administrations of both corporations would benefit from targeting these high-risk groups for a more sustainable outcome.

by Fangxiong Wang, Ziqian Tan, Zaihui Yu, Siqi Yao, Changfeng Guo

Taking the Guangdong-Hong Kong-Macao Greater Bay Area as the research area, this paper used OD cluster analysis based on Baidu migration data from January 11 to January 25 (before the sealing-off of Wuhan) and concluded that there is a significant correlation 1the migration level from Wuhan to the GBA and the epidemic severity index. This paper also analyzed the migration levels and diffusivity of the outer and inner cities of the GBA. Lastly, four evaluation indexes were selected to research the possibility of work resumption and the rating of epidemic prevention and control through kernel density estimation. According to the study, the amount of migration depends on the geographical proximity, relationship and economic development of the source region, and the severity of the epidemic depends mainly on the migration volume and the severity of the epidemic in the source region. The epidemic risk is related not only to the severity of the epidemic in the source region but also to the degree of urban traffic development and the degree of urban openness. After the resumption of work, the pressure of epidemic prevention and control has been concentrated mainly in Shenzhen and Canton; the further away a region is from the core cities, the lower the pressure in that region. The mass migration of the population makes it difficult to control the epidemic effectively. The study of the relationship between migration volume, epidemic severity and epidemic risk is helpful to further analyze transmission types and predict the trends of the epidemic.

by Taeyong Lee, Hee-Dae Kwon, Jeehyun Lee

Countries around the world have taken control measures to mitigate the spread of COVID-19, including Korea. Social distancing is considered an essential strategy to reduce transmission in the absence of vaccination or treatment. While interventions have been successful in controlling COVID-19 in Korea, maintaining the current restrictions incurs great social costs. Thus, it is important to analyze the impact of different polices on the spread of the epidemic. To model the COVID-19 outbreak, we use an extended age-structured SEIR model with quarantine and isolation compartments. The model is calibrated to age-specific cumulative confirmed cases provided by the Korea Disease Control and Prevention Agency (KDCA). Four control measures—school closure, social distancing, quarantine, and isolation—are investigated. Because the infectiousness of the exposed has been controversial, we study two major scenarios, considering contributions to infection of the exposed, the quarantined, and the isolated. Assuming the transmission rate would increase more than 1.7 times after the end of social distancing, a second outbreak is expected in the first scenario. The epidemic threshold for increase of contacts between teenagers after school reopening is 3.3 times, which brings the net reproduction number to 1. The threshold values are higher in the second scenario. If the average time taken until isolation and quarantine reduces from three days to two, cumulative cases are reduced by 60% and 47% in the first scenario, respectively. Meanwhile, the reduction is 33% and 41%, respectively, for rapid isolation and quarantine in the second scenario. Without social distancing, a second wave is possible, irrespective of whether we assume risk of infection by the exposed. In the non-infectivity of the exposed scenario, early detection and isolation are significantly more effective than quarantine. Furthermore, quarantining the exposed is as important as isolating the infectious when we assume that the exposed also contribute to infection.

Title: A importância dos repositórios institucionais em períodos de pandemia: a inserção da produção científica sobre a COVID-19 no Arca – RI da Fiocruz
Authors: Queiroz, Claudete Fernandes de; Araujo, Luciana Danielli de; Nascimento, Andréa Gonçalves do; Freyre, Éder de Almeida; Rodrigues, Raphael Belchior; Pereira, Catarina Barreto Malheiro; Silva, Rita de Cassia da; Ferreira, Leonardo Simonini; Almeida Junior, Adilson de
Abstract: A comunicação e a informação nunca foram tão importantes como neste momento de pandemia da COVID-19. Essa emergência de saúde tem mostrado como a atuação dos profissionais de informação nos Repositórios Institucionais tem sido decisiva para o avanço do conhecimento científico sobre essa doença. Essa fase tem propiciado muitas reflexões acerca das atividades desenvolvidas nos Repositórios. Eles se encontram diante de um volume expressivo de informações em tempo real sobre essa nova doença, onde os resultados obtidos nas pesquisas preliminares precisam ser divulgados rapidamente. Por isso, este trabalho apresenta o mapeamento dos processos de trabalho realizado pelos profissionais de informação da Fundação Oswaldo Cruz, com relação ao depósito da produção intelectual da Instituição no ARCA - Repositório Institucional da FIOCRUZ sobre a COVID-19, tendo como objetivo a disseminação e o acesso aos conteúdos. A primeira atitude para que a realização das tarefas no Repositório ARCA fosse possível e contínua, consistiu no
fortalecimento do vínculo da equipe. Desta forma, tornou-se necessário construir novas estratégias
na execução dos trabalhos e novo redimensionamento nas funções dos profissionais para agir com
celeridade na recuperação da produção dos estudos da comunidade científica. A proposta é manter a
população bem informada, já que nessa situação de pandemia os protocolos de prevenção contra a
COVID-19 salientam que o cuidado começa com a responsabilidade individual, pela obediência as
orientações dos gestores de saúde. No momento atual, não restam dúvidas sobre a enorme
importância que os Repositórios Institucionais representam, juntamente com a atuação essencial dos
profissionais que asseguram informações relevantes e emergenciais a todos os usuários.

Title: VODAN BR: a gestão de dados no enfrentamento da pandemia coronavírus
Authors: Veiga, Viviane; Campos, Maria Luiza; Silva, Carlos Roberto Lyra da; Henning, Patricia; Moreira, João
Abstract: O mundo está vivenciando uma pandemia provocada pela variante do Coronavírus nomeado SARS-CoV-2, causando a doença infecciosa COVID-19. Ações globais estão sendo realizadas no combate a esse vírus, dentre as quais a Virus Outbreak Data Network (VODAN), que visa estabelecer uma infraestrutura de dados federada alinhada aos princípios FAIR e que apoie a coleta de dados de prontuários de pacientes infectados por vírus de alto contágio. A FIOCRUZ, que coordena a rede GO FAIR Brasil Saúde, assumiu a rede VODAN BR em parceria com a UNIRIO e UFRJ, com a participação inicial dos hospitais Gaffrée e Guinle, Municipal São José e o Israelita Albert Einstein. Este artigo objetiva apresentar a infraestrutura nacional alinhada às diretrizes e à rede internacional, para coleta e gestão de dados de prontuários de pacientes, desses hospitais,
infectados com a COVID-19, para estabelecer modelo informacional que apoie o enfrentamento desta e de outras possíveis pandemias.

by Gerine Nijman, Maike Wientjes, Jordache Ramjith, Nico Janssen, Jacobien Hoogerwerf, Evertine Abbink, Marc Blaauw, Ton Dofferhoff, Marjan van Apeldoorn, Karin Veerman, Quirijn de Mast, Jaap ten Oever, Wouter Hoefsloot, Monique H. Reijers, Reinout van Crevel, Josephine S. van de Maat
Background To date, survival data on risk factors for COVID-19 mortality in western Europe is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients in the Netherlands, considering recovery as a competing risk. Methods In this observational multicenter cohort study we included adults with PCR-confirmed SARS-CoV-2 infection that were admitted to one of five hospitals in the Netherlands (March to May 2020). We performed a competing risk survival analysis, presenting cause-specific hazard ratios (HRCS) for the effect of preselected factors on the absolute risk of death and recovery. Results 1,006 patients were included (63.9% male; median age 69 years, IQR: 58–77). Patients were hospitalized for a median duration of 6 days (IQR: 3–13); 243 (24.6%) of them died, 689 (69.9%) recovered, and 74 (7.4%) were censored. Patients with higher age (HRCS 1.10, 95% CI 1.08–1.12), immunocompromised state (HRCS 1.46, 95% CI 1.08–1.98), who used anticoagulants or antiplatelet medication (HRCS 1.38, 95% CI 1.01–1.88), with higher modified early warning score (MEWS) (HRCS 1.09, 95% CI 1.01–1.18), and higher blood LDH at time of admission (HRCS 6.68, 95% CI 1.95–22.8) had increased risk of death, whereas fever (HRCS 0.70, 95% CI 0.52–0.95) decreased risk of death. We found no increased mortality risk in male patients, high BMI or diabetes. Conclusion Our competing risk survival analysis confirms specific risk factors for COVID-19 mortality in a the Netherlands, which can be used for prediction research, more intense in-hospital monitoring or prioritizing particular patients for new treatments or vaccination.

by Kababa Temesgen, Negash Wakgari, Bikila Tefera Debelo, Belay Tafa, Getu Alemu, Fikadu Wondimu, Tolera Gudisa, Tolosa Gishile, Gurmesa Daba, Gizachew Abdissa Bulto, Bikila Soboka

The novel coronavirus (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Despite strong efforts that have been taking place to control the pandemic globally, the virus is on the rise in many countries. Hence, this study assessed the maternal health care services utilization amidst the COVID-19 pandemic in West Shoa zone, Central Ethiopia. A community-based cross-sectional study was conducted among 844 pregnant women or those who gave birth in the last 6 months before the study. A multi-stage sampling technique was used to select the study participants. The data were collected through face-to-face interviews using a semi-structured questionnaire. Logistic regressions were performed to identify the presence of significant associations, and an adjusted odds ratio with 95%CI was employed for the strength and directions of association between the independent and outcome variables. A P-value of

by Sanne Kaelen, Wilma van den Boogaard, Umberto Pellecchia, Sofie Spiers, Caroline De Cramer, Gwennin Demaegd, Edouard Fouqueray, Rafael Van den Bergh, Stephanie Goublomme, Tom Decroo, Muriel Quinet, Elke Van Hoof, Bertrand Draguez
Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.

Title: Cellular and Molecular Immunology Approaches for the Development of Immunotherapies against the New Coronavirus (SARS-CoV-2): Challenges to Near-Future Breakthroughs
Authors: Melgaço, Juliana Gil; Brito e Cunha, Danielle; Azamor, Tamiris; Silva, Andrea Marques Vieira da; Tubarão, Luciana Neves; Gonçalves, Rafael Braga; Monteiro, Robson Q.; Missailidis, Sotiris; Neves, Patricia Cristina da Costa; Ano Bom, Ana Paula Dinis
Abstract: A síndrome respiratória aguda grave causada pelo novo coronavírus (SARS-CoV-2), denominado COVID-19, foi destacada como
a doença infecciosa mais importante do nosso tempo, sem vacina e sem tratamento disponível até o momento, com grande impacto
nos sistemas de saúde em todo o mundo e com altas taxas de mortalidade associadas a doenças virais respiratórias. As comunidades médica e científica também foram confrontadas com a necessidade urgente de compreender melhor o mecanismo de interação vírus-hospedeiro com o objetivo de desenvolver terapias e vacinas. Uma vez que esta doença viral pode desencadear uma forte resposta imune inata, causando graves danos ao trato pulmonar, imunoterapias também têm sido exploradas como um meio para verificar o efeito imunomodulador e melhorar os resultados clínicos, enquanto a imunologia COVID-19 abrangente ainda permanece sob investigação. Nesta revisão, tanto a imunopatologia celular e molecular quanto os distúrbios hemostáticos induzidos por SARS-CoV-2 são resumidos. As abordagens imunoterapêuticas baseadas nos estudos clínicos e não clínicos mais recentes, enfatizando seus efeitos para o tratamento do COVID-19, também são abordadas. As informações apresentadas elucidam insights úteis com o objetivo de preencher as lacunas de conhecimento em torno de imunoterapias promissoras que tentam controlar a disfunção de fatores do hospedeiro durante o curso desta doença viral infecciosa.

by Andreas Bollmann, Sven Hohenstein, Vincent Pellissier, Katharina Stengler, Peter Reichardt, Jörg-Peter Ritz, Holger Thiele, Michael A. Borger, Gerhard Hindricks, Andreas Meier-Hellmann, Ralf Kuhlen
Background During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P

by Jessica Leight, Catherine Hensly, Marcos Chissano, Liza Ali

The COVID-19 pandemic has increasingly disrupted the global delivery of preventive health care services, as a large number of governments have issued state of emergency orders halting service delivery. However, there is limited evidence on the realized effects of the pandemic and associated emergency orders on access to services in low-income country contexts to date. To address this gap, this paper analyzes administrative data on utilization of contraceptive health services by women referred via community health promoters in two large urban and peri-urban areas of Mozambique. We focus on the period immediately surrounding the national state of emergency declaration linked to the COVID-19 pandemic on March 31, 2020. Data reported for 109,129 women served by 132 unique promoters and 192 unique public health facilities is analyzed using logistic regression, interrupted time series analysis and hazard analysis. The results demonstrate that the imposition of the state of emergency is associated with a modest short-term drop in both service provision and utilization, followed by a relatively rapid rebound. We conclude that in this context, the accessibility of reproductive health services was not dramatically reduced during the first phase of the pandemic-related emergency.

Title: The zika virus individual participant data consortium: A global initiative to estimate the effects of exposure to zika virus during pregnancy on adverse fetal, infant, and child health outcomes
Authors: Alger, Jackeline; Ximenes, Ricardo Arraes de Alencar; Avelino-Silva, Vivian I.; Bardají, Azucena; Mojica, Carlos Hernan Becerra; Benedetti, Andrea; Teixeira, Maria de Lourdes Benamor; Bethencourt, Sarah; Aburto, Victor Hugo Borja; Brant, Fátima; Brasil, Patrícia; Brickley, Elizabeth B.; Broutet, Nathalie; Buekens, Pierre; Cafferata, María Luisa; Calvet, Guilherme; Campbell, Harlan; Carabali, Mabel; Chan, Derrick; Costa, Federico; Ferreira, Orlando da Costa; Coutinho, Conrado Milani; Cunha, Antonio Jose; Cure, Carlos; Damen, Johanna A.A.; Jong, Valentijn M.T. de; Debray, Thomas P.; DeBiasi, Roberta L.; Diaz-Martinez, Luis Alfonso; Duarte, Geraldo; Ferriol, Diana María; Ganz, Jucelia S.; Gérardin, Patrick; Gilboa, Suzanne M.; Gonzalez, Maritza; Muñiz, Concepción Grajales; Gustafson, Paul; Sanchez, Luz Angela Gutierrez; Guzmán, María G.; Hofer, Cristina; Holband, Natanael; Inwani, Irene; Jaenisch, Thomas; João, Esaú; Juliana, Amadu; Kara, Edna; Kim, Caron; Ko, Albert I.; Koopmans, Marion; LaBeaud, Angelle Desiree; Lash, Maura; Lee, Ellen H.; Leo, Yee-Sin; Levis, Brooke; Low, Nicola; Macpherson, Calum N.L.; Marbán-Castro, Elena; Mattar, Salim; Maxwell, Lauren; Mayaud, Philippe; Melo, Adriana; Menéndez, Clara; Reyes, Marcela Mercado; Montoya, María Consuelo Miranda; Miranda-Filho, Demócrito de Barros; Moons, Karel G.M.; Morales, Ivonne; Moreira, Maria Elisabeth; Mulkey, Sarah B.; Medina, José Esteban Muñoz; Mussi-Pinhata, Marisa Marcia; Natrajan, Muktha S.; Njenga, M. Kariuki; Noel, Trevor P.; Nogueira, Mauricio; Osoro, Eric; Martinez, Martha Lucia Ospina; Paladini, Marc; Passos, Saulo; Perez, Freddy; Pomar, Léo; Prata-Barbosa, Arnaldo; Reis, Mitermayer; Reveiz, Ludovic; Rodó, Carlota; Rosado, Luiza Emylce Pelá; Rosenberger, Kerstin D.; Clemente, Nuria Sanchez; Sayers, Janet L.; Silva, Antonio A.; Siqueira, Isadora C. de; Sohan, Karen; Soria-Segarra, Carmen; Soriano-Arandes, Antoni; Sousa, Patricia; Souza, João Paulo; Franch, Anna Suy; Tami, Adriana; Teixeira, Mauro; Thwin, Soe Soe; Tong, Van T.; Turchi, Marília Dalva; Martelli, Celina Maria Turchi; Valencia, Diana; Kerkhove, Maria D. Van; Araújo, Thalia Velho Barreto de; Villar, Luis Angel; Benéitez, Carmen Viñuela; Wei, Yinghui; Widdowson, Marc-Alain; Wilder-Smith, Annelies
Description: Patrícia Brasil; Guilherme Calvet - Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil. Facultad de Ciencias Médicas Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (J.A.), Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Recife 50670-901, Brazil; (R.A.d.A.X.), Medical School São Paulo, Departamento de Molestias Infecciosas e Parasitarias University of São Paulo, São Paulo 01000, Brazil; (V.I.A.S.), Maternal, Child, and Reproductive Health Initiative, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic—University of Barcelona, Barcelona 08036, Spain; (A.B. (Azucena Bardají)); (E.M.C.); (C.M.), Departamento de Obstetricia y Ginecología, Universidad Industrial de Santander, Bucaramanga 680002, Colombia; (C.H.B.M.); (L.A.G.S.), McGill University Health Centre, McGill University, Montréal, QC H4A 3J1, Canada; (A.B. (Andrea Benedetti)), Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro 22440-901, Brazil; (M.d.L.B.T.); (O.d.C.F.); (E.J.), Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia 2005, Venezuela; (S.B.), Unidad de Atención Primaria a la Salud, Instituto Mexicano del Seguro Social, Ciudad de México 06600, México; (V.H.B.A.), Universidade Federal de Minas Gerais, Minas Gerais 31270-901, Brazil; (F.B.); (M.T.); Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.B.B.), NDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland; (N.B.); (E.K.); (C.K.); (L.M.); (J.L.S.); (S.S.T.), School of Public Health and Tropical Medicine, Tulane University, New Orleans LA 70112, USA; (P.B. (Pierre Buekens)), Mother and Children Health Research Department, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1056ABH, Argentina; (M.L.C.), Department of Statistics, University of British Columbia, Vancouver BC V6T 1Z4, Canada; (H.C.); (P.G. (Patrick Gérardin)), Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal QC H3A 1A2, Canada; (M.C.), Paediatric Neurology, Paediatric Medicine, KK Women’s and Children’s Hospital, 229899 Singapore; (D.C.), Institute of Collective Health, Federal University of Bahia, Salvador 40110-909, Brazil; (F.C.), Departmento de Ginecologia e Obstetrícia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo 65470-000, Brazil; (C.M.C.), Departamento de Pediatria, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (A.J.C.), BIOMELAB SAS, Barranquilla 080001, Colombia; (C.C.C.), Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht 3584 CG, The Netherlands; (J.A.A.D.); (V.M.T.d.J.); (K.G.M.M.), Department of Epidemiology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands; (T.P.D.), Departments of Pediatrics and Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine, Children’s National Research Institute, Washington, DC 20052, USA; (R.L.D.), Departamento de Pediatría, Universidad Industrial de Santander, Bucaramanga 680002, Colombia; (L.A.D.M.), Ribeirão Preto Medical School of University of São Paulo, São Paulo 14049-900, Brazil; (G.D.), Centro Provincial de Genética Médica, Cienfuegos 90100, Cuba; (D.M.F.), Children’s Hospital Juvencio Matos, São Luís 65065-545, Brazil; (J.S.G.), Centre for Clinical Investigation (CIC1410), Centre Hospitalier Universitaire de La Réunion, Saint Pierre 97448, Réunion, France; (P.G. (Paul Gustafson)), National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.M.G.); (V.T.T.); (D.V.), Instituto Nacional de Salud—Colombia, Bogotá 111321, Colombia; (M.G.); (M.L.O.M.), División de Vigilancia Epidemiológica de Enfermedades Transmisibles, Instituto Mexicano del Seguro Social, Ciudad de México 06600, Mexico; (C.G.M.), Centro de Investigación, Diagnostico, y Referencia, Centro Colaborador OPS-OMS Para el Estudio del Dengue y su Control, Instituto de Medicina Tropical, Pedro Kourí (IPK), Havana, Cuba; (M.G.G.), Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (C.H.), Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname; (N.H.); (A.J.), Department of Paediatrics and Child Health, Kenyatta National Teaching and Referral Hospital, Nairobi 00202, Kenya; (I.I.), Heidelberg Institute for Global Health, Heidelberg University Hospital, Heidelberg 69120, Germany; (T.J.), Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (A.I.K.); (M.R.), Department of Virology, Erasmus MC, Rotterdam 3015 CN, The Netherlands; (M.K.), Pediatric—Infectious Diseases, Stanford Hospital, Palo Alto, CA 94304, USA; (A.D.L.B.), Bureau of Communicable Disease, NYC Department of Health and Mental Hygiene, New York, NY 11101, USA; (M.L.); (E.H.L.); (M.P.), Executive Director’s Office, National Centre for Infectious Diseases, 308442 Singapore; (Y.S.L.), Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele ST5 5BG, UK; (B.L.), Institute of Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland; (N.L.), Windward Islands Research and Education Foundation, St. George’s University, True Blue Point, Grenada; (C.N.L.M.); (T.P.N.), Institutos de Investigaciones Biologicas del Tropico, Universidad de Córdoba, Córdoba 14014, Colombia; (S.M.), Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (P.M.), Instituto de Pesquisa Professor Joaquim Amorim Neto, Campina Grande, Paraiba 58402-040, Brazil; (A.M.), Research, Science, and Technology Division, Instituto Nacional de Salud—Colombia, Bogotá 111321, Colombia; (M.M.R.), Facultad de Salud Carrera, Universidad Industrial de Santander, Bucaramanga 680002, Colombia; (M.C.M.M.); (L.A.V.), Faculdade de Ciencias Medicas da, Universidade de Pernambuco, Recife 50670-901, Brazil; (D.d.B.M-F.), Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg 69120, Germany; (I.M.); (K.D.R.), Department of Neonatology, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 20231-050, Brazil; (M.E.M.), Departments of Pediatrics and Neurology, The George Washington University School of Medicine, Fetal Medicine Institute, Children’s National Research Institute, Washington, DC 20052, USA; (S.B.M.), División de Laboratorios de Vigilancia e Investigación Epidemiológica, Instituto Mexicano del Seguro Social, Ciudad de México 06600, México; (J.E.M.M.), Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo 14049-900, Brazil; (M.M.M.P.), Department of Medicine, Emory University, Atlanta, Georgia 30322, USA; (M.S.N.), Washington State University Global Health Program, Washington State University, Pullman, WA 99164 USA; (M.K.N.), Department of Dermatologic Diseases, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil; (M.N.), Paul G. Allen School for Global Animal Health, Washington State University, Nairobi, Kenya; (E.O.), Department of Pediatrics, Faculty of Medicine of Jundiaí, São Paulo 13202-550, Brazil; (S.P.), Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, DC 20037, USA; (F.P.), Department of Obstetrics and Gynecology, Centre Hospitalier de l’Ouest Guyanais 97320, Saint-Laurent du Maroni, French Guiana; (L.P.), Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne 1011, Switzerland, Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro 22281-100, Brazil; (A.P.B.), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Ministry of Health, Salvador 40296-710, Brazil; (M.R.); (A.I.K.), Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, DC 20037, USA; (L.R.), Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain; (C.R.), Hospital Materno Infantil de Goiânia, Health State Secretary, Goiás 74125-090, Brazil; (L.E.P.R.), Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (N.S.C.), Department of Public Health, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.A.S.), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (Fiocruz), Salvador 40296-710, Brasil; (I.C.d.S.), Obstetrics and Gynaecology, Diagnostic (Mother & Baby) Ltd., Lange Park 120110, Trinidad and Tobago; (K.S.), SOSECALI C. Ltd.a. Universidad Católica Santiago de Guayaquil, Guayaquil 090-615, Ecuador; (C.S.S.), Department of Pediatrics, University Hospital Vall d’Hebron, Barcelona 08035, Spain; (A.S.A.), Reference Center for Neurodevelopment, Assistance, and Rehabilitation of Children, State Department of Health of Maranhão, Sao Luís 65076-820, Brazil; (P.S.), Department of Social Medicine, University of São Paulo, São Paulo 01000-000, Brazil; (J.P.S.), Obstetrics Department, Vall d’Hebron Hospital, Barcelona 08035, Spain; (A.S.F.), Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen 9712 CP, The Netherlands; (A.T.), Departamento de Parasitología Médica, Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia 2005, Venezuela, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia 74690-900, Brazil; (M.D.T.), The Research Centre Aggeu Magalhães, Fundação Oswaldo Cruz (Fiocruz), Recife 50670-420, Brazil; (C.M.T.M.), Department of Infectious Hazards Management, World Health Organization, 1211 Geneva 27, Switzerland; (M.D.V.K.), Department of Social Medicine, Federal University of Pernambuco, Recife 50670-420, Brazil; (T.V.B.d.A.), Obstetrics & Gynecology, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain; (C.V.B.), Centre for Mathematical Sciences, University of Plymouth, Plymouth PL4 8AA, UK; (Y.W.), Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya; (M.A.W.), Institute of Tropical Medicine, 2000 Antwerp, Belgium, Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.W.S.).

by Cristian Aragón-Benedí, Pablo Oliver-Forniés, Felice Galluccio, Ece Yamak Altinpulluk, Tolga Ergonenc, Abdallah El Sayed Allam, Carlos Salazar, Mario Fajardo-Pérez
Introduction The analysis of heart rate variability (HRV) has proven to be an important tool for the management of autonomous nerve system in both surgical and critically ill patients. We conducted this study to show the different spectral frequency and time domain parameters of HRV as a prospective predictor for critically ill patients, and in particular for COVID-19 patients who are on mechanical ventilation. The hypothesis is that most severely ill COVID-19 patients have a depletion of the sympathetic nervous system and a predominance of parasympathetic activity reflecting the remaining compensatory anti-inflammatory response. Materials and methods A single-center, prospective, observational pilot study which included COVID-19 patients admitted to the Surgical Intensive Care Unit was conducted. The normalized high-frequency component (HFnu), i.e. ANIm, and the standard deviation of RR intervals (SDNN), i.e. Energy, were recorded using the analgesia nociception index monitor (ANI). To estimate the severity and mortality we used the SOFA score and the date of discharge or date of death. Results A total of fourteen patients were finally included in the study. ANIm were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.020). Energy was inversely correlated with SOFA (p = 0.039) and fewer survival days (p = 0.046). A limit value at 80 of ANIm, predicted mortalities with a sensitivity of 100% and specificity of 85.7%. In the case of Energy, a limit value of 0.41 ms predicted mortality with all predictive values of 71.4%. Conclusion A low autonomic nervous system activity, i.e. low SDNN or Energy, and a predominance of the parasympathetic system, i.e. low HFnu or ANIm, due to the sympathetic depletion in COVID-19 patients are associated with a worse prognosis, higher mortality, and higher IL-6 levels.

by Ben Edwards, Nicholas Biddle, Matthew Gray, Kate Sollis
Background High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy ‘hotspots’ based on social and behavioural insights. Methods Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. Results Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated. Conclusions Our findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

by Marta Betti, Marinella Bertolotti, Daniela Ferrante, Annalisa Roveta, Carolina Pelazza, Fabio Giacchero, Serena Penpa, Costanza Massarino, Tatiana Bolgeo, Antonella Cassinari, Marco Mussa, Guido Chichino, Antonio Maconi
Background Individual differences in susceptibility to SARS-CoV-2 infection, symptomatology and clinical manifestation of COVID-19 have thus far been observed but little is known about the prognostic factors of young patients. Methods A retrospective observational study was conducted on 171 patients aged ≤ 65 years hospitalized in Alessandria’s Hospital from 1st March to 30th April 2020 with laboratory confirmed COVID-19. Epidemiological data, symptoms at onset, clinical manifestations, Charlson Comorbidity Index, laboratory parameters, radiological findings and complications were considered. Patients were divided into two groups on the basis of COVID-19 severity. Multivariable logistic regression analysis was used to establish factors associated with the development of a moderate or severe disease. Findings A total of 171 patients (89 with mild/moderate disease, 82 with severe/critical disease), of which 61% males and a mean age (± SD) of 53.6 (± 9.7) were included. The multivariable logistic model identified age (50–65 vs 18–49; OR = 3.23 CI95% 1.42–7.37), platelet count (per 100 units of increase OR = 0.61 CI95% 0.42–0.89), c-reactive protein (CPR) (per unit of increase OR = 1.12 CI95% 1.06–1.20) as risk factors for severe or critical disease. The multivariable logistic model showed a good discriminating capacity with a C-index value of 0.76. Interpretation Patients aged ≥ 50 years with low platelet count and high CRP are more likely to develop severe or critical illness. These findings might contribute to improved clinical management.

by Franck Katembo Sikakulya, Robinson Ssebuufu, Simon Binezero Mambo, Theophilus Pius, Annet Kabanyoro, Elizabeth Kamahoro, Yusuf Mulumba, Jean Kakule Muhongya, Patrick Kyamanywa
Background The world is grappling with an ever-changing COVID-19 pandemic using preventive measures such as personal hygiene, face masks, restrictions on travel and gatherings in communities, in addition to a race to find a vaccine. The purpose of this study was to evaluate the knowledge, attitudes and practices of the western Uganda community on the proper use of face masks to mitigate the spread of COVID-19. Methods A cross-sectional study using a structured questionnaire was carried out from 1st July to 10th July 2020 among western Ugandans of consent age of 18 years and above. Data was analysed using Stata version 14.2. Results Among the respondents (n = 1114), the mean age was 30.7 (SD 11.1), 51% were males, 53.9% married and 43% had attained secondary education. Most participants (60.1%, n = 670) had satisfactory knowledge on the use of face masks and participants at a tertiary education level [AOR 2.6 (95% CI: 1.42–4.67; p = 0.002)] were likely to have satisfactory knowledge than participants who had not education. On attitude, most respondents (69.4%) were confident enough to correctly put on a face mask; 83.4% believed that a face mask can protect against COVID-19 and 75.9% of respondents had never shared their face mask. The majority of respondents (95.2%) agreed wearing face masks in public places was important to protect themselves against COVID-19; 60.3% reported washing their hands before wearing and after removing the face mask. Unfortunately, 51.5% reported removing the face mask if they needed to talk to someone. Conclusion Despite the satisfactory knowledge, good attitude and practices, there is still much more to be done in terms of knowledge, attitude and practices among participants. Government, non-governmental organizations and civil society should improve sensitization of populations on how to behave with face masks while talking to avoid the spread of the COVID-19 among western Ugandans.

by Brian Neelon, Fedelis Mutiso, Noel T. Mueller, John L. Pearce, Sara E. Benjamin-Neelon
Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

by Sarinya Puwanant, Supanee Sinphurmsukskul, Laddawan Krailak, Pavinee Nakaviroj, Noppawan Boonbumrong, Sarawut Siwamogsatham, Krailerk Chettakulanurak, Aekarach Ariyachaipanich, Smonporn Boonyaratavej
Background We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. Methods Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. Results Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p

by Jia-Ni Zou, Liu Sun, Bin-Ru Wang, You Zou, Shan Xu, Yong-Jun Ding, Li-Jun Shen, Wen-Cai Huang, Xiao-Jing Jiang, Shi-Ming Chen

The characteristics and evolution of pulmonary fibrosis in patients with coronavirus disease 2019 (COVID-19) have not been adequately studied. AI-assisted chest high-resolution computed tomography (HRCT) was used to investigate the proportion of COVID-19 patients with pulmonary fibrosis, the relationship between the degree of fibrosis and the clinical classification of COVID-19, the characteristics of and risk factors for pulmonary fibrosis, and the evolution of pulmonary fibrosis after discharge. The incidence of pulmonary fibrosis in patients with severe or critical COVID-19 was significantly higher than that in patients with moderate COVID-19. There were significant differences in the degree of pulmonary inflammation and the extent of the affected area among patients with mild, moderate and severe pulmonary fibrosis. The IL-6 level in the acute stage and albumin level were independent risk factors for pulmonary fibrosis. Ground-glass opacities, linear opacities, interlobular septal thickening, reticulation, honeycombing, bronchiectasis and the extent of the affected area were significantly improved 30, 60 and 90 days after discharge compared with at discharge. The more severe the clinical classification of COVID-19, the more severe the residual pulmonary fibrosis was; however, in most patients, pulmonary fibrosis was improved or even resolved within 90 days after discharge.

by Mariano Andrés, Jose-Manuel Leon-Ramirez, Oscar Moreno-Perez, José Sánchez-Payá, Ignacio Gayá, Violeta Esteban, Isabel Ribes, Diego Torrus-Tendero, Pilar González-de-la-Aleja, Pere Llorens, Vicente Boix, Joan Gil, Esperanza Merino, on behalf of COVID19-ALC research group
Introduction This study analyzed the impact of a categorized approach, based on patients’ prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain. Methods Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI). Results Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes 15ng/L and hypotension. Advanced age, lymphocytes 240pg/mL independently associated with IMV requirement. Conclusion Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.