Monitoramento das Produções

Title: Informes semanais sobre o Banco Mundial, o FMI e o BID na Resposta Global à COVID-19 - Informes de 27 de maio a 29 de julho de 2020
Authors: Cazumbá, Isis Pillar; Minayo, Miryam de Souza

Title: Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With COVID-19 (Metcovid): A Randomised, Double-Blind, Phase IIb, Placebo-Controlled Trial
Authors: Jeronimo, Christiane Maria Prado; Farias, Maria Eduarda Leão; Val, Fernando Fonseca Almeida; Sampaio, Vanderson Souza; Alexandre, Marcia Almeida Araújo; Melo, Gisely Cardoso; Safe, Izabella Picinin; Borba, Mayla Gabriela Silva; Abreu-Netto, Rebeca Linhares; Maciel, Alex Bezerra Silva; Neto, João Ricardo Silva; Oliveira, Lucas Barbosa; Figueiredo, Erick Frota Gomes; Dinelly, Kelry Mazurega Oliveira; Rodrigues, Maria Gabriela de Almeida; Brito, Marcelo; Mourão, Maria Paula Gomes; Pivoto-João, Guilherme Augusto; Hajjar, Ludhmila Abrahão; Bassat, Quique; Romero, Gustavo Adolfo Sierra; Naveca, Felipe Gomes; Vasconcelos, Heline Lira; Tavares, Michel de Araújo; Brito-Sousa, José Diego; Costa, Fabio Trindade Maranhão; Nogueira, Maurício Lacerda; Baía-da-Silva, Djane; Xavier, Mariana Simão; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães; the Metcovid Team

Title: Cadernos CRIS-Fiocruz: Panorama da Resposta Global à COVID-19 - Informe 8 - Junho - 2020
Description: Informe 8 produzido pelo CRIS-Fiocruz, sobre a semana de 4 a 9 de junho de 2020
Projeto Gráfico: Antonio Augusto Farah de Mesquita

by Shuzhen Sim, Lee Ching Ng, Steve W. Lindsay, Anne L. Wilson

Vector-borne diseases are a major cause of morbidity and mortality worldwide. Aedes-borne diseases, in particular, including dengue, chikungunya, yellow fever, and Zika, are increasing at an alarming rate due to urbanisation, population movement, weak vector control programmes, and climate change. The World Health Organization calls for strengthening of vector control programmes in line with the Global Vector Control Response (GVCR) strategy, and many vector control programmes are transitioning to this new approach. The Singapore dengue control programme, situated within the country’s larger vision of a clean, green, and sustainable environment for the health and well-being of its citizens, provides an excellent example of the GVCR approach in action. Since establishing vector control operations in the 1960s, the Singapore dengue control programme succeeded in reducing the dengue force of infection 10-fold by the 1990s and has maintained it at low levels ever since. Key to this success is consideration of dengue as an environmental disease, with a strong focus on source reduction and other environmental management methods as the dominant vector control strategy. The programme collaborates closely with other government ministries, as well as town councils, communities, the private sector, and academic and research institutions. Community engagement programmes encourage source reduction, and house-to-house inspections accompanied by a strong legislative framework with monetary penalties help to support compliance. Strong vector and epidemiological surveillance means that routine control activities can be heightened to specifically target dengue clusters. Despite its success, the programme continues to innovate to tackle challenges such as climate change, low herd immunity, and manpower constraints. Initiatives include development of novel vector controls such as Wolbachia-infected males and spatiotemporal models for dengue risk assessment. Lessons learnt from the Singapore programme can be applied to other settings, even those less well-resourced than Singapore, for more effective vector control.

by Damien Contou, Olivier Pajot, Radj Cally, Elsa Logre, Megan Fraissé, Hervé Mentec, Gaëtan Plantefève

Hypercoagulability and endotheliopathy reported in patients with coronavirus disease 2019 (COVID-19) combined with strict and prolonged immobilization inherent to deep sedation and administration of neuromuscular blockers for Acute Respiratory Distress Syndrome (ARDS) may expose critically ill COVID-19 patients to an increased risk of venous thrombosis and pulmonary embolism (PE). We aimed to assess the rate and to describe the clinical features and the outcomes of ARDS COVID-19 patients diagnosed with PE during ICU stay. From March 13th to April 24th 2020, a total of 92 patients (median age: 61 years, 1st-3rd quartiles [55–70]; males: n = 73/92, 79%; baseline SOFA: 4 [3–7] and SAPS II: 31 [21–40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 41-bed COVID-19 ICU for ARDS due to COVID-19. Among them, 26 patients (n = 26/92, 28%) underwent a Computed Tomography Pulmonary Angiography which revealed PE in 16 (n = 16/26, 62%) of them, accounting for 17% (n = 16/92) of the whole cohort. PE was bilateral in 3 (19%) patients and unilateral in 13 (81%) patients. The most proximal thrombus was localized in main (n = 4, 25%), lobar (n = 2, 12%) or segmental (n = 10, 63%) pulmonary artery. Most of the thrombi (n = 13/16, 81%) were located in a parenchymatous condensation. Only three of the 16 patients (19%) had lower limb venous thrombosis on Doppler ultrasound. Three patients were treated with alteplase and anticoagulation (n = 3/16, 19%) while the 13 others (n = 13/16, 81%) were treated with anticoagulation alone. ICU mortality was higher in patients with PE compared to that of patients without PE (n = 11/16, 69% vs. n = 2/10, 20%; p = 0.04). The low rate of lower limb venous thrombosis together with the high rate of distal pulmonary thrombus argue for a local immuno-thrombotic process associated with the classic embolic process. Further larger studies are needed to assess the real prevalence and the risk factors of pulmonary embolism/thrombosis together with its prognostic impact on critically ill patients with COVID-19.

by Dileepa Senajith Ediriweera, Nilanthi Renuka de Silva, Gathsaurie Neelika Malavige, Hithanadura Janaka de Silva
Background Sri Lanka diagnosed its first local case of COVID-19 on 11 March 2020. The government acted swiftly to contain transmission, with extensive public health measures. At the end of 30 days, Sri Lanka had 197 cases, 54 recovered and 7 deaths; a staged relaxing of the lockdown is now underway. This paper proposes a theoretical basis for estimating the limits within which transmission should be constrained in order to ensure that the case load remains within the capacity of Sri Lanka’s health system. Methods We used the Susceptible, Infected, Recovered (SIR) model to explore the number of new infections and estimate ICU bed requirement at different levels of R0 values after lifting lockdown restrictions. We developed a web-based application that enables visualization of cases and ICU bed requirements with time, with adjustable parameters that include: population at risk; number of identified and recovered cases; percentage identified; infectious period; R0 or doubling time; percentage critically ill; available ICU beds; duration of ICU stay; and uncertainty of projection. Results The three-day moving average of the caseload suggested two waves of transmission from Day 0 to 17 (R0 = 3.32, 95% CI 1.85–5.41) and from Day 18–30 (R = 1.25, 95%CI: 0.93–1.63). We estimate that if there are 156 active cases with 91 recovered at the time of lifting lockdown restrictions, and R increases to 1.5 (doubling time 19 days), under the standard parameters for Sri Lanka, the ICU bed capacity of 300 is likely to be saturated by about 100 days, signaled by 18 new infections (95% CI 15–22) on Day 14 after lifting lockdown restrictions. Conclusion Our model suggests that to ensure that the case load remains within the available capacity of the health system after lifting lockdown restrictions, transmission should not exceed R = 1.5. This model and the web-based application may be useful in other low and middle income countries which have similar constraints on health resources.

by Luis Angel Hierro, David Cantarero, David Patiño, Daniel Rodríguez-Pérez de Arenaza

This paper seeks to determine which workers affected by lockdown measures can return to work when a government decides to apply lockdown exit strategies. This system, which we call Sequential Selective Multidimensional Decision (SSMD), involves deciding sequentially, by geographical areas, sectors of activity, age groups and immunity, which workers can return to work at a given time according to the epidemiological criteria of the country as well as that of a group of reference countries, used as a benchmark, that have suffered a lower level of lockdown de-escalation strategies. We apply SSMD to Spain, based on affiliation to the Social Security system prior to the COVID-19 pandemic, and conclude that 98.37% of the population could be affected. The proposed system makes it possible to accurately identify the target population for serological IgG antibody tests in the work field, as well as those affected by special income replacement measures due to lockdown being maintained over a longer period.

by Paolo Giorgi Rossi, Massimiliano Marino, Debora Formisano, Francesco Venturelli, Massimo Vicentini, Roberto Grilli, the Reggio Emilia COVID-19 Working Group

This is a population-based prospective cohort study on archive data describing the age- and sex-specific prevalence of COVID-19 and its prognostic factors. All 2653 symptomatic patients tested positive for SARS-CoV-2 from February 27 to April 2, 2020 in the Reggio Emilia province, Italy, were included. COVID-19 cumulative incidence, hospitalization and death rates, and adjusted hazard ratios (HR) with 95% confidence interval (95% CI) were calculated according to sociodemographic and clinical characteristics. Females had higher prevalence of infection than males below age 50 (2.61 vs. 1.84 ‰), but lower in older ages (16.49 vs. 20.86 ‰ over age 80). Case fatality rate reached 20.7% in cases with more than 4 weeks follow up. After adjusting for age and comorbidities, men had a higher risk of hospitalization (HR 1.4 95% CI 1.2 to 1.6) and of death (HR 1.6, 95% CI 1.2 to 2.1). Patients over age 80 compared to age 50 had HR 7.1 (95% CI 5.4 to 9.3) and HR 27.8 (95% CI 12.5 to 61.7) for hospitalization and death, respectively. Immigrants had a higher risk of hospitalization (HR 1.3, 95% CI 0.99 to 1.81) than Italians and a similar risk of death. Risk of hospitalization and of death were higher in patients with heart failure, arrhythmia, dementia, coronary heart disease, diabetes, and hypertension, while COPD increased the risk of hospitalization (HR 1.9, 95% CI 1.4 to 2.5) but not of death (HR 1.1, 95% CI 0.7 to 1.7). Previous use of ACE inhibitors had no effect on risk of death (HR 0.97, 95% CI 0.69 to 1.34). Identified susceptible populations and fragile patients should be considered when setting priorities in public health planning and clinical decision making.

by Fenglin Liu, Jie Wang, Jiawen Liu, Yue Li, Dagong Liu, Junliang Tong, Zhuoqun Li, Dan Yu, Yifan Fan, Xiaohui Bi, Xueting Zhang, Steven Mo

In December 2019, the novel coronavirus pneumonia (COVID-19) occurred in Wuhan, Hubei Province, China. The epidemic quickly broke out and spread throughout the country. Now it becomes a pandemic that affects the whole world. In this study, three models were used to fit and predict the epidemic situation in China: a modified SEIRD (Susceptible-Exposed-Infected-Recovered-Dead) dynamic model, a neural network method LSTM (Long Short-Term Memory), and a GWR (Geographically Weighted Regression) model reflecting spatial heterogeneity. Overall, all the three models performed well with great accuracy. The dynamic SEIRD prediction APE (absolute percent error) of China had been ≤ 1.0% since Mid-February. The LSTM model showed comparable accuracy. The GWR model took into account the influence of geographical differences, with R2 = 99.98% in fitting and 97.95% in prediction. Wilcoxon test showed that none of the three models outperformed the other two at the significance level of 0.05. The parametric analysis of the infectious rate and recovery rate demonstrated that China's national policies had effectively slowed down the spread of the epidemic. Furthermore, the models in this study provided a wide range of implications for other countries to predict the short-term and long-term trend of COVID-19, and to evaluate the intensity and effect of their interventions.

Title: FIOCRUZ NO AR: Covid-19 e a automedicação de antibióticos: uma combinação perigosa
Abstract: Ainda sem a descoberta de uma vacina para erradicar a pandemia da Covid-19 – que no mundo inteiro deve alcançar um milhão de óbitos e que no Brasil, já ultrapassou mais de 113 mil mortes no Brasil – uma nova preocupação vem chamando a atenção da Organização Mundial da Saúde (OMS): o uso de antibióticos sem prescrição médica por quem sente um ou mais sintomas da Covid-19.
Tal apreensão está na sessão de perguntas e respostas do site da OMS, onde é explicado que a Covid-19 é causada por um vírus, enquanto os antibióticos foram desenvolvidos para combater infecções bacterianas. Ou seja, não funcionam contra a Covid-19. Mesmo assim, algumas pessoas, com o sintoma da doença, insistem em se automedicar com antibióticos.
Neste podcast do Projeto Fiocruz no Ar, Isabel Tavares, coordenadora das Comissões de Infecção Hospitalar, do Instituto Nacional de Infectologia Evandro Chagas, da Fundação Oswaldo Cruz, explica os riscos da automedicação de antibióticos para pacientes com Covid-19, e Marina Rangel, enfermeira da Clínica da Família, que já teve a doença e se recuperou fala sobre como os pacientes já chegam automedicados nas unidades de saúde, dificultando o tratamento da Covid-19.

Sobre o Projeto Fiocruz no Ar
O Projeto Fiocruz no Ar produz podcasts para serem distribuídos para rádios interessadas em veicular – gratuitamente – informação de qualidade, tendo como referência a expertise de 120 anos da Fundação Oswaldo Cruz – FIOCRUZ, do Ministério da Saúde. A distribuição do material também é feita pelo Whatsapp, para que a informação chegue a um maior número de pessoas.
O Projeto é uma iniciativa da Vice-Presidência de Educação, Informação e Comunicação -VPEIC, da Fundação Oswaldo Cruz/Ministério da Saúde.
Ficha Técnica Fiocruz no Ar – Covid-19 e a automedicação de antibióticos: uma combinação perigosa
Da Vice-Presidência de Educação, Informação e Comunicação – VPEIC, da Fundação Oswaldo Cruz – Fiocruz/Ministério da Saúde
Coordenadora: Graça Portela (Ascom/Icict/Fiocruz)
Consultora técnica: Ana Paula Assef (Laboratório de Pesquisa em Infecção Hospitalar, do Instituto Oswaldo Cruz – IOC/Fiocruz)
Resistência Microbiana – Covid-19 e a automedicação de antibióticos: uma combinação perigosa – Duração: 4m16s
Reportagem e Produção: Graça Portela e Rosana Pussenti
Colaboração: Juana Portugal – Comunicação | Instituto Nacional de Infectologia Evandro Chagas - INI/Fiocruz
Locução: Rosana Pussenti
Fontes: Marina Rangel – enfermeira (povo fala) | Isabel Tavares, coordenadora das Comissões de Infecção Hospitalar, do Instituto Nacional de Infectologia Evandro Chagas, da Fundação Oswaldo Cruz/Fiocruz
Edição de áudio: Daniel Beltrão (NO3 Produções Artísticas)
Trilha sonora das vinhetas: "Life of Riley", by Kevin MacLeod (incompetech.com) | Licensed under Creative Commons: By Attribution 3.0 License | http://creativecommons.org/licenses/by/3.0/
Trilha sonora incidental: “Aretes” e “Easy Lemon”, by Kevin MacLeod (incompetech.com) | Licensed under Creative Commons: By Attribution 3.0 License | http://creativecommons.org/licenses/by/3.0/
Arte: Vera Fernandes | Imagem: Reprodução Unsplash

by Paddy Ssentongo, Anna E. Ssentongo, Emily S. Heilbrunn, Djibril M. Ba, Vernon M. Chinchilli
Background Estimating the risk of pre-existing comorbidities on coronavirus disease 2019 (COVID-19) mortality may promote the importance of targeting populations at risk to improve survival. This systematic review and meta-analysis aimed to estimate the association of pre-existing comorbidities with COVID-19 mortality. Methods We searched MEDLINE, SCOPUS, OVID, and Cochrane Library databases, and medrxiv.org from December 1st, 2019, to July 9th, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing comorbidities. We analyzed 11 comorbidities: cardiovascular diseases, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS. Two reviewers independently extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. Results Eleven pre-existing comorbidities from 25 studies were included in the meta-analysis (n = 65, 484 patients with COVID-19; mean age; 61 years; 57% male). Overall, the between-study heterogeneity was medium, and studies had low publication bias and high quality. Cardiovascular disease (risk ratio (RR) 2.25, 95% CI = 1.60–3.17, number of studies (n) = 14), hypertension (1.82 [1.43 to 2.32], n = 13), diabetes (1.48 [1.02 to 2.15], n = 16), congestive heart failure (2.03 [1.28 to 3.21], n = 3), chronic kidney disease (3.25 [1.13 to 9.28)], n = 9) and cancer (1.47 [1.01 to 2.14), n = 10) were associated with a significantly greater risk of mortality from COVID-19. Conclusions Patients with COVID-19 with cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease and cancer have a greater risk of mortality compared to patients with COVID-19 without these comorbidities. Tailored infection prevention and treatment strategies targeting this high-risk population might improve survival.

by Md. Akhtarul Islam, Sutapa Dey Barna, Hasin Raihan, Md. Nafiul Alam Khan, Md. Tanvir Hossain

The purpose of this study was to investigate the prevalence of depression and anxiety among Bangladeshi university students during the COVID-19 pandemic. It also aimed at identifying the determinants of depression and anxiety. A total of 476 university students living in Bangladesh participated in this cross-sectional web-based survey. A standardized e-questionnaire was generated using the Google Form, and the link was shared through social media—Facebook. The information was analyzed in three consecutive levels, such as univariate, bivariate, and multivariate analysis. Students were experiencing heightened depression and anxiety. Around 15% of the students reportedly had moderately severe depression, whereas 18.1% were severely suffering from anxiety. The binary logistic regression suggests that older students have greater depression (OR = 2.886, 95% CI = 0.961–8.669). It is also evident that students who provided private tuition in the pre-pandemic period had depression (OR = 1.199, 95% CI = 0.736–1.952). It is expected that both the government and universities could work together to fix the academic delays and financial problems to reduce depression and anxiety among university students.

Title: Reflexões sobre o respeito à autonomia dos pacientes no contexto da Covid-19 e além
Authors: Rego, Sergio; Palácios, Marisa; Marinho, Suely; Brito, Luciana; Narciso, Luciana; Santos, Roberta Lemos; Fortes, Pablo Dias; Lopes, Fernanda
Abstract: Em abril de 2020, foi divulgado o parecer 4/2020 do Conselho Federal de Medicina-CFM (2020), de autoria do Conselheiro
Relator Mauro Luiz de Britto Ribeiro, acerca do “Tratamento de pacientes portadores de COVID-19
com cloroquina e hidroxicloroquina”. Tal parecer, cuidadoso ao apenas propor que seja
considerada a possibilidade de uso de tais medicamentos e não de recomendar tal uso, também
foi cauteloso ao finalizá-lo ressaltando que as considerações apresentadas eram baseadas no
conhecimento disponível naquele momento e que poderiam ser modificadas a qualquer tempo. O
objetivo deste ensaio não é o de discutir a pertinência ou não do uso das duas drogas no tratamento
precoce dos enfermos da Covid-19, pois consideramos que muitas publicações de estudos
científicos já apresentam evidências sobre a não-eficácia do tratamento na administração destes
medicamentos, mas é o de discutir de que forma a autonomia do paciente está sendo
Interpretada.

by Alberto Alonso-Fernández, Nuria Toledo-Pons, Borja G. Cosío, Aina Millán, Néstor Calvo, Luisa Ramón, Sara Hermoso de Mendoza, Daniel Morell-García, Josep Miquel Bauça-Rossello, Belén Núñez, Jaume Pons, Juan A. Palmer, Luisa Martín, María Peñaranda, Joan A. Pou, Jaume Sauleda, Ernest Sala-Llinas
Introduction Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1μg/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. Material and methods Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 μg/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. Results Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0–73.0) vs. 57.0 (IQR 48.0–69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p

Title: Saúde e segurança de profissionais de saúde no atendimento a pacientes no contexto da pandemia de Covid-19: revisão de literatura
Authors: Ribeiro, Adalgisa Peixoto; Oliveira, Graziella Lage; Silva, Luiz Sergio; Souza, Edinilsa Ramos de
Abstract: Objetivo: analisar a produção científica sobre a saúde dos trabalhadores da Saúde que atendem pacientes no contexto da pandemia de COVID-19. Métodos: realizou-se revisão de literatura que incluiu artigos publicados em 2020, indexados nas bases PubMed, Web of Science e na Biblioteca Virtual em Saúde (Medline e Lilacs). Resultados: foram analisados 52 artigos, segundo grupo profissional estudado, país onde a pesquisa foi realizada, tipo de estudo e tema abordado. Os conhecimentos e questões mais atuais e relevantes e as lacunas existentes sobre o tema foram evidenciados e discutidos do ponto de vista da Saúde Coletiva, particularmente da Saúde do Trabalhador. Mais da metade dos documentos foi produzida na China (55,7%) e focalizou as diferentes categorias profissionais de saúde em conjunto (57,7%). Estudos do tipo ensaio/opinião (46,1%) e estudos transversais (30,8%) foram os mais frequentes. Os temas destacados foram o conhecimento dos profissionais sobre a doença, os casos de COVID-19 entre os profissionais, a saúde mental dos trabalhadores da saúde e a segurança no trabalho. Conclusão: os estudos publicados no início da pandemia destacam a insuficiência de conhecimentos atualizados e falhas na proteção da saúde dos trabalhadores e recomendam o gerenciamento dos processos e locais de trabalho, dos casos de COVID-19, das políticas públicas e dos direitos dos trabalhadores.

by Rami M. Elshazli, Eman A. Toraih, Abdelaziz Elgaml, Mohammed El-Mowafy, Mohamed El-Mesery, Mohamed N. Amin, Mohammad H. Hussein, Mary T. Killackey, Manal S. Fawzy, Emad Kandil
Objective Evidence-based characterization of the diagnostic and prognostic value of the hematological and immunological markers related to the epidemic of Coronavirus Disease 2019 (COVID-19) is critical to understand the clinical course of the infection and to assess in development and validation of biomarkers. Methods Based on systematic search in Web of Science, PubMed, Scopus, and Science Direct up to April 22, 2020, a total of 52 eligible articles with 6,320 laboratory-confirmed COVID-19 cohorts were included. Pairwise comparison between severe versus mild disease, Intensive Care Unit (ICU) versus general ward admission and expired versus survivors were performed for 36 laboratory parameters. The pooled standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using the DerSimonian Laird method/random effects model and converted to the Odds ratio (OR). The decision tree algorithm was employed to identify the key risk factor(s) attributed to severe COVID-19 disease. Results Cohorts with elevated levels of white blood cells (WBCs) (OR = 1.75), neutrophil count (OR = 2.62), D-dimer (OR = 3.97), prolonged prothrombin time (PT) (OR = 1.82), fibrinogen (OR = 3.14), erythrocyte sedimentation rate (OR = 1.60), procalcitonin (OR = 4.76), IL-6 (OR = 2.10), and IL-10 (OR = 4.93) had higher odds of progression to severe phenotype. Decision tree model (sensitivity = 100%, specificity = 81%) showed the high performance of neutrophil count at a cut-off value of more than 3.74x109/L for identifying patients at high risk of severe COVID‐19. Likewise, ICU admission was associated with higher levels of WBCs (OR = 5.21), neutrophils (OR = 6.25), D-dimer (OR = 4.19), and prolonged PT (OR = 2.18). Patients with high IL-6 (OR = 13.87), CRP (OR = 7.09), D-dimer (OR = 6.36), and neutrophils (OR = 6.25) had the highest likelihood of mortality. Conclusions Several hematological and immunological markers, in particular neutrophilic count, could be helpful to be included within the routine panel for COVID-19 infection evaluation to ensure risk stratification and effective management.

by Antoni Sisó-Almirall, Belchin Kostov, Minerva Mas-Heredia, Sergi Vilanova-Rotllan, Ethel Sequeira-Aymar, Mireia Sans-Corrales, Elisenda Sant-Arderiu, Laia Cayuelas-Redondo, Angela Martínez-Pérez, Noemí García-Plana, August Anguita-Guimet, Jaume Benavent-Àreu
Background In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. Aim To determine clinical factors of a poor prognosis in patients with COVID-19 infection. Design and setting Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. Method Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. Results We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. Conclusion Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.

by Ross McQueenie, Hamish M. E. Foster, Bhautesh D. Jani, Srinivasa Vittal Katikireddi, Naveed Sattar, Jill P. Pell, Frederick K. Ho, Claire L. Niedzwiedz, Claire E. Hastie, Jana Anderson, Patrick B. Mark, Michael Sullivan, Catherine A. O’Donnell, Frances S. Mair, Barbara I. Nicholl
Background It is now well recognised that the risk of severe COVID-19 increases with some long-term conditions (LTCs). However, prior research primarily focuses on individual LTCs and there is a lack of data on the influence of multimorbidity (≥2 LTCs) on the risk of COVID-19. Given the high prevalence of multimorbidity, more detailed understanding of the associations with multimorbidity and COVID-19 would improve risk stratification and help protect those most vulnerable to severe COVID-19. Here we examine the relationships between multimorbidity, polypharmacy (a proxy of multimorbidity), and COVID-19; and how these differ by sociodemographic, lifestyle, and physiological prognostic factors. Methods and findings We studied data from UK Biobank (428,199 participants; aged 37–73; recruited 2006–2010) on self-reported LTCs, medications, sociodemographic, lifestyle, and physiological measures which were linked to COVID-19 test data. Poisson regression models examined risk of COVID-19 by multimorbidity/polypharmacy and effect modification by COVID-19 prognostic factors (age/sex/ethnicity/socioeconomic status/smoking/physical activity/BMI/systolic blood pressure/renal function). 4,498 (1.05%) participants were tested; 1,324 (0.31%) tested positive for COVID-19. Compared with no LTCs, relative risk (RR) of COVID-19 in those with 1 LTC was no higher (RR 1.12 (CI 0.96–1.30)), whereas those with ≥2 LTCs had 48% higher risk; RR 1.48 (1.28–1.71). Compared with no cardiometabolic LTCs, having 1 and ≥2 cardiometabolic LTCs had a higher risk of COVID-19; RR 1.28 (1.12–1.46) and 1.77 (1.46–2.15), respectively. Polypharmacy was associated with a dose response higher risk of COVID-19. All prognostic factors were associated with a higher risk of COVID-19 infection in multimorbidity; being non-white, most socioeconomically deprived, BMI ≥40 kg/m2, and reduced renal function were associated with the highest risk of COVID-19 infection: RR 2.81 (2.09–3.78); 2.79 (2.00–3.90); 2.66 (1.88–3.76); 2.13 (1.46–3.12), respectively. No multiplicative interaction between multimorbidity and prognostic factors was identified. Important limitations include the low proportion of UK Biobank participants with COVID-19 test data (1.05%) and UK Biobank participants being more affluent, healthier and less ethnically diverse than the general population. Conclusions Increasing multimorbidity, especially cardiometabolic multimorbidity, and polypharmacy are associated with a higher risk of developing COVID-19. Those with multimorbidity and additional factors, such as non-white ethnicity, are at heightened risk of COVID-19.

by Natalie J. Shook, Barış Sevi, Jerin Lee, Benjamin Oosterhoff, Holly N. Fitzgerald

The coronavirus disease 2019 (COVID-19) poses a serious global health threat. Without a vaccine, behavior change is the most effective means of reducing disease transmission. Identifying psychological factors that may encourage engagement in preventative health behaviors is crucial. The behavioral immune system (BIS) represents a set of psychological processes thought to promote health by encouraging disease avoidance behaviors. This study examined whether individual differences in BIS reactivity (germ aversion, pathogen disgust sensitivity) were associated with concern about COVID-19 and engagement in recommended preventative health behaviors (social distancing, handwashing, cleaning/disinfecting, avoiding touching face, wearing facemasks). From March 20 to 23, 2020, a US national sample (N = 1019) completed an online survey. Germ aversion and pathogen disgust sensitivity were the two variables most consistently associated with COVID-19 concern and preventative health behaviors, while accounting for demographic, health, and psychosocial covariates. Findings have implications for the development of interventions intended to increase preventative health behaviors.

by Anders Peder Højer Karlsen, Sebastian Wiberg, Jens Laigaard, Casper Pedersen, Kim Zillo Rokamp, Ole Mathiesen
Aim To identify investigated interventions for COVID-19 prevention or treatment via trial registry entries on planned or ongoing randomised clinical trials. To assess these registry entries for recruitment status, planned trial size, blinding and reporting of mortality. Methods We identified trial registry entries systematically via the WHO International Clinical Trials Registry Platform and 33 trial registries up to June 23, 2020. We included relevant trial registry entries for randomized clinical trials investigating medical preventive, adjunct or supportive therapies and therapeutics for treatment of COVID-19. Studies with non-random and single-arm design were excluded. Trial registry entries were screened by two authors independently and data were systematically extracted. Results We included 1303 trial registry entries from 71 countries investigating 381 different single interventions. Blinding was planned in 47% of trials. Sample size was >200 participants in 40% of trials and a total of 611,364 participants were planned for inclusion. Mortality was listed as an outcome in 57% of trials. Recruitment was ongoing in 54% of trials and completed in 8%. Thirty-five percent were multicenter trials. The five most frequent investigational categories were immune modulating drugs (266 trials (20%)), unconventional medicine (167 trials (13%)), antimalarial drugs (118 trials (9%)), antiviral drugs (100 trials (8%)) and respiratory adjuncts (78 trials (6%)). The five most frequently tested uni-modal interventions were: chloroquine/hydroxychloroquine (113 trials with 199,841 participants); convalescent plasma (64 trials with 11,840 participants); stem cells (51 trials with 3,370 participants); tocilizumab (19 trials with 4,139 participants) and favipiravir (19 trials with 3,210 participants). Conclusion An extraordinary number of randomized clinical trials investigating COVID-19 management have been initiated with a multitude of medical preventive, adjunctive and treatment modalities. Blinding will be used in only 47% of trials, which may have influence on future reported treatment effects. Fifty-seven percent of all trials will assess mortality as an outcome facilitating future meta-analyses.

by Patrice Abry, Nelly Pustelnik, Stéphane Roux, Pablo Jensen, Patrick Flandrin, Rémi Gribonval, Charles-Gérard Lucas, Éric Guichard, Pierre Borgnat, Nicolas Garnier

Among the different indicators that quantify the spread of an epidemic such as the on-going COVID-19, stands first the reproduction number which measures how many people can be contaminated by an infected person. In order to permit the monitoring of the evolution of this number, a new estimation procedure is proposed here, assuming a well-accepted model for current incidence data, based on past observations. The novelty of the proposed approach is twofold: 1) the estimation of the reproduction number is achieved by convex optimization within a proximal-based inverse problem formulation, with constraints aimed at promoting piecewise smoothness; 2) the approach is developed in a multivariate setting, allowing for the simultaneous handling of multiple time series attached to different geographical regions, together with a spatial (graph-based) regularization of their evolutions in time. The effectiveness of the approach is first supported by simulations, and two main applications to real COVID-19 data are then discussed. The first one refers to the comparative evolution of the reproduction number for a number of countries, while the second one focuses on French departments and their joint analysis, leading to dynamic maps revealing the temporal co-evolution of their reproduction numbers.

by Xuwen Gao, Xinjie Shi, Hongdong Guo, Yehong Liu

Drawing on a recent online survey combined with city-level data, this paper examines the impact of the COVID-19 on consumers’ online food purchase behavior in the short term. To address the potential endogeneity issues, we adopt an instrumental variable (IV) strategy, using the distance from the surveyed city to Wuhan as the instrumental variable. We show that our IV method is effective in minimizing potential bias. It is found that the share of confirmed COVID-19 cases increases the possibility of consumers purchasing food online. This is more likely to be the case for young people having a lower perceived risk of online purchases and living in large cities. Despite some limitations, this paper has policy implications for China and other countries that have been influenced by the COVID-19 epidemic. Specifically, government support and regulation should focus on (i) ensuring the safety of food sold on the internet, (ii) protecting the carrier from becoming infected, and (iii) providing financial support to the poor since they may have difficulties in obtaining access to food living in small cities. Moreover, how to help those who are unable to purchase food online because of their technical skills (e.g., the elderly who are not familiar with smart phones or the internet) also deserves more attention for the government and the public.

by Mohammad Sorowar Hossain, Mahbubul H. Siddiqee, Umme Ruman Siddiqi, Enayetur Raheem, Rokeya Akter, Wenbiao Hu

by Vincent Legros, Patricia Jeannin, Julien Burlaud-Gaillard, Thibault Chaze, Quentin Giai Gianetto, Gillian Butler-Browne, Vincent Mouly, Jim Zoladek, Philippe V. Afonso, Mariela-Natacha Gonzàlez, Mariette Matondo, Ingo Riederer, Philippe Roingeard, Antoine Gessain, Valérie Choumet, Pierre-Emmanuel Ceccaldi

Muscle cells are potential targets of many arboviruses, such as Ross River, Dengue, Sindbis, and chikungunya viruses, that may be involved in the physiopathological course of the infection. During the recent outbreak of Zika virus (ZIKV), myalgia was one of the most frequently reported symptoms. We investigated the susceptibility of human muscle cells to ZIKV infection. Using an in vitro model of human primary myoblasts that can be differentiated into myotubes, we found that myoblasts can be productively infected by ZIKV. In contrast, myotubes were shown to be resistant to ZIKV infection, suggesting a differentiation-dependent susceptibility. Infection was accompanied by a caspase-independent cytopathic effect, associated with paraptosis-like cytoplasmic vacuolization. Proteomic profiling was performed 24h and 48h post-infection in cells infected with two different isolates. Proteome changes indicate that ZIKV infection induces an upregulation of proteins involved in the activation of the Interferon type I pathway, and a downregulation of protein synthesis. This work constitutes the first observation of primary human muscle cells susceptibility to ZIKV infection, and differentiation-dependent restriction of infection from myoblasts to myotubes. Since myoblasts constitute the reservoir of stem cells involved in reparation/regeneration in muscle tissue, the infection of muscle cells and the viral-induced alterations observed here could have consequences in ZIKV infection pathogenesis.

Title: Informes semanais sobre o G20 e a OCDE na Resposta Global à COVID-19: Informes de 6 de abril a 29 de julho de 2020
Authors: Fonseca, Luiz Eduardo

Plano de Convivência com a Covid-19 nos ambientes alimentares da Fundação Oswaldo Cruz
Desde 11 de março de 2020, foi decretado pela OMS o estado de pandemia da Covid-19 e confirmado no Brasil em 16 de março de 2020. A partir de então, diversas medidas foram tomadas visando à redução da contaminação da população brasileira (OMS, 2020). Compreendendo a gravidade sanitária instaurada e em consonância com o Ministério da Saúde, a Fundação Oswaldo Cruz (Fiocruz), por meio do seu Plano de Contingência, vem adotando diversas medidas de prevenção e proteção de seus trabalhadores (FIOCRUZ, 2021). Os processos de trabalho sofreram grandes modificações, visto que sua organização apresenta um papel importante na prevenção da contaminação dos trabalhadores e na redução da disseminação do vírus, contribuindo, assim, para o enfrentamento da pandemia (FILHO et al., 2020). Levando em consideração que os serviços de alimentação são caracterizados como essenciais, torna-se necessária a elaboração de um documento para nortear as novas medidas sanitárias no que se refere aos ambientes alimentares nos campi da instituição. Tal iniciativa se configura como um incremento na adoção de medidas coletivas de controle para a segurança alimentar e nutricional da comunidade Fiocruz no que tange à saúde do trabalhador, que sendo um campo de práticas e conhecimentos da saúde coletiva, tem suas ações pautadas na vigilância, promoção e prevenção da saúde, buscando conhecer e intervir nas relações de trabalho e no processo de saúde-doença (GOMEZ et al., 2018). Portanto, este documento está em consonância com as ações voltadas à saúde dos trabalhadores da instituição, destacando a relevância das medidas de segurança alimentar e nutricional, nos ambientes alimentares da Fiocruz, no contexto da pandemia, com ênfase na prevenção e atenção à saúde dos trabalhadores. Nesse sentido, o Plano de convivência com a Covid-19 nos ambientes alimentares da Fundação Oswaldo Cruz visa a orientar os trabalhadores acerca das medidas de segurança alimentar e nutricional nos ambientes alimentares da instituição, conforme as novas medidas estabelecidas pelo Ministério da Saúde (MS) e pela Agência Nacional de Vigilância Sanitária (Anvisa) para o enfrentamento da pandemia de Covid-19, assim como pelo Plano Em defesa da vida – Convivência com a Covid-19 na Fiocruz e demais documentos elaborados pela instituição. O documento será revisado pelo grupo de trabalho responsável à medida que novas orientações forem adquiridas e de acordo com o cenário epidemiológico da doença no Brasil.

by Leticia del Carmen Castillo Signor, Thomas Edwards, Luis E. Escobar, Yolanda Mencos, Agnes Matope, Mariana Castaneda-Guzman, Emily R. Adams, Luis E. Cuevas

Dengue fever occurs worldwide and about 1% of cases progress to severe haemorrhage and shock. Dengue is endemic in Guatemala and its surveillance system could document long term trends. We analysed 17 years of country-wide dengue surveillance data in Guatemala to describe epidemiological trends from 2000 to 2016.Data from the national dengue surveillance database were analysed to describe dengue serotype frequency, seasonality, and outbreaks. We used Poisson regression models to compare the number of cases each year with subsequent years and to estimate incidence ratios within serotype adjusted by age and gender. 91,554 samples were tested. Dengue was confirmed by RT-qPCR, culture or NS1-ELISA in 7097 (7.8%) cases and was IgM ELISA-positive in 19,290 (21.1%) cases. DENV1, DENV2, DENV3, and DENV4 were detected in 2218 (39.5%), 2580 (45.9%), 591 (10.5%), and 230 (4.1%) cases. DENV1 and DENV2 were the predominant serotypes, but all serotypes caused epidemics. The largest outbreak occurred in 2010 with 1080 DENV2 cases reported. The incidence was higher among adults during epidemic years, with significant increases in 2005, 2007, and 2013 DENV1 outbreaks, the 2010 DENV2 and 2003 DENV3 outbreaks. Adults had a lower incidence immediately after epidemics, which is likely linked to increased immunity.

by Khalifa S. Al-Khalifa, Rasha AlSheikh, Abdullah S. Al-Swuailem, Muneera S. Alkhalifa, Mahmoud H. Al-Johani, Saud A. Al-Moumen, Zainab I. Almomen
Background Dental offices are among the highest risk for transmission of the COVID-19, having the potential to transmit the virus via routine dental procedures. This cross-sectional study assessed the preparedness and perception of infection control measures against the COVID-19 pandemic by dentists in Saudi Arabia. Materials and methods This online survey addressed the impact and perception of the COVID-19 pandemic on dental practice in Saudi Arabia. The questionnaire comprised 26 closed-ended questions. Descriptive statistics included frequency distributions with percentages. In addition, the significance between the different demographic variables and questions about dentists’ perception of the COVID-19 pandemic was tested using the Chi-square test. Results COVID-19 management in dental clinics varied in terms of adherence to the Ministry of Health (MOH) guidelines. Dental clinics’ screening questionnaire for patients showed good adherence (67%), while the lowest agreement was detected with the question on the existence of an airborne infection in the isolation room (15%). Almost two-thirds of the respondents agreed that the dental reception area adopted the proper COVID-19 preventive measures. Greatest accord was observed in their answers on questions about dentists’ perception of the COVID-19 pandemic, ranging from 64%–89%. In addition, there were statistically significant differences in questions about the perception of dentists towards the COVID-19 pandemic by different demographic variables such as age and years of work experience (p 0.05). Conclusion The response of most dentists regarding the preparedness and perception of infection control measures against the COVID-19 pandemic was positive. Dental clinics need to adhere more to the MOH recommendations in preparedness of their facilities or by educating their dentists and staff.

Title: Boletim Observatório COVID-19: semanas epidemiológicas 29 e 30
Abstract: O Boletim visa apresentar dados, de forma clara e didática, da situação dos estados brasileiros e do Distrito Federal, em relação ao cenário epidemiológico da Síndrome Respiratória Aguda Grave (SRAG) e da Covid-19, assim como da capacidade do sistema de saúde para o enfrentamento da pandemia.

Title: Covid-19 desnuda adoecimento da sociedade e revela a face obscura do Brasil
Authors: Guljor, Ana Paula
Abstract: Os tempos de pandemia têm confrontado povos de todo o mundo com o desafio de superar uma doença ainda sem tratamento efetivamente reconhecido. A evolução para a cura ou agravamento fatal possui um componente do imponderável, apesar dos grupos de risco possuírem taxas de letalidade mais significativas.