Monitoramento das Produções

by Russell Hays, Doris Pierce, Paul Giacomin, Alex Loukas, Peter Bourke, Robyn McDermott

by Dziedzom K. de Souza, Albert Picado, Sylvain Biéler, Sarah Nogaro, Joseph Mathu Ndung’u

by Sei Won Kim, Sung Jin Jo, Heayon Lee, Jung Hwan Oh, Jihyang Lim, Sang Haak Lee, Jung Hyun Choi, Jehoon Lee
Background Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees. Methods We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients. Results A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital. Conclusions The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.

by Tom Li, Yan Liu, Man Li, Xiaoning Qian, Susie Y. Dai

Efficient strategies to contain the coronavirus disease 2019 (COVID-19) pandemic are peremptory to relieve the negatively impacted public health and global economy, with the full scope yet to unfold. In the absence of highly effective drugs, vaccines, and abundant medical resources, many measures are used to manage the infection rate and avoid exhausting limited hospital resources. Wearing masks is among the non-pharmaceutical intervention (NPI) measures that could be effectively implemented at a minimum cost and without dramatically disrupting social practices. The mask-wearing guidelines vary significantly across countries. Regardless of the debates in the medical community and the global mask production shortage, more countries and regions are moving forward with recommendations or mandates to wear masks in public. Our study combines mathematical modeling and existing scientific evidence to evaluate the potential impact of the utilization of normal medical masks in public to combat the COVID-19 pandemic. We consider three key factors that contribute to the effectiveness of wearing a quality mask in reducing the transmission risk, including the mask aerosol reduction rate, mask population coverage, and mask availability. We first simulate the impact of these three factors on the virus reproduction number and infection attack rate in a general population. Using the intervened viral transmission route by wearing a mask, we further model the impact of mask-wearing on the epidemic curve with increasing mask awareness and availability. Our study indicates that wearing a face mask can be effectively combined with social distancing to flatten the epidemic curve. Wearing a mask presents a rational way to implement as an NPI to combat COVID-19. We recognize our study provides a projection based only on currently available data and estimates potential probabilities. As such, our model warrants further validation studies.

by Mathieu Nacher, Maylis Douine, Mélanie Gaillet, Claude Flamand, Dominique Rousset, Cyril Rousseau, Chedli Mahdaoui, Stanley Carroll, Audrey Valdes, Nathalie Passard, Gabriel Carles, Félix Djossou, Magalie Demar, Loïc Epelboin

by Glen E. Duncan, Ally R. Avery, Edmund Seto, Siny Tsang
Background Physical distancing and other COVID-19 pandemic mitigation strategies may have unintended consequences on a number of health behaviors and health outcomes. The purpose of this study was to investigate the association between perceived change in physical activity or exercise and mental health outcomes over the short-term in response to COVID-19 mitigation strategies in a sample of adult twins. Methods This was a cross-sectional study of 3,971 identical and same-sex fraternal adult twins (909 pairs, 77% identical) from the community-based Washington State Twin Registry. Participants in this study completed an online survey examining the impact of COVID-19 mitigation on a number of health-related behaviors and outcomes, administered between March 26 and April 5, 2020. In the present study, the exposure was perceived change in physical activity or exercise. The outcomes were levels of perceived anxiety and stress. Results More twin pairs reported a decrease in physical activity levels (42%) than those reporting no change (31%) or increased physical activity levels (27%). A perceived decrease in physical activity or exercise was associated with higher stress and anxiety levels. However, the physical activity–stress relationship was confounded by genetic and shared environmental factors. On the other hand, the physical activity–anxiety relationship held after controlling for genetic and shared environmental factors, although it was no longer significant after further controlling for age and sex, with older twins more likely to report lower levels of anxiety and females more likely to report higher levels of anxiety. Conclusions Strategies to mitigate the COVID-19 pandemic may be impacting physical activity and mental health, with those experiencing a decrease in physical activity also having higher levels of stress and anxiety. These relationships are confounded by genetic and shared environmental factors, in the case of stress, and age and sex, in the case of anxiety.

by Andrew Ip, Donald A. Berry, Eric Hansen, Andre H. Goy, Andrew L. Pecora, Brittany A. Sinclaire, Urszula Bednarz, Michael Marafelias, Scott M. Berry, Nicholas S. Berry, Shivam Mathura, Ihor S. Sawczuk, Noa Biran, Ronaldo C. Go, Steven Sperber, Julia A. Piwoz, Bindu Balani, Cristina Cicogna, Rani Sebti, Jerry Zuckerman, Keith M. Rose, Lisa Tank, Laurie G. Jacobs, Jason Korcak, Sarah L. Timmapuri, Joseph P. Underwood, Gregory Sugalski, Carol Barsky, Daniel W. Varga, Arif Asif, Joseph C. Landolfi, Stuart L. Goldberg

Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80–1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83–1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75–1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57–1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials.
Trial Registration: Clinicaltrials.gov Identifier: NCT04347993

by Héctor López-Carral, Klaudia Grechuta, Paul F. M. J. Verschure

The COVID-19 crisis resulted in a large proportion of the world’s population having to employ social distancing measures and self-quarantine. Given that limiting social interaction impacts mental health, we assessed the effects of quarantine on emotive perception as a proxy of affective states. To this end, we conducted an online experiment whereby 112 participants provided affective ratings for a set of normative images and reported on their well-being during COVID-19 self-isolation. We found that current valence ratings were significantly lower than the original ones from 2015. This negative shift correlated with key aspects of the personal situation during the confinement, including working and living status, and subjective well-being. These findings indicate that quarantine impacts mood negatively, resulting in a negatively biased perception of emotive stimuli. Moreover, our online assessment method shows its validity for large-scale population studies on the impact of COVID-19 related mitigation methods and well-being.

by Stefan Morreel, Hilde Philips, Veronique Verhoeven
Background During the COVID-19 pandemic, general practitioners worldwide re-organise care in very different ways because of the lack of evidence-based protocols. Objective This paper describes the organisation and the characteristics of consultations in Belgian out-of-hours primary care during five weekends at the peak of a COVID-19 outbreak and compares it to a similar period in 2019. Methods Real-time observational study using pseudonymised routine clinical data extracted out of reports from home visits, telephone- and physical consultations (iCAREdata). Nine general practice cooperatives (GPCs) participated covering a population of 1 513 523. Results All GPCs rapidly re-organised care in order to handle the outbreak and provide a safe working environment. The average consultation rate was 222 per 100 000 citizens per weekend. These consultations were handled by telephone alone in 40% (N = 6293). A diagnosis at risk of COVID-19 was registered in 6692 (43%) consultations,. Out of 5311 physical consultations, 1460 were at risk of COVID-19 of which 443 (30%) did not receive prior telephone consultation to estimate this risk. Compared to 2019, the workload initially increased due to telephone consultations but afterwards declined drastically. The physical consultation rate declined by 45% with a marked decline in diagnoses unrelated to COVID-19. Conclusions General practitioners can rapidly re-organise out-of-hours care to handle patient flows during a COVID-19 outbreak. Forty percent of the out-of-hours primary care contacts are handled by telephone consultations alone. We recommend to give a telephone consultation to all patients and not to rely on call takers to differentiate between infectious and regular care. The demand for physical consultations declined drastically provoking questions about patient’s safety for care unrelated to COVID-19.

by Michael Allen, Amir Bhanji, Jonas Willemsen, Steven Dudfield, Stuart Logan, Thomas Monks

This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 dialysis patients), but are applicable elsewhere. A discrete-event simulation was used to model a worst case spread of COVID-19, to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans. If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed. Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and inpatients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity. Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities.

by Yani Ding, Xueying Du, Qinmei Li, Miao Zhang, Qingjun Zhang, Xiaodong Tan, Qing Liu
Objective At the end of 2019, the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was a serious threat to public health. This study aimed to evaluate the risk perception of COVID-19 among college students in China during the quarantine, explore its related factors, and provide reference for future study. Methods This study invited college students from various provinces of China to participate in the survey through the Internet, and a total of 1,461 college students were included. T-test and analysis of variance were used to explore the relationship between demographic characteristics, social pressure, knowledge and risk perception. Multiple linear regression was used to identify factors associated with risk perception. Results This study shows that college students in China have high risk perception of COVID-19. Female college students (p

by Sarah Guth, Kathryn A. Hanley, Benjamin M. Althouse, Mike Boots

Pathogens originating from wildlife (zoonoses) pose a significant public health burden, comprising the majority of emerging infectious diseases. Efforts to control and prevent zoonotic disease have traditionally focused on animal-to-human transmission, or “spillover.” However, in the modern era, increasing international mobility and commerce facilitate the spread of infected humans, nonhuman animals (hereafter animals), and their products worldwide, thereby increasing the risk that zoonoses will be introduced to new geographic areas. Imported zoonoses can potentially “spill back” to infect local wildlife—a danger magnified by urbanization and other anthropogenic pressures that increase contacts between human and wildlife populations. In this way, humans can function as vectors, dispersing zoonoses from their ancestral enzootic systems to establish reservoirs elsewhere in novel animal host populations. Once established, these enzootic cycles are largely unassailable by standard control measures and have the potential to feed human epidemics. Understanding when and why translocated zoonoses establish novel enzootic cycles requires disentangling ecologically complex and stochastic interactions between the zoonosis, the human population, and the natural ecosystem. In this Review, we address this challenge by delineating potential ecological mechanisms affecting each stage of enzootic establishment—wildlife exposure, enzootic infection, and persistence—applying existing ecological concepts from epidemiology, invasion biology, and population ecology. We ground our discussion in the neotropics, where four arthropod-borne viruses (arboviruses) of zoonotic origin—yellow fever, dengue, chikungunya, and Zika viruses—have separately been introduced into the human population. This paper is a step towards developing a framework for predicting and preventing novel enzootic cycles in the face of zoonotic translocations.

Title: Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study
Authors: Prata-Barbosa, Arnaldo; Lima-Setta, Fernanda; Santos, Gustavo Rodrigues Dos; Lanziotti, Vanessa Soares; Castro, Roberta Esteves Vieira de; Souza, Daniela Carla de; Raymundo, Carlos Eduardo; Oliveira, Felipe Rezende Caino de; Lima, Lucio Flavio Peixoto de; Tonial, Cristian Tedesco; Colleti, José; Bellinat, Ana Paula Novaes; Lorenzo, Vivian Botelho; Zeitel, Raquel de Seixas; Pulcheri, Lucas; Costa, Fernanda Ciuffo Monte da; La Torre, Fabíola Peixoto Ferreira; Figueiredo, Elaine Augusta das Neves; Silva, Thiago Peres da; Riveiro, Paula Marins; Mota, Isabele Coelho Fonseca da; Brandão, Igor Bromonschenkel; Azevedo, Zina Maria Almeida de; Gregory, Simone Camera; Boedo, Fernanda Raquel Oliveira; Carvalho, Rosana Novais de; Castro, Natália Almeida de Arnaldo Silva Rodriguez; Genu, Daniel Hilário Santos; Foronda, Flavia Andrea Krepel; Cunha, Antonio José Ledo A.; Magalhães-Barbosa, Maria Clara de

Title: Crises dentro da crise: respostas, incertezas e desencontros no combate à pandemia da Covid-19 no Brasil
Authors: Henriques, Cláudio Maierovitch Pessanha; Vasconcelos, Wagner Robson Manso de
Abstract: O autores descrevem a organização, no âmbito do Sistema Único de Saúde, do arcabouço para resposta a situações de emergência em saúde pública, especificamente a preparação para a entrada da pandemia causada por Sars-CoV-2 no Brasil. São discutidas as contradições da ação do Estado em meio à grave crise político-institucional. A resistência ao conhecimento científico num ambiente de conflito político e crescimento do autoritarismo é representada na disputa de narrativas que sustentam propostas antagônicas para enfrentar a crise. Informações falsas (fake-news) alimentam a cisão e confundem-se com a própria decisão do Governo Federal de dificultar o acesso a informações. A negação da gravidade da situação e a inexistência de um plano nacional de ação são mais exuberantes no momento em que o país se torna um dos epicentros da pandemia de Covid-19.

by Justin J. Turcotte, Barry R. Meisenberg, James H. MacDonald, Nandakumar Menon, Marcia B. Fowler, Michaline West, Jane Rhule, Sadaf S. Qureshi, Eileen B. MacDonald
Background The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations. Objective To evaluate risk factors for severe illness. Design Retrospective, observational case series. Setting Single-institution. Participants First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020. Exposure None. Main outcomes and measures Intensive care unit admission or death. Results In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011–1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630–27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218–63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528–15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients. Conclusions At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.

by Chutipong Sukkanon, Jirod Nararak, Michael John Bangs, Jeffrey Hii, Theeraphap Chareonviriyaphap

Airborne spatial repellency (SR) is characterized and distinguished from other chemical actions including contact locomotor excitation and toxicity. The use of volatile spatial repellents is a potential new intervention class for combatting mosquito-borne pathogen transmission; therefore, continuing investigations on the actions of these chemicals that modify mosquito host‐seeking behavior (i.e., bite prevention) is needed. The objective of this study is to characterize the key behavioral avoidance actions of transfluthrin (TFT) to advance spatial repellent development into practical products. Behavioral avoidance responses were observed for adult laboratory strains of Aedes aegypti, Anopheles minimus and An. dirus, and two field populations of An. harrisoni and Ae. aegypti, respectively. Established TFT sublethal (LC50 and LC75), lethal concentrations (LC99) and discriminating concentrations (DCs) were selected corresponding to each mosquito test species. Spatial repellency and contact excitation (‘irritancy’) responses on adult mosquitoes to TFT were assessed using an excito-repellency assay system. At LC50, TFT exhibited strong avoidance with An. minimus (60.1% escape) and An. dirus (80% escape) laboratory strains, showing between 12 and 16x greater escape response than Ae. aegypti (5% escape). Repellency responses for field collected Ae. aegypti and An. harrisoni were 54.9 and 47.1% escape, respectively. After adjusting the initial contact escape response (a measure of combined irritancy and repellency) to estimate only escape due to contact, the LC50 and LC99 showed moderate escape irritancy with laboratory Ae. aegypti (41.4% escape) and no contact activity against the field population. Adjustment showed only weak contact activity (16.1% escape) in laboratory An. minimus at LC50. Spatial repellency is the predominant mode of action of TFT among colonized and field mosquitoes used in this study. Established baseline (susceptible) dose-response curves assist in optimizing SR products for mosquito control and pathogen transmission prevention.

by Jaqueline Goes de Jesus, Tiago Gräf, Marta Giovanetti, Maria Angélica Mares-Guia, Joilson Xavier, Maricelia Lima Maia, Vagner Fonseca, Allison Fabri, Roberto Fonseca dos Santos, Felicidade Mota Pereira, Leandro Ferraz Oliveira Santos, Luciana Reboredo de Oliveira da Silva, Zuinara Pereira Gusmão Maia, Jananci Xavier Gomes Cerqueira, Julien Thèze, Leandro Abade, Mirza de Carvalho Santana Cordeiro, Sintia Sacramento Cerqueira Torquato, Eloisa Bahia Santana, Neuza Santos de Jesus Silva, Rosemary Sarmento Oitiçica Dourado, Ademilson Brás Alves, Adeilde do Socorro Guedes, Pedro Macedo da Silva Filho, Nuno Rodrigues Faria, Carlos F. Campelo de Albuquerque, André Luiz de Abreu, Alessandro Pecego Martins Romano, Julio Croda, Rodrigo Fabiano do Carmo Said, Gabriel Muricy Cunha, Jeane Magnavita da Fonseca Cerqueira, Arabela Leal e Silva de Mello, Ana Maria Bispo de Filippis, Luiz Carlos Junior Alcantara

Yellow fever virus (YFV) causes a clinical syndrome of acute hemorrhagic hepatitis. YFV transmission involves non-human primates (NHP), mosquitoes and humans. By late 2016, Brazil experienced the largest YFV outbreak of the last 100 years, with 2050 human confirmed cases, with 681 cases ending in death and 764 confirmed epizootic cases in NHP. Among affected areas, Bahia state in Northeastern was the only region with no autochthonous human cases. By using next generation sequence approach, we investigated the molecular epidemiology of YFV in NHP in Bahia and discuss what factors might have prevented human cases. We investigated 47 YFV positive tissue samples from NHP cases to generate 8 novel YFV genomes. ML phylogenetic tree reconstructions and automated subtyping tools placed the newly generated genomes within the South American genotype I (SA I). Our analysis revealed that the YFV genomes from Bahia formed two distinct well-supported phylogenetic clusters that emerged most likely of an introduction from Minas Gerais and Espírito Santo states. Vegetation coverage analysis performed shows predominantly low to medium vegetation coverage in Bahia state. Together, our findings support the hypothesis of two independent YFV SA-I introductions. We also highlighted the effectiveness of the actions taken by epidemiological surveillance team of the state to prevented human cases.

by The PLOS ONE Staff

by Lara Jehi, Xinge Ji, Alex Milinovich, Serpil Erzurum, Amy Merlino, Steve Gordon, James B. Young, Michael W. Kattan
Background Coronavirus Disease 2019 is a pandemic that is straining healthcare resources, mainly hospital beds. Multiple risk factors of disease progression requiring hospitalization have been identified, but medical decision-making remains complex. Objective To characterize a large cohort of patients hospitalized with COVID-19, their outcomes, develop and validate a statistical model that allows individualized prediction of future hospitalization risk for a patient newly diagnosed with COVID-19. Design Retrospective cohort study of patients with COVID-19 applying a least absolute shrinkage and selection operator (LASSO) logistic regression algorithm to retain the most predictive features for hospitalization risk, followed by validation in a temporally distinct patient cohort. The final model was displayed as a nomogram and programmed into an online risk calculator. Setting One healthcare system in Ohio and Florida. Participants All patients infected with SARS-CoV-2 between March 8, 2020 and June 5, 2020. Those tested before May 1 were included in the development cohort, while those tested May 1 and later comprised the validation cohort. Measurements Demographic, clinical, social influencers of health, exposure risk, medical co-morbidities, vaccination history, presenting symptoms, medications, and laboratory values were collected on all patients, and considered in our model development. Results 4,536 patients tested positive for SARS-CoV-2 during the study period. Of those, 958 (21.1%) required hospitalization. By day 3 of hospitalization, 24% of patients were transferred to the intensive care unit, and around half of the remaining patients were discharged home. Ten patients died. Hospitalization risk was increased with older age, black race, male sex, former smoking history, diabetes, hypertension, chronic lung disease, poor socioeconomic status, shortness of breath, diarrhea, and certain medications (NSAIDs, immunosuppressive treatment). Hospitalization risk was reduced with prior flu vaccination. Model discrimination was excellent with an area under the curve of 0.900 (95% confidence interval of 0.886–0.914) in the development cohort, and 0.813 (0.786, 0.839) in the validation cohort. The scaled Brier score was 42.6% (95% CI 37.8%, 47.4%) in the development cohort and 25.6% (19.9%, 31.3%) in the validation cohort. Calibration was very good. The online risk calculator is freely available and found at https://riskcalc.org/COVID19Hospitalization/. Limitation Retrospective cohort design. Conclusion Our study crystallizes published risk factors of COVID-19 progression, but also provides new data on the role of social influencers of health, race, and influenza vaccination. In a context of a pandemic and limited healthcare resources, individualized outcome prediction through this nomogram or online risk calculator can facilitate complex medical decision-making.

by Kosmas Kosmidis, Panos Macheras

The COVID-19 pandemic has already had a shocking impact on the lives of everybody on the planet. Here, we present a modification of the classical SI model, the Fractal Kinetics SI model which is in excellent agreement with the disease outbreak data available from the World Health Organization. The fractal kinetic approach that we propose here originates from chemical kinetics and has successfully been used in the past to describe reaction dynamics when imperfect mixing and segregation of the reactants is important and affects the dynamics of the reaction. The model introduces a novel epidemiological parameter, the “fractal” exponent h which is introduced in order to account for the self-organization of the societies against the pandemic through social distancing, lockdowns and flight restrictions.

Title: Zika Virus Infects Human Placental Mast Cells and the HMC-1 Cell Line, and Triggers Degranulation, Cytokine Release and Ultrastructural Changes
Authors: Rabelo, Kíssila; Gonçalves, Antônio José da Silva; Souza, Luiz José de; Sales, Anna Paula; Lima, Sheila Maria Barbosa de; Trindade, Gisela Freitas; Ciambarella, Bianca Torres; Tasmo, Natália Recardo Amorim; Diaz, Bruno Lourenço; Carvalho, Jorge José de; Duarte, Márcia Pereira de Oliveira; Paes, Marciano Viana

by Priscila Marques de Macedo, Dayvison Francis Saraiva Freitas, Andrea Gina Varon, Cristiane da Cruz Lamas, Livia Cristina Fonseca Ferreira, Andrea d’Avila Freitas, Marcel Treptow Ferreira, Estevão Portela Nunes, Marilda Mendonça Siqueira, Valdiléa G. Veloso, Antonio Carlos Francesconi do Valle

by Nguyen Quynh Huong, Nguyen Thi Thanh Nga, Nguyen Van Long, Bach Duc Luu, Alice Latinne, Mathieu Pruvot, Nguyen Thanh Phuong, Le Tin Vinh Quang, Vo Van Hung, Nguyen Thi Lan, Nguyen Thi Hoa, Phan Quang Minh, Nguyen Thi Diep, Nguyen Tung, Van Dang Ky, Scott I. Roberton, Hoang Bich Thuy, Nguyen Van Long, Martin Gilbert, Leanne Wicker, Jonna A. K. Mazet, Christine Kreuder Johnson, Tracey Goldstein, Alex Tremeau-Bravard, Victoria Ontiveros, Damien O. Joly, Chris Walzer, Amanda E. Fine, Sarah H. Olson

Outbreaks of emerging coronaviruses in the past two decades and the current pandemic of a novel coronavirus (SARS-CoV-2) that emerged in China highlight the importance of this viral family as a zoonotic public health threat. To gain a better understanding of coronavirus presence and diversity in wildlife at wildlife-human interfaces in three southern provinces in Viet Nam 2013–2014, we used consensus Polymerase Chain Reactions to detect coronavirus sequences. In comparison to previous studies, we observed high proportions of positive samples among field rats (34.0%, 239/702) destined for human consumption and insectivorous bats in guano farms (74.8%, 234/313) adjacent to human dwellings. Most notably among field rats, the odds of coronavirus RNA detection significantly increased along the supply chain from field rats sold by traders (reference group; 20.7% positivity, 39/188) by a factor of 2.2 for field rats sold in large markets (32.0%, 116/363) and 10.0 for field rats sold and served in restaurants (55.6%, 84/151). Coronaviruses were also detected in rodents on the majority of wildlife farms sampled (60.7%, 17/28). These coronaviruses were found in the Malayan porcupines (6.0%, 20/331) and bamboo rats (6.3%, 6/96) that are raised on wildlife farms for human consumption as food. We identified six known coronaviruses in bats and rodents, clustered in three Coronaviridae genera, including the Alpha-, Beta-, and Gammacoronaviruses. Our analysis also suggested either mixing of animal excreta in the environment or interspecies transmission of coronaviruses, as both bat and avian coronaviruses were detected in rodent feces on wildlife farms. The mixing of multiple coronaviruses, and their apparent amplification along the wildlife supply chain into restaurants, suggests maximal risk for end consumers and likely underpins the mechanisms of zoonotic spillover to people.

by Elodie Calvez, Somphavanh Somlor, Souksakhone Viengphouthong, Charlotte Balière, Phaithong Bounmany, Sitsana Keosenhom, Valérie Caro, Marc Grandadam

Dengue fever is one of the major public health problems in Lao PDR. Over the last decade, dengue virus (DENV) epidemics were characterized by a novel predominant serotype accompanied by at least two other serotypes. Since 2008, DENV-2 circulated at a low level in Lao PDR but its epidemiologic profile changed at the end of 2018. Indeed, the number of confirmed DENV-2 cases suddenly increased in October 2018 and DENV-2 became predominant at the country level in early 2019. We developed a Genotype Screening Protocol (GSP) to determine the origin(s) of the Lao DENV-2 and study their genetic polymorphism. With a good correlation with full envelope gene sequencing data, this molecular epidemiology tool evidence the co-circulation of two highly polymorphic DENV-2 genotypes, i.e. Asian I and Cosmopolitan genotypes, over the last five years, suggesting multiple introductions of DENV-2 in the country. GSP approach provides relevant first line information that may help countries with limited laboratory resources to reinforce their capabilities to DENV-2 and to follow the epidemics progresses and assess situations at the regional level.

by Long Huang, Wansheng Lei, Fuming Xu, Hairong Liu, Liang Yu

The coronavirus disease (COVID-19) outbreak in December has seen more than 76,000 cases in China, causing more than 3,000 medical staff infections. As the disease is highly contagious, can be fatal in severe cases, and there are no specific medicines, it poses a huge threat to the life and health of nurses, leading to a severe impact on their emotional responses and coping strategies. Therefore, this study will investigate nurses’ emotional responses and coping styles, and conduct a comparative study with nursing college students. This study was conducted through the online survey ‘questionnaire star’ from February 1st to February 20th, 2020 in Anhui Province, using the snowball sampling method to invite subjects. The results found that women showed more severe anxiety and fear than men. Participants from cities exhibited these symptoms more than participants from rural areas, however rural participants experienced more sadness than urban participants. The nearer a COVID-19 zone is to the participants, the stronger the anxiety and anger. The COVID-19 outbreak has placed immense pressure on hospitals and those nurses at the frontline are more seriously affected. Hospitals should focus on providing psychological support to nurses and training in coping strategies.

by Li Li, Wen-Hui Liu, Zhou-Bin Zhang, Yuan Liu, Xiao-Guang Chen, Lei Luo, Chun-Quan Ou

In 2019, dengue incidences increased dramatically in many countries. However, the prospective growth in dengue incidence did not occur in Guangzhou, China. We examined the effectiveness of early start of Grade III response to dengue in Guangzhou. We extracted the data on daily number of dengue cases during 2017–2019 in Guangzhou and weekly data for Foshan and Zhongshan from the China National Notifiable Disease Reporting System, while the data on weekly number of positive ovitraps for adult and larval Aedes albopictus were obtained from Guangzhou Center for Disease Control and Prevention. We estimated the number of dengue cases prevented by bringing forward the starting time of Grade III response from September in 2017–2018 to August in 2019 in Guangzhou using a quasi-Poisson regression model and applied the Baron and Kenny’s approach to explore whether mosquito vector density was a mediator of the protective benefit. In Guangzhou, early start of Grade III response was associated with a decline in dengue incidence (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.43–0.70), with 987 (95% CI: 521–1,593) cases averted in 2019. The rate of positive ovitraps also significantly declined (RR: 0.64, 95% CI: 0.53–0.77). Moreover, both mosquito vector density and early start of Grade III response was significantly associated with dengue incidence after adjustment for each other. By comparing with the incidence in Foshan and Zhongshan where the Grade III response has not been taken, benefits from the response starting in August were confirmed but not if starting from September. Early start of Grade III response has effectively mitigated the dengue burden in Guangzhou, China, which might be partially through reducing the mosquito vector density. Our findings have important public health implications for development and implementation of dengue control interventions for Guangzhou and other locations with dengue epidemics.

by Janet Ong, Chee-Seng Chong, Grace Yap, Caleb Lee, Muhammad Aliff Abdul Razak, Suzanna Chiang, Lee-Ching Ng

House Index, Container Index, and Breteau Index are the most commonly used indices for dengue vector surveillance. However, these larval indices are a poor proxy for measuring the adult population—which is responsible for disease transmission. Information on the adult distribution and density are important for assessing transmission risk as well as for developing effective control strategies. This study introduces a new entomological index, Gravitrap aegypti index (GAI), which estimates the adult female Aedes aegypti population in the community and presents its association with dengue cases. Gravitraps were deployed across 34 treatment sites in Singapore from September 2013 to September 2016. The GAI, derived from the Gravitrap surveillance data, was analysed to investigate the spatio-temporal patterns of the Ae. aegypti population in Singapore. The index was further categorised into low, moderate, and high-risk groups and its association with dengue cases were examined. A Before-After Control Impact analysis was performed to evaluate the epidemiology impact of Gravitrap system on dengue transmission. The Ae. aegypti population exhibits a seasonal pattern, and spatial heterogeneity in Ae. aegypti abundance was observed among treatment sites. The Ae. aegypti population was also found to be unevenly distributed among floors of an apartment block, with low floors (floors 1–4) having a higher abundance of mosquitoes trapped than mid (floors 5–8) and high (floors ≥9) floors. Areas with high GAI were shown to have higher dengue case count. Gravitrap has also demonstrated to be a good dengue control tool. The contribution of cases by treatment sites to the national numbers was lower after Gravitraps deployment. The GAI, which is of better relevance to dengue transmission risk, could be recommended as an indicator for decision making in vector control efforts, and to monitor the spatio-temporal variability of the adult Aedes population in the country. In addition, findings from this study indicate that Gravitraps can be used as a dengue control tool to reduce dengue transmission.

by Tabitha E. Hoornweg, Ellen M. Bouma, Denise P.I. van de Pol, Izabela A. Rodenhuis-Zybert, Jolanda M. Smit

Chikungunya virus (CHIKV) is a re-emerging mosquito-borne alphavirus, which has rapidly spread around the globe thereby causing millions of infections. CHIKV is an enveloped virus belonging to the Togaviridae family and enters its host cell primarily via clathrin-mediated endocytosis. Upon internalization, the endocytic vesicle containing the virus particle moves through the cell and delivers the virus to early endosomes where membrane fusion is observed. Thereafter, the nucleocapsid dissociates and the viral RNA is translated into proteins. In this study, we examined the importance of the microtubule network during the early steps of infection and dissected the intracellular trafficking behavior of CHIKV particles during cell entry. We observed two distinct CHIKV intracellular trafficking patterns prior to membrane hemifusion. Whereas half of the CHIKV virions remained static during cell entry and fused in the cell periphery, the other half showed fast-directed microtubule-dependent movement prior to delivery to Rab5-positive early endosomes and predominantly fused in the perinuclear region of the cell. Disruption of the microtubule network reduced the number of infected cells. At these conditions, membrane hemifusion activity was not affected yet fusion was restricted to the cell periphery. Furthermore, follow-up experiments revealed that disruption of the microtubule network impairs the delivery of the viral genome to the cell cytosol. We therefore hypothesize that microtubules may direct the particle to a cellular location that is beneficial for establishing infection or aids in nucleocapsid uncoating.

Title: Radar Covid-19: favelas
Authors: Lima, André; Araújo, Fábio; Madureira, José Leonídio; Martins, Mariane; Gondim, Roberta; Batistella, Carlos Eduardo
Abstract: Informativo produzido no âmbito da Sala de Situação Covid-19 nas Favelas do Rio de Janeiro, vinculada ao Observatório COVID-19 da Fiocruz. Estruturado com base no monitoramento ativo (vigilância de rumores) de fontes não oficiais – mídias, redes sociais e contato direto com moradores, coletivos, movimentos sociais, instituições e articuladores locais – busca sistematizar, analisar e disseminar informações sobre a situação de saúde nos territórios selecionados, visando promover a visibilidade das diversas situações de vulnerabilidade e antecipar as iniciativas de enfrentamento da pandemia. Os relatos são coletados por meio da constituição de uma rede de interlocutores, valorizando a produção compartilhada de conhecimento, o acesso e a participação ativa de moradores de favelas e de seus movimentos sociais.
Description: Movimentos Sociais e coletivos:
Associação Raízes Gericinó
Espaço Casa Viva - RedeCCAP
Frente de Mobilização da Maré
Movimento de Mães, Pais e Responsáveis
pela Escola Pública Municipal Carioca - Movem-Rio
Movimento Negro Unificado - MNU
Organização Mulheres de Atitude - OMA;

Revisão:
Fábio Araújo
Luiza Gomes
Roberta Gondim;

Projeto Gráfico:
Mariane Martins

Title: Nota rápida de evidência: o papel das escolas na transmissão do COVID-19
Authors: Camargo, Erika Barbosa; Elias, Flávia Tavares Silva
Abstract: Tecnologia: Escolas e a transmissão do COVID-19
Indicação: Teletrabalho para servidores que possuem crianças em idade escolar
Caracterização da tecnologia: A nota rápida de evidência foi elaborada para atualizar as evidências referentes ao papel das escolas na transmissão do COVID-19. As evidências apresentadas são as que estão atualmente disponíveis e devem ser revisadas com a finalidade de renovar e de tornar público dados de importância para a saúde pública.
Contexto e Pergunta: A Fiocruz Brasília está elaborando proposta de plano de retorno e em reunião entre assessoria da Direção, o Núcleo de Epidemiologia e Vigilância em Saúde (NEVS) e o Programa de Evidencias para Políticas e Tecnologias em Saúde (PEPTS) surgiu a necessidade de uma nota de revisão rápida sobre qual a participação das escolas na transmissão do COVID-19.
Busca e análise das evidências científicas: As buscas foram realizadas no dia 24/07/2012 via OVID nas seguintes bases de dados: Database: EBM Reviews - Cochrane Database of Systematic Reviews , Embase Classic+Embase , Global Health , Joanna Briggs Institute EBP Database, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) Search Strategy: Resumo dos resultados dos estudos selecionados: No total foram encontrados 140 artigos científicos e após filtrados para revisão sistemática foram encontrados dois estudos Viner et al1 e Nussbaumer-Streit2.
A revisão sistemática de Viner et al, 20201 incluiu um total de 16 estudos e teve como objetivo responder a seguinte pergunta: o que se sabe sobre o uso, a efetividade e o custo-efetividade do distanciamento social e fechamento de escolas nas transmissão de infecções por coronavírus? No que concerne a efetividade do distanciamento social nas escolas no total 12 estudos trataram do tema, sendo que nove estudos investigaram o fechamento das escolas no surto de influenza e três estudos investigaram diretamente o COVID-19. Em Hong Kong dois estudos encontraram que as medidas de distanciamento social implementadas durante o surto de COVID-19 reduziram a transmissão da comunidade em 44%3, muito maior do que a redução estimada de 10 a 15% na transmissão da influenza4. Outro estudo conduzido em Seatle nos Estados Unidos visou examinar os efeitos na transmissão de coronavírus de comportamento endêmico e outros vírus, concluindo que a estimativa do fechamento por cinco dias resultou em uma redução de 5,6% (IC95% 4,1-6,9) nas infecções por coronavírus5. No que concerne aos estudos de modelagem para estimar o efeito do fechamento das escolas, quatro estudos foram incluídos, sendo que três tratavam de COVID-19 e um de outro tipo de infecção viral. O estudo conduzido em Wuhan na China examinou o efeito do fechamento da escola juntamente com outras medidas de distanciamento social na transmissão do COVID-19 concluindo que o pacote de medidas de distanciamento social era eficaz na redução do tamanho final e na incidência máxima do surto, além de atrasar o pico da curva de transmissao6. Outro estudo de modelagem conduzido na Inglaterra examinou o efeito do fechamento da escola separadamente de outras medidas de distanciamento social. Utilizando dados de surtos anteriores de influenza, os autores assumiram que os contatos per capita nas escolas eram o dobro daqueles em residências, locais de trabalho ou na comunidade, e que, no geral, aproximadamente um terço da transmissão ocorria nas escolas. O estudo concluiu que o fechamento da escola como uma medida isolada previa a redução do total de mortes em cerca de 2 a 4% durante um surto de COVID-19 no Reino Unido7. Um estudo de modelagem construído a partir de dados do censo Australiano, com doença semelhante à SARS em crianças em idade escolar, concluiu que uma política de fechamento escolar reduziria o R (reproduction) efetivo em 12 a 41%, dependendo da proporção de interação entre as famílias durante o horário escolar. O estudo observou que a modelagem foi baseada em suposições plausíveis em relação às características do vírus da SARS e que a obtenção de estimativas de boa qualidade dos parâmetros epidemiológicos da SARS foi difícil pois o surto foi contido rapidamente8. Os valores de R1 reportados para a transmissão de COVID-19 são altos (≥2,5) sendo que as crianças se contaminam nas mesmas taxas que os adultos, no entanto desenvolvem formas brandas ou assintomáticas da doença9. Segundo Viner et al 2020, existem poucos dados disponíveis na literatura que orientem os países sobre o fechamento de escolas durante a pandemia do COVID-19. As evidências para apoiar o fechamento de escolas para combater o COVID-19 são fracas1. Apesar de diferentes do COVID-19, dados de surtos de INFLUENZA têm sido usados como pontos de partida para prever o comportamento do COVID-19 nas escolas. As evidências disponíveis destacam uma heterogeneidade de efeitos do fechamento das escolas variando desde pouco efeito na redução da transmissão até efeitos mais substanciais.
A outra revisão sistemática de Nussbaumer-Streit2 avaliou os efeitos da quarentena de indivíduos que tiveram contato com casos confirmados de COVID-19. A revisão sistemática incluiu 29 estudos, desses, três tratam do tema escola e COVID-19. A revisão cita o estudo de modelagem de transmissão de Ferguson 20207, já citada na revisão sistemática acima de Viner1, que considerou R0 = 2- 2.6 (2.4 na linha basal), período de incubação de 5,1 dias, média de período de infecção 6,5 dias. Geng et al , 2020 10 modelou o processo de transmissão do SARS-CoV-2 e conclui que a quarentena da comunidade e fechamento das escolas em Wuhan reduziu o pico de transmissão entre 45,7% e 29,9%, respectivamente. O estudo de Fang et al 202011, citou que a implementação de uma combinação de medidas de contenção, incluindo quarentena, fechamento de escolas, restrições de viagens, cancelamento de reuniões em massa e triagem rigorosa, reduziria o R0 de 2,9 para 2,3 a partir de 2 semanas após a sua implementação. Os autores da revisão sistemática de Nussbaumer-Streit2 concluíram que estudos de modelagem fazem suposições com base no conhecimento atual ou seja na medida em que o conhecimento vai se sedimentando os modelos podem ser mais efetivos, e que resultados indicam consistentemente, que a quarentena em combinação com outras medidas incluindo o fechamento das escolas são importantes na redução da incidência e mortalidade durante a pandemia do COVID-19.
Recomendação: Baseando-se nas escassas evidências disponíveis até o momento, as duas revisões apresentaram informações favoráveis ao fechamento das escolas associado a outras medidas de isolamento social para a redução da incidência durante a pandemia do COVID-19. Evidências sobre impactos de reabertura das escolas devem ser avaliadas para reiniciar as atividades escolares.