Critical analysis on the use of cholecalciferol as a COVID-19 intervention: a narrative review

ABSTRACT BACKGROUND: The World Health Organization has declared that a pandemic situation exists in relation to the disease caused by the new coronavirus, COVID-19. So far, the absence of a vaccine against the new coronavirus has led people worldwide to seek various therapeutic alternatives, including use of cholecalciferol. DESIGN AND SETTING: Narrative review developed by a research group at a public university in Recife (PE), Brazil. METHODS: We searched the literature on the use of cholecalciferol for prevention or treatment of COVID-19, using the MEDLINE and LILACS databases, with the keywords "vitamin D", "cholecalciferol", "SARS-CoV-2", "COVID-19" and "coronavirus", from January 1, 2020, to June 10, 2020. Narrative reviews, cohort studies and ecological studies were selected. RESULTS: We retrieved 32 references, of which 8 were considered eligible for intensive review and critical analysis. These comprised five narrative reviews, two observational studies and one protocol proposal. Most of the studies selected reported positive effects from use of vitamin D for prevention or treatment of COVID-19. However, there was little quantitative data to assess the real impact of using this vitamin as an intervention against this disease. CONCLUSIONS: Current studies on vitamin D used for purposes other than bone health promotion cannot be taken as support to justify its use in a disease as recent as COVID-19. Studies of greater robustness, with higher levels of clinical evidence, need to be conducted. Rational use of this vitamin needs to be ensured, thereby minimizing the impacts on the patient and the public healthcare system.

SARS-CoV-2 and arbovirus infection: a rapid systematic review

ABSTRACT BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. Protocol registration number in the PROSPERO database: CRD42020183460

Clinical characteristics and outcomes among Brazilian patients with severe acute respiratory syndrome coronavirus 2 infection: an observational retrospective study

ABSTRACT BACKGROUND: Since February 2020, data on the clinical features of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their clinical evolution have been gathered and intensively discussed, especially in countries with dramatic dissemination of this disease. OBJECTIVE: To assess the clinical features of Brazilian patients with SARS-CoV-2 and analyze its local epidemiological features. DESIGN AND SETTING: Observational retrospective study conducted using data from an official electronic platform for recording confirmed SARS-CoV-2 cases. METHODS: We extracted data from patients based in the state of Pernambuco who were registered on the platform of the Center for Strategic Health Surveillance Information, between February 26 and May 25, 2020. Clinical signs/symptoms, case evolution over time, distribution of confirmed, recovered and fatal cases and relationship between age group and gender were assessed. RESULTS: We included 28,854 patients who were positive for SARS-CoV-2 (56.13% females), of median age 44.18 years. SARS-CoV-2 infection was most frequent among adults aged 30-39 years. Among cases that progressed to death, the most frequent age range was 70-79 years. Overall, the mortality rate in the cohort was 8.06%; recovery rate, 30.7%; and hospital admission rate (up to the end of follow-up), 17.3%. The average length of time between symptom onset and death was 10.3 days. The most commonly reported symptoms were coughing (42.39%), fever (38.03%) and dyspnea/respiratory distress with oxygen saturation < 95% (30.98%). CONCLUSION: Coughing, fever and dyspnea/respiratory distress with oxygen saturation < 95% were the commonest symptoms. The case-fatality rate was 8.06% and the hospitalization rate, 17.3%.