COVID-19 EM CRIANÇAS E ADOLESCENTES DE BOTUCATU-SP: TENDÊNCIA E ANÁLISE DE CARACTERIZAÇÃO CLINICO EPIDEMIOLÓGICA NOS DOIS ANOS PANDÊMICOS

Introdução Entre os casos diagnosticados de SARS-CoV-2, apesar de crianças e adolescentes serem os menos acometidos, no Brasil foram registrados cerca de 2.500 óbitos por Covid-19 nesta população. Em Botucatu/SP, a tendência de casos e internações nessa população merece ser investigada, considerando a influência da vacinação em massa dos munícipes adultos em mai/2021, do retorno às aulas presenciais em ago/2021, do surgimento da ômicron em dez/2021 e do início da vacinação em crianças em fev/2022. Objetivo Analisar a tendência e o perfil clínico e epidemiológico dos casos de Covid-19 registrados em Botucatu-SP em crianças e adolescentes, no período de março de 2020 a março de 2022. Método Trata-se de estudo descritivo a partir dos dados de vigilância epidemiológica do município (E-sus, SIVEP-gripe e Vacivida), utilizando Modelo de Regressão de Poisson, Teste T e Gamma. Foram investigadas informações clínicas e gravidade da doença, para casos suspeitos de SARS-CoV-2 em menores de 18 anos (população estimada: 34.000 habitantes), e internações por Síndrome Respiratória Aguda Grave (SRAG). Resultados De 28129 casos suspeitos de infecção por SARS-CoV-2, 7204 (25,6%) foram confirmados. Cerca de 80% desta população era composta por não vacinados. Sintomatologia esteve presente em 83% dos casos de Covid-19 e maior prevalência foi observada entre dez/2021 a fev/2022. Casos de internação por Covid-19 foram também mais evidentes em jan-fev/2022, e SRAG por outras causas, ocorreu no período anterior, de ago/2021 a jan/2022. Entre os 853 casos notificados de SRAG, 31 (3,6%) eram de Covid-19, acometendo principalmente as crianças de 0-10 anos (83,9%). Em hospitalizados por Covid-19: 38,7% apresentavam comorbidades e 26% necessitaram de UTI (vs 9% SRAG não-Covid-19, p = 0,002);houve maior tempo de internação (7,8 dias vs 5,0 dias, p < 0,001) e a taxa de óbito foi de 3,2% (vs 0,9% SRAG não Covid-19, p = 0,01). Conclusão Apesar da imunidade de rebanho possivelmente refletir em diminuição de casos de Covid-19 em crianças, o retorno às aulas aumentou substancialmente casos de SRAG não Covid, e a ômicron evidentemente contribuiu no maior número de casos de SRAG por Covid-19 nessa população. Portanto, há necessidade de políticas públicas que oportunizem medidas de restrição e diagnóstico precoce de Covid-19, especialmente no ambiente escolar, local de potencial impacto na cadeia de transmissão e que pode impulsionar surtos desta e de outras doenças.

MORTALIDADE POR SÍNDROME RESPIRATÓRIA AGUDA GRAVE DURANTE A PANDEMIA DE COVID-19: INFLUÊNCIA DO CONSTRUTO TEÓRICO E ESCOLHA DO MODELO MULTIVARIADO NA VALIDADE DOS ACHADOS

Introdução Estudos de preditores de mortalidade em Síndrome Respiratória Aguda Grave (SRAG) têm inferido associações ora a partir de desfechos dicotômicos, ora a partir de modelos tempo-evento. Embora pareçam semelhantes, tais associações têm diferentes significados. Objetivo Identificar preditores de óbito em SRAG e Covid-19, comparando modelos multivariados de desfechos dicotômicos e tempo-evento. Método A partir de banco de dados de pacientes internados por SRAG (SIVEP-Gripe) residentes em Botucatu/SP (mar/2020 a mar/2022), utilizamos modelos multivariados de Poisson com desfecho binomial e modelos de riscos proporcionais (tempo-evento) de Cox para identificar fatores associados ao óbito. Resumidamente, dados demográficos, comorbidades, necessidades assistenciais e vacinas foram incluídos em um modelo único (single-step). Análises foram feitas para casos de SRAG como um todo e para os confirmados para Covid-19 isoladamente. Resultados Foram incluídos 3995 sujeitos, dos quais 1338 testaram positivo para SARS-CoV-2. Foram identificados 866 óbitos, sendo 42,8% deles por Covid-19. No total de casos de SRAG, foram preditores de mortalidade: maior idade, presença de doenças neurológicas, imunossupressão, obesidade e necessidade de suporte ventilatório invasivo, tanto utilizando o modelo de Poisson quanto o de Cox. Entretanto, o teste de Poisson revelou também que eram preditores de mortalidade a necessidade de UTI (RR: 1,624;1,331-1,981) e o diagnóstico de Covid-19 (RR: 1,245;1,058-1,465), sendo que o sexo feminino teve um efeito protetor contra a morte (RR: 0,851;0,727-0,996). Em subanálise para Covid-19, foram preditores, utilizando ambos os modelos: maior idade, presença de doenças neurológicas, necessidade de UTI e de suporte ventilatório invasivo. Entretanto, apenas o modelo de Cox demonstrou que o maior número de doses de vacinas foi um fator protetor de mortalidade (HR: 0,855;0,739-0,989). Conclusão Os achados de modelos preditores dicotômicos e tempo-evento podem diferir, e seu significado depende dos pressupostos epidemiológicos e da questão de pesquisa.

Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression.

BACKGROUND: SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown. Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression. METHODS: We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied. RESULTS: After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12). Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027). On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012). No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein). CONCLUSIONS: In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.

Playing remotely in times of crisis: A program to overcome social isolation.

OBJECTIVES: This study aims to examine the feasibility of an intergenerational remote intervention program designed to promote the wellbeing and social connection of vulnerable older adults, mainly people with aphasia and dementia during the COVID-19 pandemic in the south of Brazil. Undergraduate students were guided to lead weekly sessions of clowning, storytelling, dancing, and cooking-related activities for 3 months (from November/2020 to February/2021). METHOD: The mixed-method design of the study addresses the implementation and feasibility of the program. Data analysis considered both quantitative-number of individuals who accepted the invitation to participate, voluntary dropouts, attendance-and qualitative data-participative observation and thematic analysis of evaluative conversations. An inclusive group of 34 older adults with stroke-induced cognitive impairments, dementia and individuals without any neurological conditions enrolled in the program based on social and racial equity principles. Feasibility and acceptability were addressed in terms of recruitment, implementation, remote evaluation, delivery of remote intervention, adherence, and attendance. Activities and participants' perceptions are described. RESULTS: The initial period of the program achieved 83.7% of adherence and sustainability for additional 3 months. Preliminary results suggest feasibility and acceptability, considering formal and informal support in digital inclusion. Participatory observations describe that the structure of sessions and activities were well received. The analysis of participants' perceptions detects the thematic saliency of feelings of social connection and a sense of having learned with the group. CONCLUSIONS: Preliminary results of this study demonstrate the feasibility and acceptability of the program, pointing to its potential mental health benefits.

Mass molecular testing for COVID19 using NGS-based technology and a highly scalable workflow.

Since the first reported case of the new coronavirus infection in Wuhan, China, researchers and governments have witnessed an unseen rise in the number of cases. Thanks to the rapid work of Chinese scientists, the pathogen now called SARS-CoV-2 has been identified and its whole genome was deposited in public databases by early January 2020. The availability of the genome has allowed researchers to develop Reverse Transcription-Polymerase Chain Reaction (RT-PCR) assays, which are now the gold-standard for molecular diagnosis of the respiratory syndrome COVID19. Because of the rising number of cases and rapid spreading, the world has been facing a shortage of RT-PCR supplies, especially the ones involved in RNA extraction. This has been a major bottleneck to increase testing capacity in many countries that do not significantly manufacture these supplies, such as Brazil. Additionally, RT-qPCR scalability is highly dependent on equipment that usually performs testing of 96 samples at a time. In this work, we describe a cost-effective molecular NGS-based test for diagnosis of COVID19, which uses a single-step RNA extraction and presents high scalability and accuracy when compared to the gold-standard RT-qPCR. A single run of the NGS-based test using the Illumina NextSeq 550 mid-end sequencing equipment is able to multiplex 1,536 patient's samples, providing individual semi-qualitative results (detected, not detected). Detected results are provided with fragments per million (FPM) values, which was demonstrated to correlate with RT-qPCR Cycle Threshold (CT) values. Besides, usage of the high-end Illumina Novaseq platform may yield diagnostic for up to 6144 samples in a single run. Performance results when compared with RT-qPCR show general accuracy of 96%, and 98% when only samples with CT values (gene N) lower than 30 are considered. We have also developed an online platform, termed VarsVID, to help test executors to easily scale testing numbers. Sample registering, wet-lab worksheets generation, sample sheet for sequencing and results' display are all features provided by VarsVID. Altogether, these results will contribute to control COVID19 pandemics.

SARSCOVIDB-A New Platform for the Analysis of the Molecular Impact of SARS-CoV-2 Viral Infection.

The COVID-19 pandemic caused by the new coronavirus (SARS-CoV-2) has become a global emergency issue for public health. This threat has led to an acceleration in related research and, consequently, an unprecedented volume of clinical and experimental data that include changes in gene expression resulting from infection. The SARS-CoV-2 infection database (SARSCOVIDB: https://sarscovidb.org/) was created to mitigate the difficulties related to this scenario. The SARSCOVIDB is an online platform that aims to integrate all differential gene expression data, at messenger RNA and protein levels, helping to speed up analysis and research on the molecular impact of COVID-19. The database can be searched from different experimental perspectives and presents all related information from published data, such as viral strains, hosts, methodological approaches (proteomics or transcriptomics), genes/proteins, and samples (clinical or experimental). All information was taken from 24 articles related to analyses of differential gene expression out of 5,554 COVID-19/SARS-CoV-2-related articles published so far. The database features 12,535 genes whose expression has been identified as altered due to SARS-CoV-2 infection. Thus, the SARSCOVIDB is a new resource to support the health workers and the scientific community in understanding the pathogenesis and molecular impact caused by SARS-CoV-2.

Oncology practice during COVID-19 pandemic: a fast response is the best response

SUMMARY The first confirmed case of coronavirus disease 2019 (COVID-19) in Brasil was reported on February 25th, 2020, and by April 3rd, 8076 were confirmed in the country. As COVID-19 disease incidence escalates in Brasil, management of cancer patients requires immediate action and oncology clinics are urged to establish a contingency plan. We have installed a COVID-19 Management Committee to elaborate and implement best practices to assist cancer outpatients as well as to provide a safe environment for clinical staff and other employees at the outpatient clinics. The challenges of cancer treatment in the midst of COVID-19 global pandemic highlight the importance of a rapid response by institutions, where organizational structure, strategic planning, agility in guidelines implementation and alternative ways to protect and support clinical staff, employees and patients may be the key to mitigate pandemic effects. RESUMO O primeiro caso confirmado de Doença Associada ao Coronavírus 2019 (COVID-19) no Brasil foi confirmado em 25 de fevereiro de 2020 e em 3 de abril já haviam 8076 casos confirmados no país. A medida que a incidência de COVID-19 aumenta no Brasil, o tratamento de pacientes com câncer exige ação imediata e as clínicas oncológicas são instadas a estabelecer um plano de contingência. Instalamos um Comitê de Manejo de COVID-19 para elaborar e implementar as melhores práticas para ajudar pacientes ambulatoriais com câncer, bem como proporcionar um ambiente seguro para a equipe clínica e outros funcionários das clínicas ambulatoriais. Os desafios do tratamento do câncer em meio à pandemia global do COVID-19 destacam a importância de uma resposta rápida das instituições, onde a estrutura organizacional, o planejamento estratégico, a agilidade na implementação de diretrizes e formas alternativas de proteger e apoiar a equipe clínica, funcionários e pacientes podem ser a chave para mitigar os efeitos da pandemia.

Oncology practice during COVID-19 pandemic: a fast response is the best response.

The first confirmed case of coronavirus disease 2019 (COVID-19) in Brasil was reported on February 25th, 2020, and by April 3rd, 8076 were confirmed in the country. As COVID-19 disease incidence escalates in Brasil, management of cancer patients requires immediate action and oncology clinics are urged to establish a contingency plan. We have installed a COVID-19 Management Committee to elaborate and implement best practices to assist cancer outpatients as well as to provide a safe environment for clinical staff and other employees at the outpatient clinics. The challenges of cancer treatment in the midst of COVID-19 global pandemic highlight the importance of a rapid response by institutions, where organizational structure, strategic planning, agility in guidelines implementation and alternative ways to protect and support clinical staff, employees and patients may be the key to mitigate pandemic effects.