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The first documented cases of Coronavirus disease of 2019 (COVID-19) in Wuhan city (Hubei province, China) were caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), studies mention viral transmission is more common in indoor and poorly ventilated environments compared to outdoor environments or environments with abundant airflow. In this context, this research aimed to estimate, through a mathematical model by a Box-Behnken design, the time and occupancy required in a physical space to reach CO2 levels that exceed the risk level established as a safer condition of 700 ppm for SARS-CoV-2 transmission. According to the proposed mathematical model, it is possible to predict safe conditions. With this, it was found that natural ventilation is the best option to reduce CO2 concentration, considering the occupancy/m3 and time, allowing a constant airflow;the use of air conditioners to control the temperature in rooms without natural ventilation is suggested;notwithstanding, these types of equipment are not designed to reduce CO2 concentration. Thus, their use in rooms with open windows and doors leads to a shorter equipment lifetime, for this reason, its operation in special conditions, such as in rooms without natural ventilation should be considered
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The COVID-19 pandemic has caused a decrease in tourism activity. This has caused huge losses to the tourism industry, so different approaches have been devised for economic reactivation. This article aims to provide a novel strategy for mass molecular monitoring of clinically healthy individuals, and also including potentially asymptomatic carriers of SARS-CoV-2, who traveled to a tourist resort The monitoring consisted of collecting individual saliva samples (n=120) and conforming groups of 10 samples, thus setting 12 individual pools, which were analyzed by qRT-PCR. Obtained data showed that all the samples analyzed were negative, thus confirming that no individuals were infected with SARS-CoV-2 before and during the travel. The proposed molecular protocol allowed the analysis of massive saliva samples and detect individual infected persons (negative or positive). protocol for evaluate massive event, thus promoting the economic activation of the tourism industry.
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Background: Understanding the long-term kinetics of the immune response against SARS-CoV-2 infection is crucial in guiding public health policies and optimizing of vaccination strategies. While it is known that SARS-CoV-2 specific antibodies may persist in adults 12 months after infection, data are lacking in the pediatric population. We herein describe the long-term immune response in children following SARS-CoV-2 infection. Methods: Single-centre, prospective observational study analyzing family clusters of COVID-19 attending the Pediatric Department, University of Padua (Italy). Confirmed COVID-19 infection was defined by positive SARS-CoV-2 PCR and/or IgG serology. All patients with confirmed infection at enrolment underwent serological follow-up at 1-4, 5-10, and >10 months after infection. Plasma was analyzed to quantify anti-SARS-CoV-2 S-RBD IgG, by chemiluminescent immunoassay, performed on MAGLUMI™2000 Plus (Snibe Diagnostics). IgG title >4.3 kBAU/L was considered positive. Results: Among 902 subjects (252 COVID-19 family clusters), 698 had confirmed COVID-19, including 352 children/older siblings aged 8.6 ±5.1 years, and 346 parents aged 42.5 ±7.1 years;of those, 96.5% cases had asymptomatic/mild COVID-19. Children showed significantly higher S-RBD IgG titers than older subjects across all follow-up time points, with an overall mean S-RBD IgG titer <3 years of age five-fold higher than adults (282.3 [139-516.6] kBAU/L vs 56.7 [24.6-136.9] kBAU/L, p<0.001) (Table). The longitudinal analysis of 60 subjects sampled at least twice during follow-up demonstrated the persistence of antibodies up to 10 months from infection in all age classes. Subjects >6 years of age showed a significant progressive decline of the S-RBD IgG titer from the first serological follow-up. While, in younger children antibodies remained stable at 5-10 months of follow-up (p=0.0625), with a subsequent significant decline afterwards (p<0.001). Conclusion: In our unique family cluster cohort, we confirmed the different kinetics of the COVID-19 humoral response across several age groups of asymptomatic/mild COVID-19 cases in our family-cluster cohort. Children presented with higher S-RBD IgG titer at every time point up to 10 months of follow-up. Children less than 3 years demonstrated a more intense long-term resilience of their immune response, which started to decline significantly only after ten months from infection.
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In the context of the emerging COVID-19 pandemic, one of the great challenges is to generate effective strategies for the control of nosocomial infections, specifically in psychiatric hospitals with populations considered at risk (older adults or individuals with comorbidities). This article describes the strategies for prevention, containment and treatment of infection transmission implemented during a COVID-19 outbreak that occurred in July 2020 in a psychiatric hospital of the State of Mexico. The population was comprised by women with prolonged hospital stay (mean = 24 years), mostly geriatric (mean = 64 years), with various psychiatric disorders and comorbidities. In total, 19 COVID-19-positive cases were diagnosed, out of which thirteen had mild symptoms and six were asymptomatic. There were no alterations in mental state, psychiatric symptoms or underlying diseases. Algorithms were developed for the management and treatment of suspected/confirmed COVID-19 cases. Finally, the generation of comprehensive strategies, quick and timely actions, as well as adequate management of human resources favoring interdisciplinary work, were deemed to have contributed to contain and mitigate the COVID-19 outbreak, which constitutes a precedent in the psychiatric field with institutionalized patients.
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This article reflects on possible and necessary transformations, based on the experiences lived by teachers, students, and educational institutions throughout the year 2020, as they survived, learned and adapted to the COVID-19 pandemic. Teaching should be based on pedagogical evidence, collaborative practices, educational technology, supported by computer infrastructure and evaluative practices that foster learning, through feedback and a closer interaction between learner and teacher. The direction pointed in the future includes and is based on blended education to help students to achieve competence for professional practice. The development of interpersonal skills will be fundamental, especially in the training of health professionals. Offering opportunities for faculty development and creating communities of practice for collaborative learning will also be essential. The greater flexibility of curricula and the technological mediation of the teaching and learning process should favor exchanges and the internationalization of institutions. In this way, both undergraduate, graduate and stricto-sensu education tends to expand its scope and will no longer be limited to its original niches, expanding to national and international agreements. University spaces and face-to-face moments will be adapted to a new reality, which allows the student to acquire essential clinical and relational skills, and which require activities in the professional practice settings. In the HPE, ensuring these training moments will continue to be a fundamental requirement. Thus, classrooms, laboratories and internship fields must be safe, allowing direct guidance and supervision by teachers and preceptors. It is possible and probable that, for a long time, it will still be necessary to maintain some social distance, use of personal protective equipment, hand and environment hygiene so that students are not deprived of these experiences during their training. In the health area, it will be necessary to reaffirm that there is no dilemma between the training of health professionals and patient safety, as we experienced with the interruption of most practical activities in the HPE undergraduate courses in Brazil, during the first semester of 2020. Training health professionals, in a context of a health & sanitary emergency, is equivalent to caring for people in any context or setting. It is the same if we are talking about access to personal protective equipment or access to vaccines. The challenges are launched and the possibilities for advancement emerge and need to be taken advantage of from a cohesive work between university managers, faculty, administrative staff and students.
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After the suspension of face-to-face classes in 2020, due to the Covid-19 pandemic, it was necessary to provide emergency remote education for thousands of students at all levels of education in Brazil. No one was prepared to face such a challenge. Due to the lack of familiarity with technology-mediated education strategies, the only available at that, this situation soon brought to light signs of fatigue and stress among teachers and students. It was also noticeable the need, on the part of teachers, of training to take advantage of the existing resources for remote education at the university. The energy expended for the preparation of classes, activities, and assessments in the context of remote education was enormous and it would be necessary to acquire basic skills to keep the teaching-learning and assessment processes of students happening and with good quality. These signs and requests for help on the part of teachers and students began to become evident at the end of May 2020 at the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP). Students complained about content overload, overlapping and disorganization of the activities proposed for the virtual environment, and were very anxious about the assessments they would have at the end of the semester. On the other hand, we saw insecure teachers offering online activities, unsure of how to take care of various aspects, such as: recording attendance, engaging students in online classes and, most importantly, student assessment. In short, how to use remote education resources, starting from little or almost no previous experience? In this context, the Center of Faculty Development for Teaching (CDDE) of FMRP-USP assesses the needs of teachers and proposes a training focused on the use of the USP e-Disciplines platform, according to the basic principles of good education and student assessment. For those teachers with greater expertise in remote education, we conducted two complete courses using hybrid teaching based on the remote flipped classroom strategy. For a more novice audience or for those who would not be able to dedicate themselves to the complete course, we provided personalized help. This is the experience that we present in this article and that will serve as a basis for the necessary adaptations to face the education challenge during and after the most acute phase of the Covid-19 pandemic.
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All accumulated knowledge about the teaching and learning process, considering the best teaching practices and the concepts of adult learning, meaningful learning and student-centered learning must be continually exercised and revisited, regardless of the format: face-to-face, remote teaching (ER) or distance learning (EaD). The need to expand the use of emergency ER, determined by the pandemic crisis of 2020, has brought new challenges for teachers and students worldwide. Among the challenges is the reinterpretation of the concepts present in the teaching and learning process under the lens of the digital world. This review aims to present the best practices from the perspective of the new context of digital life in teaching for the health professions, including here the opportunities offered by the pandemic.
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The pandemic caused by the new coronavirus (SARS-CoV-2) imposed a worldwide scenario of social isolation and suspension of face-to-face teaching activities at all levels of education. It has forced the emergency adoption of remote teaching strategies to maintain the continuity of the didactic activities, even though in a limited way. On the other hand, most teachers, at all levels of education, had barely or no knowledge and experience with remote teaching. Although the educational institutions offered support, to some degree or another, it was up to individual teachers to do most of theirselves training, prepare, and deliver their subjects. Also, many courses were migrated to the virtual learning environment without the proper adaptations, which may result in worse learning outcomes. Although there are different methodologies for planning and implementing e-learning, the ADDIE model is largely popular and relatively simple to implement, and for this reason, it was chosen for the development of this article. Thus, we present the steps of analysis, design, development, implementation, and evaluation of a remote course. Additionally, we include practical elements such as an indication of equipment, software, links, and suggestions to accomplish these steps.
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Background: SARS-CoV-2 infected children are often asymptomatic or paucisymptomatic compared to adults. The immune response plays a pivotal role in dictating the clinical outcome in infected adults, but it is still poorly investigated in the pediatric population. Methods: Fifty-seven family clusters of SARS-CoV-2, attending the Department for Women's and Children's Health (University of Padova), were enrolled between March and September 2020, for a total 209 subjects. SARS-CoV-2 infection was confirmed in 155 patients (SARS+: 93 ≥15 years [group A];34 children ≥6-15 years [group B];28 children <6 years [group C]) by virus molecular detection and/or serology. In 41 available samples, measurement of SARS-CoV-2 levels (VL) was performed by an in-house quantitative One-Step ddPCR method. A blood sample was obtained at a median [IQR] of 2.8 [2.1-3.7] months after baseline (symptom's onset and/or first positive virus detection). Neutralizing antibodies (Nabs) were detected by a Plaque Reduction Neutralization Test (PRNT). Activated (CD8+CD38+HLA-DR+) and regulatory T cells (T-regs;CD4+Foxp3+CD127-CD25+) were analyzed by flow cytometry. Results: VL did not differ by age (18507 [326-339315], 6723 [3427-114587], and 21106 [162-152500] copies/5μl, in group A, B and C, respectively;overall, p=0.955). Group C had the highest PRNT titer compared to the other groups (overall, p<0.0001). Activated CD8 and regulatory T cells were significantly higher in SARS+ than in SARS- subjects (p<0.001). CD8 activated cells were significantly higher in group A compared to the other groups (p<0.001;Figure a), and were inversely correlated with PRNT titer (group A: rs=-0.527, p<0.0001;B: rs=-0.494 p=0.003;C: rs=-0.547 p<0.0001;Figure b). Conversely, T-regs were significantly higher in group C compared to the others (p<0.001;Figure c), and were positively correlated with PRNT values in children (group C: rs=0.662 p=0.0001, B: rs =0.532 p=0.001;A: rs =0.160, p=0.125;Figure d). Conclusion: Levels of SARS-CoV-2 did not differ among age classes, but adults displayed a higher T cell activation and a lower production of anti-SARS Nabs than children. Conversely, younger infected children had the highest production of anti-SARS Nabs and the lowest non-specific T cell activation, most likely due to their higher expression of regulatory T cells.
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Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke release.