Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study.

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Synthesis of Isatins and Oxindoles Derivatives as SARS-CoV-2 Inhibitors Evaluated through Phenotypic Screening with Vero Cells

To expand the variety of density functionalized compounds evaluated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we decided to prepare new acetylated and disubstituted 3-hydroxy bis-oxindoles and isoindigos coupling compounds using known protocols. The corresponding isatin derivatives were synthesized by ZrCl4/EtOH/reflux or HCl/AcOH/ reflux coupling conditions using oxindole and functionalized isatins, furnishing new 3-hydroxy bis-oxindoles, which were dehydrated into new isoindigos. A total of 27 compounds bearing halogen, nitro and/or hydroxy groups on the isatin moiety, at the 3-, 5- and 7-positions, were prepared, including 5 new 3-hydroxy bis-oxindoles and 3 new halogenated isoindigos prepared according adapted procedures described in the literature. This library of nitrogen-isatin derivatives was evaluated against SARS-CoV-2 using a phenotypic screening assay. In this investigation, isatin derivatives 3d, 3e, 3h and 3i showed antiviral activity when tested at a single concentration. Compound 3e showed antiviral activity against SARS-CoV-2 in the concentration-response assay, however, it showed cellular toxicity in Vero cells. The present study identified substituted isatins as a promising new starting point for the development of anti-SARS-CoV-2 agents.

Epitope identification of SARS-CoV-2 structural proteins using in silico approaches to obtain a conserved rational immunogenic peptide.

The short time between the first cases of COVID-19 and the declaration of a pandemic initiated the search for ways to stop the spread of SARS-CoV-2. There are great expectations regarding the development of effective vaccines that protect against all variants, and in the search for it, we hypothesized the obtention of a predicted rational immunogenic peptide from structural components of SARS-CoV-2 might help the vaccine research direction. In the search for a candidate of an immunogenic peptide of the SARS-CoV-2 envelope (E), membrane (M), nucleocapsid (N), or spike (S) proteins, we access the predicted sequences of each protein after the genome sequenced worldwide. We obtained the consensus amino acid sequences of about 14,441 sequences of each protein of each continent and the worldwide consensus sequence. For epitope identification and characterization from each consensus structural protein related to MHC-I or MHC-II interaction and B-cell receptor recognition, we used the IEDB reaching 68 epitopes to E, 174 to M, 245 to N, and 833 to S proteins. To select an epitope with the highest probability of binding to the MHC or BCR, all epitopes of each consensus sequence were aligned. The curation indicated 1, 4, 8, and 21 selected epitopes for E, M, N, and S proteins, respectively. Those epitopes were tested in silico for antigenicity obtaining 16 antigenic epitopes. Physicochemical properties and allergenicity evaluation of the obtained epitopes were done. Ranking the results, we obtained one epitope of each protein except for the S protein that presented two epitopes after the selection. To check the 3D position of each selected epitope in the protein structure, we used molecular homology modeling. Afterward, each selected epitope was evaluated by molecular docking to reference MHC-I or MHC-II allelic protein sequences. Taken together, the results obtained in this study showed a rational search for a putative immunogenic peptide of SARS-CoV-2 structural proteins that can improve vaccine development using in silico approaches. The epitopes selected represent the most conserved sequence of new coronavirus and may be used in a variety of vaccine development strategies since they are also presented in the described variants of SARS-CoV-2.

O impacto da pandemia em trabalhadores de um acolhimento institucional

O presente estudo apresenta resultados de uma pesquisa de opinião sobre o impacto da pandemia realizada com trabalhadores de um acolhimento institucional. A pandemia de Covid-19 é um problema mundial de saúde pública. As medidas de contingência sanitária e os procedimentos, tais como o uso de EPIs tem impactado muitos trabalhadores. O objetivo deste trabalho é avaliar o impacto da pandemia em trabalhadores de um acolhimento institucional. A amostra foi composta por 12 trabalhadores com idades entre 35 e 60 anos. O questionário utilizado foi composto por questões sobre o perfil socioeconômico e fatores associados ao isolamento e o impacto da pandemia e o uso de EPIs na rotina de trabalho. A coleta de dados foi realizada presencialmente de forma individual. Os resultados obtidos indicam que o uso de EPIs impactou de forma significativa o relacionamento dos trabalhadores com as crianças acolhidas na instituição e de forma significativa menor o relacionamento com os colegas de trabalho quando comparado com o relacionamento com as crianças. No âmbito familiar o impacto foi significativamente superior à média esperada pela escala. Referente às medidas sanitárias adotadas pela instituição a maioria dos profissionais consideraram adequadas. Esperamos que este estudo possa contribuir para que outros trabalhadores se sintam representados e que atitudes sejam tomadas para diminuir os impactos causados pela pandemia.Alternate :This study presents the results of an opinion poll on the impact of the pandemic carried out with workers from an institutional host. The Covid-19 pandemic is a worldwide public health problem. Health contingency measures and procedures, such as the use of PPE, have impacted many workers. The aim of this work is to assess the impact of the pandemic on workers in an institutional shelter. The sample consisted of 12 workers between 35 and 60 years old. The questionnaire used was composed of questions about the socioeconomic profile and factors associated with isolation and the impact of the pandemic and the use of PPE in the work routine. Data collection was carried out in person on an individual form. The results obtained indicate that the use of PPE had a significant impact on the relationship of workers with the children admitted to the institution and significantly less on the relationship with co-workers when compared to the relationship with children. Within the family, the impact was significantly higher than the average expected by the scale. Regarding the sanitary measures adopted by the institution, most professionals considered it appropriate. We hope that this study can contribute to make other workers feel represented and that actions are taken to reduce the impacts caused by the pandemic.

Building Global Capacity for COVID-19 Vaccination Through Interactive Virtual Learning (preprint)

Background: To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and SMS-messaging discussions in English and French. Methods This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data was tracked for each session and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and other). Results The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 181 countries or 93% of the WHO Member States; 78% of participants were from low-and middle-income countries (LMICs). More than 60% of participants reported using the resources provided during the sessions and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20.3% stated that the initiative “somewhat” improved their confidence. In the post-series survey, 70% of participants reported that they will “definitely use” the knowledge derived from this learning series in their work; an additional 19.7% will “probably use” and 8.6% would “possibly use” this knowledge in their work. Conclusion The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced the WHO’s ability to disseminate knowledge, normative guidance, and best practices to COVID-19 vaccination stakeholders in real-time. This approach allowed the WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and trainings to support COVID-19 vaccine introduction. The WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programmes moving forward.

Effect of Increased Alcohol Consumption During COVID-19 Pandemic on Alcohol-related Liver Disease: A Modelling Study (preprint)

Objectives The burden of alcohol-related liver disease (ALD) is surging in the US. There is evidence that alcohol consumption increased during the early periods of the coronavirus disease-2019 (COVID-19) pandemic. We describe the impact of increased alcohol consumption on alcohol-related liver disease. Design Microsimulation model Setting Model parameters estimated from publicly available data sources, including national surveys on drug and alcohol use and published studies informing the impact of alcohol consumption on ALD severity. Participants US residents Methods We extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the US born between 1950-2012. We modelled short- and long-term outcomes of current drinking patterns during COVID-19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and April 2020. We compared these outcomes with a counter-factual scenario wherein no COVID-19 occurs, and drinking patterns do not change. Reported outcomes are for individuals aged 18-65. Main outcome measures ALD-related deaths inclusive of HCC mortality, the prevalence and incidence of decompensated cirrhosis and hepatocellular carcinoma, and disability-adjusted life-years (DALYs) Results Increases in alcohol consumption during 2020 due to the COVID-19 pandemic are estimated to result in to 8,200 [95% UI 7,700 – 8,700] additional ALD-related deaths (1% increase compared with the counter-factual scenario), 17,100 [95% UI 16,100 – 18,200] cases of decompensated cirrhosis (2% increase) and 1,100 [95% UI 1,100 – 1,200] cases of HCC (1% increase) between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 [100-200] additional deaths and 2,200 [2,200-2,300] additional decompensations in patients suffering from alcohol-related liver disease. Conclusions A short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the US. Summary Box” What is already known on this topic The impact of an increase in alcohol consumption during coronavirus disease 2019 (COVID-19) on drinking trajectory changes and alcohol-related liver diseases is not known. Studies have reported increases in hospital admissions for alcohol-related liver disease or pancreatitis potentially related to COVID-19, increases in alcohol consumption, and exacerbation of pre-existing liver injury, though limited evidence exists for the long-term effect of increased drinking on alcohol-related liver cirrhosis and liver cancer in the USA. Added value of this study Our study provides new data on liver disease morbidity and mortality associated with increased consumption of alcohol during the COVID-19 pandemic. Our study suggests that drinking changes associated with the COVID-19 pandemic it is expected to lead to increases in both mortality and morbidity in the long term. to 8,200 additional ALD-related deaths, 17,100 cases of decompensated cirrhosis, and 1,100 cases of HCC between 2020 and 2040 2