ABSTRACT
This is a newly developed conceivable mathematical model for analyzing the spreading behavior of COVID-19 during the first wave of the pandemic in Egypt. We emphasized the impact of detection and control measures in flattening the spread of disease. This knowledge of the early spread dynamics of infection and assessing the efficiency of control measures is critical for reviewing and evaluating the potential for sustained transmission to occur during the coming waves. This proposed empirical model for the accelerated spread phase is based on non-linear regression technique, interpolations, tangents, least-square, and optimization methods to delimit different phases of the pandemic and predict the delayed phase. We prove that our model is mathematically consistent and present various simulation results using the best-estimated parameter value. The model can be easily updated when restrictions and other issues become changed. These simulation results may guide the local authorities to make timely right decisions. Copyright © 2022 Assiut University. All rights reserved.
ABSTRACT
Background: CLD patients may experience substantial burden and disruption of life associated with COVID-19 pandemic. The aim was to assess the impact of COVID-19 pandemic on CLD patients. Methods: CLD patients from our Global Liver and Global NASH Registries (GLR/GNR) were invited to complete a COVID-19 survey with 23 items starting March 2020. Questions included whether patients had been infected with COVID-19, characteristics of the illness for those who had been infected, and various aspects of pandemicrelated disruptions of life regardless of being diagnosed with COVID-19. Results: Out of 10,500 GLR/GNR enrollees, 2500 from 7 countries completed the survey: 20% chronic hepatitis B (CHB), 14% chronic hepatitis C (CHC), and 66% non-alcoholic fatty liver disease (NAFLD), mean (SD) age 49±13 years, 53% male. Of all survey completers, 9.3% had had COVID-19. Of those infected, 86% were diagnosed by laboratory test, 93% had least one symptom, 75% received treatment for their symptoms. The mean duration of illness was 12.5±10.5 days, 64% reported receiving antiviral treatment, 19% were hospitalized, 13% needed oxygen support, no one required mechanical ventilation. Of patients regardless of COVID-19 diagnosis, 11.3% reported that the pandemic had an impact on their liver disease with 73% reporting delays in follow-up care. The Life Disruption Event Perception (LDEP) questionnaire confirmed that 81% of COVID-19-infected patients vs. 69% patients without COVID-19 (p=0.0001) experienced worsening in at least one aspect of their life (Figure). Self-assessed health scores were lower in patients with COVID-19: 6.7±2.2 vs. 7.4±2.2 (on a 1-10 scale with 10 indicating perfect health) (p<0.0001) despite having reported similar scores before the pandemic (8.5±1.4 vs. 8.4±1.6, p=0.59). The highest proportion of exercise and social impairments were reported from Turkey and Mexico, respectively. In multivariate analysis, after adjustment for country of enrollment, liver disease etiology and severity, age, sex, BMI, diabetes, history of psychiatric comorbidities, having had COVID-19 was found to be independently associated with lower self-assessed health scores (β=-0.71±0.14, p<0.0001). Conclusion: CLD patients experience substantial burden of COVID-19 pandemic on their daily lives regardless of whether they had been infected. However, self-reported health scores were lower in CLD patients with COVID-19 infection in comparison to those who did not have it.
ABSTRACT
Introduction: Owing to the similarity between SARS-CoV-2 and hepatitis C virus (both SARS-CoV-2 Mpro protease and HCV NS3/4A protease are double B-barrel folded with similar orientation), and based on molecular docking models, many researchers suggested using hepatitis C direct acting antiviral drugs (DAAs) for the treatment of SARS-CoV-2 infection. Aims & Methods: This study aimed to estimate the prevalence of SARSCoV- 2 infection among chronic hepatitis C patients receiving treatment with sofosbuvir plus daclatasvir in comparison to chronic hepatitis C patients who finished treatment course one year before COVID-19 pandemic (control group). A retrospective case-control study was designed including 500 chronic hepatitis C patients receiving treatment with sofosbuvir plus daclatasvir (study group) during COVID-19 pandemic (March to September 2020) in comparison to matched 500 individuals who finished treatment course for hepatitis C one year (March to September 2019) before COVID-19 pan demic (control group). Both groups were followed up for 6 months starting from March 2020 up to September 2020. Baseline demographic data, comorbidities, history of confirmed diagnosis of with SARS-CoV-2 infection, residence in an area endemic with SARS-CoV-2 infection or close contact with confirmed or suspected cases were compared in both groups. Results: Our study included 1000 participants (500 in each group), mean age (± standard deviation) was 48.45 (± 7.68) in the study group and 47.67 (± 10.56) in the control group (p value=0.18). Most of participants in the study were males, 400 (80%) in the study group and 380 (76%) in the control group. No significant differences were present in baseline characteristics including area of residence (rural versus urban), level of education, work in medical field, smoking, presence of liver cirrhosis or other comorbidities (Diabetes mellitus, Hypertension, Chest diseases, Cardiac disease, Autoimmune disease or Obesity). In the study group 22 (4.4%) patients had contact with SARS-CoV-2 infected patient while in the control group 24 (4.8%) individuals had contact with SARS-CoV-2 infected patient (p value= 0.88). Patient receiving chronic hepatitis C treatment with sofosbuvir plus daclatasvir had a lower rate of SARS-CoV-2 infection (2.2%, 11 SARSCoV- 2 infections) than individuals in the control group (6%, 30 SARS-CoV-2 infections). Conclusion: Chronic hepatitis C treatment (sofosbuvir plus daclatasvir) can protect against SARS-CoV-2 infection. Larger randomized controlled studies are urgently required to explore the efficacy of sofosbuvir plus daclatasvir combination as a potential therapy for SARS-CoV-2 infection.
ABSTRACT
Introduction: In response to the COVID-19 epidemic, Egypt established a unique care model based on quarantine hospitals where only externally-referred confirmed COVID-19 patients were admitted, and healthcare workers (HCWs) resided continuously over 1- to 2-week working shifts. Objectives: To estimate the risk of COVID-19 infection among HCWs in quarantine-hospital settings and assess the relative contribution of HCW-to-HCW (HtoH) and patient-to-HCW (PtoH) transmissions. Methods: Detailed longitudinal data was collected in two Egyptian healthcare facilities (hereafter denoted by Hosp1 and Hosp2), during the 2020 first wave of the COVID-19 epidemic (Hosp1: March 14th- August 1st;Hosp2: June 6th- July 11th). In both hospitals, only HCWs with no SARS-CoV-2 antibodies were allowed to start working shifts. During shifts, HCWs were tested using RT-PCR on nasopharyngeal swabs: i) routinely at the end of the shift, ii) upon symptoms, and iii) in case of outbreak suspicion (> 2 positive tests among HCWs). Using a stochastic compartmental model for the spread of SARS-CoV-2 in each hospital, we assessed the risk of SARS-CoV-2 acquisition overall and by transmission route (HtoH vs PtoH). We estimated the model parameters using Markov Chain Monte Carlo approaches. Results: Over a total follow-up of 6,601 person-days (PD), we estimated an incidence rate of 0.97 (95% CrI: 0.56-1.53) per 100 PD at Hosp1 and 8.98 (95% CrI: 3.81-17.75) per 100 PD at Hosp2. The probability for a HCW to be infected at the end of a shift was 12.8% (95% CrI: 7.6%-19.5%) for a 2-week shift at Hosp1, which lies within the range of risk levels previously documented in standard healthcare settings, whereas it was > threefold higher for a 7-day shift at Hosp2 (48.2%, 95%CrI: 23.8%-74.5%). Infection risk was mostly driven by HtoH transmission in both hospitals, although a substantial contribution from PtoH transmission was also found in Hosp2. Conclusion: The large variation in the infection risk found between the two quarantine hospitals we studied suggests that HCWs may face a high risk of infection, but that, with sufficient anticipation and infection control measures, especially those preventing patient-to-HCW transmission, this risk can be brought down to levels similar to those observed in standard healthcare settings.