Investigation and control actions of an outbreak COVID-19 onset in a hospital at Campos Gerais, Parana

As a result of the COVID-19 pandemic, several hospitals around the world reported the transmission of the disease in inpatient units not directed to the care of patients affected by the disease. The objective was to report the epidemiological investigation of two outbreaks of COVID-19 in an onset of a university hospital in the general fields. It took place between July and October/2021, the data were analyzed with the SIR model (susceptible-infected-recovered) to obtain the transmission rate (R). In the first outbreak (July-August), 49 people were investigated, 25/49 (51.0%) cases, 10/25 (40.0%) staff, 15/25 (60.0%) patients, 8/25 (33.3%) medical clinic, 16/25 (66.7%) surgical clinic and 21/25 (84.0%) symptomatic. Among the cases in patients, 11/15 (73.3%) had onset of symptoms after 7 days of hospitalization. The 5W2H matrix was used as an action plan. After the execution of the actions, there were active cases for 7-10 days. The duration was 35 days, the most critical moment occurred 17 days after the first patient presented symptoms, there were 15 patients active at the same time and the R was 2.92. In the second outbreak (SeptemberOctober), 127 people were investigated and there were 6/127, of these 2/6 (33.3%) staff, 4/6 (66.6%) patients, 4/6 (66.6%) medical clinic, 2/6 (33.3%) surgical clinic, 4/6 (66.6%) symptomatic. After the execution of the actions, there were active cases for 7-10 days and there were no new cases. The duration was 18 days, the most critical moment occurred after 7 days of the first patient presenting symptoms, there were 6 people active at the same time and the R was 1.35. The first experience was effective, however late in controlling the cases. The second experiment, using data from the first, was timely, the investigation was more robust and contained the outbreak quickly and efficiently.

Factors associated with disability in patients after discharge from Intensive Care Units COVID-19

Objective: to evaluate factors associated with disability of patients after hospital discharge in COVID-19intensive care units. Methods: cross-sectional analytical research with sociodemographic, clinical, self-perception of health and WHODAS 2.0 scale data of patients discharged from a teaching hospital. Patients admitted to an intensive care unit for COVID-19 for more than eight days, discharged from the hospital at least 365 days before data collection and older than 18 years were included. Information analysis was performed using data mining. Results: 32 individuals were eligible, 25% were disabled. These individuals presented low cognition, mobility, self-care, limitation in daily activities, justified by biological and clinical parameters. Still, 37% by obesity and polymedication, 75%, impaired concentration and 50%, neurological developments. The length of hospitalization and the therapeutic resources demanded in this period were also associated with the disability observed. Conclusion: the COVID-19 virus added to the length of hospitalization and clinical factors ware related to disability 12 months after hospital discharge with strong presence of neurological symptoms. Contributions to practice: it is expected to contribute to the understanding of the long-term impacts of COVID-19, enabling to offer better assistance and quality of life to patients affected by the disease.

Non-specific blood tests as proxies for COVID-19 hospitalisation: are there plausible associations after excluding noisy predictors?

This study applied causal criteria in directed acyclic graphs for handling covariates in associations for prognosis of severe coronavirus disease 2019 (COVID-19) cases. To identify non-specific blood tests and risk factors as predictors of hospitalisation due to COVID-19, one has to exclude noisy predictors by comparing the concordance statistics (area under the curve - AUC) for positive and negative cases of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Predictors with significant AUC at negative stratum should be either controlled for their confounders or eliminated (when confounders are unavailable). Models were classified according to the difference of AUC between strata. The framework was applied to an open database with 5644 patients from Hospital Israelita Albert Einstein in Brazil with SARS-CoV-2 reverse transcription - polymerase chain reaction (RT-PCR) exam. C-reactive protein (CRP) was a noisy predictor: hospitalisation could have happened due to causes other than COVID-19 even when SARS-CoV-2 RT-PCR is positive and CRP is reactive, as most cases are asymptomatic to mild. Candidates of characteristic response from moderate-to-severe inflammation of COVID-19 were: combinations of eosinophils, monocytes and neutrophils, with age as risk factor; and creatinine, as risk factor, sharpens the odds ratio of the model with monocytes, neutrophils and age.