T cell maturation is significantly affected by SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An adequate T cell response is essential not only for fighting disease but also for the creation of immune memory. Thus, the present study aims to evaluate the T cells of patients with moderate, severe and critical COVID-19 not only at the time of illness but also 2 months after diagnosis to observe whether changes in this compartment persist. In this study, 166 COVID-19 patients were stratified into moderate/severe and critical disease categories. The maturation and activation of T cells were evaluated through flow cytometry. In addition, Treg cells were analysed. Until 15 days after diagnosis, patients presented a reduction in absolute and relative T lymphocyte counts. After 2 months, in moderate/severe patients, the counts returned to a similar level as that of the control group. In convalescent patients who had a critical illness, absolute T lymphocyte values increased considerably. Patients with active disease did not show differentiation of T cells. Nonetheless, after 2 months, patients with critical COVID-19 showed a significant increase in CD4+ EMRA (CD45RA+ effector memory) T lymphocytes. Furthermore, COVID-19 patients showed delayed T cell activation and reduced CD8+ suppressor T cells even 2 months after diagnosis. A reduction in CD4+ Treg cells was also observed, and their numbers returned to a similar level as that of healthy controls in convalescent patients. The results demonstrate that COVID-19 patients have a delayed activation and differentiation of T cells. In addition, these patients have a great reduction of T cells with a suppressor phenotype.

Recruiting health professionals to the COVID-19 response, Brazil.

Problem: The coronavirus disease 2019 (COVID-19) pandemic posed a major workforce challenge to Brazil, which has a large land area and a shortage of health workers in regions distant from the big cities. Approach: The Brazilian health ministry implemented a computerized solution to provide rapid support to states and municipalities to hire health professionals from large urban centres to work in underserved areas during the COVID-19 pandemic. We designed an online system for health professionals to register their willingness to work on the COVID-19 response; the system was launched to the public in April 2020. Local setting: Brazil is a large country with great heterogeneity in access to health care across its different regions. Before the initiative was launched, 5 156 020 health professionals were officially registered with professional councils. However, an estimated 3 200 000, more than 60% of them, were working in the two regions with the highest standard of living. Relevant changes: Up to February 2022, 1 007 138 health professionals had self-registered on the system, providing a sizeable database of professionals from a range of disciplines. Of these, 371 275 professionals were willing to work on the COVID-19 response in remote areas. By 1 February 2022, 157 755 professionals have been trained and deployed to these underserved areas. Lessons learnt: Partnership of the government with professional councils and the use of official communication channels were important strategies to improve registration and ensure the success of the scheme. We predict that the database will assist with future public health campaigns in Brazil.

Recruiting health professionals to the COVID-19 response, Brazil Recrutement de professionnels de la santé pour lutter contre la COVID-19 au Brésil Reclutamiento de profesionales sanitarios como respuesta a la COVID-19 en Brasil توظيف أخصائيين للصحة لمواجهة كوفيد 19، البرازيل 巴西招募卫生专业人员应对新型冠状病毒肺炎 Набор медицинских работников для борьбы с COVID-19, Бразилия

Problem The coronavirus disease 2019 (COVID-19) pandemic posed a major workforce challenge to Brazil, which has a large land area and a shortage of health workers in regions distant from the big cities. Approach The Brazilian health ministry implemented a computerized solution to provide rapid support to states and municipalities to hire health professionals from large urban centres to work in underserved areas during the COVID-19 pandemic. We designed an online system for health professionals to register their willingness to work on the COVID-19 response;the system was launched to the public in April 2020. Local setting Brazil is a large country with great heterogeneity in access to health care across its different regions. Before the initiative was launched, 5 156 020 health professionals were officially registered with professional councils. However, an estimated 3 200 000, more than 60% of them, were working in the two regions with the highest standard of living. Relevant changes Up to February 2022, 1 007 138 health professionals had self-registered on the system, providing a sizeable database of professionals from a range of disciplines. Of these, 371 275 professionals were willing to work on the COVID-19 response in remote areas. By 1 February 2022, 157 755 professionals have been trained and deployed to these underserved areas. Lessons learnt Partnership of the government with professional councils and the use of official communication channels were important strategies to improve registration and ensure the success of the scheme. We predict that the database will assist with future public health campaigns in Brazil.

The relationship between peripheral immune response and disease severity in SARS-CoV-2-infected subjects: A cross-sectional study.

Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and marked by an intense inflammatory response and immune dysregulation in the most severe cases. In order to better clarify the relationship between peripheral immune system changes and the severity of COVID-19, this study aimed to evaluate the frequencies and absolute numbers of peripheral subsets of neutrophils, monocytes, and dendritic cells (DCs), in addition to quantifying the levels of inflammatory mediators. One hundred fifty-seven COVID-19 patients were stratified into mild, moderate, severe, and critical disease categories. The cellular components and circulating cytokines were assessed by flow cytometry. Nitric oxide (NOx) and myeloperoxidase (MPO) levels were measured by colourimetric tests. COVID-19 patients presented neutrophilia, with signs of emergency myelopoiesis. Alterations in the monocytic component were observed in patients with moderate to critical illness, with an increase in classical monocytes and a reduction in nonclassical monocytes, in addition to a reduction in the expression of HLA-DR in all subtypes of monocytes, indicating immunosuppression. DCs, especially plasmacytoid DCs, also showed a large reduction in moderate to critical patients. COVID-19 patients showed an increase in MPO, interleukin (IL)-12, IL-6, IL-10, and IL-8, accompanied by a reduction in IL-17A and NOx. IL-10 levels ≥14 pg/ml were strongly related to the worst outcome, with a sensitivity of 78·3% and a specificity of 79·1%. The results of this study indicate the presence of systemic effects induced by COVID-19, which appear to be related to the pathophysiology of the disease, highlighting the potential of IL-10 as a possible prognostic biomarker for COVID-19.