ABSTRACT
The main objective of this research is to demonstrate the effectiveness of non-pharmaceutical interventions (social isolation and quarantine) and of vaccination.The SIR epidemiological numerical model has been revised to obtain a new model (SAIRDQ), which involves additional variables: the population that died due to the disease (D), the isolated (A), quarantined population (Q) and the effect of vaccination. We have obtained the epidemiological parameters from the data, which are not constant during the evolution of the pandemic, using an iterative approximation method.Analysis of the data of infected and deceased suggest that the evolution of the coronavirus epidemic in Peru has arrived at the end of the second wave (around October 2021). We have simulated the effect of quarantine and vaccination, which are effective measures to reduce the impact of the pandemic. For a variable infection and isolation rate, due to the end of the quarantine, the death toll would be around 200 thousand;if the isolation and quarantine were relaxed since March 01, 2021, there could be more than 280 thousand deaths.Without non-pharmaceutical interventions and vaccination, the number of deaths would be much higher than 280 thousand.
ABSTRACT
Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.