Exploring the correlations between epi indicators of COVID-19 and the concentration of pharmaceutical compounds in wastewater treatment plants in Northern Portugal.

The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 µg L - 1 in WWTP2 and 123. 506 µg L - 1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g - 1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.

Remdesivir and corticosteroids in the treatment of hospitalized COVID-19 patients.

Coronavirus disease 2019 (COVID-19) is a pandemic infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2. Remdesivir (RDV) and corticosteroids are used mainly in COVID-19 patients with acute respiratory failure. The main objective of the study was to assess the effectiveness of remdesivir with and without corticosteroids in the treatment of COVID-19 patients. We conducted a prospective observational study, including adult patients consecutively hospitalized with confirmed COVID-19 and acute respiratory failure. Patients were divided according to treatment strategy: RDV alone versus RDV with corticosteroids. The primary outcome was the time to recovery in both treatment groups. We included 374 COVID-19 adult patients, 184 were treated with RDV, and 190 were treated with RDV and corticosteroid. Patients in the RDV group had a shorter time to recovery in comparison with patients in the RDV plus corticosteroids group at 28 days after admission [11 vs. 16 days (95% confidence Interval 9.7-12.8; 14.9-17.1; p = .016)]. Patients treated with RDV alone had a shorter length of hospital stay. The use of corticosteroids as adjunctive therapy of RDV was not associated with improvement in mortality of COVID-19 patients.

Retrospective Insights of the COVID-19 Epidemic in the Major Latin American City, São Paulo, Southeastern Brazil.

São Paulo is the financial center of Brazil, with a population of over 12 million, that receives travelers from all over the world for business and tourism. It was the first city in Brazil to report a case of COVID-19 that rapidly spread across the city despite the implementation of the restriction measures. Despite many reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the city of São Paulo. Thus, in this study, we provide a retrospective overview of the COVID-19 epidemic in São Paulo City, Southeastern, Brazil, by generating a total of 9995 near-complete genome sequences from all the city's different macro-regions (North, West, Central, East, South, and Southeast). Our analysis revealed that multiple independent introduction events of different variants (mainly Gamma, Delta, and Omicron) occurred throughout time. Additionally, our estimates of viral movement within the different macro-regions further suggested that the East and the Southeast regions were the largest contributors to the Gamma and Delta viral exchanges to other regions. Meanwhile, the North region had a higher contribution to the dispersion of the Omicron variant. Together, our results reinforce the importance of increasing SARS-CoV-2 genomic monitoring within the city and the country to track the real-time evolution of the virus and to detect earlier any eventual emergency of new variants of concern that could undermine the fight against COVID-19 in Brazil and worldwide.

How Anaesthesiology Helped to Fight the First Wave of the COVID-19 Pandemic in Portugal.

INTRODUCTION: The dissemination of the COVID-19 pandemic in Europe, namely in Portugal, demanded an organizational and clinical reaction from the Portuguese National Health Service. With the unpredictable impact of COVID-19 infected patients redefining hospital logistics, reducing non-priority elective care and extending the hospital capacity for critical care patients made mobilizing a significant part of human resources a priority. We conducted a national survey to monitor the contribution and the role of anaesthesiologists belonging to the 53 Portuguese National Health Service hospitals in the first wave fight against the pandemic. MATERIAL AND METHODS: This prospective cross-sectional observational study used a weekly survey sent to the Directors of the Anaesthesiology Departments of all Portuguese National Health Service hospitals, between the period of 13th April and 21st June 2020. Directors were asked about human resources, hospital logistics, anaesthetic activity and residency programs in their departments as well as contingency plans facing the impact of the pandemic growth in the PNHS. RESULTS: Contingency strategy for all Portuguese National Health Service hospitals planned for a total of 1524 level III critical care beds during the initial phases of the pandemic, an increase of 151% from the existing 607 level III critical care beds in Portugal in January 2020. This re-configuration effort of the Portuguese National Health Service was only possible due to the partial or total suspension of non-urgent elective activity that reached over 90% of these institutions in the first pandemic months (March and April) and the deployment of anaesthesiologists from their normal activities to the treatment of critical care patients. During the peak of the first pandemic wave, 209 anaesthesiology specialists and 170 trainees (22.9% of the total anaesthesiologist's staff in the Portuguese National Health Service) were deployed in critical care. There was an almost complete interruption of the residency program rotation in 70.4% of hospitals with anaesthesiology residents, between March and April 2020. CONCLUSION: During the first pandemic wave there was an effective and fast reorganisation of the Portuguese National Health Service in order to increase level III critical care beds, which might have contributed to the low mortality rates in Portugal. We believe that this could have also been a result of the contribution given by all public anaesthesiology departments.

Introdução: A disseminação da pandemia por COVID-19 na Europa, designadamente em Portugal, exigiu uma resposta clínica e organizativa por parte do Serviço Nacional de Saúde português. Com o imprevisível impacto da COVID-19 nos doentes infectados, foi prioritário redefinir a logística hospitalar, reduzir a prestação de cuidados electivos não prioritários, e estender a capacidade hospitalar ao tratamento do doente crítico, mobilizando uma parte significativa dos recursos humanos. Utilizou-se um inquérito nacional que permitisse monitorizar a contribuição que os anestesiologistas pertencentes aos 53 hospitais do Serviço Nacional de Saúde tiveram no combate à COVID-19 durante a primeira vaga da pandemia. Material e Métodos: Estudo observacional transversal de tipo prospectivo, baseado num inquérito semanal enviado aos directores dos Serviços de Anestesiologia de todos os hospitais do Serviço Nacional de Saúde, entre 13 de abril e 21 de junho de 2020. Foi solicitada informação relativa aos recursos humanos, logística hospitalar, atividade assistencial, programa de formação pós-graduado, assim como plano de contingência face ao crescimento da pandemia. Resultados: O plano de contingência hospitalar nos hospitais do Serviço Nacional de Saúde previu um total de 1524 camas de cuidados intensivos de nível III, o que corresponde a um crescimento de 151% das 607 camas existentes em janeiro de 2020. Esta reconfiguração dos hospitais do Serviço Nacional de Saúde só foi possível devido à suspensão parcial ou total da atividade eletiva não prioritária que afectou mais de 90% das instituições hospitalares nos primeiros meses da pandemia (março e abril), e à mobilização dos anestesiologistas das suas atividades eletivas para o tratamento do doente crítico. Nos piores momentos, esta mobilização envolveu 209 especialistas e 170 internos de especialidade (22,9% do total destes profissionais nos hospitais do Serviço Nacional de Saúde). Por outro lado, registou-se uma interrupção quase total do programa de formação pós-graduada em mais de 70,4% dos hospitais com esta idoneidade formativa, de março a abril de 2020. Conclusão: Durante a primeira vaga da pandemia houve uma rápida reorganização do Serviço Nacional de Saúde que poderá ter contribuído para a baixa taxa de mortalidade em Portugal. Os autores acreditam que para esse resultado poderá ainda ter contribuído a ajuda dada pelos serviços de Anestesiologia do Serviço Nacional de Saúde.

SARS-CoV-2 Lineage P.4 Detection in Southeast Brazil: A Retrospective Genomic and Clinical Overview

São Paulo state has been the epicenter of the Coronavirus Disease 2019 (COVID-19) in Brazil, ranking first by state with over six million reported cases. In February 2021, the P.4 lineage was reported in 21 cities across the state by public health authorities due to the L452R mutation. Here, by analyzing 17,304 genome sequences of SARS-CoV-2 sampled between February and August of 2021 in 476 distinct cities in São Paulo, we assess the transmission dynamics of the P.4 lineage and other SARS-CoV-2 variants that were, at the time of the study, co-circulating in the state. Additionally, clinical parameters from the city of Araras, São Paulo (N = 251) were considered to estimate the potential risk and mortality rate associated with the P.4 lineage since its higher prevalence was observed in that city. Our data suggest a low frequency (0.55%) of the P.4 lineage across the state, with the gamma variant being the dominant form in all regions (90%) at that time. Furthermore, no evidence of increased transmissibility and disease severity related to the P.4 lineage was observed. The displacement through the time of different lineages in São Paulo highlights how challenging genomic surveillance appears to track the emergence of new SARS-CoV-2 lineages, which could better guide the implementation of control measures. [ FROM AUTHOR]

A traveling SARS-CoV-2 laboratory as part of a pandemic response among vulnerable Brazilian populations.

BACKGROUND: Brazil has been dramatically hit by the SARS-CoV-2 pandemic and is a world leader in COVID-19 morbidity and mortality. Additionally, the largest country of Latin America has been a continuous source of SARS-CoV-2 variants and shows extraordinary variability of the pandemic strains probably related to the country´s outstanding position as a Latin American economical and transportation hub. Not all regions of the country show sufficient infrastructure for SARS-CoV-2 diagnosis and genotyping which can negatively impact the pandemic response. METHODS: Due to this reason and to disburden the diagnostic system of the inner São Paulo State, the Butantan Institute established the Mobile Laboratory (in Portuguese: LabMovel) for SARS-CoV-2 testing which started a trip of the most important "hotspots" of the most populous Brazilian region. The LabMovel initiated in two important cities of the State: Aparecida do Norte (an important religious center) and the Baixada Santista region which incorporates the port of Santos, the busiest in Latin America. The LabMovel was fully equipped with an automatized system for SARS-CoV-2 diagnosis and sequencing/genotyping. It also integrated the laboratory systems for patient records and results divulgation including in the Federal Brazilian Healthcare System. RESULTS: Currently,16,678 samples were tested, among them 1,217 from Aparecida and 4,564 from Baixada Santista. We tracked the delta introductio in the tested regions with its high diversification. The established mobile SARS-CoV-2 laboratory had a major impact on the Public Health System of the included cities including timely delivery of the results to the healthcare agents and the Federal Healthcare system, evaluation of the vaccination status of the positive individuals in the background of exponential vaccination process in Brazil and scientific and technological divulgation of the fieldwork to the most vulnerable populations. CONCLUSIONS: The SARS-CoV-2 pandemic has demonstrated worldwide the importance of science to fight against this viral agent and the LabMovel shows that it is possible to integrate researchers, clinicians, healthcare workers and patients to take rapid actions that can in fact mitigate this and other epidemiological situations.

Non-COVID-19 respiratory viral infection

Implemented control measures brought about by the coronavirus disease 2019 (COVID-19) pandemic have changed the prevalence of other respiratory viruses, often relegating them to a secondary plan. However, it must not be forgotten that a diverse group of viruses, including other human coronaviruses, rhinoviruses, respiratory syncytial virus, human metapneumoviruses, parainfluenza and influenza, continue to be responsible for a large burden of disease. In fact, they are among the most common causes of acute upper and lower respiratory tract infections globally. Viral respiratory infections can be categorised in several ways, including by clinical syndrome or aetiological agent. We describe their clinical spectrum. Distinctive imaging features, advances in microbiological diagnosis and treatment of severe forms are also discussed. Educational aims To summarise the knowledge on the spectrum of disease that respiratory viral infections can cause and recognise how often they overlap. To learn the most common causes of respiratory viral infections and acknowledge other less frequent agents that may target certain key populations (e.g. immunocompromised patients). To improve awareness of the recent advances in diagnostic methods, including molecular assays and helpful features in imaging techniques. To identify supportive care strategies pivotal in the management of severe respiratory viral infections. Non-COVID-19 respiratory viral infections are a major burden of disease. Emerging molecular-based detection methods and knowledge of viral lower respiratory tract infections’ distinctive features improve diagnosis, treatment and outcome of severe forms.https://bit.ly/3qMqk3T

Correction: Lesbon et al. Nucleocapsid (N) Gene Mutations of SARS-CoV-2 Can Affect Real-Time RT-PCR Diagnostic and Impact False-Negative Results. Viruses 2021, 13, 2474.

The authors hereby request the inclusion of two authors (Olivia Teixeira and Maria Cristina Nonato) in the recently published article in Viruses entitled "Nucleocapsid (N) gene mutations of SARS-CoV-2 can affect real-time RT-PCR diagnostic and impact false-negative results" [...].

Dynamics of SARS-CoV-2 Variants of Concern in Vaccination Model City in the State of Sao Paulo, Brazil.

From a country with one of the highest SARS-CoV-2 morbidity and mortality rates, Brazil has implemented one of the most successful vaccination programs. Brazil's first model city vaccination program was performed by the CoronaVac vaccine (Sinovac Biotech) in the town of Serrana, São Paulo State. To evaluate the vaccination effect on the SARS-CoV-2 molecular dynamics and clinical outcomes, we performed SARS-CoV-2 molecular surveillance on 4375 complete genomes obtained between June 2020 and April 2022 in this location. This study included the period between the initial SARS-CoV-2 introduction and during the vaccination process. We observed that the SARS-CoV-2 substitution dynamics in Serrana followed the viral molecular epidemiology in Brazil, including the initial identification of the ancestral lineages (B.1.1.28 and B.1.1.33) and epidemic waves of variants of concern (VOC) including the Gamma, Delta, and, more recently, Omicron. Most probably, as a result of the immunization campaign, the mortality during the Gamma and Delta VOC was significantly reduced compared to the rest of Brazil, which was also related to lower morbidity. Our phylogenetic analysis revealed the evolutionary history of the SARS-CoV-2 in this location and showed that multiple introduction events have occurred over time. The evaluation of the COVID-19 clinical outcome revealed that most cases were mild (88.9%, 98.1%, 99.1% to Gamma, Delta, and Omicron, respectively) regardless of the infecting VOC. In conclusion, we observed that vaccination was responsible for reducing the death toll rate and related COVID-19 morbidity, especially during the gamma and Delta VOC; however, it does not prevent the rapid substitution rate and morbidity of the Omicron VOC.

Indoor Air Quality: A Review of Cleaning Technologies

Aims: Indoor air quality (IAQ) has attracted increased attention with the emergence of COVID-19. Ventilation is perhaps the area in which the most changes have been proposed in response to the emergency caused by this virus. However, other strategies are possible, such as source control and the extraction of pollutants. The latter incorporates clean technologies, an emergent area with respect to IAQ. Method: Various air treatment technologies can be used to control contaminants, which are reviewed and discussed in this work, including physicochemical technologies (e.g., filtration, adsorption, UV-photocatalytic oxidation, ultraviolet disinfection and ionization) and biological technologies (e.g., plant purification methods and microalgae-based methods). Results and interpretation: This work reviews currently available solutions and technologies for 'cleaning';indoor air, with a focus on their advantages and disadvantages. One of the most common problems in this area is the emission of pollutants that are sometimes more dangerous to human health than those that the technologies were developed to remove. Another aspect to consider is the limitation of each technology in relation to the type of pollutants that need to be removed. Each of the investigated technologies works well for a family of pollutants with similar characteristics, but it is not applicable to all pollutant types. Thus, the optimal solution may involve the use of a combination of technologies to extend the scope of application, in addition to the development of new materials, for example, through the use of nanotechnology.

IMPACTO DA PANDEMIA DE COVID-19 NO DESFECHO DE TRATAMENTO DA TUBERCULOSE EM HOSPITAL TERCIÁRIO

Introdução O relatório global da Organização Mundial de Saúde mostrou que o número de casos novos notificados de tuberculose (TB) caiu de 7,1 para 5,8 milhões entre os anos de 2019 e 2020. Revelou também que houve aumento do número de óbitos por tuberculose, fato ocorrido pela primeira vez na última década. Objetivo Comparar a apresentação, diagnóstico e desfecho do tratamento dos casos novos notificados de tuberculose em período prévio e durante a pandemia de COVID-19. Método Trata-se de um estudo descritivo, observacional, a partir de dados secundários do sistema de informação TB-WEB referente às notificações de tuberculose de um Hospital Universitário de referência para tuberculose multirresistente, HIV e transplantes do estado de São Paulo no período pré-pandêmico (2018/2019) e pandêmico (2020/2021) de COVID-19. Foram analisadas as variáveis apresentação clínica, comorbidades e o desfecho dos casos em ambos os períodos. Resultados Entre janeiro de 2018 a dezembro de 2021, foram notificados 349 casos de tuberculose no hospital, sendo 206 em 2018/2019 e 143 em 2020/2021, o que representou um declínio de 30,6% das notificações no período pandêmico. Em relação as comorbidades associadas, o acometimento pulmonar foi observado em 63% (220/349) dos casos e 37% (129/349) apresentavam forma extrapulmonar ou disseminada, 20% (70/349) dos pacientes tinham HIV associado, 10,9% (38/349) diabetes mellitus e 57,1% (199/349) outras comorbidades. Não foram observadas diferenças estatisticamente significativas na forma de apresentação da doença e frequência das comorbidades entre os dois períodos avaliados. Dos 349 pacientes notificados, 302 tiveram desfecho no hospital, 5 foram transferidos e os demais permanecem em tratamento. O desfecho do tratamento da TB foi favorável em 74% (148/200) dos casos no pré-pandêmico e 54% (54/102) no pandêmico (p = 0,001). As taxas de óbito e o óbito por tuberculose também diferiram de forma significativa na comparação entre os períodos (p < 0,05). Conclusão Houve uma redução do número de casos notificados com tuberculose. As apresentações clínicas foram semelhantes nos dois períodos, entretanto o grau de severidade necessita ser avaliado bem como a co-apresentação TB/COVID-19. A elevação nas taxas de óbitos por tuberculose requer a reorganização dos serviços para a suspeição, diagnóstico e tratamento de forma hierarquizada na dinâmica do SUS para retomar as metas de controle da doença.

COINFECÇÃO TUBERCULOSE E COVID-19

Introdução A pandemia de COVID-19 impactou no diagnóstico e tratamento da tuberculose (TB), principalmente em relação a descoberta precoce dos casos de tuberculose e supervisão do tratamento diretamente observado. Além disto, a coinfecção TB e COVID-19 deve ser estudada no sentido de compreender a interação destes dois patógenos e o impacto na apresentação e desfechos clínicos. Objetivo Descrever e avaliar o desfecho dos casos de coinfecção tuberculose/COVID-19 em um hospital de referência. Método Trata-se de um estudo descritivo, realizado com dados secundários do banco de dados dos casos internados por Síndrome Respiratória Aguda Grave de um hospital de referência do interior paulista e do Sistema de Informação TB-WEB para confirmação dos casos notificados de tuberculose. Foram selecionados os casos de COVID-19 confirmados por RT-PCR ou critério clínico radiológico, internados no hospital, que tinham tuberculose ativa (história prévia ou atual de tuberculose). Analisado as variáveis sociodemográficas (sexo, idade e raça/cor), forma clínica (pulmonar, extrapulmonar, pulmonar e extrapulmonar), comorbidades e desfecho dos casos internados (alta para tratamento ambulatorial, óbito). Resultados Dentre os 2.565 casos de COVID-19 positivos, 2.383 foram internados. Tuberculose e COVID-19 foi diagnosticada em 14 casos, em 8 a tuberculose foi diagnosticada e curada previamente e em 6 o diagnóstico de tuberculose ativa ocorreu durante a internação por COVID-19. Das variáveis sociodemográficas, 79,0% eram do sexo masculino, 71,0% tinham mais de 40 anos de idade, 79,0% eram brancos. Em relação a forma clínica, 86,0% tinham a forma pulmonar, 14,0% a forma extrapulmonar. Quanto as comorbidades, 29,0% faziam uso de álcool, 21,0% de drogas, 21,0% tinham doença renal, 7,0% HIV, 7,0% diabetes. Em relação ao desfecho dos casos durante a internação, 9 (64%) casos receberam alta hospitalar e 5 (36,0%) foram a óbito. Dos que foram a óbito, 4 pacientes receberam o diagnóstico de TB ativa e iniciaram o tratamento intra-hospitalar, eram predominantemente adultos jovens, que faziam uso de drogas e que apresentaram resultados microbiológicos baciloscopia, TRM-TB e cultura positivos. Conclusão Observou-se a ocorrência de diagnóstico tardio de tuberculose entre os casos positivos de COVID-19 que foram internados associado à elevada letalidade.

Airline stock markets reaction to the COVID-19 outbreak and vaccines: An event study.

This paper examines the short-term market reaction of the airline industry to the declaration of COVID-19 as a global pandemic and to the announcements of the effectiveness of COVID-19 vaccines in the US. Using an event study, we observe a negative and statistically significant stock price reaction to the announcement of COVID-19 as a global pandemic. In contrast, we find a positive impact on the stock market due to the announcements of the effectiveness of COVID-19 vaccines in the US. These results are consistent with the investor sentiment hypothesis and the asset-pricing perspective. The empirical results also show a higher stock market reaction to the announcement of the effectiveness of the Pfizer-BioNTech COVID-19 vaccine in the US compared to the announcements of the effectiveness of subsequent vaccines. This result is explained by the innovation race competition effect and the greater reduction in investor uncertainty levels. These reactions were reinforced or mitigated by firm-specific characteristics such as liquidity, size, leverage, ownership concentration, state control and business model (i.e., low-cost versus full-service).

Genomic epidemiology of the SARS-CoV-2 epidemic in Brazil.

The high numbers of COVID-19 cases and deaths in Brazil have made Latin America an epicentre of the pandemic. SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, but important gaps remain in our understanding of virus transmission dynamics at a national scale. We use 17,135 near-complete genomes sampled from 27 Brazilian states and bordering country Paraguay. From March to November 2020, we detected co-circulation of multiple viral lineages that were linked to multiple importations (predominantly from Europe). After November 2020, we detected large, local transmission clusters within the country. In the absence of effective restriction measures, the epidemic progressed, and in January 2021 there was emergence and onward spread, both within and abroad, of variants of concern and variants under monitoring, including Gamma (P.1) and Zeta (P.2). We also characterized a genomic overview of the epidemic in Paraguay and detected evidence of importation of SARS-CoV-2 ancestor lineages and variants of concern from Brazil. Our findings show that genomic surveillance in Brazil enabled assessment of the real-time spread of emerging SARS-CoV-2 variants.

Online Financing without FinTech: Evidence from Online Informal Loans

We present the first comprehensive dataset on an online informal micro-lending community. These informal loans are small, short duration and high-cost. Using our unique micro data, and the Covid-19 pandemic as a laboratory, we uncover different types of information contained on loan terms and on the narratives of market participants. First, loan terms reflect the aggregate economic context of borrowers and lenders. Second, narratives among market participants contain additional and timely information about aggregate and individual borrower circumstances. Third, lenders imperfectly screen on both loan terms and narrative information. These findings highlight the role of data in FinTech. Transparency on micro-loans can improve the efficiency of the credit market, democratizing access to finance for borrowers, while protecting lenders.

Indoor Air Quality in Elderly Centers: Pollutants Emission and Health Effects

The world population is ageing, in particular in the developed world, with a significant increase in the percentage of people above 60 years old. They represent a segment of the population that is more vulnerable to adverse environmental conditions. Among them, indoor air quality is one of the most relevant, as elders spend comparatively more time indoors than younger generations. Furthermore, the recent COVID-19 pandemic contributed immensely to raising awareness of the importance of breathing air quality for human health and of the fact that indoor air is a vector for airborne infections and poisoning. Hence, this work reviews the state of the art regarding indoor air quality in elderly centers, considering the type of pollutants involved, their emission sources, and their health effects. Moreover, the influence of ventilation on air quality is also addressed. Notwithstanding the potential health problems with the corresponding costs and morbidity effects, only a few studies have considered explicitly indoor air quality and its impacts on elderly health. More studies are, therefore, necessary to objectively identify what are the impacts on the health of elderly people due to the quality of indoor air and how it can be improved, either by reducing the pollutants emission sources or by more adequate ventilation and thermal comfort strategies.

The Divergent Pattern of SARS-CoV-2 Variant Predominance and Transmission Dynamics in the Brazilian Island of Ilhabela.

Our effort in SARS-CoV-2 genomic surveillance in Brazil has detected the Alpha Variant of Concern with a predominance higher than 75% in the population of Ilhabela island (São Paulo State) at a time when the Gamma VOC was already predominating the mainland raised concerns for closer surveillance on this island. Therefore, we intensified the surveillance for 24 weeks by generating data from 34% of local positive cases. Our data show that the patterns of VOC predominance dynamics and infection rates were in general distinct from the mainland. We report here the first known case of Alpha predominance in a Brazilian population, a delay greater than 3 months for the Gamma to dominate the previous variants compared to the mainland, and a faster dispersion rate of Gamma and Delta VOCs compared to the mainland. Phylogenetic analysis revealed the SARS-CoV-2 transmission dynamics in Ilhabela were characterized by multiple independent introduction events of Gamma and Delta, with a few events of Alpha introduction, two of them followed by community transmission. This study evidenced the peculiar behavior of SARS-CoV-2 variants in an isolated population and brought to light the importance of specific programs for SARS-CoV-2 genomic surveillance in isolated populations.

Non-COVID-19 respiratory viral infection.

Implemented control measures brought about by the coronavirus disease 2019 (COVID-19) pandemic have changed the prevalence of other respiratory viruses, often relegating them to a secondary plan. However, it must not be forgotten that a diverse group of viruses, including other human coronaviruses, rhinoviruses, respiratory syncytial virus, human metapneumoviruses, parainfluenza and influenza, continue to be responsible for a large burden of disease. In fact, they are among the most common causes of acute upper and lower respiratory tract infections globally. Viral respiratory infections can be categorised in several ways, including by clinical syndrome or aetiological agent. We describe their clinical spectrum. Distinctive imaging features, advances in microbiological diagnosis and treatment of severe forms are also discussed. Educational aims: To summarise the knowledge on the spectrum of disease that respiratory viral infections can cause and recognise how often they overlap.To learn the most common causes of respiratory viral infections and acknowledge other less frequent agents that may target certain key populations (e.g. immunocompromised patients).To improve awareness of the recent advances in diagnostic methods, including molecular assays and helpful features in imaging techniques.To identify supportive care strategies pivotal in the management of severe respiratory viral infections.

SARS-COV-2 genomic monitoring in the state of São Paulo unveils two emerging AY.43 sublineages.

Delta VOC is highly diverse with more than 120 sublineages already described as of November 30, 2021. In this study, through active monitoring of circulating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants in the state of São Paulo, southeast Brazil, we identified two emerging sublineages from the ancestral AY.43 strain which were classified as AY.43.1 and AY.43.2. These sublineages were defined by the following characteristic nonsynonymous mutations ORF1ab:A4133V and ORF3a:T14I for the AY.43.1 and ORF1ab:G1155C for the AY.43.2 and our analysis reveals that they might have a likely-Brazilian origin. Much is still unknown regarding their dissemination in the state of São Paulo and Brazil as well as their potential impact on the ongoing vaccination process. However, the results obtained in this study reinforce the importance of genomic surveillance activity for timely identification of emerging SARS-CoV-2 variants which can impact the ongoing SARS-CoV-2 vaccination and public health policies.