Safety of Endoscopy Units during the COVID-19 Pandemic

Introduction: The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. Material and Methods: This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient's clinical records and the Trace COVID platform. Results: A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, n = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, n = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, n = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. Discussion/Conclusion: Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.

DIAGNÓSTICO SITUACIONAL MEDIANTE MONITORAMENTO DA LINHA DE CUIDADO DAS PESSOAS VIVENDO COM HIV/AIDS: UM ESTUDO TRANSVERSAL

Introdução Desigualdades de acesso ao tratamento do HIV foram aprofundadas pela pandemia;entretanto, os benefícios de continuar a fornecer serviços de HIV superam o risco de mortes adicionais relacionadas à COVID-19. Na última década, Porto Alegre-RS está no topo do ranking do HIV, sendo necessário reconhecer as fragilidades da Linha de Cuidado(LC) das pessoas vivendo com HIV/AIDS (PVHA), em especial, as populações-chave. Objetivo Monitorar a LC das PVHA que acessaram os serviços do Consultório na Rua (CR) e da Unidade de Saúde (US) tradicional em Porto Alegre durante a pandemia do COVID-19. Métodos Estudo transversal, com dados do monitoramento 121 PVHA por 1 ano desde abril de 2020 nos serviços de CR e US, situados no mesmo estabelecimento. Resultados No CR, com 5332 pessoas cadastradas, 67 (1,2%) foram atendidos pelo HIV, sendo 22 (32,8%) pretos e pardos, 11 (16,4%) com 50 anos ou mais e 56 (83,6%) homens cis, enquanto na US, com 140000 cadastrados, atendeu-se 54 (0,38%), sendo 16 (29,6%) pretos e pardos, 23 (42,5%) com 50 anos ou mais e 21 (38,9%) mulher cis e 2 (3,7%) mulher trans. Em relação a adesão ao TARV, na US 35 (64,8%) retirando a medicação nos últimos 90 dias, e no CR 38(56,7%). Estão com a CV indetectável para o HIV na US 37 (68,5%) e no CR 28 (41,7%). O CD4<350 na última coleta, verificou-se 13 (24%) pacientes na US versus 25 (37,3%) no CR. Na US, 20 (37%) estão em uso de Dolutegravir-Tenofovir-Lamivudina, no CR, 19 (28,8%) estão em uso do mesmo esquema. Estão em uso de Tenofovir-Lamivudina-Efavirenz, 14 (25,9%) dos usuários da US e 22 (33,3%) dos usuários do CR, assim 34 (50,7%) e 41 (75,9%) estão em esquema de primeira linha nos serviços do CR e US, respectivamente. Os encaminhamentos para a especialidade de Infectologia foram na US 31 (57,4%) e no CR 38 (56,7%). O histórico de tuberculose está presente na US, 8 (14%) e no CR 14 (20,8%). Conclusões A Atenção Primária à Saúde (APS) pode colaborar na LC das PVHA, em especial as em situação de rua, em conjunto com serviços de Infectologia como garantia de acesso e direcionamento dos casos previstos de AIDS ou co-infecção. O monitoramento por tabela de Excel organizadas pelos valores de CD4 auxiliam a APS a promover a adesão na LC, agiliza o acolhimento das demandas e proporciona planejamento das buscas ativas para a retomada dos tratamentos pelas suas equipes de assistência multiprofissional. A otimização dos esquemas antirretrovirais para primeira linha facilita o papel da APS para atingir a Meta 90-90-90.

In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil.

Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed. Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.

Tourism and COVID-19: The Show Must Go On

Tourism and hospitality actors face an unprecedented challenge in reigniting these industries through digital communication. All past knowledge regarding tourist behavior and preferences has been rendered irrelevant since the outbreak of the COVID-19 pandemic and its resulting enforced changes. Several reports have pointed to the existence of a travel sentiment that may be actionable by communication. This work attempts to reveal some of the elements that may compose this travel sentiment. To pursue this aim, an online pilot survey was conducted among those who were regular travelers before the COVID-19 outbreak. The data was used to validate the conceptual model through a partial least squares structural equation model estimation. The findings revealed that travel constraints are the most influential dimension, along with social media and technology usage, in affecting tourist behavior. Thus, in their communication strategy, tourism and hospitality players should reinforce the health- and hygiene-related measures taken, while simultaneously promoting the trustworthiness of the shared information.

Computational Strategies to Combat COVID-19: Useful Tools to Accelerate SARS-CoV-2 and Coronavirus Research (preprint)

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a novel virus of the family Coronaviridae. The virus causes the infectious disease COVID-19. The biology of coronaviruses has been studied for many years. However, bioinformatics tools designed explicitly for SARS-CoV-2 have only recently been developed as a rapid reaction to the need for fast detection, understanding, and treatment of COVID-19. To control the ongoing COVID-19 pandemic, it is of utmost importance to get insight into the evolution and pathogenesis of the virus. In this review, we cover bioinformatics workflows and tools for the routine detection of SARS-CoV-2 infection, the reliable analysis of sequencing data, the tracking of the COVID-19 pandemic and evaluation of containment measures, the study of coronavirus evolution, the discovery of potential drug targets and development of therapeutic strategies. For each tool, we briefly describe its use case and how it advances research specifically for SARS-CoV-2. All tools are freely available online, either through web applications or public code repositories.