Post-viral fatigue following SARS-CoV-2 infection during pregnancy: a longitudinal comparative study (preprint)

Background: Several studies have reported post-COVID-19 fatigue in the general population, but none explored post-COVID-19 fatigue among pregnant women. The objectives of this study were to determine the prevalence over time, duration and risk factors of post-viral fatigue among pregnant women infected with SARS-CoV-2. Methods: Longitudinal comparative study involving 588 pregnant women with SARS-CoV-2 investigation during pregnancy or at delivery in Sao Paulo, Brazil. Three groups were investigated: G1 (N=259) women with COVID-19 (symptomatic SARS-CoV-2 infection) identified during pregnancy; G2 (N=131) women with positive SARS-CoV-2 serology determined at delivery; G3 (N=198) women with negative SARS-CoV-2 serology at delivery. Questionnaires investigating fatigue were applied at 6 weeks, 3 and 6 months after SARS-CoV-2 identification for G1; and at delivery, 6 weeks, 3 and 6 months after delivery for all groups. The prevalence of fatigue, fatigue most of the time, and significant fatigue were determined at all timepoints. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the risk of remaining with fatigue over time in G1 women.Results: Prevalence of overall fatigue in G1 women at 6 weeks, 3 and 6 months were 40.6%, 33.6% and 27.8%, respectively. The cumulative risk of remaining with fatigue increased over time according to the severity of disease, with HR of 1.69 (95%CI: 0.89-3.20) and 2.43 (95%CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. In multivariate analysis, the independent risk factors of fatigue in G1 women were cough and myalgia. At and after delivery the prevalence of fatigue was significantly higher in G1 women compared to G2 and G3 women at all time points. Conclusions: The prevalence of post-viral fatigue is higher in pregnant women acquiring SARS-CoV-2 during pregnancy, and the risk and duration of fatigue increase with severity of infection.

Tracking the emergence of disparities in the subnational spread of COVID-19 in Brazil using an online application for real-time data visualisation. (preprint)

Brazil is one of the countries worst affected by the COVID-19 pandemic. We have developed CLIC-Brazil an online application for the real-time visualisation of COVID-19 data in Brazil at the municipality level. In the app, case and death data are standardised to allow comparisons to be made between places and over time. Estimates of Rt , a measure of the rate of propagation of the epidemic, over time are also made. Using data from the app, regression analyses identified factors associated with; the rate of initial spread, early epidemic intensity and predictions of the likelihood of occurrence of new incidence maxima. Municipalities with higher metrics of social development experienced earlier onset and faster growing epidemics, although space and time were the predominant predictive factors. Differences in the initial epidemic intensity (mean Rt ) were largely driven by geographic location and the date of local onset. This study demonstrates that by monitoring, standardising and analysing the development of an epidemic at a local level, insights can be gained into spatial and temporal heterogeneities.

How did COVID-19 measures impact sexual behaviour and access to STI&HIV services in Panama? Results from a national cross-sectional online survey (preprint)

Objectives To describe changes in sexual behaviours, including virtual sex (sexting and cybersex), and access to STI&HIV testing and care during COVID-19 measures in Panama. Methods We conducted an online cross-sectional survey from August 8 to September 12, 2020, among adults ([≥]18 years) residing in Panama. Participants were recruited through social media. Questions included demographics, access to STI&HIV testing and HIV care and sexual behaviours three months before COVID-19 social distancing measures and during social distancing measures (COVID-19 measures). Logistic regression was used to identify associations between variables and behavioural changes. Results We recruited 960 participants; 526 (54.8%) identified as cis-women, 366 (38.1%) cis-men, and 68 (7.1%) non-binary or another gender; median age was 28y (IQR:23-37y), 531/957 (55.5%) were of mixed-ethnicity (mixed-Indigenous/European/Afro-descendant ancestry). Before COVID-19 measures, virtual sex was reported by 38.5% (181/470) cis-women, 58.4% (184/315) cis-men and 45.0% (27/60) non-binary participants; during COVID-19 measures, virtual sex increased among 17.2% cis-women, 24.7% cis-men and 8.9% non-binary participants. During COVID-19 measures, 230/800 [28.8%] of participants reported decreased casual sex compared to pre-COVID-19 measures. Compared to pre-COVID-19 measures, decreased casual sex were reported more frequently during COVID-19 measures by cis-men compared to cis-women (39.2% versus 22.9%, urban/rural adjusted odds ratio [AOR]=2.17, 95% confidence interval [CI]:1.57-3.01); and by Afro-descendant compared to mixed-ethnicity participants (40.0% versus 29.8%, AOR=1.78, 95%CI:1.07-2.94). Compared to no change in virtual sex (16.8%), increase in virtual sex (38.5%, AOR=1.78, 95%CI:1.10-2.88); and decreased virtual sex (86.7%, AOR=16.53, 95%CI:7.74-35.27) were associated with decreased casual sex encounters. During COVID-19 measures, STI&HIV testing could not be obtained by 58.0% (58/100) participants who needed a test, and interrupted HIV care was reported by 53.3% (8/15) HIV-positive participants. Conclusions COVID-19 measures in Panama were associated with a decrease in casual sex among cis-men and Afro-descendant peoples, whilst access to STI&HIV testing and care was seriously disrupted.

A primary care approach to the COVID-19 pandemic: clinical features and natural history of 2,073 suspected cases in the Corona Sao Caetano programme, Sao Paulo, Brazil (preprint)

Background: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. Methods and findings: The Corona Sao Caetano program is a primary care initiative offering COVID-19 care to all residents of Sao Caetano do Sul, Brazil. After triage of potentially severe cases, consecutive patients presenting between 13th April and 13th May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days. RT-PCR-negative patients were offered SARS-CoV-2 serology. We describe the clinical features, virology and natural history of this prospective population-based cohort. Of 2,073 suspected COVID-19 cases, 1,583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95%CI: 25.9% - 30.3%) were positive; 604/1,136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever, anosmia, and ageusia were most associated with a positive COVID-19 diagnosis. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia, and around symptom onset. The rates of hospitalization and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalized group. Conclusions: COVID-19 presents similarly to other mild respiratory disease in primary care. Some symptoms assist the differential diagnosis. Most patients can be managed at home.

Epidemiological and clinical characteristics of the early phase of the COVID-19 epidemic in Brazil (preprint)

BackgroundThe first case of COVID-19 was detected in Brazil on February 25, 2020. We report the epidemiological, demographic, and clinical findings for confirmed COVID-19 cases during the first month of the epidemic in Brazil. MethodsIndividual-level and aggregated COVID-19 data were analysed to investigate demographic profiles, socioeconomic drivers and age-sex structure of COVID-19 tested cases. Basic reproduction numbers (R0) were investigated for Sao Paulo and Rio de Janeiro. Multivariate logistic regression analyses were used to identify symptoms associated with confirmed cases and risk factors associated with hospitalization. Laboratory diagnosis for eight respiratory viruses were obtained for 2,429 cases. FindingsBy March 25, 1,468 confirmed cases were notified in Brazil, of whom 10% (147 of 1,468) were hospitalised. Of the cases acquired locally (77{middle dot}8%), two thirds (66{middle dot}9% of 5,746) were confirmed in private laboratories. Overall, positive association between higher per capita income and COVID-19 diagnosis was identified. The median age of detected cases was 39 years (IQR 30-53). The median R0 was 2{middle dot}9 for Sao Paulo and Rio de Janeiro. Cardiovascular disease/hypertension were associated with hospitalization. Co-circulation of six respiratory viruses, including influenza A and B and human rhinovirus was detected in low levels. InterpretationSocioeconomic disparity determines access to SARS-CoV-2 testing in Brazil. The lower median age of infection and hospitalization compared to other countries is expected due to a younger population structure. Enhanced surveillance of respiratory pathogens across socioeconomic statuses is essential to better understand and halt SARS-CoV-2 transmission. FundingSao Paulo Research Foundation, Medical Research Council, Wellcome Trust and Royal Society.