Lupus patients infected by sars-cov2 performed less social isolation with higher hospitalization associated with hypertensionand cyclophosphamide pulsotherapy-data from reumacov Brazil

Objectives: To determine the main risk factors associated with COVID-19 in SLE patients. Methods: The Reuma CoV Brazil is a multicenter, observational, prospective cohort designed to monitor immune-mediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. SLE adult patients according to SLE SLICC criteria classification (2012), with and without (control group-CG) COVID-19 diagnosis were matched. Demographic data, managing of COVID-19, comorbidities, clinical characteristics (disease activity: Patient Report Outcomes-PROs, Physician Global Assessment and SLEDAI-2 K)were collected. Results: From May 2020 to January 2021, 604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the CG. Both groups were homogeneous and comparable regarding sex and comorbidities. SLE patients with COVID-19 declared a lower level of social isolation (49.5% vs. 61.9%;p = 0.002), worked more commonly in health professions (10.4% vs. 3.5%;p = 0.002), presented more frequently joint (32.5% vs. 22.0%;p = 0.004) and hematological manifestations (18.0% vs. 11.5%;p = 0.025). SLEDAI-2 K did not differ among groups prior and after COVID-19 infection. However, considering the mean duration of COVID-19 symptoms (12.1 ± 8.8 days), infected patients had more severe disease activity's PROs after resolution of COVID-19 symptoms (2.9 ± 2.9 vs. 2.3 ± 2.6;p = 0.031). The hospitalization rate was 20.5% (n = 65), of whom 23 (7.2%) needed intensive care unit and 14 (4.4%) patients died. Hypertension [5,26 (1,9714,07);p = 0.001] and recently cyclophosphamide pulses [39,21 (4,17-368,53);p = 0.001] were associated with hospitalization and patients who received telemedicine medical care presented 72% less chance of hospitalization [0.28 (0.09-0.83);p = 0.023). Conclusion: COVID-19 was associated with a lower level of declared social isolation and more severe disease activity perception after SARS-CoV-2 infection according to PROs. Hypertension and cyclophosphamide were associated with hospitalization and telemedicine can be a useful tool for SLE patients with COVID-19. These data should be considered to perform public health policy and national guidelines to manage SLE patients during the pandemic, as well as to prioritize some special groups for the immunization program.

On the use of telemedicine in the context of COVID-19: legal aspects and a systematic review of technology

Purpose: The aim of this study was to carry out a systematic review of telemedicine technology and to discuss the role of legislation in the application of telemedicine technology within the scope of COVID-19. Methods: The search for papers was conducted in the databases Cochrane Central, MEDLINE, and Embase. The keywords considered for this systematic review were (coronavirus OR “2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19” OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*))) AND ((telemedicine OR telehealth OR “remote assessment” OR telemonitoring)). The review process was carried out by six independent reviewers, using the PRISMA-P method. Results: As a result, a total of 34 papers were selected, which addressed the study of telemedicine technologies used in times of endemics, epidemics, and pandemics, focusing on COVID-19. Conclusion: Telemedicine allows for care in remote areas and at a lower cost to the patient and, in the current situation, it can reduce the number of contagions as well as the occupation of beds in health facilities. Telemedicine may suffer from limitations, mainly due to current legislation, but in this pandemic era of COVID-19, several countries around the world have made their laws more flexible to allow more widespread use of telemedicine. © 2021, Sociedade Brasileira de Engenharia Biomedica.

An analysis of the social-political aspect of COVID-19 in the urban space

This paper was made during social distancing, when the COVID-19 contaminations increases in Brazil, counting 27.276 deaths on May 29th of 2020, besides several not accounted cases and recent alteration in accounting methods. In this context, to write about something which is in course is challenging and, why not to say, risky, because the lack of deep analyses. It is also a singular opportunity to talk about the intends of the social and economic project in course in Brazil at and the combat actions to the virus pandemic by the federal government. Therefore, we want to demonstrate the current contradictions of neoliberalism - within the Brazilian political-ideological project - in view of the exposure of social, economic and spatial vulnerabilities and inequalities in urban spaces (cities) to fight COVID-19. The methodology used consists of a bibliographic review based on scientific journals and newspaper articles. Lastly, this article emphasizes the need to redefine the urban dynamic facing the unitary logic of the capital - labor, because we should not understand social distancing as a privilege. We are assertive in believing that social distancing is a right, which for now is being denied and placed as a class privilege.

Social isolation relaxation and the effective reproduction number (Rt) of COVID-19 in twelve Brazilian cities

We analyzed the social isolation relaxation strategies adopted by the twelve biggest Brazilian cities in 2020, in relation to the number of cases, number of deaths and the effective reproduction number (Rt), which are internationally considered the fundamental epidemiological criteria for allowing wider population mobility in public spaces. The Brazilian central government has not set unique guidelines neither for closure nor for opening, and states and cities have taken the lead in strategy definition. Until July 31 2020, in Belem do Para, Fortaleza, Manaus, Recife and Rio de Janeiro, where the epidemic peak had already been surpassed, and in Salvador and Sao Paulo, in which the peak seemed to be already reached, the Rt curve followed a decreasing path after the openings. Porto Alegre, a city in which the epidemic curve was flattened, had an increase in Rt after the start of relaxation. In Belo Horizonte, Brasilia, Curitiba and Goiania, where the curve was also flattened, the Rt remained stable after the opening. The decision on how to operationalize the relaxation of social isolation and the speed with which it happened was heterogeneous among the cities studied. Also, broad population testing strategies were not done in any of the cities.