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1.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-334727

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. NOTE: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . ONE SENTENCE SUMMARY: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

2.
PUBMED; 2021.
Preprint in English | PUBMED | ID: ppcovidwho-292866

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. Note: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . One sentence summary: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

3.
Revista do Instituto de Medicina Tropical de Sao Paulo ; 63:e74, 2021.
Article in English | MEDLINE | ID: covidwho-1443895

ABSTRACT

Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A cross-sectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ Swab TM, in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR;RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC R CCL-81 TM). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (Ct ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.

4.
HemaSphere ; 5(SUPPL 2):378-379, 2021.
Article in English | EMBASE | ID: covidwho-1393418

ABSTRACT

Background: The COVID-19 pandemic had a high burden in Brazil. To date, data on mortality and prognostic factors of COVID-19 infection in Brazilian patients with hematological disorders are scarce. Aims: To describe the characteristics and outcomes of patients with hematological disorders admitted to the hematological COVID care unit of a reference center in Brazil;to analyze the impact of prognostic factors on in-hospital mortality. Methods: This prospective, single-center study,included 118 patients who have been admitted to the hematological COVID care unit of the Hospital das Clínicas da Faculdade de Medicina da USP, S.o Paulo, Brazil, from March to September 2020.All patients had >18 years,an underlying hematological disease and a moderate or severe COVID- 19 infection.For analyses, patients were grouped in:(1)benign or no oncological treatment(n=43),(2) intensive chemotherapy,including induction protocols for acute leukemia and stem cell transplantation conditioning(n=44) or(3) intermediate chemotherapy,including lymphoma regimens,myeloma triple treatment or continuous treatment( n=31).The primary outcome was in-hospital mortality;secondary outcome was overall survival after admission in the COVID-19 unit.Univariate analysis(UVA) used odds ratio(OR) for baseline characteristics and ROC curve analysis for laboratory tests collected at admission.Multivariate analyses(MVA) were adjusted by age and hematological disease status group.The median follow-up and survival time after COVID-19-unit admission were estimated by Kaplan- Meier method.All statistical tests were two-sided;p-values<0.05 were considered significant. Results: Median age was 58(19-90) years and 55% of patients were male. Most patients(83%)had hematological malignancies,- mainly non-Hodgkin lymphoma(29%) and multiple myeloma(19%). The most frequent benign disease was sickle cell disease(5%).12 patients had undergone hematopoietic stem cell transplantation (HSCT),4 allogeneic and 8 autologous.70% had at least one comorbidity, mostly arterial hypertension and diabetes mellitus. Thromboembolic events occurred in 9%. Median hospital stay in the COVID-19 unit was 12(1-63) days;54% needed intensive care and 41% mechanical ventilation.In-hospital mortality rate was 41%[95%CI 32-50];most deaths occurred in patients with malignancies. Median follow-up was 73(95%CI 61-81) and 54(95%CI 39-66) days after admission and discharge from the COVID-19 unit, respectively.UVA showed a risk of death increased by 25% every 10 years old.The risk of in-hospital death was 3-fold and 5-fold higher in groups 2 and 3 compared with group 1.MVA showed higher risk of death in patients from group 2(OR=11.1,95% CI 2.9- 54.8) or group 3(OR=9.7,95%CI 2.4-47.5]),who had lactate dehydrogenase( LDH)>440 U/L(OR=16.8,95%CI 4.9-71.8),C-reactive protein(CRP)>100 mg/L(OR=4.1,95%CI 1.4-13.6) or platelet count<150x10e9/L(OR=3.7,95%CI 1.3-11.7), regardless of age(OR=1.2,95%CI 1.0-1.5).79% of in-hospital deaths were from COVID-19;others were mainly due to hematological disease.The overall median survival time after admission was 92 days(95% CI 34-NA) and the 75-day survival probability was 51%(95%CI 41-60).25% of patients had hospital readmission,mostly due to other infections. Summary/Conclusion: In line with other reports,patients with hematological diseases are at higher risk of mortality from COVID-19 infection, particularly in low and middle income countries.In our cohort, prognostic factors were status of disease,platelets count,LDH and CRP. These findings might help risk stratification and prioritization of vaccines in this setting.

5.
Red-Revista Electronica De Direito ; 24(1):83-100, 2021.
Article in French | Web of Science | ID: covidwho-1273927

ABSTRACT

With the pandemic caused by COVID-19, teleworking has been more and more frequent in Portugal. The remote work can often be done from outside Portugal. This circumstance can have relevant consequences for both employers and workers. In this article we propose to analyze the tax, labour and social security framework for teleworking from abroad and the risks it may imply.

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