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1.
Nature ; 583(7816): 331-332, 2020 07.
Article in English | MEDLINE | ID: covidwho-666475
2.
Sci Rep ; 10(1): 11746, 2020 07 16.
Article in English | MEDLINE | ID: covidwho-654915

ABSTRACT

Category A and B biothreat agents are deemed to be of great concern by the US Centers for Disease Control and Prevention (CDC) and include the bacteria Francisella tularensis, Yersinia pestis, Burkholderia mallei, and Brucella species. Underscored by the impact of the 2020 SARS-CoV-2 outbreak, 2016 Zika pandemic, 2014 Ebola outbreak, 2001 anthrax letter attacks, and 1984 Rajneeshee Salmonella attacks, the threat of future epidemics/pandemics and/or terrorist/criminal use of pathogenic organisms warrants continued exploration and development of both classic and alternative methods of detecting biothreat agents. Volatile organic compounds (VOCs) comprise a large and highly diverse group of carbon-based molecules, generally related by their volatility at ambient temperature. Recently, the diagnostic potential of VOCs has been realized, as correlations between the microbial VOC metabolome and specific bacterial pathogens have been identified. Herein, we describe the use of microbial VOC profiles as fingerprints for the identification of biothreat-relevant microbes, and for differentiating between a kanamycin susceptible and resistant strain. Additionally, we demonstrate microbial VOC profiling using a rapid-throughput VOC metabolomics method we refer to as 'simultaneous multifiber headspace solid-phase microextraction' (simulti-hSPME). Finally, through VOC analysis, we illustrate a rapid non-invasive approach to the diagnosis of BALB/c mice infected with either F. tularensis SCHU S4 or Y. pestis CO92.


Subject(s)
Metabolomics/methods , Tularemia/metabolism , Volatile Organic Compounds/metabolism , Animals , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/virology , Disease Outbreaks , Drug Resistance, Microbial/drug effects , Drug Resistance, Microbial/genetics , Female , Francisella tularensis/drug effects , Francisella tularensis/isolation & purification , Francisella tularensis/metabolism , Kanamycin/pharmacology , Mice , Mice, Inbred BALB C , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/virology , Solid Phase Microextraction , Tularemia/microbiology , Tularemia/pathology , Tularemia/veterinary , Volatile Organic Compounds/analysis , Volatile Organic Compounds/isolation & purification , Yersinia pestis/drug effects , Yersinia pestis/isolation & purification , Yersinia pestis/metabolism
3.
J Travel Med ; 27(3)2020 05 18.
Article in English | MEDLINE | ID: covidwho-688204

ABSTRACT

BACKGROUND: A key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges. METHODOLOGY: We conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014-16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews. RESULTS: Numerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders. CONCLUSION: This article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014-16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.


Subject(s)
Communicable Disease Control/methods , Disease Outbreaks/prevention & control , Hemorrhagic Fever, Ebola/epidemiology , Travel , Africa, Western , Aircraft , Betacoronavirus , Communication , Coronavirus Infections , Decision Making , Hemorrhagic Fever, Ebola/history , History, 21st Century , Humans , Industry , Mass Media , Pandemics , Pneumonia, Viral
4.
Ann Biol Clin (Paris) ; 78(4): 446-448, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-634852

ABSTRACT

Training and education are essential for medical students. During the COVID-19 outbreak, numerous schools and universities have had to close. Ensuring pedagogical continuity requires alternatives to the traditional classroom, especially in medical education. Usual distance learning tools such as videos and downloadable handouts are not sufficient to promote efficient teaching. Distance learning requires self-motivation and does not give you direct access to your instructor. Some students fear the loss of human contact with an instructor - like asking questions during and after class - which promotes learning, understanding and communication. Moreover, classical distance learning methods do not offer immediate feedback that can help students in their understanding of the lecture. In this context, interactive pedagogic tools (IPT) could be useful for medical education continuity and for maintaining human contact necessary in pedagogy. We briefly evaluated interactive pedagogic tool compared to traditionnal distancial tools on medical students. This study showed the importance to have direct contact with a teacher and feedback during a lecture and to not exclusively perform distance learning without direct interaction and feedback. Hence, in the present context, we encourage teacher to use this type of tools to maintain direct interaction with students - which is essential in pedagogy - and ensure a qualitative pedagogical continuity.


Subject(s)
Computer-Assisted Instruction/methods , Coronavirus Infections/epidemiology , Education, Distance/methods , Education, Medical, Continuing/methods , Pneumonia, Viral/epidemiology , Simulation Training , Software , Betacoronavirus , Clinical Laboratory Services/organization & administration , Computer-Assisted Instruction/standards , Coronavirus Infections/prevention & control , Disease Outbreaks , Education, Distance/organization & administration , Education, Distance/standards , Education, Medical, Continuing/organization & administration , Humans , Internet/organization & administration , Internet/standards , Learning , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Problem-Based Learning/methods , Problem-Based Learning/organization & administration , Problem-Based Learning/standards , Simulation Training/methods , Simulation Training/organization & administration , Simulation Training/standards , Students, Medical/psychology , Students, Medical/statistics & numerical data , Video Recording/methods , Video Recording/standards
5.
World J Surg ; 44(9): 2837-2841, 2020 09.
Article in English | MEDLINE | ID: covidwho-632243

ABSTRACT

Today's COVID-19 pandemic offers many similarities with previous pandemics hitting our country. In particular, the smallpox epidemics during the 1700s threatened the lives of multitudes and created panic and fear in the society, similar to the situation caused by the coronavirus. Remedies that were instituted, especially inoculations, were met with opposition and even violence when first introduced. The newspapers were filled with headlines reflecting the disputes. There was a "six feet rule" during the smallpox epidemics, although it had a different meaning than today. Politicians and other leaders of the society were engaged in the war against the infection. Boston became involved in the fight against the smallpox by Dr. Zabdiel Boylston's and Rev. Cotton Mather's introduction of inoculations. When George Washington realized the benefits of the procedure and ordered mass inoculations of the Continental Army, it became an important factor in winning not only the fight against smallpox but the Revolutionary War as well. Looking back at history, realizing that we have survived previous outbreaks of devastating diseases, can provide hope during the current pandemic.


Subject(s)
Disease Outbreaks/history , Immunization/history , Physician's Role , Smallpox/history , Surgeons , Betacoronavirus , Coronavirus Infections/epidemiology , History, 18th Century , Humans , Mass Vaccination/history , Pandemics , Pneumonia, Viral/epidemiology , Smallpox/epidemiology , United States/epidemiology
6.
F1000Res ; 9: 352, 2020.
Article in English | MEDLINE | ID: covidwho-769911

ABSTRACT

Background: School closures have been a recommended non-pharmaceutical intervention in pandemic response owing to the potential to reduce transmission of infection between children, school staff and those that they contact. However, given the many roles that schools play in society, closure for any extended period is likely to have additional impacts. Literature reviews of research exploring school closure to date have focused upon epidemiological effects; there is an unmet need for research that considers the multiplicity of potential impacts of school closures. Methods: We used systematic searching, coding and synthesis techniques to develop a systems-based logic model. We included literature related to school closure planned in response to epidemics large and small, spanning the 1918-19 'flu pandemic through to the emerging literature on the 2019 novel coronavirus. We used over 170 research studies and a number of policy documents to inform our model. Results: The model organises the concepts used by authors into seven higher level domains: children's health and wellbeing, children's education, impacts on teachers and other school staff, the school organisation, considerations for parents and families, public health considerations, and broader economic impacts. The model also collates ideas about potential moderating factors and ethical considerations. While dependent upon the nature of epidemics experienced to date, we aim for the model to provide a starting point for theorising about school closures in general, and as part of a wider system that is influenced by contextual and population factors. Conclusions: The model highlights that the impacts of school closures are much broader than those related solely to health, and demonstrates that there is a need for further concerted work in this area. The publication of this logic model should help to frame future research in this area and aid decision-makers when considering future school closure policy and possible mitigation strategies.


Subject(s)
Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Influenza, Human/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Schools , Betacoronavirus , Disease Outbreaks/prevention & control , Humans , Models, Theoretical
8.
Cien Saude Colet ; 25(9): 3377-3384, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-750934

ABSTRACT

At the end of 2019, the outbreak of COVID-19 was reported in Wuhan, China. The outbreak spread quickly to several countries, becoming a public health emergency of international interest. Without a vaccine or antiviral drugs, control measures are necessary to understand the evolution of cases. Here, we report through spatial analysis the spatial pattern of the COVID-19 outbreak. The study site was the State of São Paulo, Brazil, where the first case of the disease was confirmed. We applied the Kernel Density to generate surfaces that indicate where there is higher density of cases and, consequently, greater risk of confirming new cases. The spatial pattern of COVID-19 pandemic could be observed in São Paulo State, in which its metropolitan region standed out with the greatest cases, being classified as a hotspot. In addition, the main highways and airports that connect the capital to the cities with the highest population density were classified as medium density areas by the Kernel Density method.It indicates a gradual expansion from the capital to the interior. Therefore, spatial analyses are fundamental to understand the spread of the virus and its association with other spatial data can be essential to guide control measures.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Cities , Humans , Pandemics , Public Health , Spatial Analysis
9.
J Med Internet Res ; 22(8): e19642, 2020 08 24.
Article in English | MEDLINE | ID: covidwho-750821

ABSTRACT

BACKGROUND: Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. METHODS: This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. RESULTS: Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P<.001; 15% vs 33%, P<.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, P<.001; 2.1 vs 0.3µg/mL, P<.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. CONCLUSIONS: The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Adult , China , Disease Outbreaks , Female , Humans , Pandemics , Pregnancy , Retrospective Studies , Treatment Outcome
10.
Zhonghua Er Ke Za Zhi ; 58(8): 635-639, 2020 Aug 02.
Article in Chinese | MEDLINE | ID: covidwho-749115

ABSTRACT

Objective: To investigate the spectrum of pathogenic agents in pediatric patients with acute respiratory infections (ARI) during the outbreak of coronavirus infectious diseases 2019 (COVID-19). Methods: Three groups of children were enrolled into the prospective study during January 20 to February 20, 2020 from Capital Institute of Pediatrics, including children in the exposed group with ARI and epidemiological history associated with COVID-19 from whom both pharyngeal and nasopharyngeal swabs were collected, children in the ARI group without COVID-19 associated epidemiological history and children in the screening group for hospital admission, with neither COVID-19 associated epidemiological history nor ARI. Only nasopharyngeal swabs were collected in the ARI group and screening group. Each group is expected to include at least 30 cases. All specimens were tested for 2019-nCoV nucleic acid by two diagnostic kits from different manufacturers. All nasopharyngeal swabs were tested for multiple respiratory pathogens, whilst the results from the ARI group were compared with that in the correspondence periods of 2019 and 2018 used by t or χ(2) test. Results: A total of 244 children were enrolled into three groups, including 139 males and 105 females, the age was (5±4) years. The test of 2019-nCoV nucleic acid were negative in all children, and high positive rates of pathogens were detected in exposed (69.4%, 25/36) and ARI (55.3%, 73/132) groups, with the highest positive rate for mycoplasma pneumoniae (MP) (19.4%, 7/36 and 17.4%, 23/132, respectively), followed by human metapneumovirus (hMPV) (16.7%, 6/36 and 9.8%, 13/132, respectively). The positive rate (11.8%, 9/76) of pathogens in the screening group was low. In the same period of 2019, the positive rate of pathogens was 83.7% (77/92), with the highest rates for respiratory syncytial virus (RSV) A (29.3%, 27/92), followed by influenza virus (Flu) A (H1N1) (19.6%, 18/92) and adenovirus (ADV) (14.1%, 13/92), which showed significant difference with the positive rates of the three viruses in 2020 (RSV A: χ(2)=27.346, P<0.01; FluA (H1N1): χ(2)=28.083, P<0.01; ADV: χ(2)=7.848, P=0.005) . In 2018, the positive rate of pathogens was 61.0% (50/82), with the highest rate for human bocavirus (HBoV) (13.4%, 11/82) and followed by ADV (11.0%, 9/82), and significant difference was shown in the positive rate of HBoV with that in 2020 (χ(2)=6.776, P=0.009). Conclusions: The infection rate of 2019-nCoV is low among children in Beijing with no family clustering or no close contact, even with epidemiological history. The spectrum of pathogens of ARI in children during the research period is quite different from that in the previous years when the viral infections were dominant. MP is the highest positively detected one among the main pathogens during the outbreak of COVID-19 in Beijing where there is no main outbreak area.


Subject(s)
Disease Outbreaks , Metapneumovirus/isolation & purification , Mycoplasma pneumoniae/isolation & purification , Paramyxoviridae Infections/diagnosis , Respiratory Tract Infections/diagnosis , Beijing/epidemiology , Betacoronavirus , Child , Child, Preschool , Coronavirus , Coronavirus Infections , Female , Humans , Infant , Influenza A Virus, H1N1 Subtype , Male , Metapneumovirus/pathogenicity , Mycoplasma pneumoniae/pathogenicity , Pandemics , Paramyxoviridae Infections/epidemiology , Pediatrics , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/epidemiology , Pneumonia, Viral , Prospective Studies , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/virology
11.
Geriatr Psychol Neuropsychiatr Vieil ; 18(3): 238-240, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-749031

ABSTRACT

The Coronarovirus disease 2019 (Covid-19) outbreak strongly affected nursing and was responsible for a high mortality rate. During the pandemic of March-May 2020, 17 French nursing homes organized staff confinement periods with residents 24 hours a day and 7 days a week, to reduce the risk of entry of the SARS-CoV-2 virus into their facilities, in a context where visits to residents were prohibited. By means of a telephone survey of their directors, we observed that 16 nursing homes (94%) had no cases of COVID-19 among the residents, and that mortality from COVID-19 was very low compared to that recorded at the national level by Santé publique France (p<10-4). Moreover, the number of cases of Covid-19 among the staff of these nursing homes was also lower than that recorded by Santé publique France (p<10-4). These establishments experienced certain difficulties which the directors managed to overcome and the investment of these teams was widely appreciated by the families of the residents and through the press.


Subject(s)
Coronavirus Infections , Nursing Homes , Pandemics , Pneumonia, Viral , Quarantine , Aged , Betacoronavirus , Disease Outbreaks , Female , France , Health Personnel , Humans
12.
BMC Psychiatry ; 20(1): 436, 2020 09 05.
Article in English | MEDLINE | ID: covidwho-745684

ABSTRACT

BACKGROUND: Neurological symptoms are increasingly being noted among COVID-19 patients. Currently, there is little data on the mental health of neurological healthcare workers. The aim of this study was to identify the prevalence and influencing factors on anxiety and depression in neurological healthcare workers in Hunan Province, China during the early stage of the Coronavirus Disease 2019 (COVID-19) outbreak. METHODS: An online cross-sectional study was conducted among neurological doctors and nurses in early February 2020 in Hunan Province. Symptoms of anxiety and depression were assessed by the Chinese version of the Self-Rating Anxiety Scale (SAS) (defined as a total score ≥ 50) and Self-Rating Depression Scale (SDS) (defined as a total score ≥ 53). The prevalences of probable anxiety and depression were compared between different groups, and multivariate logistic regression analysis was used to understand the independent influencing factors on anxiety and depression. RESULTS: The prevalence of probable anxiety and depression in neurological nurses (20.3 and 30.2%, respectively) was higher than that in doctors (12.6 and 20.2%, respectively). Female healthcare workers (18.4%) had a higher proportion of anxiety than males (10.8%). Probable anxiety and depression were more prevalent among nurses, younger workers (≤ 40 years), and medical staff with junior titles. Logistic regression analysis showed that a shortage of protective equipment was independently associated with probable anxiety (OR = 1.980, 95% CI: 1.241-3.160, P = 0.004), while young age was a risk factor for probable depression (OR = 2.293, 95% CI: 1.137-4.623, P = 0.020) among neurological healthcare workers. CONCLUSIONS: Probable anxiety and depression were more prevalent among neurological nurses than doctors in Hunan Province. The shortage of protective equipment led to probable anxiety, and young age led to probable depression in healthcare workers in neurology departments, which merits attention during the battle against COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections , Depressive Disorder/epidemiology , Nurses/psychology , Pandemics , Physicians/psychology , Pneumonia, Viral , Adult , China/epidemiology , Cross-Sectional Studies , Depressive Disorder/psychology , Disease Outbreaks , Female , Hospital Units , Humans , Male , Neurology , Prevalence , Surveys and Questionnaires
14.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(6): 641-648, 2020 Jun 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745314

ABSTRACT

OBJECTIVES: To understand the psychological status of the staff in a general hospital during the coronavirus disease 2019 and its influential factors, and to provide references for the mental health services to hospital staff. METHODS: Using star platform of questionnaire, the staff in the general hospital were investigated via Depression, Anxiety, Stress Scale (DASS-21), Social Support Rating Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ). The influential factors were discussed by descriptive analysis, rank sum test, single factor analysis, correlation analysis and multiple factors binary logistic regression analysis. RESULTS: A total of 2 060 valid questionnaires were collected. The negative emotions of nurses and cleaners were the most obvious. The depression scores, anxiety scores and stress scores for nurses and cleaners were 5.06±7.47, 6.36±7.84, 9.75±8.65, and 6.72±8.84, 4.51±6.56, 9.69±9.56, respectively. Multivariate binary logistic regression analysis showed that staff types, education levels, job status, economic situation and concerns on the supplies of protective goods were the main influential factors for depression; staff types, contacting status with infected patients, economic situation, concerns on the supplies of protective goods, history of disease were the main influential factors for anxiety; contacting status with infected patients, economic situation, concerns on the supplies of protective goods were the main influential factors for stress. CONCLUSIONS: There are differences in psychological characteristics among different groups of staff in the general hospital under the outbreak. Thus psychological protection and intervention measures should be formulated according to different groups and work status.


Subject(s)
Coronavirus Infections/psychology , Personnel, Hospital/psychology , Pneumonia, Viral/psychology , Stress, Psychological , Adaptation, Psychological , Anxiety/diagnosis , Betacoronavirus , China , Cross-Sectional Studies , Depression/diagnosis , Disease Outbreaks , Hospitals, General , Humans , Pandemics , Surveys and Questionnaires
15.
Euro Surveill ; 25(35)2020 09.
Article in English | MEDLINE | ID: covidwho-745113

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends' gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied.


Subject(s)
Coronavirus Infections/transmission , Disease Outbreaks , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/transmission , Betacoronavirus , Coronavirus Infections/epidemiology , Disease Notification , Humans , Leisure Activities , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Spain/epidemiology
16.
Biomed Res Int ; 2020: 2721381, 2020.
Article in English | MEDLINE | ID: covidwho-744899

ABSTRACT

Introduction: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. Methods: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of "highly suspicious for COVID-19" and "COVID-19 as differential diagnosis." All respiratory and infectious symptoms were included as at least "differential diagnosis" as an expanded suspicion strategy. Results: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. Conclusion: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Aged , Aged, 80 and over , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Critical Illness , Diagnosis, Differential , Disease Outbreaks , Emergency Service, Hospital , False Negative Reactions , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , RNA, Viral/genetics , RNA, Viral/isolation & purification , Real-Time Polymerase Chain Reaction , Resuscitation , Retrospective Studies , Tomography, X-Ray Computed , Triage
17.
J Med Libr Assoc ; 108(3): 494-497, 2020 Jul 01.
Article in English | MEDLINE | ID: covidwho-743487
18.
Rev Peru Med Exp Salud Publica ; 37(2): 195-202, 2020.
Article in Spanish, English | MEDLINE | ID: covidwho-740608

ABSTRACT

OBJECTIVES: To determine the probability of controlling the outbreak of COVID-19 in Peru, in a pre- and post-quarantine scenario using mathematical simulation models. MATERIALS AND METHODS: Outbreak si mulations for the COVID-19 pandemic are performed, using stochastic equations under the following assumptions: a pre-quarantine population R0 of 2.7 or 3.5, a post-quarantine R0 of 1.5, 2 or 2.7, 18% or 40%, of asymptomatic positives and a maximum response capacity of 50 or 150 patients in the intensive care units. The success of isolation and contact tracing is evaluated, no other mitigation measures are included. RESULTS: In the pre-quarantine stage, success in controlling more than 80% of the simulations occurred only if the isolation of positive cases was implemented from the first case, after which there was less than 40% probability of success. In post-quarantine, with 60 positive cases it is necessary to isolate them early, track all of their contacts and decrease the R0 to 1.5 for outbreak control to be successful in more than 80% of cases. Other scenarios have a low probability of success. CONCLUSIONS: The control of the outbreak in Peru during pre-quarantine stage demanded requirements that were difficult to comply with, therefore quarantine was necessary; to successfully suspend it would require a significant reduction in the spread of the disease, early isolation of positives and follow-up of all contacts of positive patients.


Subject(s)
Computer Simulation , Coronavirus Infections/epidemiology , Disease Outbreaks/prevention & control , Pneumonia, Viral/epidemiology , Contact Tracing/methods , Coronavirus Infections/prevention & control , Humans , Intensive Care Units/statistics & numerical data , Models, Theoretical , Pandemics/prevention & control , Peru/epidemiology , Pneumonia, Viral/prevention & control , Probability , Quarantine
19.
Cien Saude Colet ; 25(9): 3377-3384, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-740431

ABSTRACT

At the end of 2019, the outbreak of COVID-19 was reported in Wuhan, China. The outbreak spread quickly to several countries, becoming a public health emergency of international interest. Without a vaccine or antiviral drugs, control measures are necessary to understand the evolution of cases. Here, we report through spatial analysis the spatial pattern of the COVID-19 outbreak. The study site was the State of São Paulo, Brazil, where the first case of the disease was confirmed. We applied the Kernel Density to generate surfaces that indicate where there is higher density of cases and, consequently, greater risk of confirming new cases. The spatial pattern of COVID-19 pandemic could be observed in São Paulo State, in which its metropolitan region standed out with the greatest cases, being classified as a hotspot. In addition, the main highways and airports that connect the capital to the cities with the highest population density were classified as medium density areas by the Kernel Density method.It indicates a gradual expansion from the capital to the interior. Therefore, spatial analyses are fundamental to understand the spread of the virus and its association with other spatial data can be essential to guide control measures.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Cities , Humans , Pandemics , Public Health , Spatial Analysis
20.
J Biol Dyn ; 14(1): 730-747, 2020 12.
Article in English | MEDLINE | ID: covidwho-740143

ABSTRACT

In this study, we estimate the severity of the COVID-19 outbreak in Pakistan prior to and after lockdown restrictions were eased. We also project the epidemic curve considering realistic quarantine, social distancing and possible medication scenarios. The pre-lock down value of R 0 is estimated to be 1.07 and the post lock down value is estimated to be 1.86. Using this analysis, we project the epidemic curve. We note that if no substantial efforts are made to contain the epidemic, it will peak in mid-September, 2020, with the maximum projected active cases being close to 700, 000. In a realistic, best case scenario, we project that the epidemic peaks in early to mid-July, 2020, with the maximum active cases being around 120, 000. We note that social distancing measures and medication will help flatten the curve; however, without the reintroduction of further lock down, it would be very difficult to make R 0 < 1 .


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Basic Reproduction Number/statistics & numerical data , Biostatistics , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Epidemics , Forecasting/methods , Humans , Mathematical Concepts , Models, Biological , Pakistan/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Quarantine/statistics & numerical data
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