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2.
Allergy Asthma Proc ; 42(5): 400-402, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1394713

ABSTRACT

Background: On January 20, 2020, the first documented case of novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) was reported in the United States. The U.S. Centers for Disease Control and Prevention continues to report more morbidity and mortality in adults than in children. Early in Pandemic, there was a concern that patients with asthma would be affected disproportionately from COVID-19, but this was not manifested. It is now recognized that angiotensin-converting enzyme 2 receptors that are used by the coronavirus for infection have low expression in children with atopy that may contribute to decreased infectivity in children who are atopic. There are several early reports of decreased emergency department (ED) visits for children with asthma. The authors previously reported a decrease in pediatric ED visits in the spring of 2020, which correlated with school closure. Objective: To determine if this trend of decreased ED visits for pediatric asthma was sustained throughout the first COVID-19 pandemic year. Methods: ED data from one inner city children's hospital were collected by using standard medical claims codes. Conclusion: We reported a sustained year of decreased ED visits for children with asthma in one pediatric ED in an inner-city hospital; this seemed to be secondary to school closure and decreased exposure to upper respiratory infections.


Subject(s)
Asthma , COVID-19/prevention & control , Disease Progression , Emergency Service, Hospital/trends , Facilities and Services Utilization/trends , Acute Disease , Adolescent , Asthma/etiology , Asthma/physiopathology , Asthma/therapy , Child , Child, Preschool , Environmental Exposure/prevention & control , Environmental Exposure/statistics & numerical data , Female , Humans , Male , Michigan , Physical Distancing , Schools , Urban Health
3.
J Stroke Cerebrovasc Dis ; 30(8): 105860, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1240473

ABSTRACT

OBJECTIVES: Amongst all the global catastrophe due to Coronavirus disease 2019, a significant bright spot is a reduction in air pollution as countries undergo lockdowns to limit the spread of infection. Another reduction that has been reported is in the number of strokes presenting to hospitals, despite the virus implicated in causing a hypercoagulable state. Acute exposure to air pollution has been linked to increase in stroke incidence and the improvement in air quality may be responsible for the decrease in stroke presentations. MATERIALS AND METHODS: To explore this hypothesis, we compared the air quality index (AQI) of Karachi, the largest cosmopolitan city of Pakistan, during the lockdown period in 2020 to the same period in the previous year. RESULTS: We found a significant drop in AQI depicting an improvement in air quality. Simultaneously, we identified a drop in number of stroke admissions to less than half from 2019 to 2020 at one of the largest tertiary care hospitals of the city, during this period of interest. CONCLUSION: We hypothesize that one important reason for this drop in stroke admissions, may be an actual reduction in stroke incidence brought about by an improvement in air quality.


Subject(s)
Air Pollutants/adverse effects , Air Pollution/adverse effects , COVID-19 , Environmental Exposure/prevention & control , Ischemic Stroke/epidemiology , Patient Admission/trends , Urban Health/trends , Aged , Environmental Exposure/adverse effects , Environmental Monitoring , Female , Humans , Incidence , Ischemic Stroke/diagnosis , Ischemic Stroke/prevention & control , Male , Middle Aged , Pakistan/epidemiology , Risk Assessment , Risk Factors , Time Factors
5.
Environ Health ; 20(1): 34, 2021 03 26.
Article in English | MEDLINE | ID: covidwho-1154012

ABSTRACT

BACKGROUND: An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. OBJECTIVES: To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. METHODS: An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. DISCUSSION: Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life. CONCLUSION: A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.


Subject(s)
COVID-19/epidemiology , Child Health , Environmental Exposure/adverse effects , Environmental Health , Adult , Age Factors , Air Pollution/adverse effects , Air Pollution/prevention & control , COVID-19/immunology , COVID-19/pathology , COVID-19/prevention & control , Child , Disease Susceptibility/epidemiology , Disease Susceptibility/immunology , Disease Susceptibility/pathology , Environmental Exposure/prevention & control , Fetal Development , Humans , Hygiene Hypothesis , Immunity, Innate , Respiratory System/pathology , Respiratory System/virology , SARS-CoV-2
6.
Am J Physiol Gastrointest Liver Physiol ; 320(4): G586-G600, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1050415

ABSTRACT

As countries continue to industrialize, major cities experience diminished air quality, whereas rural populations also experience poor air quality from sources such as agricultural operations. These exposures to environmental pollution from both rural and populated/industrialized sources have adverse effects on human health. Although respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease) are the most commonly reported following long-term exposure to particulate matter and hazardous chemicals, gastrointestinal complications have also been associated with the increased risk of lung disease from inhalation of polluted air. The interconnectedness of these organ systems has offered valuable insights into the roles of the immune system and the micro/mycobiota as mediators of communication between the lung and the gut during disease states. A topical example of this relationship is provided by reports of multiple gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19), whereas the rapid transmission and increased risk of COVID-19 has been linked to poor air quality and high levels of particulate matter. In this review, we focus on the mechanistic effects of environmental pollution on disease progression with special emphasis on the gut-lung axis.


Subject(s)
COVID-19 , Environmental Exposure , Gastrointestinal Diseases , Lung Diseases , Air Pollution , COVID-19/epidemiology , COVID-19/prevention & control , Comorbidity , Disease Progression , Environmental Exposure/adverse effects , Environmental Exposure/prevention & control , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/prevention & control , Humans , Lung Diseases/epidemiology , Lung Diseases/prevention & control , Public Health , SARS-CoV-2
7.
Emerg Infect Dis ; 27(2): 352-359, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-961594

ABSTRACT

Virus shedding in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur before onset of symptoms; less is known about symptom progression or infectiousness associated with initiation of viral shedding. We investigated household transmission in 5 households with daily specimen collection for 5 consecutive days starting a median of 4 days after symptom onset in index patients. Seven contacts across 2 households implementing no precautionary measures were infected. Of these 7, 2 tested positive for SARS-CoV-2 by reverse transcription PCR on day 3 of 5. Both had mild, nonspecific symptoms for 1-3 days preceding the first positive test. SARS-CoV-2 was cultured from the fourth-day specimen in 1 patient and from the fourth- and fifth-day specimens in the other. We also describe infection control measures taken in the households that had no transmission. Persons exposed to SARS-CoV-2 should self-isolate, including from household contacts, wear a mask, practice hand hygiene, and seek testing promptly.


Subject(s)
COVID-19/transmission , Disease Transmission, Infectious/statistics & numerical data , Environmental Exposure/statistics & numerical data , SARS-CoV-2/isolation & purification , Virus Shedding , Adolescent , Adult , Child , Disease Transmission, Infectious/prevention & control , Environmental Exposure/prevention & control , Family Characteristics , Female , Humans , Infection Control/methods , Male , Middle Aged , Specimen Handling , Time Factors , Utah
8.
J Acoust Soc Am ; 148(4): 1824, 2020 10.
Article in English | MEDLINE | ID: covidwho-901218

ABSTRACT

Peru declared a state of emergency on March 16 in order to prevent SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmissions; thus, the International Airport was closed and the soundscape of urban zones under the flight tracks have been changed in view of the fact that airplane traffic was suspended. The authors have been conducting noise monitoring since February and because of that sufficient noise data for knowing the soundscape before and during the lockdown were obtained. This article presents a case of aircraft annoyance noise in one of Lima's city districts, which is near the aircraft climbing curve, toward the ocean on departure from Lima.


Subject(s)
Air Travel , Coronavirus Infections/transmission , Environmental Exposure/prevention & control , Irritable Mood , Noise, Transportation/prevention & control , Pneumonia, Viral/transmission , Social Isolation , Urban Health , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Environmental Monitoring , Humans , Pandemics/prevention & control , Peru , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Sound Spectrography , Time Factors
10.
Ecotoxicol Environ Saf ; 208: 111421, 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-842450

ABSTRACT

This study aims to explore the relationship between ambient NO2 levels and the transmission ability (basic reproductive number, R0) of COVID-19 in 63 Chinese cities. After adjustment for temperature and relative humidity, R0 was positively associated with NO2 concentration at city level. The temporal analysis within Hubei province indicated that all the 11 Hubei cities (except Xianning City) had significant positive correlations between NO2 concentration (with 12-day time lag) and R0 (r > 0.51, p < 0.005). Since the association between ambient NO2 and R0 indicated NO2 may increase underlying risk of infection in the transmission process of COVID-19. In addition, NO2 is also an indicator of traffic-related air pollution, the association between NO2 and COVID-19's spreadability suggest that reduced population movement may have reduced the spread of the SARS-CoV-2.


Subject(s)
Air Pollutants/analysis , COVID-19/epidemiology , COVID-19/transmission , Nitrogen Dioxide/analysis , Particulate Matter/analysis , China/epidemiology , Cities , Environmental Exposure/analysis , Environmental Exposure/prevention & control , Humans , SARS-CoV-2 , Temperature
12.
Lancet Planet Health ; 4(10): e474-e482, 2020 10.
Article in English | MEDLINE | ID: covidwho-779865

ABSTRACT

BACKGROUND: Exposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact. METHODS: For this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016-20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020). FINDINGS: The lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 µg m-3 across China (-29·7%) and 2·2 µg m-3 across Europe (-17·1%), with unprecedented reductions of 40 µg m-3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380-26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960-2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600-86 900) to 287 000 (233 700-328 300) for China, and from 13 600 (11 900-15 300) to 29 500 (25 800-33 300) for Europe, depending on the future scenarios of economic recovery adopted. INTERPRETATION: These results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted. FUNDING: None.


Subject(s)
Air Pollution/prevention & control , Communicable Disease Control/legislation & jurisprudence , Coronavirus Infections/prevention & control , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Air Pollutants/analysis , Air Pollution/analysis , Betacoronavirus , COVID-19 , China/epidemiology , Communicable Disease Control/economics , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Environmental Exposure/analysis , Environmental Exposure/prevention & control , Europe/epidemiology , Humans , Mortality, Premature/trends , Pandemics/economics , Particulate Matter/analysis , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , SARS-CoV-2
13.
J Korean Med Sci ; 35(35): e321, 2020 Sep 07.
Article in English | MEDLINE | ID: covidwho-745664

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed significant global public health challenges and created a substantial economic burden. Korea has experienced an extensive outbreak, which was linked to a religion-related super-spreading event. However, the implementation of various non-pharmaceutical interventions (NPIs), including social distancing, spring semester postponing, and extensive testing and contact tracing controlled the epidemic. Herein, we estimated the effectiveness of each NPI using a simulation model. METHODS: A compartment model with a susceptible-exposed-infectious-quarantined-hospitalized structure was employed. Using the Monte-Carlo-Markov-Chain algorithm with Gibbs' sampling method, we estimated the time-varying effective contact rate to calibrate the model with the reported daily new confirmed cases from February 12th to March 31st (7 weeks). Moreover, we conducted scenario analyses by adjusting the parameters to estimate the effectiveness of NPI. RESULTS: Relaxed social distancing among adults would have increased the number of cases 27.4-fold until the end of March. Spring semester non-postponement would have increased the number of cases 1.7-fold among individuals aged 0-19, while lower quarantine and detection rates would have increased the number of cases 1.4-fold. CONCLUSION: Among the three NPI measures, social distancing in adults showed the highest effectiveness. The substantial effect of social distancing should be considered when preparing for the 2nd wave of COVID-19.


Subject(s)
COVID-19/transmission , Communicable Disease Control/methods , Contact Tracing/methods , Coronavirus Infections/transmission , Mass Screening/methods , Pneumonia, Viral/transmission , Betacoronavirus , COVID-19/prevention & control , Computer Simulation , Coronavirus Infections/prevention & control , Environmental Exposure/prevention & control , Humans , Markov Chains , Models, Theoretical , Monte Carlo Method , Pandemics , Physical Distancing , Pneumonia, Viral/prevention & control , Public Health Practice/legislation & jurisprudence , Republic of Korea , SARS-CoV-2
15.
J Med Virol ; 92(11): 2498-2510, 2020 11.
Article in English | MEDLINE | ID: covidwho-595840

ABSTRACT

Pandemic coronavirus disease-2019 (COVID-19) gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regard to CoV containment generically and then to translate these findings into timely applications for COVID-19. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Presymptomatic, asymptomatic, and post-14 day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real-life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS-CoV, Middle East respiratory syndrome-related coronavirus (MERS-CoV), and SARS-CoV-2 are required.


Subject(s)
Coronavirus/drug effects , Decontamination , Disinfectants/chemistry , Environmental Exposure/prevention & control , Sewage/virology , COVID-19/prevention & control , Humans , Hydrogen-Ion Concentration , Radiation
19.
Head Neck ; 42(7): 1491-1496, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-291715

ABSTRACT

The global pandemic of 2019 novel coronavirus disease (COVID-19) has tremendously altered routine medical service provision and imposed unprecedented challenges to the health care system. This impacts patients with dysphagia complications caused by head and neck cancers. As this pandemic of COVID-19 may last longer than severe acute respiratory syndrome (SARS) in 2003, a practical workflow for managing dysphagia is crucial to ensure a safe and efficient practice to patients and health care personnel. This document provides clinical practice guidelines based on available evidence to date to balance the risks of SARS-CoV-2 exposure with the risks associated with dysphagia. Critical considerations include reserving instrumental assessments for urgent cases only, optimizing the noninstrumental swallowing evaluation, appropriate use of personal protective equipment (PPE), and use of telehealth when appropriate. Despite significant limitations in clinical service provision during the pandemic of COVID-19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.


Subject(s)
Betacoronavirus , Coronavirus Infections , Deglutition Disorders/diagnosis , Head and Neck Neoplasms/complications , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Air Filters , Barium Sulfate , COVID-19 , Contrast Media , Deglutition Disorders/etiology , Environmental Exposure/prevention & control , Esophagoscopy , Fluoroscopy , Humans , Occupational Exposure/prevention & control , Personal Protective Equipment , Quarantine , SARS-CoV-2 , Telemedicine , Video Recording
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