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2.
BMJ Open ; 11(2): e044384, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1090929

ABSTRACT

OBJECTIVE: The aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London. DESIGN: Observational cohort study. SETTING: London North West Healthcare NHS Trust (LNWH). PARTICIPANTS: Patients tested and/or admitted for COVID-19 at LNWH during March and April 2020 MAIN OUTCOME MEASURES: Descriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19. RESULTS: The outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients. CONCLUSION: The findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.


Subject(s)
/epidemiology , Hospitalization , Adolescent , Adult , Aged , Aged, 80 and over , /mortality , Child , Child, Preschool , Cohort Studies , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Intensive Care Units , London/epidemiology , Male , Middle Aged , Respiration, Artificial , Risk Factors , Young Adult
3.
Mil Med Res ; 8(1): 13, 2021 02 16.
Article in English | MEDLINE | ID: covidwho-1088620

ABSTRACT

BACKGROUND: Until January 18, 2021, coronavirus disease-2019 (COVID-19) has infected more than 93 million individuals and has caused a certain degree of panic. Viral pneumonia caused by common viruses such as respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses have been more common in children. However, the incidence of COVID-19 in children was significantly lower than that in adults. The purpose of this study was to describe the clinical manifestations, treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak. METHODS: Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study. A total of 64 children with COVID-19 were defined as the COVID-19 cohort, of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort. Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort. The epidemiologic, clinical, and laboratory findings were compared by Kolmogorov-Smirnov test, t-test, Mann-Whitney U test and Contingency table method. Drug usage, immunotherapy, blood transfusion, and need for oxygen support were collected as the treatment indexes. Mortality, intensive care needs and symptomatic duration were collected as the outcome indicators. RESULTS: Compared with the viral pneumonia cohort, children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19 (53/64 vs. 23/284), were of older median age (6.3 vs. 3.2 years), and had a higher proportion of ground-glass opacity (GGO) on computed tomography (18/40 vs. 0/38, P < 0.001). Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases (1/40 vs. 38/284, P = 0.048), and lower cases with high fever (3/40 vs. 167/284, P < 0.001), requiring intensive care (1/40 vs. 32/284, P < 0.047) and with shorter symptomatic duration (median 5 vs. 8 d, P < 0.001). The proportion of cases with evaluated inflammatory indicators, biochemical indicators related to organ or tissue damage, D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort (P < 0.05). No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs (lopinavir-ritonavir, ribavirin, and arbidol) as compared with duration in 39 children without antiviral therapy [median 10 vs. 9 d, P = 0.885]. CONCLUSION: The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia. Lopinavir-ritonavir, ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19. During the COVID-19 outbreak, attention also must be given to children with infection by other pathogens infection.


Subject(s)
/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Adolescent , /therapy , Child , Child, Preschool , China/epidemiology , Female , Humans , Infant , Male , Pandemics , Retrospective Studies , Severe Acute Respiratory Syndrome/physiopathology , Severe Acute Respiratory Syndrome/therapy , Severity of Illness Index
6.
Obstet Gynecol Clin North Am ; 48(1): 53-74, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1083654

ABSTRACT

Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.


Subject(s)
Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/therapy , Virus Diseases/therapy , Virus Diseases/transmission , Adult , Antiviral Agents/therapeutic use , /transmission , Cytomegalovirus Infections/therapy , Cytomegalovirus Infections/transmission , Female , HIV Infections/therapy , HIV Infections/transmission , Hepatitis B/therapy , Hepatitis B/transmission , Hepatitis C/therapy , Hepatitis C/transmission , Herpes Simplex/therapy , Herpes Simplex/transmission , Humans , Infant , Pregnancy , Pregnancy Complications, Infectious/virology
7.
MMWR Morb Mortal Wkly Rep ; 70(6): 189-192, 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-1079852

ABSTRACT

At its October 2020 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the 2021 Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger. After Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine by the Food and Drug Administration (FDA), ACIP issued an interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years at its December 12, 2020, meeting (1). In addition, ACIP approved an amendment to include COVID-19 vaccine recommendations in the child and adolescent immunization schedule. After Emergency Use Authorization of Moderna COVID-19 vaccine by FDA, ACIP issued an interim recommendation for use of Moderna COVID-19 vaccine in persons aged ≥18 years at its December 19, 2020, emergency meeting (2).


Subject(s)
Immunization/standards , Practice Guidelines as Topic , Vaccines/administration & dosage , Adolescent , Advisory Committees , Centers for Disease Control and Prevention, U.S. , Child , Child, Preschool , Humans , Immunization Schedule , Infant , United States
8.
PLoS One ; 16(2): e0246808, 2021.
Article in English | MEDLINE | ID: covidwho-1079375

ABSTRACT

As of mid-August 2020, Brazil was the country with the second-highest number of cases and deaths by the COVID-19 pandemic, but with large regional and social differences. In this study, using data from the Brazilian Ministry of Health, we analyze the spatial patterns of infection and mortality from Covid-19 across small areas of Brazil. We apply spatial autoregressive Bayesian models and estimate the risks of infection and mortality, taking into account age, sex composition of the population and other variables that describe the health situation of the spatial units. We also perform a decomposition analysis to study how age composition impacts the differences in mortality and infection rates across regions. Our results indicate that death and infections are spatially distributed, forming clusters and hotspots, especially in the Northern Amazon, Northeast coast and Southeast of the country. The high mortality risk in the Southeast part of the country, where the major cities are located, can be explained by the high proportion of the elderly in the population. In the less developed areas of the North and Northeast, there are high rates of infection among young adults, people of lower socioeconomic status, and people without access to health care, resulting in more deaths.


Subject(s)
/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Bayes Theorem , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Risk Factors , Sex Factors , Socioeconomic Factors , Young Adult
9.
PLoS Comput Biol ; 17(2): e1008559, 2021 02.
Article in English | MEDLINE | ID: covidwho-1079303

ABSTRACT

One of the significant unanswered questions about COVID-19 epidemiology relates to the role of children in transmission. This study uses data on infections within households in order to estimate the susceptibility and infectivity of children compared to those of adults. The data were collected from households in the city of Bnei Brak, Israel, in which all household members were tested for COVID-19 using PCR (637 households, average household size of 5.3). In addition, serological tests were performed on a subset of the individuals in the study. Inspection of the PCR data shows that children are less likely to be tested positive compared to adults (25% of children positive over all households, 44% of adults positive over all households, excluding index cases), and the chance of being positive increases with age. Analysis of joint PCR/serological data shows that there is under-detection of infections in the PCR testing, which is more substantial in children. However, the differences in detection rates are not sufficient to account for the differences in PCR positive rates in the two age groups. To estimate relative transmission parameters, we employ a discrete stochastic model of the spread of infection within a household, allowing for susceptibility and infectivity parameters to differ among children and adults. The model is fitted to the household data using a simulated maximum likelihood approach. To adjust parameter estimates for under-detection of infections in the PCR results, we employ a multiple imputation procedure using estimates of under-detection in children and adults, based on the available serological data. We estimate that the susceptibility of children (under 20 years old) is 43% (95% CI: [31%, 55%]) of the susceptibility of adults. The infectivity of children was estimated to be 63% (95% CI: [37%, 88%]) relative to that of adults.


Subject(s)
/transmission , Family Characteristics , Adolescent , Adult , /epidemiology , Child , Child, Preschool , Female , Humans , Infant , Israel/epidemiology , Likelihood Functions , Stochastic Processes , Young Adult
10.
mSphere ; 6(1)2021 02 10.
Article in English | MEDLINE | ID: covidwho-1079035

ABSTRACT

Compared to other human coronaviruses, the genetic diversity and evolution of human coronavirus 229E (HCoV-229E) are relatively understudied. We report a fatal case of COVID-19 pneumonia coinfected with HCoV-229E in Hong Kong. Genome sequencing of SARS-CoV-2 and HCoV-229E from a nasopharyngeal sample of the patient showed that the SARS-CoV-2 strain HK13 was most closely related to SARS-CoV-2 type strain Wuhan-Hu-1 (99.99% nucleotide identity), compatible with his recent history of travel to Wuhan. The HCoV-229E strain HK20-42 was most closely related to HCoV-229E strain SC0865 from the United States (99.86% nucleotide identity). To investigate if it may represent a newly emerged HCoV-229E genotype in Hong Kong, we retrieved 41 archived respiratory samples that tested positive for HCoV-229E from 2004 to 2019. Pneumonia and exacerbations of chronic airway diseases were common among infected patients. Complete RdRp, S, and N gene sequencing of the 41 HCoV-229E strains revealed that our contemporary HCoV-229E strains have undergone significant genetic drift with clustering of strains in chronological order. Two novel genogroups were identified, in addition to previously described genogroups 1 to 4, with recent circulating strains including strain HK20-42 belonging to novel genogroup 6. Positive selection was detected in the spike protein and receptor-binding domain, which may be important for viral evolution at the receptor-binding interphase. Molecular dating analysis showed that HCoV-229E shared the most recent common ancestor with bat and camel/alpaca 229E-related viruses at ∼1884, while camel/alpaca viruses had a relatively recent common ancestor at ∼1999. Further studies are required to ascertain the evolutionary origin and path of HCoV-229E.IMPORTANCE Since its first appearance in the 1960s, the genetic diversity and evolution of human coronavirus 229E (HCoV-229E) have been relatively understudied. In this study, we report a fatal case of COVID-19 coinfected with HCoV-229E in Hong Kong. Genome sequencing revealed that our SARS-CoV-2 strain is highly identical to the SARS-CoV-2 strain from Wuhan, compatible with the patient's recent travel history, whereas our HCoV-229E strain in this study is highly identical to a recent strain in the United States. We also retrieved 41 archived HCoV-229E strains from 2004 to 2019 in Hong Kong for sequence analysis. Pneumonia and exacerbations of chronic airway diseases were common diagnoses among the 41 patients. The results showed that HCoV-229E was evolving in chronological order. Two novel genogroups were identified in addition to the four preexisting HCoV-229E genogroups, with recent circulating strains belonging to novel genogroup 6. Molecular clock analysis dated bat-to-human and bat-to-camelid transmission to as early as 1884.


Subject(s)
/pathology , Common Cold/pathology , Coronavirus 229E, Human/genetics , Genetic Variation/genetics , /genetics , Adolescent , Adult , Aged , Aged, 80 and over , Base Sequence , Child , Child, Preschool , Coinfection/virology , Evolution, Molecular , Female , Genome, Viral/genetics , Hong Kong , Humans , Infant , Male , Middle Aged , Protein Domains/genetics , Sequence Analysis, RNA , Spike Glycoprotein, Coronavirus/genetics , Young Adult
11.
Rev Peru Med Exp Salud Publica ; 37(4): 689-693, 2020.
Article in Spanish, English | MEDLINE | ID: covidwho-1076943

ABSTRACT

The aim of the study was to describe the clinical and epidemiological characteristics of children with COVID-19. We analyzed the clinical records of inpatients and outpatients of the Instituto Nacional de Salud del Niño San Borja from the period between March and May, 2020. A total of 33 patients were registered, 57.6% were males with a median age of 4.8 years (range: 2 months - 17 years). We found that 81.8% of the children had contact with a positive COVID-19 case, 60.6% had concomitant diseases, 93.9% presented symptoms (mainly fever and cough) and the median incubation period was 7 days. The hemogram and acute-phase reactants were normal in most cases. Chest X-ray was abnormal in 11/16 patients. All patients received supportive treatment; 2 patients required supplemental oxygen. One patient died from complications associated with a terminal phase brain tumor. We report the clinical and epidemiological characteristics of children with COVID-19 during the first months of the pandemic in Peru.


Subject(s)
/epidemiology , Cough/epidemiology , Fever/epidemiology , Adolescent , Child , Child, Preschool , Cough/virology , Female , Fever/virology , Hospitals, Pediatric , Humans , Infant , Male , Peru/epidemiology , Retrospective Studies
12.
Emerg Infect Dis ; 27(2): 385-395, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1076427

ABSTRACT

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.


Subject(s)
/complications , Inpatients/statistics & numerical data , Outpatients/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Colorado/epidemiology , Cough/epidemiology , Cough/virology , Disease Progression , Dyspnea/epidemiology , Dyspnea/virology , Fatigue/epidemiology , Fatigue/virology , Female , Fever/epidemiology , Fever/virology , Humans , Infant , Male , Middle Aged , Myalgia/epidemiology , Myalgia/virology , Symptom Assessment , Young Adult
14.
BMC Med ; 19(1): 45, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1076140

ABSTRACT

BACKGROUND: All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS: On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS: Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS: The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.


Subject(s)
/therapeutic use , Health Personnel , Immunization Programs/methods , Patient Selection , Police , Adolescent , Aged , /mortality , Child , China/epidemiology , Comorbidity , Ethical Theory , Female , Food Industry , Health Priorities , Hospitalization , Humans , Immunization Programs/organization & administration , Infant , Influenza Vaccines/therapeutic use , Influenza, Human/prevention & control , Intensive Care Units , Male , Middle Aged , Mortality , Nursing Homes , Pandemics/prevention & control , Policy Making , Pregnancy , Transportation , Vaccination , Young Adult
15.
mBio ; 12(1)2021 02 09.
Article in English | MEDLINE | ID: covidwho-1075939

ABSTRACT

Whether mother-to-infant SARS-CoV-2 transmission can occur during breastfeeding and, if so, whether the benefits of breastfeeding outweigh this risk during maternal COVID-19 illness remain important questions. Using RT-qPCR, we did not detect SARS-CoV-2 RNA in any milk sample (n = 37) collected from 18 women following COVID-19 diagnosis. Although we detected evidence of viral RNA on 8 out of 70 breast skin swabs, only one was considered a conclusive positive result. In contrast, 76% of the milk samples collected from women with COVID-19 contained SARS-CoV-2-specific IgA, and 80% had SARS-CoV-2-specific IgG. In addition, 62% of the milk samples were able to neutralize SARS-CoV-2 infectivity in vitro, whereas milk samples collected prior to the COVID-19 pandemic were unable to do so. Taken together, our data do not support mother-to-infant transmission of SARS-CoV-2 via milk. Importantly, milk produced by infected mothers is a beneficial source of anti-SARS-CoV-2 IgA and IgG and neutralizes SARS-CoV-2 activity. These results support recommendations to continue breastfeeding during mild-to-moderate maternal COVID-19 illness.IMPORTANCE Results from prior studies assaying human milk for the presence of SARS-CoV-2, the causative virus of COVID-19, have suggested milk may act as a potential vehicle for mother-to-child transmission. Most previous studies are limited because they followed only a few participants, were cross-sectional, and/or failed to report how milk was collected and/or analyzed. As such, considerable uncertainty remains regarding whether human milk is capable of transmitting SARS-CoV-2 from mother to child. Here, we report that repeated milk samples collected from 18 women following COVID-19 diagnosis did not contain SARS-CoV-2 RNA; however, risk of transmission via breast skin should be further evaluated. Importantly, we found that milk produced by infected mothers is a source of anti-SARS-CoV-2 IgA and IgG and neutralizes SARS-CoV-2 activity. These results support recommendations to continue breastfeeding during mild-to-moderate maternal COVID-19 illness as milk likely provides specific immunologic benefits to infants.


Subject(s)
Antibodies, Neutralizing/metabolism , Antibodies, Viral/metabolism , Milk, Human/immunology , Pregnancy Complications, Infectious/immunology , /immunology , Adult , Breast/virology , Breast Feeding , /virology , Female , Humans , Infant , Infectious Disease Transmission, Vertical , Male , Milk, Human/virology , Mothers , Pregnancy , Pregnancy Complications, Infectious/virology , RNA, Viral/isolation & purification , /isolation & purification
16.
Fam Community Health ; 44(2): 87-98, 2021.
Article in English | MEDLINE | ID: covidwho-1075639

ABSTRACT

The COVID-19 pandemic and related quarantine orders will impact the mental health of millions of individuals in the United States. Mental health difficulties, including depression, anxiety, traumatic stress, and other negative mental health sequelae are likely and likely to persist. These challenges will require response from the psychotherapeutic and medical community that addresses the mental health needs of the population. Using binary logistic regression (n = 322 at time 1, and n = 189 at time 2), researchers in the present study examined promotive factors related to having sought medical or behavioral health treatment during a 30-day period in the midst of the COVID-19 pandemic in the United States. Approximately 10% of the sample indicated having sought either type of help. Results from the binary logistic regressions indicated those who sought counseling or medical help were those who reported increased depression symptoms at time 1. The likelihood of help seeking was heightened for those who reported greater caregiving burden, highlighting the need to consider the availability of services for those caring for children during this community-wide crisis.


Subject(s)
Anxiety Disorders/psychology , Depressive Disorder/psychology , Help-Seeking Behavior , Parents/psychology , Patient Acceptance of Health Care , Stress, Psychological/psychology , Adolescent , Adult , Anxiety/psychology , Child , Child, Preschool , Depression/psychology , Female , Humans , Infant , Infant, Newborn , Logistic Models , Male , Mental Health , Middle Aged , Pandemics , Patient Health Questionnaire , Severity of Illness Index , Surveys and Questionnaires , United States
17.
Epidemiol Infect ; 149: e48, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1075130

ABSTRACT

To understand the characteristics and influencing factors related to cluster infections in Jiangsu Province, China, we investigated case reports to explore transmission dynamics and influencing factors of scales of cluster infection. The effectiveness of interventions was assessed by changes in the time-dependent reproductive number (Rt). From 25th January to 29th February, Jiangsu Province reported a total of 134 clusters involving 617 cases. Household clusters accounted for 79.85% of the total. The time interval from onset to report of index cases was 8 days, which was longer than that of secondary cases (4 days) (χ2 = 22.763, P < 0.001) and had a relationship with the number of secondary cases (the correlation coefficient (r) = 0.193, P = 0.040). The average interval from onset to report was different between family cluster cases (4 days) and community cluster cases (7 days) (χ2 = 28.072, P < 0.001). The average time interval from onset to isolation of patients with secondary infection (5 days) was longer than that of patients without secondary infection (3 days) (F = 9.761, P = 0.002). Asymptomatic patients and non-familial clusters had impacts on the size of the clusters. The average reduction in the Rt value in family clusters (26.00%, 0.26 ± 0.22) was lower than that in other clusters (37.00%, 0.37 ± 0.26) (F = 4.400, P = 0.039). Early detection of asymptomatic patients and early reports of non-family clusters can effectively weaken cluster infections.


Subject(s)
/epidemiology , Coinfection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Cluster Analysis , Female , Humans , Infant , Male , Middle Aged , Young Adult
18.
Pan Afr Med J ; 37(Suppl 1): 42, 2020.
Article in English | MEDLINE | ID: covidwho-1069975

ABSTRACT

The aim of this study was to evaluate the main clinical and evolutionary features of SARS-CoV-2 infection in children aged 0-18 years who were suspected and diagnosed for COVID-19 during routine consultations in the pediatric ward of the Ignace Deen National Hospital in Conakry. This retrospective study targeted all children admitted to the Pediatrics Department during the study period and focused on children whose clinical examination and/or history indicated a suspicion of SARS-CoV-2 infection. Only children with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test were included. Clinical and paraclinical data were rigorously analyzed. Anonymity and respect for ethical rules were the norm. Medical records were used as the data source and a questionnaire was developed for collection. The analysis was done using STATA/SE version 11.2 software. The mean age of the patients observed was 9.66±1.32 years, with a sex ratio of 1.25. The history of the patients found that 36.11 had already been in contact with a COVID-19 positive subject, of which 8 or 22 had close relatives treated for COVID-19 and 5 had been with classmates treated for COVID-19. Fever and physical asthenia, runny nose and throat pain were respectively found in 58.33%, 50% and 30.55% of patients with irritability in 25%. Asymptomatic children were 30.55%. The diagnosis was confirmed after a positive RT-PCR test. Thoracic computed tomography (CT) scan was normal in 80.55% of the children. They were given mostly azithromycin 15mg/kg, zinc and chloroquine sulfate 5mg/kg. The mean age of the patients observed was 9.66 years, with a sex ratio of 1.25. The history of the patients found that 36.11 had already been in contact with a COVID-19 positive subject, of which 8 or 22 had close relatives treated for COVID-19 and 5 had been with classmates treated for COVID-19. Fever and physical asthenia, runny nose and throat pain were respectively found in 58.33%, 50% and 30.55% of patients with irritability in 25%. Asymptomatic children were 30.55%. The diagnosis was confirmed after a positive RT-PCR test. Thoracic computed tomography (CT) scan was normal in 80.55% of the children. They were given mostly azithromycin 15mg/kg, zinc and chloroquine sulfate 5mg/kg.


Subject(s)
Asymptomatic Infections/epidemiology , Hospitalization , Adolescent , Azithromycin/administration & dosage , /physiopathology , Child , Child, Preschool , Chloroquine/administration & dosage , Female , Guinea , Humans , Infant , Male , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Tomography, X-Ray Computed , Zinc/administration & dosage
19.
BMC Infect Dis ; 21(1): 155, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1069544

ABSTRACT

BACKGROUND: The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. METHODS: Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. RESULTS: Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). CONCLUSIONS: The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.


Subject(s)
/physiopathology , Adult , Aged , Child, Preschool , China , Comorbidity , Cough , Disease Outbreaks , Female , Fever , Hospitalization , Humans , Infant , Lung/diagnostic imaging , Lymphopenia , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
20.
Sci Rep ; 11(1): 3354, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1069120

ABSTRACT

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R0, for that model. Applying the [Formula: see text] formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible [Formula: see text] for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a "tunneling" effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity.


Subject(s)
/epidemiology , Models, Statistical , Pandemics , Quarantine/methods , Adolescent , Adult , Aged , Basic Reproduction Number , /virology , Canada/epidemiology , Child , Child, Preschool , China/epidemiology , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Markov Chains , Mexico/epidemiology , Middle Aged , Niger/epidemiology , Public Health , Time Factors , Young Adult
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