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4.
Am J Phys Med Rehabil ; 100(3): 209-212, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1087859

ABSTRACT

ABSTRACT: Postacute COVID-19 patients are at risk of long-term functional impairment, and the rehabilitation community is calling for action preparing for a "tsunami of rehabilitation needs" in this patient population. In the absence of standard guidelines and local evidence, a 3-wk pulmonary telerehabilitation program was successfully delivered to a postacute severe COVID-19 patient in Malawi. The patient experienced persistent dyspnea and fatigue, with a remarkable impact on his health status. On the final assessment, all his respiratory severity scores had fallen by more than their thresholds for clinical significance. He reported no continued or new complaints, was walking longer distances, had returned to work, and was discharged from follow-up. Our case shows that an improvised pulmonary telerehabilitation program for postacute COVID-19 patients could be feasible and acceptable in a low-resource setting. Benefits include reducing risk of transmission and use of personal protective equipment.


Subject(s)
/rehabilitation , Quality of Life , Telerehabilitation/organization & administration , Female , Humans , Male , Recovery of Function , Time Factors , Treatment Outcome
5.
Nat Commun ; 12(1): 1058, 2021 02 16.
Article in English | MEDLINE | ID: covidwho-1087441

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a respiratory disease with rapid human-to-human transmission caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the exponential growth of infections, identifying patients with the highest mortality risk early is critical to enable effective intervention and prioritisation of care. Here, we present the COVID-19 early warning system (CovEWS), a risk scoring system for assessing COVID-19 related mortality risk that we developed using data amounting to a total of over 2863 years of observation time from a cohort of 66 430 patients seen at over 69 healthcare institutions. On an external cohort of 5005 patients, CovEWS predicts mortality from 78.8% (95% confidence interval [CI]: 76.0, 84.7%) to 69.4% (95% CI: 57.6, 75.2%) specificity at sensitivities greater than 95% between, respectively, 1 and 192 h prior to mortality events. CovEWS could enable earlier intervention, and may therefore help in preventing or mitigating COVID-19 related mortality.


Subject(s)
/mortality , Computer Systems , Electronic Health Records , Early Warning Score , Humans , Organ Dysfunction Scores , Survival Analysis , Time Factors
6.
JAMA ; 325(3): 254-264, 2021 01 19.
Article in English | MEDLINE | ID: covidwho-1086209

ABSTRACT

Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, Setting, and Participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main Outcomes and Measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and Relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04364893.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Patient Discharge , Withholding Treatment , Aged , /diagnosis , Disease Progression , Female , Heart Failure/epidemiology , Hospitalization , Humans , Male , Middle Aged , Myocardial Infarction/epidemiology , Odds Ratio , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Sample Size , Shock/drug therapy , Time Factors , Treatment Outcome
8.
Isr Med Assoc J ; 23(2): 71-75, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1085835

ABSTRACT

BACKGROUND: The coronavirus disease-2019 (COVID-19) crisis has affected how hospitals work and has had an effect on orthopedic surgery. OBJECTIVES: To compare patient management and low-energy and high-energy trauma treatment at two orthopedic trauma units during the COVID-19 crisis and to clarify resource demands and preparedness in orthopedic clinics during the state of emergency caused by the COVID-19 pandemic. METHODS: This retrospective study was conducted at two orthopedic trauma units from 14 March 2019 to 14 April 2019 and from 14 March 2020 to 14 April 2020. RESULTS: The proportion of patients admitted in the multi-trauma orthopedic unit decreased by one-third, the mean time interval from admission to surgery significantly decreased, and the number of surgeries and mean length of stay in hospital decreased in 2020 compared to the same test period in 2019. In the orthopedic trauma unit, the number of patients and surgeries also decreased. CONCLUSIONS: Our study highlights changes in orthopedic injury characteristics in two orthopedic units during the COVID-19 crisis in Latvia and compares these changes to data from the same time period one year earlier.


Subject(s)
Hospitalization/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Trauma Centers/statistics & numerical data , Wounds and Injuries/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Latvia , Length of Stay/statistics & numerical data , Male , Middle Aged , Musculoskeletal System/injuries , Musculoskeletal System/surgery , Retrospective Studies , Time Factors , Young Adult
9.
J Med Internet Res ; 23(2): e25734, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1084678

ABSTRACT

BACKGROUND: In a fast-evolving public health crisis such as the COVID-19 pandemic, multiple pieces of relevant information can be posted sequentially on a social media platform. The interval between subsequent posting times may have a different impact on the transmission and cross-propagation of the old and new information that results in a different peak value and a final size of forwarding users of the new information, depending on the content correlation and whether the new information is posted during the outbreak or quasi-steady-state phase of the old information. OBJECTIVE: This study aims to help in designing effective communication strategies to ensure information is delivered to the maximal number of users. METHODS: We developed and analyzed two classes of susceptible-forwarding-immune information propagation models with delay in transmission to describe the cross-propagation process of relevant information. A total of 28,661 retweets of typical information were posted frequently by each opinion leader related to COVID-19 with high influence (data acquisition up to February 19, 2020). The information was processed into discrete points with a frequency of 10 minutes, and the real data were fitted by the model numerical simulation. Furthermore, the influence of parameters on information dissemination and the design of a publishing strategy were analyzed. RESULTS: The current epidemic outbreak situation, epidemic prevention, and other related authoritative information cannot be timely and effectively browsed by the public. The ingenious use of information release intervals can effectively enhance the interaction between information and realize the effective diffusion of information. We parameterized our models using real data from Sina Microblog and used the parameterized models to define and evaluate mutual attractiveness indexes, and we used these indexes and parameter sensitivity analyses to inform optimal strategies for new information to be effectively propagated in the microblog. The results of the parameter analysis showed that using different attractiveness indexes as the key parameters can control the information transmission with different release intervals, so it is considered as a key link in the design of an information communication strategy. At the same time, the dynamic process of information was analyzed through index evaluation. CONCLUSIONS: Our model can carry out an accurate numerical simulation of information at different release intervals and achieve a dynamic evaluation of information transmission by constructing an indicator system so as to provide theoretical support and strategic suggestions for government decision making. This study optimizes information posting strategies to maximize communication efforts for delivering key public health messages to the public for better outcomes of public health emergency management.


Subject(s)
/epidemiology , Health Education , Information Dissemination , Public Health/statistics & numerical data , Public Opinion , Social Media/statistics & numerical data , Communication , Disease Outbreaks , Government , Humans , Pandemics , Time Factors
10.
BMJ ; 372: n311, 2021 02 11.
Article in English | MEDLINE | ID: covidwho-1083594

ABSTRACT

OBJECTIVE: To evaluate whether early initiation of prophylactic anticoagulation compared with no anticoagulation was associated with decreased risk of death among patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United States. DESIGN: Observational cohort study. SETTING: Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated national healthcare system. PARTICIPANTS: All 4297 patients admitted to hospital from 1 March to 31 July 2020 with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and without a history of anticoagulation. MAIN OUTCOME MEASURES: The main outcome was 30 day mortality. Secondary outcomes were inpatient mortality, initiating therapeutic anticoagulation (a proxy for clinical deterioration, including thromboembolic events), and bleeding that required transfusion. RESULTS: Of 4297 patients admitted to hospital with covid-19, 3627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3600) of treated patients received subcutaneous heparin or enoxaparin. 622 deaths occurred within 30 days of hospital admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospital stay. Using inverse probability of treatment weighted analyses, the cumulative incidence of mortality at 30 days was 14.3% (95% confidence interval 13.1% to 15.5%) among those who received prophylactic anticoagulation and 18.7% (15.1% to 22.9%) among those who did not. Compared with patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30 day mortality (hazard ratio 0.73, 95% confidence interval 0.66 to 0.81). Similar associations were found for inpatient mortality and initiation of therapeutic anticoagulation. Receipt of prophylactic anticoagulation was not associated with increased risk of bleeding that required transfusion (hazard ratio 0.87, 0.71 to 1.05). Quantitative bias analysis showed that results were robust to unmeasured confounding (e-value lower 95% confidence interval 1.77 for 30 day mortality). Results persisted in several sensitivity analyses. CONCLUSIONS: Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.


Subject(s)
Anticoagulants/therapeutic use , Enoxaparin/therapeutic use , Thromboembolism/prevention & control , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Enoxaparin/adverse effects , Female , Hemorrhage/chemically induced , Humans , Male , Middle Aged , Patient Admission , Thromboembolism/virology , Time Factors , United States/epidemiology
12.
Nat Commun ; 12(1): 943, 2021 02 11.
Article in English | MEDLINE | ID: covidwho-1078586

ABSTRACT

The COVID-19 pandemic began in early 2020 with major health consequences. While a need to disseminate information to the medical community and general public was paramount, concerns have been raised regarding the scientific rigor in published reports. We performed a systematic review to evaluate the methodological quality of currently available COVID-19 studies compared to historical controls. A total of 9895 titles and abstracts were screened and 686 COVID-19 articles were included in the final analysis. Comparative analysis of COVID-19 to historical articles reveals a shorter time to acceptance (13.0[IQR, 5.0-25.0] days vs. 110.0[IQR, 71.0-156.0] days in COVID-19 and control articles, respectively; p < 0.0001). Furthermore, methodological quality scores are lower in COVID-19 articles across all study designs. COVID-19 clinical studies have a shorter time to publication and have lower methodological quality scores than control studies in the same journal. These studies should be revisited with the emergence of stronger evidence.


Subject(s)
Data Accuracy , Periodicals as Topic , Animals , Clinical Studies as Topic , Humans , Pandemics , Peer Review, Research , Research Design , Time Factors
13.
Epidemiol Serv Saude ; 30(1): e2020680, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1076317

ABSTRACT

OBJECTIVE: To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. METHODS: The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. RESULTS: The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. CONCLUSION: Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.


Subject(s)
/mortality , Forecasting , Pandemics/statistics & numerical data , Brazil/epidemiology , /prevention & control , Humans , Masks/statistics & numerical data , Models, Theoretical , Mortality/trends , Time Factors
14.
PLoS One ; 16(2): e0246867, 2021.
Article in English | MEDLINE | ID: covidwho-1076273

ABSTRACT

Widespread diagnostic testing is needed to reduce transmission of COVID-19 and manage the pandemic. Effective mass screening requires robust and sensitive tests that reliably detect the SARS-CoV-2 virus, including asymptomatic and pre-symptomatic infections with a low viral count. Currently, the most accurate tests are based on detection of viral RNA by RT-PCR. We developed a method to process COVID-19 specimens that simplifies and increases the sensitivity of viral RNA detection by direct RT-qPCR, performed without RNA purification. In the method, termed Alkaline-Glycol Processing (AG Processing), a SARS-CoV-2-containing biological specimen, such as saliva or a swab-collected suspension, is processed at pH 12.2 to 12.8 for 5 min at room temperature. An aliquot of the AG-processed specimen is used for detection of SARS-CoV-2 RNA by direct RT-qPCR. AG processing effectively lyses viruses and reduces the effect of inhibitors of RT-PCR that are present in biological specimens. The sensitivity of detecting viral RNA using AG processing is on par with methods that include a viral RNA purification step. One copy of SARS-CoV-2 virus per reaction, equivalent to 300 copies per ml of saliva, is detectable in the AG-processed saliva. The LOD is 300 viral copies per ml of initial saliva specimen. AG processing works with saliva specimens or swab specimens collected into Universal Transport Medium, is compatible with heat treatment of saliva, and was confirmed to work with a range of CDC-approved RT-qPCR products and kits. Detection of SARS-CoV-2 RNA using AG processing with direct RT-qPCR provides a reliable and scalable diagnostic test for COVID-19 that can be integrated into a range of workflows, including automated settings.


Subject(s)
/diagnosis , Molecular Diagnostic Techniques/methods , RNA, Viral/genetics , /isolation & purification , Humans , Limit of Detection , Mass Screening , Reagent Kits, Diagnostic , Real-Time Polymerase Chain Reaction , Saliva/virology , Specimen Handling , Time Factors
17.
PLoS One ; 16(2): e0246772, 2021.
Article in English | MEDLINE | ID: covidwho-1069634

ABSTRACT

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, daily counts of confirmed cases and deaths have been publicly reported in real-time to control the virus spread. However, substantial undocumented infections have obscured the true size of the currently infected population, which is arguably the most critical number for public health policy decisions. We developed a machine learning framework to estimate time courses of actual new COVID-19 cases and current infections in all 50 U.S. states and the 50 most infected countries from reported test results and deaths. Using published epidemiological parameters, our algorithm optimized slowly varying daily ascertainment rates and a time course of currently infected cases each day. Severe under-ascertainment of COVID-19 cases was found to be universal across U.S. states and countries worldwide. In 25 out of the 50 countries, actual cumulative cases were estimated to be 5-20 times greater than the confirmed cases. Our estimates of cumulative incidence were in line with the existing seroprevalence rates in 46 U.S. states. Our framework projected for countries like Belgium, Brazil, and the U.S. that ~10% of the population has been infected once. In the U.S. states like Louisiana, Georgia, and Florida, more than 4% of the population was estimated to be currently infected, as of September 3, 2020, while in New York this fraction is 0.12%. The estimation of the actual fraction of currently infected people is crucial for any definition of public health policies, which up to this point may have been misguided by the reliance on confirmed cases.


Subject(s)
/epidemiology , /virology , Humans , Reproducibility of Results , Seroepidemiologic Studies , Time Factors , United States/epidemiology
18.
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
19.
Nat Commun ; 12(1): 844, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1069105

ABSTRACT

There are only few data concerning persistence of neutralizing antibodies (NAbs) among SARS-CoV-2-infected healthcare workers (HCW). These individuals are particularly exposed to SARS-CoV-2 infection and at potential risk of reinfection. We followed 26 HCW with mild COVID-19 three weeks (D21), two months (M2) and three months (M3) after the onset of symptoms. All the HCW had anti-receptor binding domain (RBD) IgA at D21, decreasing to 38.5% at M3 (p < 0.0001). Concomitantly a significant decrease in NAb titers was observed between D21 and M2 (p = 0.03) and between D21 and M3 (p < 0.0001). Here, we report that SARS-CoV-2 can elicit a NAb response correlated with anti-RBD antibody levels. However, this neutralizing activity declines, and may even be lost, in association with a decrease in systemic IgA antibody levels, from two months after disease onset. This short-lasting humoral protection supports strong recommendations to maintain infection prevention and control measures in HCW, and suggests that periodic boosts of SARS-CoV-2 vaccination may be required.


Subject(s)
Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , Health Personnel/statistics & numerical data , /immunology , Adult , Binding Sites/immunology , Cell Line, Tumor , Female , Humans , Immunoglobulin A/immunology , Male , Middle Aged , Protein Binding , Receptors, Virus/metabolism , Spike Glycoprotein, Coronavirus/immunology , Spike Glycoprotein, Coronavirus/metabolism , Time Factors
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