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1.
Front Public Health ; 9: 586299, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1156164

RESUMEN

Background: The COVID 19 epidemic submerged many health systems in the Amazon. The objective of the present study was to focus on the epidemic curves of the COVID 19 epidemic in different centers, and to look at testing and mortality data. Methods: Publicly available datasets were used. The log10 of the daily cumulated number of cases starting from the day the territory reached 100 cumulated cases was plotted to compare the magnitude, shape and slope of the different curves. The maximum daily testing efforts were plotted for each territory in relation to the maximum daily number of diagnoses. The case fatality rate was computed by dividing the number of COVID 19 deaths by the number of confirmed cases. Results: In the Amazonian regions in general the speed of growth was generally lower than in Europe or the USA, or Southern Brazil. Whereas, countries like South Korea or New Zealand "broke" the curve relatively rapidly the log linear trajectory seemed much longer with signs of a decline in growth rate as of early July 2020. After a very slow start, French Guiana had the lowest slope when compared to other Amazonian territories with significant epidemics. The Amazonian states of Roraima, Amazonas, Parà, and Amapà had among the highest number of cases and deaths per million inhabitants in the world. French Guiana had significantly fewer deaths relative to its number of confirmed cases than other Amazonian territories. French Guiana had a late epidemic surge with intense testing scale-up often exceeding 4,000 persons tested daily per million inhabitants. Brazil was an outlier with low daily testing levels in relation to the number of daily diagnoses. Conclusions: There were marked heterogeneities mortality rates suggesting that socioeconomic, political factors, and perhaps ethnic vulnerability led to striking outcome differences in this Amazonian context.


Asunto(s)
/epidemiología , Causas de Muerte , Brotes de Enfermedades/estadística & datos numéricos , Epidemias/estadística & datos numéricos , Internacionalidad , Brasil/epidemiología , Europa (Continente)/epidemiología , Guyana Francesa/epidemiología , Humanos , América del Norte/epidemiología
2.
PLoS One ; 16(3): e0237294, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1156076

RESUMEN

The coronavirus disease 2019 (COVID-19) outbreak in North, Central, and South America has become the epicenter of the current pandemic. We have suggested previously that the infection rate of this virus might be lower in people living at high altitude (over 2,500 m) compared to that in the lowlands. Based on data from official sources, we performed a new epidemiological analysis of the development of the pandemic in 23 countries on the American continent as of May 23, 2020. Our results confirm our previous finding, further showing that the incidence of COVID-19 on the American continent decreases significantly starting at 1,000 m above sea level (masl). Moreover, epidemiological modeling indicates that the virus transmission rate is lower in the highlands (>1,000 masl) than in the lowlands (<1,000 masl). Finally, evaluating the differences in the recovery percentage of patients, the death-to-case ratio, and the theoretical fraction of undiagnosed cases, we found that the severity of COVID-19 is also decreased above 1,000 m. We conclude that the impact of the COVID-19 decreases significantly with altitude.


Asunto(s)
Altitud , /patología , /epidemiología , /virología , América Central/epidemiología , Humanos , Incidencia , América del Norte/epidemiología , Índice de Severidad de la Enfermedad , América del Sur/epidemiología
3.
Genet Epidemiol ; 45(3): 316-323, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1139233

RESUMEN

Over 10,000 viral genome sequences of the SARS-CoV-2virus have been made readily available during the ongoing coronavirus pandemic since the initial genome sequence of the virus was released on the open access Virological website (http://virological.org/) early on January 11. We utilize the published data on the single stranded RNAs of 11,132 SARS-CoV-2 patients in the GISAID database, which contains fully or partially sequenced SARS-CoV-2 samples from laboratories around the world. Among many important research questions which are currently being investigated, one aspect pertains to the genetic characterization/classification of the virus. We analyze data on the nucleotide sequencing of the virus and geographic information of a subset of 7640 SARS-CoV-2 patients without missing entries that are available in the GISAID database. Instead of modeling the mutation rate, applying phylogenetic tree approaches, and so forth, we here utilize a model-free clustering approach that compares the viruses at a genome-wide level. We apply principal component analysis to a similarity matrix that compares all pairs of these SARS-CoV-2 nucleotide sequences at all loci simultaneously, using the Jaccard index. Our analysis results of the SARS-CoV-2 genome data illustrates the geographic and chronological progression of the virus, starting from the first cases that were observed in China to the current wave of cases in Europe and North America. This is in line with a phylogenetic analysis which we use to contrast our results. We also observe that, based on their sequence data, the SARS-CoV-2 viruses cluster in distinct genetic subgroups. It is the subject of ongoing research to examine whether the genetic subgroup could be related to diseases outcome and its potential implications for vaccine development.


Asunto(s)
/virología , Análisis por Conglomerados , Genoma Viral/genética , Mapeo Geográfico , /genética , /epidemiología , China/epidemiología , Bases de Datos Genéticas , Europa (Continente)/epidemiología , Humanos , Epidemiología Molecular , América del Norte/epidemiología , Pandemias , Filogenia , Análisis de Componente Principal , Pronóstico , /patogenicidad , Análisis Espacio-Temporal
4.
Sci Rep ; 11(1): 4619, 2021 02 25.
Artículo en Inglés | MEDLINE | ID: covidwho-1104548

RESUMEN

We apply a versatile growth model, whose growth rate is given by a generalised beta distribution, to describe the complex behaviour of the fatality curves of the COVID-19 disease for several countries in Europe and North America. We show that the COVID-19 epidemic curves not only may present a subexponential early growth but can also exhibit a similar subexponential (power-law) behaviour in the saturation regime. We argue that the power-law exponent of the latter regime, which measures how quickly the curve approaches the plateau, is directly related to control measures, in the sense that the less strict the control, the smaller the exponent and hence the slower the diseases progresses to its end. The power-law saturation uncovered here is an important result, because it signals to policymakers and health authorities that it is important to keep control measures for as long as possible, so as to avoid a slow, power-law ending of the disease. The slower the approach to the plateau, the longer the virus lingers on in the population, and the greater not only the final death toll but also the risk of a resurgence of infections.


Asunto(s)
/epidemiología , Algoritmos , Europa (Continente)/epidemiología , Humanos , América del Norte/epidemiología , Pandemias , /aislamiento & purificación
5.
Nutrients ; 13(2)2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: covidwho-1055093

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has increased the already high levels of stress that higher education students experience. Stress influences health behaviors, including those related to dietary behaviors, alcohol, and sleep; yet the effects of stress can be mitigated by resilience. To date, past research studying the connections between dietary behaviors, alcohol misuse, sleep, and resilience commonly investigated singular relationships between two of the constructs. The aim of the current study was to explore the relationships between these constructs in a more holistic manner using mediation and moderation analyses. METHODS: Higher education students from China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands, and the United States were enrolled in a cross-sectional study from April to May 2020, which was during the beginning of the COVID-19 pandemic for most participants. An online survey, using validated tools, was distributed to assess perceived stress, dietary behaviors, alcohol misuse, sleep quality and duration, and resilience. RESULTS: 2254 students completed the study. Results indicated that sleep quality mediated the relationship between perceived stress and dietary behaviors as well as the relationship between perceived stress and alcohol misuse. Further, increased resilience reduced the strength of the relationship between perceived stress and dietary behaviors but not alcohol misuse. CONCLUSION: Based on these results, higher education students are likely to benefit from sleep education and resilience training, especially during stressful events.


Asunto(s)
Alcoholismo , Dieta , Sueño , Estrés Fisiológico , Adolescente , Adulto , Asia/epidemiología , Europa (Continente)/epidemiología , Conducta Alimentaria , Femenino , Salud Global , Humanos , Masculino , América del Norte/epidemiología , Resiliencia Psicológica , Estudiantes , Universidades , Adulto Joven
6.
Genes (Basel) ; 12(1)2020 12 24.
Artículo en Inglés | MEDLINE | ID: covidwho-1016121

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) glycoprotein D614G mutation became the predominant globally circulating variant after its emergence in the early coronavirus disease 2019 (COVID-19) pandemic. Studies showed that this mutation results in an open conformation of the S glycoprotein receptor-binding domain (RBD), and increased angiotensin 1-converting enzyme 2 (ACE2) binding and fusion, which result in an increase in SARS-CoV-2 transmissibility and infectivity. Dynamic tracking of SARS-CoV-2 showed that the D614G variant became predominant after emergence in Europe and North America, but not in China. The current absence of selective pressures from antiviral treatment suggests that the driving force for viral evolution could be variations in human population genetics. Results show that ACE2 expression is higher in Asian populations than that in European, North American, and African populations. This supports the idea that lower ACE2 expression is a driving force in the positive selection for the D614G mutation. This study suggests that the dynamics of the SARS-CoV-2 D614G mutation during the early-to-mid pandemic is associated with enhanced transmission efficiency in populations with lower ACE2 expression. Understanding the role that human genetic diversity plays in the adaptive evolution of SARS-CoV-2 may have an important impact on public health and measures to control the pandemic.


Asunto(s)
/genética , Mutación Missense , Pandemias , Mutación Puntual , Receptores Virales/genética , Glicoproteína de la Espiga del Coronavirus/genética , África/epidemiología , Alelos , Sustitución de Aminoácidos , Sitios de Unión , /transmisión , China/epidemiología , Grupos Étnicos/genética , Europa (Continente)/epidemiología , Evolución Molecular , Expresión Génica , Predisposición Genética a la Enfermedad , Variación Genética , Humanos , América del Norte/epidemiología , Unión Proteica , Conformación Proteica , Dominios Proteicos , Receptores Virales/biosíntesis , Selección Genética
7.
J Bone Joint Surg Am ; 102(13): e70, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: covidwho-981472

RESUMEN

BACKGROUND: The detection of coronavirus disease 2019 (COVID-19) cases remains a huge challenge. As of April 22, 2020, the COVID-19 pandemic continues to take its toll, with >2.6 million confirmed infections and >183,000 deaths. Dire projections are surfacing almost every day, and policymakers worldwide are using projections for critical decisions. Given this background, we modeled unobserved infections to examine the extent to which we might be grossly underestimating COVID-19 infections in North America. METHODS: We developed a machine-learning model to uncover hidden patterns based on reported cases and to predict potential infections. First, our model relied on dimensionality reduction to identify parameters that were key to uncovering hidden patterns. Next, our predictive analysis used an unbiased hierarchical Bayesian estimator approach to infer past infections from current fatalities. RESULTS: Our analysis indicates that, when we assumed a 13-day lag time from infection to death, the United States, as of April 22, 2020, likely had at least 1.3 million undetected infections. With a longer lag time-for example, 23 days-there could have been at least 1.7 million undetected infections. Given these assumptions, the number of undetected infections in Canada could have ranged from 60,000 to 80,000. Duarte's elegant unbiased estimator approach suggested that, as of April 22, 2020, the United States had up to >1.6 million undetected infections and Canada had at least 60,000 to 86,000 undetected infections. However, the Johns Hopkins University Center for Systems Science and Engineering data feed on April 22, 2020, reported only 840,476 and 41,650 confirmed cases for the United States and Canada, respectively. CONCLUSIONS: We have identified 2 key findings: (1) as of April 22, 2020, the United States may have had 1.5 to 2.029 times the number of reported infections and Canada may have had 1.44 to 2.06 times the number of reported infections and (2) even if we assume that the fatality and growth rates in the unobservable population (undetected infections) are similar to those in the observable population (confirmed infections), the number of undetected infections may be within ranges similar to those described above. In summary, 2 different approaches indicated similar ranges of undetected infections in North America. LEVEL OF EVIDENCE: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Aprendizaje Automático , Pandemias/estadística & datos numéricos , Neumonía Viral/diagnóstico , Teorema de Bayes , Betacoronavirus , Canadá/epidemiología , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Predicción , Humanos , América del Norte/epidemiología , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
8.
Vaccine ; 39(2): 309-316, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: covidwho-974716

RESUMEN

A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethical represent an important roadblock to their implementation; accordingly, both the World Health Organization and numerous scholars have called for consulting the public regarding them. We answered these calls by conducting a cross-national survey (n = 5920) in Australia, Canada, Hong Kong, New Zealand, South Africa, Singapore, the United Kingdom, and the United States. The survey explained key differences between traditional vaccine trials and two accelerated designs: a challenge trial or a trial integrating a Phase II safety and immunogenicity trial into a larger Phase III efficacy trial. Respondents' answers to comprehension questions indicate that they largely understood the key differences and ethical trade-offs between the designs from our descriptions. We asked respondents whether they would prefer scientists to conduct traditional trials or one of these two accelerated designs. We found broad majorities prefer for scientists to conduct challenge trials (75%) and integrated trials (63%) over standard trials. Even as respondents acknowledged the risks, they perceived both accelerated trials as similarly ethical to standard trial designs. This high support is consistent across every geography and demographic subgroup we examined, including vulnerable populations. These findings may help assuage some of the concerns surrounding accelerated designs.


Asunto(s)
/administración & dosificación , Toma de Decisiones , Pandemias/prevención & control , Proyectos de Investigación , Vacunación/psicología , Asia/epidemiología , Australia/epidemiología , /psicología , /biosíntesis , Conducta de Elección , Ensayos Clínicos como Asunto , Femenino , Humanos , Inmunidad Innata/efectos de los fármacos , Esquemas de Inmunización , Inmunogenicidad Vacunal , Masculino , América del Norte/epidemiología , Seguridad del Paciente , Salud Pública , Encuestas y Cuestionarios , Factores de Tiempo , Reino Unido/epidemiología , Vacunación/métodos
9.
BMJ Open ; 10(11): e042573, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: covidwho-919175

RESUMEN

OBJECTIVE: To analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19. DESIGN: Meta-analysis. DATA SOURCES: PubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020. STUDY SELECTION: Studies examining the following demographics and outcomes were included: patients' age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection. RESULTS: A total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92-4.25) and an OR of 6.07, 95% CI (2.53-14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83-15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13-13.36). CONCLUSION: AKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.


Asunto(s)
Lesión Renal Aguda/epidemiología , Infecciones por Coronavirus/fisiopatología , Mortalidad Hospitalaria , Neumonía Viral/fisiopatología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Factores de Edad , Betacoronavirus , China/epidemiología , Terapia de Reemplazo Renal Continuo , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Europa (Continente)/epidemiología , Humanos , América del Norte/epidemiología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
11.
Vaccine ; 38(48): 7668-7673, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: covidwho-872530

RESUMEN

BACKGROUND: More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic. PURPOSE: To investigate predictors associated with global caregivers' intent to vaccinate their children against COVID-19, when the vaccine becomes available. METHOD: An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020. RESULTS: 65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine's novelty (52%). CONCLUSIONS: The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine's safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Negativa a la Vacunación/psicología , Vacunación/psicología , Vacunas Virales/economía , Adulto , Betacoronavirus/inmunología , Niño , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Estudios Transversales , Servicio de Urgencia en Hospital , Europa (Continente)/epidemiología , Femenino , Humanos , Inmunidad Colectiva , Cooperación Internacional , Israel/epidemiología , Japón/epidemiología , Masculino , Análisis Multivariante , América del Norte/epidemiología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Cobertura de Vacunación/estadística & datos numéricos , Negativa a la Vacunación/estadística & datos numéricos , Vacunas Virales/biosíntesis
12.
J Community Health ; 45(6): 1270-1282, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-754402

RESUMEN

OBJECTIVES: The main aim of this study was to find the prevalence of mortality among hospitalized COVID-19 infected patients and associated risk factors for death. METHODS: Three electronic databases including PubMed, Science Direct and Google Scholar were searched to identify relevant cohort studies of COVID-19 disease from January 1, 2020, to August 11, 2020. A random-effects model was used to calculate pooled prevalence rate (PR), risk ratio (RR) and 95% confidence interval (CI) for both effect measures. Cochrane chi-square test statistic Q, [Formula: see text], and [Formula: see text] tests were used to measure the presence of heterogeneity. Publication bias and sensitivity of the included studies were also tested. RESULTS: In this meta-analysis, a total of 58 studies with 122,191 patients were analyzed. The pooled prevalence rate of mortality among the hospitalized COVID-19 patients was 18.88%, 95% CI (16.46-21.30), p < 0.001. Highest mortality was found in Europe [PR 26.85%, 95% CI (19.41-34.29), p < 0.001] followed by North America [PR 21.47%, 95% CI (16.27-26.68), p < 0.001] and Asia [PR 14.83%, 95% CI (12.46- 17.21), p < 0.001]. An significant association were found between mortality among COVID-19 infected patients and older age (> 65 years vs. < 65 years) [RR 3.59, 95% CI (1.87-6.90), p < 0.001], gender (male vs. female) [RR 1.63, 95% CI (1.43-1.87), p < 0.001], ICU admitted patients [RR 3.72, 95% CI (2.70-5.13), p < 0.001], obesity [RR 2.18, 95% CI (1.10-4.34), p < 0.05], hypertension [RR 2.08,95% CI (1.79-2.43) p < 0.001], diabetes [RR 1.87, 95% CI (1.23-2.84), p < 0.001], cardiovascular disease [RR 2.51, 95% CI (1.20-5.26), p < 0.05], and cancer [RR 2.31, 95% CI (1.80-2.97), p < 0.001]. In addition, significant association for high risk of mortality were also found for cerebrovascular disease, COPD, coronary heart disease, chronic renal disease, chronic liver disease, chronic lung disease and chronic kidney disease. CONCLUSION: This meta-analysis revealed that the mortality rate among COVID-19 patients was highest in the European region and older age, gender, ICU patients, patients with comorbidity had a high risk for case fatality. Those findings would help the health care providers to reduce the mortality rate and combat this pandemic to save lives using limited resources.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Prevalencia , Adulto , Anciano , Anciano de 80 o más Años , Asia/epidemiología , Betacoronavirus , Comorbilidad , Bases de Datos Factuales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , América del Norte/epidemiología , Pandemias , Factores de Riesgo , América del Sur/epidemiología
13.
J Transl Med ; 18(1): 338, 2020 09 02.
Artículo en Inglés | MEDLINE | ID: covidwho-742417

RESUMEN

BACKGROUND: Severe acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus. METHODS: The calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data . Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p value was adjusted using Holm method. We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected. RESULTS: In this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy. CONCLUSIONS: Strict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Mutación/genética , Neumonía Viral/mortalidad , Neumonía Viral/virología , Europa (Continente)/epidemiología , Genoma Viral , Geografía , Humanos , América del Norte/epidemiología , Pandemias , Análisis de Secuencia de ADN
14.
J Int Med Res ; 48(8): 300060520938943, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-737613

RESUMEN

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 and continues to spread worldwide. Rapid and accurate identification of suspected cases is critical in slowing spread of the virus that causes the disease. We aimed to highlight discrepancies in the various criteria used by international agencies and highly impacted individual countries around the world. METHODS: We reviewed the criteria for identifying a suspected case of COVID-19 used by two international public health agencies and 10 countries across Asia, Europe, and North America. The criteria included information on the clinical causes of illness and epidemiological risk factors. Non-English language guidelines were translated into English by a co-author who is fluent in that particular language. RESULTS: Although most criteria are modifications of World Health Organization recommendations, the specific clinical features and epidemiological risks for triggering evaluation of patients with suspected COVID-19 differed widely among countries. The rationale for these differences may be related to each country's resources, politics, experience with previous outbreaks or pandemics, health insurance system, COVID-19 outbreak severity, and other undetermined factors. CONCLUSION: We found no consensus regarding the best diagnostic criteria for identifying a suspected case of COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Reglamento Sanitario Internacional , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Salud Pública/legislación & jurisprudencia , Asia/epidemiología , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Europa (Continente)/epidemiología , Humanos , Cooperación Internacional , América del Norte/epidemiología , Pandemias , Estados Unidos , Organización Mundial de la Salud
15.
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e53-e57, 2020 Jul 17.
Artículo en Inglés | MEDLINE | ID: covidwho-696034

RESUMEN

During the COVID-19 pandemic, most citizens in North America receive daily updates, which highlight the number of new cases per day in a specified region. However, as this data metric is often presented alone on media and news platforms, the spread of the novel coronavirus may often be misinterpreted. Among these daily updates which are critical to informing the public, the authors emphasize the importance of controlling for variation attributed to changes in surveillance. The number of test results that have been analyzed each day along with the total number of tests being conducted in a region have a significant impact on capturing virus spread and should always be included in widespread data. Presenting these variables may help to differentiate increases or decreases of new cases attributed to the expansion of surveillance and testing, or rather other environmental and behavioral factors. Overall, to best inform politicians, healthcare workers, and all citizens of the progress against COVID-19, there is a need to constantly improve analyses and reporting of data.


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Difusión de la Información/métodos , Neumonía Viral/epidemiología , Infecciones por Coronavirus/diagnóstico , Humanos , América del Norte/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Vigilancia de la Población/métodos
16.
Eur J Clin Invest ; 50(10): e13364, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-684466

RESUMEN

BACKGROUND: COVID-19 is currently the most urgent threat to public health in the world. The aim of this study is to provide an overview of the first cases of COVID-19 to make further improvements in health policies and prevention measurements in response to the outbreak of COVID-19. METHODS: We performed a search in PubMed, the CNKI (China National Knowledge Infrastructure), Web of Science and the WHO database of publications on COVID-19 for peer-reviewed papers from 1 December 2019 to 9 July 2020. We analysed the demographics, epidemiological characteristics, clinical features, signs and symptoms of the disease at the onset. RESULTS: We identified the first cases of COVID-19 in 16 different countries/regions from Asia, Europe, North America and South America. Of these 16 cases, 8 (50.0%) were male, with a mean of age 43.38 ± 15.19 years. All the cases had a history of travel or exposure. Twelve cases (75.0%) occurred in January, eight patients were Chinese, two patients were international students in Wuhan, one patient had a history of travelling in Wuhan, and one patient was in contact with Chinese patient. The longest hospital stay was 24 days (1 patient), and the shortest was 5 days (1 patient). The usual hospital stay was 9 days (4 patients). CONCLUSION: Understanding the epidemiological characteristics, clinical characteristics, and diagnosis and treatment of the first patients in various countries are of great significance for the identification, prevention and control of COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Tiempo de Internación/estadística & datos numéricos , Neumonía Viral/epidemiología , Viaje , Adulto , Distribución por Edad , Anciano , Asia/epidemiología , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/fisiopatología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Pandemias , Neumonía Viral/fisiopatología , Distribución por Sexo , América del Sur/epidemiología , Enfermedad Relacionada con los Viajes , Adulto Joven
17.
Am J Trop Med Hyg ; 102(6): 1178-1180, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-668710

RESUMEN

The 2019 novel coronavirus disease (COVID-19) pandemic highlights the experience of communities in the global South that have grappled with vulnerability and scarcity for decades. In the global North, many frontline workers are now being similarly forced to provide and ration care in unprecedented ways, with minimal guidance. We outline six reflections gained as Western practitioners working in resource-denied settings which inform our current experience with COVID-19. The reflections include the following: managing trauma, remaining flexible in dynamic situations, and embracing discomfort to think bigger about context-specific solutions to collectively build back our systems. Through this contextualized reflection on resilience, we hope to motivate strength and solidarity for providers, patients, and health systems, while proposing critical questions for our response moving forward.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Asignación de Recursos para la Atención de Salud/ética , Accesibilidad a los Servicios de Salud/economía , Pandemias , Neumonía Viral/epidemiología , Salud Pública/economía , Toma de Decisiones Clínicas/ética , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/terapia , Asignación de Recursos para la Atención de Salud/economía , Disparidades en Atención de Salud/ética , Humanos , Relaciones Interpersonales , América del Norte/epidemiología , Pandemias/economía , Neumonía Viral/diagnóstico , Neumonía Viral/economía , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Salud Pública/ética , Incertidumbre
19.
J Pediatr Surg ; 55(8): 1431-1435, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-591535

RESUMEN

INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. RESULTS: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. CONCLUSIONS: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. LEVEL OF EVIDENCE: III.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Hospitales Pediátricos , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/epidemiología , Procedimientos Quirúrgicos Operativos/normas , Telemedicina/métodos , Niño , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Humanos , América del Norte/epidemiología , Pandemias
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