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PLoS One ; 15(11): e0241959, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1218365


The coronavirus disease 2019 (Covid-19) pandemic, caused by SARS-CoV-2, has resulted in a global testing supply shortage. In response, pooled testing has emerged as a promising strategy that can immediately increase testing capacity. In pooled sample testing, multiple samples are combined (or pooled) together and tested as a single unit. If the pool is positive, the individual samples can then be individually tested to identify the positive case(s). Here, we provide support for the adoption of sample pooling with the point-of-care Cepheid Xpert® Xpress SARS-CoV-2 molecular assay. Corroborating previous findings, the limit of detection of this assay was comparable to laboratory-developed reverse-transcription quantitative PCR SARS-CoV-2 tests, with observed detection below 100 copies/mL. The Xpert® Xpress assay detected SARS-CoV-2 after samples with minimum viral loads of 461 copies/mL were pooled in groups of six. Based on these data, we recommend the adoption of pooled testing with the Xpert® Xpress SARS-CoV-2 assay where warranted based on public health needs. The suggested number of samples per pool, or the pooling depth, is unique for each point-of-care testing site and can be determined by the positive test rates. To statistically determine appropriate pooling depth, we have calculated the pooling efficiency for numerous combinations of pool sizes and test rates. This information is included as a supplemental dataset that we encourage public health authorities to use as a guide to make recommendations that will maximize testing capacity and resource conservation.

Betacoronavirus/genética , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , ARN Viral/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/virología , Pruebas en el Punto de Atención , ARN Viral/genética , Juego de Reactivos para Diagnóstico , Manejo de Especímenes , Carga Viral
Appl Environ Microbiol ; 86(18)2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1218186


Temperature and relative humidity are major factors determining virus inactivation in the environment. This article reviews inactivation data regarding coronaviruses on surfaces and in liquids from published studies and develops secondary models to predict coronaviruses inactivation as a function of temperature and relative humidity. A total of 102 D values (i.e., the time to obtain a log10 reduction of virus infectivity), including values for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were collected from 26 published studies. The values obtained from the different coronaviruses and studies were found to be generally consistent. Five different models were fitted to the global data set of D values. The most appropriate model considered temperature and relative humidity. A spreadsheet predicting the inactivation of coronaviruses and the associated uncertainty is presented and can be used to predict virus inactivation for untested temperatures, time points, or any coronavirus strains belonging to Alphacoronavirus and Betacoronavirus genera.IMPORTANCE The prediction of the persistence of SARS-CoV-2 on fomites is essential in investigating the importance of contact transmission. This study collects available information on inactivation kinetics of coronaviruses in both solid and liquid fomites and creates a mathematical model for the impact of temperature and relative humidity on virus persistence. The predictions of the model can support more robust decision-making and could be useful in various public health contexts. A calculator for the natural clearance of SARS-CoV-2 depending on temperature and relative humidity could be a valuable operational tool for public authorities.

Betacoronavirus/fisiología , Infecciones por Coronavirus/virología , Modelos Biológicos , Neumonía Viral/virología , Inactivación de Virus , Fómites/virología , Humanos , Humedad , Pandemias , Salud Pública , Suspensiones , Temperatura
Int J Clin Pract ; 74(8): e13512, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1218110
Clin Exp Dermatol ; 45(6): 748-749, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1218094
Clin Infect Dis ; 71(15): 863-865, 2020 07 28.
Artículo en Inglés | MEDLINE | ID: covidwho-1217826


We analyzed age-/sex-specific morbidity and mortality data from the SARS-CoV-2 pandemic in China and Republic of Korea (ROK). Data from China exhibit a Gaussian distribution with peak morbidity in the 50-59-year cohort, while the ROK data have a bimodal distribution with the highest morbidity in the 20-29-year cohort.

Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Adulto , Betacoronavirus/patogenicidad , China/epidemiología , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Pandemias , Neumonía Viral/virología , República de Corea/epidemiología , Adulto Joven
Clin Infect Dis ; 71(15): 786-792, 2020 07 28.
Artículo en Inglés | MEDLINE | ID: covidwho-1217824


BACKGROUND: Rapid identification of COVID-19 cases, which is crucial to outbreak containment efforts, is challenging due to the lack of pathognomonic symptoms and in settings with limited capacity for specialized nucleic acid-based reverse transcription polymerase chain reaction (PCR) testing. METHODS: This retrospective case-control study involves subjects (7-98 years) presenting at the designated national outbreak screening center and tertiary care hospital in Singapore for SARS-CoV-2 testing from 26 January to 16 February 2020. COVID-19 status was confirmed by PCR testing of sputum, nasopharyngeal swabs, or throat swabs. Demographic, clinical, laboratory, and exposure-risk variables ascertainable at presentation were analyzed to develop an algorithm for estimating the risk of COVID-19. Model development used Akaike's information criterion in a stepwise fashion to build logistic regression models, which were then translated into prediction scores. Performance was measured using receiver operating characteristic curves, adjusting for overconfidence using leave-one-out cross-validation. RESULTS: The study population included 788 subjects, of whom 54 (6.9%) were SARS-CoV-2 positive and 734 (93.1%) were SARS-CoV-2 negative. The median age was 34 years, and 407 (51.7%) were female. Using leave-one-out cross-validation, all the models incorporating clinical tests (models 1, 2, and 3) performed well with areas under the receiver operating characteristic curve (AUCs) of 0.91, 0.88, and 0.88, respectively. In comparison, model 4 had an AUC of 0.65. CONCLUSIONS: Rapidly ascertainable clinical and laboratory data could identify individuals at high risk of COVID-19 and enable prioritization of PCR testing and containment efforts. Basic laboratory test results were crucial to prediction models.

Betacoronavirus/genética , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/virología , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa/métodos , Estudios Retrospectivos , Singapur/epidemiología , Esputo/virología , Adulto Joven
Clin Infect Dis ; 71(15): 778-785, 2020 07 28.
Artículo en Inglés | MEDLINE | ID: covidwho-1217823


BACKGROUND: The emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. The current method of detection involves a quantitative polymerase chain reaction (qPCR)-based technique, which identifies the viral nucleic acids when present in sufficient quantity. False-negative results can be achieved and failure to quarantine the infected patient would be a major setback in containing the viral transmission. We aim to describe the time kinetics of various antibodies produced against the 2019 novel coronavirus (SARS-CoV-2) and evaluate the potential of antibody testing to diagnose COVID-19. METHODS: The host humoral response against SARS-CoV-2, including IgA, IgM, and IgG response, was examined by using an ELISA-based assay on the recombinant viral nucleocapsid protein. 208 plasma samples were collected from 82 confirmed and 58 probable cases (qPCR negative but with typical manifestation). The diagnostic value of IgM was evaluated in this cohort. RESULTS: The median duration of IgM and IgA antibody detection was 5 (IQR, 3-6) days, while IgG was detected 14 (IQR, 10-18) days after symptom onset, with a positive rate of 85.4%, 92.7%, and 77.9%, respectively. In confirmed and probable cases, the positive rates of IgM antibodies were 75.6% and 93.1%, respectively. The detection efficiency by IgM ELISA is higher than that of qPCR after 5.5 days of symptom onset. The positive detection rate is significantly increased (98.6%) when combining IgM ELISA assay with PCR for each patient compared with a single qPCR test (51.9%). CONCLUSIONS: The humoral response to SARS-CoV-2 can aid in the diagnosis of COVID-19, including subclinical cases.

Betacoronavirus/inmunología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Inmunidad Humoral/inmunología , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Adulto , Secuencia de Aminoácidos , Anticuerpos Antivirales/inmunología , Niño , Preescolar , Infecciones por Coronavirus/virología , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa/métodos
Clin Infect Dis ; 71(15): 769-777, 2020 07 28.
Artículo en Inglés | MEDLINE | ID: covidwho-1217822


BACKGROUND: From December 2019 to February 2020, 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a serious outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China. Related clinical features are needed. METHODS: We reviewed 69 patients who were hospitalized in Union hospital in Wuhan between 16 January and 29 January 2020. All patients were confirmed to be infected with SARS-CoV-2, and the final date of follow-up was 4 February 2020. RESULTS: The median age of 69 enrolled patients was 42.0 years (interquartile range 35.0-62.0), and 32 patients (46%) were men. The most common symptoms were fever (60 [87%]), cough (38 [55%]), and fatigue (29 [42%]). Most patients received antiviral therapy (66 [98.5%] of 67 patients) and antibiotic therapy (66 [98.5%] of 67 patients). As of 4 February 2020, 18 (26.9%) of 67 patients had been discharged, and 5 patients had died, with a mortality rate of 7.5%. According to the lowest SpO2 during admission, cases were divided into the SpO2 ≥ 90% group (n = 55) and the SpO2 < 90% group (n = 14). All 5 deaths occurred in the SpO2 < 90% group. Compared with SpO2 ≥ 90% group, patients of the SpO2 < 90% group were older and showed more comorbidities and higher plasma levels of interleukin (IL) 6, IL10, lactate dehydrogenase, and C reactive protein. Arbidol treatment showed tendency to improve the discharging rate and decrease the mortality rate. CONCLUSIONS: COVID-19 appears to show frequent fever, dry cough, and increase of inflammatory cytokines, and induced a mortality rate of 7.5%. Older patients or those with underlying comorbidities are at higher risk of death.

Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Neumonía Viral/patología , Neumonía Viral/virología , Adulto , Anciano , Betacoronavirus/patogenicidad , Proteína C-Reactiva/metabolismo , China , Infecciones por Coronavirus/metabolismo , Tos/metabolismo , Tos/patología , Tos/virología , Femenino , Fiebre/metabolismo , Fiebre/patología , Fiebre/virología , Hospitalización , Humanos , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente , Neumonía Viral/metabolismo
J Med Virol ; 92(4): 448-454, 2020 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1217360


To investigate the genetic diversity, time origin, and evolutionary history of the 2019-nCoV outbreak in China and Thailand, a total of 12 genome sequences of the virus with known sampling date (24 December 2019 and 13 January 2020) and geographic location (primarily Wuhan city, Hubei Province, China, but also Bangkok, Thailand) were analyzed. Phylogenetic and likelihood-mapping analyses of these genome sequences were performed. On the basis of our results, the star-like signal and topology of 2019-nCoV may be indicative of potentially large "first generation" human-to-human virus transmission. We estimated that 2019-nCoV likely originated in Wuhan on 9 November 2019 (95% credible interval: 25 September 2019 and 19 December 2019), and that Wuhan is the major hub for the spread of the 2019-nCoV outbreak in China and elsewhere. Our results could be useful for designing effective prevention strategies for 2019-nCoV in China and beyond.

Quirópteros , Coronavirus , Neumonía , Animales , Betacoronavirus , China , Brotes de Enfermedades , Humanos , Filogenia , Tailandia
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.1): 311-313, Feb. 2021.
Artículo en Inglés | LILACS (Américas) | ID: covidwho-1215193


Abstract The authors bring reflections about people with sickle cell disease in the pandemic era. They comment on some common clinical situations in these two diseases which may delay or confuse the diagnosis of COVID-19 in patients with sickle cell disease. We consider that people with sickle cell disease are part of the risk group for the complications of COVID-19 and the topic should be addressed in the scientific literature.

Resumo Os autores trazem reflexões sobre as pessoas com doença falciforme na era da pandemia. Eles comentam algumas situações clínicas comuns nessas duas doenças que podem retardar ou confundir o diagnóstico de COVID-19 em pacientes com doença falciforme. Consideramos que as pessoas com doença falciforme fazem parte do grupo de risco para complicações da COVID-19 e o tema deve ser abordado na literatura científica.

Humanos , Infecciones por Coronavirus , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/diagnóstico , Diagnóstico Precoz , Síndrome Torácico Agudo , Betacoronavirus
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.1): 263-274, Feb. 2021. tab, graf
Artículo en Inglés | LILACS (Américas) | ID: covidwho-1215190


Abstract The COVID-19 pandemic has brought countless challenges to the health institutions around the world, especially those located in countries such as Brazil, with large territorial dimensions and many social and economic differences. This technical report aims to publish the actions carried out and the products developed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) before and during the pandemic - from January 31st to September 4th, 2020 - facing it efficiently and effectively, seeking institutional sustainability. The mobilization of the professional staff at the institution was fundamental to create protocols ofas-sistance, adapt the physical structures in the hospital and outpatient care, care for the health professionals, offer teaching and research activities in the distance mode, articulate management members to make decisions based on systematically collected data on the pandemic situationat real time. All actions were carried out with a single objective of assisting all the patients affected by COVID-19 admitted at the institution.

Resumo A pandemia da COVID-19 trouxe incontáveis desafios para as instituições de saúde de todo o mundo, em especial as localizadas em países como o Brasil, com grande dimensão territorial e muitas diferenças sociais e econômicas. Este informe técnico tem como objetivo publicizar as ações realizadas e os produtos desenvolvidos no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) antes e durante a pandemia - no período de 31 de janeiro até 04 de setembro de 2020 - enfrentando-a com eficiência e eficácia, buscando a sustentabilidade institucional. A mobilização do corpo profissional da instituição foi fundamental para a construir protocolos de atendimento, adaptar as estruturas físicas na assistência ao paciente em âmbito hospitalar e ambulatorial, cuidar dos profissionais de saúde, ofertar as atividades de ensino e pesquisa na modalidade à distância, articular os membros da gestão para tomar decisões baseadas em dados sistematicamente coletados sobre a situação da pandemia em tempo real. Todas as ações foram realizadas com um uníssono objetivo de atender a todos os pacientes acometidos pela COVID-19 admitidos na instituição.

Organización y Administración/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Atención Integral de Salud , Pandemias , Betacoronavirus , Atención al Paciente , Brasil , Personal de Salud/educación , Educación a Distancia
J Trauma Acute Care Surg ; 89(6): 1092-1098, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1214720


BACKGROUND: Invasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients. METHODS: Data of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020, were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge. RESULTS: Among 40 COVID-19 patients with IMV, 31 died, and 9 survived and was discharged. The median age was 70 years (interquartile range [IQR], 62-76 years), and nonsurvivors were older than survivors. The median period from the noninvasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR, 2-42 hours) in IMV survivors and 54 hours (IQR, 28-143 hours) in IMV nonsurvivors. We observed that, when the time interval from NIV/HFNC to intubation was less than 50 hours (about 2 calendar days), together with Acute Physiology and Chronic Health Evaluation II (APACHE II) score of less than 10 or pneumonia severity index (PSI) score of less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation and high levels of APACHE II and PSI before intubation were associated with higher mortality in critically ill patients. Multiple organ damage was common among these nonsurvivors in the course of treatment. CONCLUSION: Early initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI scores might help physicians in decision making about timing of intubation for curbing subsequent mortality. LEVEL OF EVIDENCE: Therapeutic, level V.

Infecciones por Coronavirus/terapia , Enfermedad Crítica/terapia , Mortalidad Hospitalaria , Ventilación no Invasiva/métodos , Oxígeno/administración & dosificación , Neumonía Viral/terapia , APACHE , Anciano , Betacoronavirus , China , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica/mortalidad , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/métodos , Pandemias , Neumonía Viral/mortalidad , Estudios Retrospectivos , Factores de Tiempo
Rev Panam Salud Publica ; 45, apr. 2021
Artículo | PAHOIRIS | ID: covidwho-1212110


[ABSTRACT]. Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in the FTA is unready to face such an epidemic and that intensive care bed capacity must be increased. In conclusion, the critical care sector in the FTA requires upgrading of infrastructure, human resources, and equipment as well as enhancement of multidisciplinary care. Also needed are promotion of training, research, and regional and international medical and scientific cooperation.

[RESUMEN]. Los hospitales en los territorios franceses de la Región de las Américas funcionan según las normas francesas e internacionales. El objetivo de este artículo es describir distintos aspectos de los cuidados intensivos en los territorios franceses. Para ello, hemos revisado los datos oficiales sobre el tamaño de la población y el número de camas de las unidades de cuidados intensivos (UCI), así como la bibliografía sobre algunos aspectos específicos de las UCI, en los territorios franceses. Las personas que viven en los territorios franceses, o que están de visita en ellos, están expuestas a riesgos específicos: principalmente traumatismos graves causados por el tránsito, envenenamiento por mordeduras, heridas de bala o por apuñalamiento, y enfermedades infecciosas tropicales emergentes. La atención de estos traumatismos y enfermedades puede requerir conocimientos específicos y cuidados intensivos. Sin embargo, no hay suficientes camas de UCI en los territorios franceses. De hecho, hay 7,2 camas de UCI por 100 000 habitantes en Guadalupe, 7,2 en Martinica y 4,5 en Guayana Francesa. Además, los pacientes gravemente enfermos que viven en zonas remotas a menudo tienen que ser trasladados, normalmente por helicóptero, lo que retrasa su ingreso en la unidad de cuidados intensivos. La crisis de la COVID-19 ha puesto de manifiesto que el sistema de atención de salud en los territorios franceses no está preparado para enfrentarse a una epidemia de estas dimensiones y que debe aumentarse la capacidad hospitalaria de las unidades de cuidados intensivos. En conclusión, el sector de los cuidados intensivos en los territorios franceses tiene que mejorar su infraestructura, recursos humanos y equipamiento, así como perfeccionar la atención multidisciplinaria. También es necesario promover la capacitación, la investigación y la cooperación médica y científica, tanto regional como internacional.

[RESUMO]. Os hospitais nos territórios ultramarinos franceses nas Américas funcionam segundo os padrões franceses e internacionais. O objetivo deste artigo é descrever os diversos aspectos da atenção intensiva nesta região. Analisamos os dados oficiais relativos ao tamanho da população e ao número de leitos de unidade de terapia intensiva (UTI) nestes territórios junto com uma revisão da literatura científica sobre as características particulares destes centros de terapia intensiva. Os residentes locais ou visitantes dos territórios ultramarinos franceses nas Américas são expostos a riscos específicos, sobretudo acidentes de trânsito graves, envenenamentos por animais peçonhentos, ferimentos por armas brancas ou armas de fogo e doenças infecciosas tropicais emergentes que requerem conhecimento especializado e atenção intensiva. Porém, não há leitos suficientes de UTI nos territórios ultramarinos franceses nas Américas: são 7,2 leitos de UTI por 100.000 habitantes em Guadalupe, 7,2 na Martinica e 4,5 na Guiana Francesa. Ademais, em áreas remotas, os pacientes em estado crítico frequentemente precisam ser transferidos por helicóptero, o que causa demora na internação em UTI. A crise da COVID-19 demonstra o despreparo do sistema de saúde para enfrentar a pandemia e a necessidade de aumentar o número de leitos de UTI nestes territórios. Em conclusão, é imprescindível modernizar a infraestrutura e os equipamentos, capacitar melhor os recursos humanos e melhorar a atenção multidisciplinar. Incentivar a formação profissional, pesquisa e cooperação médico-científica regional e mundial é também fundamental.

Cuidados Críticos , Medicina Tropical , Infecciones por Coronavirus , Infecciones por Coronavirus , Betacoronavirus , Guyana Francesa , Guadalupe , Martinica , Cuidados Críticos , Infecciones por Coronavirus , Medicina Tropical , Guyana Francesa , Guadalupe , Martinica , Infecciones por Coronavirus , Guyana Francesa