SARS-CoV-2 Detection and Culture in Different Biological Specimens from Immunocompetent and Immunosuppressed COVID-19 Patients Infected with Two Different Viral Strains (preprint)

Introduction- The dynamics of SARS-CoV-2 shedding and replication in humans remain incompletely understood. Methods- We analyzed SARS-CoV-2 shedding from multiple sites in individuals with an acute COVID-19 infection by weekly sampling for five weeks in 98 immunocompetent and 25 immunosuppressed individuals. Samples and culture supernatants were tested by RT-PCR for SARS-CoV-2 to determine viral clearance rates and in vitro replication. Results- A total of 2447 clinical specimens were evaluated, including 557 nasopharyngeal swabs, 527 saliva samples, 464 urine specimens, 437 anal swabs and 462 blood samples. The SARS-CoV-2 genome sequences at each site were classified as belonging to the B.1.128 (ancestral strain) or Gamma lineage. SARS CoV-2 detection was highest in nasopharyngeal swabs regardless of the virus strain involved or the immune status of infected individuals. The duration of viral shedding varied between clinical specimens and individual patients. Prolonged shedding of potentially infectious virus varied from 10 days up to 191 days, and primarily occurred in immunosuppressed individuals. Virus was isolated in culture from 18 nasal swab or saliva samples collected 10 or more days after onset of disease. Conclusions-Our findings indicate that persistent SARS-CoV-2 shedding may occur in both competent or immunosuppressed individuals, at multiple clinical sites and in a minority of subjects is capable of in vitro replication.

Evaluating Burnout Among Health Workers Routinely Screened for SARS-CoV-2 (preprint)

Background: Healthcare workers (HW) are a vulnerable group to develop burnout during the COVID-19 pandemic. The aims of this study were to evaluate the perception of HW about the antibody test, and, secondarily, the prevalence of burnout and factors associated with burnout among HW who took the test.Methods: In this cross-sectional study, we evaluated burnout among HW in a 600-bed building entirely dedicated to COVID-19 inpatients care at Hospital das Clinicas (HC), located in São Paulo, Brazil. The HW answered an online questionnaire that included questions on burnout, a single-item scale based on the Maslach Burnout Inventory; demographic data, professional category, type of Protective Personal Equipment (PPE) used, distancing from social support; and emotional reactions to their serology result. Bivariate and multivariate analyses were done to evaluate the risk of burnout.Outcomes: Among 4,417 HW tested, 528 (12.0%) were positive for SARS-CoV-2 and 1,945 answered the questionnaire. Burnout was reported by 308 (15.8%); anxiety, tenseness, and depression associated with COVID-19 were reported by 344 (17.7%); 292 (15.1%); and 181(9.3%) of the participants, respectively. The risk factors for burnout were: being a physician [adjOR:1.604;(95%CI 1.604-1.080;p=0.019)]; a physiotherapist [adjOR:2.047;(95%CI:1.285–3.261;p=0.003)]; perceiving a decrease in public safety[adjOR:1.983;(95%CI:1.229–3.199;p=0.005)]; anxiety [adjOR:2.721;(95%CI:1.812–4.085;p=<0.001)], and depression associated with COVID-19[adjOR:2.071;(95%CI:1.308–3.279;p=0.002)]; and having negative feeling towards had a previously negative SARS-CoV-2 serology[adjOR:1,989;(95%CI:1.484-2.664; p<0.001)]. Interpretation: Routine serological testing was one of the strategies used in our hospital to promote the well-being of HW. We observed that those who had negative feeling regarding testing negative to COVID-19 in previous serologies were at higher risk of burnout, suggesting that the risk of contracting the disease is a major stressor for HW.Funding Statement: Internal funding from the Hospital das Clínicas of University of São Paulo, Brazil trough donation from Banco Pactual.Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: grant funding from the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: This study was approved by the Hospital das Clinicas da faculdade de Medicina da Universidade de Sao Paulo (protocol number 30701920200000068).

Evaluating burnout among health workers routinely screened for SARS-CoV-2. (preprint)

Background: Healthcare workers (HW) are a vulnerable group to develop burnout during the COVID-19 pandemic. The aims of this study were to evaluate the perception of HW about the antibody test, and, secondarily, the prevalence of burnout and factors associated with burnout among HW who took the test.Methods: In this cross-sectional study, we evaluated burnout among HW in a 600-bed building entirely dedicated to COVID-19 inpatients care at Hospital das Clinicas (HC), located in São Paulo, Brazil. The HW answered an online questionnaire that included questions on burnout, a single-item scale based on the Maslach Burnout Inventory; demographic data, professional category, type of Protective Personal Equipment (PPE) used, distancing from social support; and emotional reactions to their serology result. Bivariate and multivariate analyses were done to evaluate the risk of burnout.Outcomes: Among 4,417 HW tested, 528 (12.0%) were positive for SARS-CoV-2 and 1,945 answered the questionnaire. Burnout was reported by 308 (15.8%); anxiety, tenseness, and depression associated with COVID-19 were reported by 344 (17.7%); 292 (15.1%); and 181(9.3%) of the participants, respectively. The risk factors for burnout were: being a physician [adjOR:1.604;(95%CI 1.604-1.080;p=0.019)]; a physiotherapist [adjOR:2.047;(95%CI:1.285–3.261;p=0.003)]; perceiving a decrease in public safety[adjOR:1.983;(95%CI:1.229–3.199;p=0.005)]; anxiety [adjOR:2.721;(95%CI:1.812–4.085;p=<0.001)], and depression associated with COVID-19[adjOR:2.071;(95%CI:1.308–3.279;p=0.002)]; and having negative feeling towards had a previously negative SARS-CoV-2 serology[adjOR:1,989;(95%CI:1.484-2.664; p<0.001)].Interpretation: Routine serological testing was one of the strategies used in our hospital to promote the well-being of HW. We observed that those who had negative feeling regarding testing negative to COVID-19 in previous serologies were at higher risk of burnout, suggesting that the risk of contracting the disease is a major stressor for HW.

Are Mobile Phones part of the chain of transmission of SARS-CoV-2 in the hospital? (preprint)

SARS-CoV-2 cross-transmission has become an concern in hospitals. We investigate healthcare workers(HCWs) knowledge about SARS-CoV-2 cross-transmission and conceptions whether the virus can remain on HCWs mobile phones(MPs) and be part of the chain of transmission. A cross-sectional study was conducted at a COVID-19 Intensive Care Unit of a teaching-hospital. Fifty-one MPs were swabbed and a questionnaire about hand hygiene and MP use and disinfection was applied after an educational campaign. Although most of HCWs believed on the importance of cross-transmission and increased hand hygiene adhesion and MP disinfection during the pandemic, SARS-CoV-2 RNA was detected in two MPs(culture of the samples was negative). Implementation of official hospital policies to guide HCWs regarding disinfection and care of personal MP are needed.

EVALUATION OF ELEVEN IMMUNOCHROMATOGRAPHIC ASSAYS FOR SARS-CoV-2 DETECTION: INVESTIGATING DENGUE CROSS-REACTION (preprint)

Background: COVID-19 disease (Coronavirus disease 2019) caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) is widespread worldwide, affecting more than 11 million people globally (July 6th, 2020). Diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and low cost alternative for monitoring the spread of COVID-19 in the population. Methods: Here we evaluate the sensitivity and specificity of eleven different immunochromatografic tests in 98 serum samples from confirmed cases of COVID-19 through RT-PCR and 100 negative serum samples from blood donors collected in February 2019. Considering the endemic situation of Dengue in Brazil, we also evaluated the cross-reactivity with Dengue using 20 serum samples from patients with confirmed diagnosis for Dengue collected in early 2019 through four different tests. Results: Our results demonstrated agreement between immunochromatographic assays and RT-PCR, especially after 10 days since the onset of symptoms. The evaluation of IgG and IgM antibodies combined demonstrated a strong level of agreement (0.85) of IC assays and RT-PCR. It was observed cross-reactivity between Dengue and COVID-19 using four different IC assays for COVID-19 diagnosis. The specificity of IC assays to detected COVID-19 IgM antibodies using Dengue serum samples varied from 80% to 85%; the specificity of IgG detection was 100% and total antibody was 95%. Conclusions: We found high sensitivity, specificity and good agreement of IC assays, especially after 10 days onset of symptoms. However, we detected cross-reactivity between Dengue and COVID-19 mainly with IgM antibodies demonstrating the need for better studies about diagnostic techniques for these diseases.