201
|
Strålin K, Wahlström E, Walther S, Bennet-Bark AM, Heurgren M, Lindén T, Holm J, Hanberger H. Mortality in hospitalized COVID-19 patients was associated with the COVID-19 admission rate during the first year of the pandemic in Sweden. Infect Dis (Lond) 2021; 54:145-151. [PMID: 34612774 DOI: 10.1080/23744235.2021.1983643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Studies from the first pandemic wave found associations between COVID-19 hospital load and mortality. Here, we aimed to study if mortality of hospitalized COVID-19 patients was associated with the COVID-19 admission rate during a full year of the pandemic in Sweden. METHOD Observational review of all patients admitted to hospital with COVID-19 in Sweden between March 2020 and February 2021 (n = 42,017). Primary outcome was 60-day all-cause mortality related to number of COVID-19 hospital admissions per month/100,000 inhabitants. Poisson regression was used to estimate the relative risk for death by month of admission, adjusting for pre-existing factors. RESULTS The overall mortality was 17.4%. Excluding March 2020, mortality was clearly correlated to the number of COVID-19 admissions per month (coefficient of correlation ρ=.96; p<.0001). After adjustment for pre-existing factors, the correlation remained significant (ρ=.75, p=.02). Patients admitted in December (high admission rate and high mortality) had more comorbidities and longer hospital stays, and patients treated in intensive care units (ICU) had longer pre-ICU hospital stays and worse respiratory status on ICU admission than those admitted in July to September (low admission rate and low mortality). CONCLUSION Mortality in hospitalized COVID-19 patients was clearly associated with the COVID-19 admission rate. Admission of healthier patients between pandemic waves and delayed ICU care during wave peaks could contribute to this pattern. The study supports measures to flatten-the-curve to reduce the number of COVID-19 patients admitted to hospital.
Collapse
Affiliation(s)
- Kristoffer Strålin
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Infectious Diseases Section, National Programme for Evidence-based Healthcare Management: Sweden's Regions in Collaboration, Stockholm, Sweden
| | - Erik Wahlström
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Sten Walther
- Swedish Intensive Care Register, Värmland County Council, Karlstad, Sweden.,Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden.,Department of Health, Medicine, and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna M Bennet-Bark
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Mona Heurgren
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Thomas Lindén
- Department for Knowledge-Based Policy of Health Care, National Board of Health and Welfare, Stockholm, Sweden
| | - Johanna Holm
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Håkan Hanberger
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| |
Collapse
|
202
|
da Silva Ramos FJ, de Freitas FGR, Machado FR. Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe? Curr Opin Crit Care 2021; 27:474-479. [PMID: 34292175 PMCID: PMC8452249 DOI: 10.1097/mcc.0000000000000861] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates. RECENT FINDINGS In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings. Patients with severe COVID-19 present a phenotype of multiorgan dysfunction that leads to death in an unacceptable high percentage of the patients, with wide variability around the world. Similarly to endemic sepsis, the mortality of COVID-19 critically ill patients is higher in low-income and middle-income countries as compared with high-income countries. Disparities, including hospital strain, resources limitations, higher incidence of healthcare-associated infections (HAI), and staffing issues could in part explain this variability. SUMMARY The high mortality rates of critically ill patients with severe COVID-19 disease are not only related to the severity of patient disease but also to modifiable factors, such as the ICU strain, HAI incidence, and organizational aspects. Therefore, HAI prevention and the delivery of best evidence-based care for these patients to avoid additional damage is important. Quality improvement interventions might help in improving outcomes mainly in resource-limited settings.
Collapse
|
203
|
Geographical variation in demand, utilization, and outcomes of hospital services for COVID-19 in Brazil: A descriptive serial cross-sectional study. PLoS One 2021; 16:e0257643. [PMID: 34591896 PMCID: PMC8483366 DOI: 10.1371/journal.pone.0257643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021. Methods Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil. Results There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively. Conclusion The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes.
Collapse
|
204
|
Ortiz GX, Lenhart G, Becker MW, Schwambach KH, Tovo CV, Blatt CR. Drug-induced liver injury and COVID-19: A review for clinical practice. World J Hepatol 2021; 13:1143-1153. [PMID: 34630881 PMCID: PMC8473488 DOI: 10.4254/wjh.v13.i9.1143] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/18/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) consists of a systemic disease that can present many complications. The infection presents broad clinical symptoms and a high rate of transmissibility. In addition to severe acute respiratory syndrome, the patients manifest complications beyond the respiratory system. The frequency of liver damage in COVID-19 patients ranges from 14.8% to 53% of patients. One should pay attention to drug-induced liver injury (DILI) in patients with COVID-19, especially considering the off-label use of drugs in prophylactic and therapeutic regimens applied on large scales. This review aims to present relevant information on the medication used so far in COVID-19 patients and its possible hepatotoxicity. We reviewed liver damage in patients with COVID-19 on PubMed and Virtual Health Library to investigate DILI cases. Four studies were selected, involving the medicines remdesivir, tocilizumab and a pharmacovigilance analysis study. The hepatotoxicity profile of drugs presented in the literature considers use in accordance to usual posology standards for treatment. However, drugs currently used in the management of COVID-19 follow different dosages and posology than those tested by the pharmaceutical industry. The deficiency of uniformity and standardization in the assessment of hepatotoxicity cases hinders the publication of information and the possibility of comparing information among healthcare professionals. It is suggested that severe liver injury in COVID-19 patients should be reported in pharmacovigilance institutions, and physicians should pay attention to any considerable abnormal liver test elevation as it can demonstrate unknown drug hepatotoxicity. Liver disorders in COVID-19 patients and the use of several concomitant off-label medications — with a potential risk of further damaging the liver - should at least be a warning sign for rapid identification and early intervention, thus preventing liver damage from contributing to severe impairment in patients.
Collapse
Affiliation(s)
- Gabriela Xavier Ortiz
- Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Gabriele Lenhart
- Multiprofessional Residency Integrated in Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Matheus William Becker
- Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Karin Hepp Schwambach
- Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Cristiane Valle Tovo
- Internal Medicine Department, Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Carine Raquel Blatt
- Pharmacoscience Department, Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| |
Collapse
|
205
|
Lobo SM, Mello PMVDC. Challenges of the coronavirus pandemic for Brazilian intensivists: present and future. Rev Bras Ter Intensiva 2021; 33:339-340. [PMID: 35107543 PMCID: PMC8555395 DOI: 10.5935/0103-507x.20210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Suzana Margareth Lobo
- Divisão de Terapia Intensiva, Hospital de Base, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brasil
| | | |
Collapse
|
206
|
Therapeutic application of estrogen for COVID-19: Attenuation of SARS-CoV-2 spike protein and IL-6 stimulated, ACE2-dependent NOX2 activation, ROS production and MCP-1 upregulation in endothelial cells. Redox Biol 2021; 46:102099. [PMID: 34509916 PMCID: PMC8372492 DOI: 10.1016/j.redox.2021.102099] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023] Open
Abstract
The outbreak of COVID-19 has remained uncontained with urgent need for robust therapeutics. We have previously reported sex difference of COVID-19 for the first time indicating male predisposition. Males are more susceptible than females, and more often to develop into severe cases with higher mortality. This predisposition is potentially linked to higher prevalence of cigarette smoking. Nonetheless, we found for the first time that cigarette smoking extract (CSE) had no effect on angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) expression in endothelial cells. The otherwise observed worse outcomes in smokers is likely linked to baseline respiratory diseases associated with chronic smoking. Instead, we hypothesized that estrogen mediated protection might underlie lower morbidity, severity and mortality of COVID-19 in females. Of note, endothelial inflammation and barrier dysfunction are major mediators of disease progression, and development of acute respiratory distress syndrome (ARDS) and multi-organ failure in patients with COVID-19. Therefore, we investigated potential protective effects of estrogen on endothelial cells against oxidative stress induced by interleukin-6 (IL-6) and SARS-CoV-2 spike protein (S protein). Indeed, 17β-estradiol completely reversed S protein-induced selective activation of NADPH oxidase isoform 2 (NOX2) and reactive oxygen species (ROS) production that are ACE2-dependent, as well as ACE2 upregulation and induction of pro-inflammatory gene monocyte chemoattractant protein-1 (MCP-1) in endothelial cells to effectively attenuate endothelial dysfunction. Effects of IL-6 on activating NOX2-dependent ROS production and upregulation of MCP-1 were also completely attenuated by 17β-estradiol. Of note, co-treatment with CSE had no additional effects on S protein stimulated endothelial oxidative stress, confirming that current smoking status is likely unrelated to more severe disease in chronic smokers. These data indicate that estrogen can serve as a novel therapy for patients with COVID-19 via inhibition of initial viral responses and attenuation of cytokine storm induced endothelial dysfunction, to substantially alleviate morbidity, severity and mortality of the disease, especially in men and post-menopause women. Short-term administration of estrogen can therefore be readily applied to the clinical management of COVID-19 as a robust therapeutic option.
Collapse
|
207
|
Siqueira TS, Silva JRS, Souza MDR, Leite DCF, Edwards T, Martins-Filho PR, Gurgel RQ, Santos VS. Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100076. [PMID: 34541570 PMCID: PMC8432892 DOI: 10.1016/j.lana.2021.100076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health. METHODS This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities' risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19. FINDINGS A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19. INTERPRETATION In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators. FUNDING None.
Collapse
Affiliation(s)
- Thayane Santos Siqueira
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | | | | | | | - Thomas Edwards
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Paulo Ricardo Martins-Filho
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | | | - Victor Santana Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
- Health Science Graduate Program, Federal University of Alagoas, Maceió, Brazil
- Corresponding author:-Victor S. Santos, PhD, Federal University of Alagoas, Campus Arapiraca, Rodovia AL-115, Bom Sucesso, Arapiraca, Alagoas 57309-005, Brazil .
| |
Collapse
|
208
|
Castro MC, Gurzenda S, Turra CM, Kim S, Andrasfay T, Goldman N. Reduction in life expectancy in Brazil after COVID-19. Nat Med 2021; 27:1629-1635. [PMID: 34188224 PMCID: PMC8446334 DOI: 10.1038/s41591-021-01437-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
Brazil has been heavily affected by coronavirus disease 2019 (COVID-19). In this study, we used data on reported total deaths in 2020 and in January-April 2021 to measure and compare the death toll across states. We estimate a decline in 2020 life expectancy at birth (e0) of 1.3 years, a mortality level not seen since 2014. The reduction in life expectancy at age 65 (e65) in 2020 was 0.9 years, setting Brazil back to 2012 levels. The decline was larger for males, widening by 9.1% the female-male gap in e0. Among states, Amazonas lost 60.4% of the improvements in e0 since 2000. In the first 4 months of 2021, COVID-19 deaths represented 107% of the total 2020 figures. Assuming that death rates would have been equal to 2019 all-cause rates in the absence of COVID-19, COVID-19 deaths in 2021 have already reduced e0 in 2021 by 1.8 years, which is slightly larger than the reduction estimated for 2020 under similar assumptions.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Susie Gurzenda
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Cassio M Turra
- Demography Department, Cedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sun Kim
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Theresa Andrasfay
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, Los Angeles, CA, USA
| | - Noreen Goldman
- Office of Population Research and Princeton School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| |
Collapse
|
209
|
Abstract
Slower than anticipated, COVID-19 vaccine production and distribution have impaired efforts to curtail the current pandemic. The standard administration schedule for most COVID-19 vaccines currently approved is two doses administered 3 to 4 wk apart. To increase the number of individuals with partial protection, some governments are considering delaying the second vaccine dose. However, the delay duration must take into account crucial factors, such as the degree of protection conferred by a single dose, the anticipated vaccine supply pipeline, and the potential emergence of more virulent COVID-19 variants. To help guide decision-making, we propose here an optimization model based on extended susceptible, exposed, infectious, and removed (SEIR) dynamics that determines the optimal delay duration between the first and second COVID-19 vaccine doses. The model assumes lenient social distancing and uses intensive care unit (ICU) admission as a key metric while selecting the optimal duration between doses vs. the standard 4-wk delay. While epistemic uncertainties apply to the interpretation of simulation outputs, we found that the delay is dependent on the vaccine mechanism of action and first-dose efficacy. For infection-blocking vaccines with first-dose efficacy ≥50%, the model predicts that the second dose can be delayed by ≥8 wk (half of the maximal delay), whereas for symptom-alleviating vaccines, the same delay is recommended only if the first-dose efficacy is ≥70%. Our model predicts that a 12-wk second-dose delay of an infection-blocking vaccine with a first-dose efficacy ≥70% could reduce ICU admissions by 400 people per million over 200 d.
Collapse
|
210
|
Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay. Ir J Med Sci 2021; 191:1905-1911. [PMID: 34458950 PMCID: PMC8403522 DOI: 10.1007/s11845-021-02752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has put considerable strain on healthcare systems. AIM To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. METHODS We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002-2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. RESULTS There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016-2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)-OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor-OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved-OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased. CONCLUSION A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.
Collapse
|
211
|
Ranzani OT, Hitchings MDT, Dorion M, D'Agostini TL, de Paula RC, de Paula OFP, Villela EFDM, Torres MSS, de Oliveira SB, Schulz W, Almiron M, Said R, de Oliveira RD, Vieira da Silva P, de Araújo WN, Gorinchteyn JC, Andrews JR, Cummings DAT, Ko AI, Croda J. Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study. BMJ 2021; 374:n2015. [PMID: 34417194 PMCID: PMC8377801 DOI: 10.1136/bmj.n2015] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant. DESIGN Test negative case-control study. SETTING Community testing for covid-19 in São Paulo state, Brazil. PARTICIPANTS 43 774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 29 April 2021. 26 433 cases with symptomatic covid-19 and 17 622 test negative controls with covid-19 symptoms were formed into 13 283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days). INTERVENTION Vaccination with a two dose regimen of CoronaVac. MAIN OUTCOME MEASURES RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. RESULTS Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)-59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths-and declined with increasing age. CONCLUSIONS Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population.
Collapse
Affiliation(s)
- Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Matt D T Hitchings
- Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Murilo Dorion
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | | | | | - Wade Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Almiron
- Pan American Health Organization, Brasília, DF, Brazil
| | - Rodrigo Said
- Pan American Health Organization, Brasília, DF, Brazil
| | | | | | - Wildo Navegantes de Araújo
- Pan American Health Organization, Brasília, DF, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
- National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
| |
Collapse
|
212
|
The evolution of Brazilian Health Sciences and the present situation. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100044. [PMID: 36777403 PMCID: PMC9903842 DOI: 10.1016/j.lana.2021.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
|
213
|
dos Santos HLPC, Maciel FBM, Santos GM, Martins PC, Prado NMDBL. Public expenditure on hospitalizations for COVID-19 treatment in 2020, in Brazil. Rev Saude Publica 2021; 55:52. [PMID: 34406320 PMCID: PMC8352564 DOI: 10.11606/s1518-8787.2021055003666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Describe the expenditure resulting from hospitalizations for clinical treatment of users diagnosed with COVID-19 in the Unified Health System (SUS) between February and December 2020. METHODS This is a descriptive study based on data from the Hospital Information System about government expenditure on hospitalizations for clinical treatment of users diagnosed with COVID-19 and causes included in the ICD-10 chapters. We obtained the number of hospitalizations, average length of stay, lethality rate, and total expenditure considering hospital services, professional services and average expenditure per hospitalization. RESULTS In the period evaluated, SUS registered 462,149 hospitalizations, 4.9% of them for COVID-19 treatment. Total expenditure exceeded R$ 2.2 billion, with 85% allocated to hospital services and 15% to professional services. Expenditure for treating COVID-19 was distributed differently between the country's regions. The Southeast region had the highest number of hospitalizations, highest total amount spent, highest average length of stay in days, and highest lethality rate; the South region, in turn, recorded the highest percentage of spending on non-profit hospitals (58%) and corporate hospitals (15%). CONCLUSIONS Hospitalizations for clinical treatment of coronavirus infection were more costly compared to those for treatment of acute respiratory failure and pneumonia or influenza. Our results show the disparities in hospitalization expenditure for similar procedures between the regions of Brazil, underlining the vulnerability and the need for strategies to reduce the differences in access, use, and distribution of SUS resources, ensuring equanimity, and considering the unfair inequalities between the country's regions.
Collapse
Affiliation(s)
- Hebert Luan Pereira Campos dos Santos
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdeVitória da ConquistaBABrasil Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Campus Anísio Teixeira. Vitória da Conquista, BA, Brasil
| | - Fernanda Beatriz Melo Maciel
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdeVitória da ConquistaBABrasil Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Campus Anísio Teixeira. Vitória da Conquista, BA, Brasil
| | - Geovani Moreno Santos
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdePrograma de Pós-Graduação em Saúde ColetivaVitória da ConquistaBABrasil Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Campus Anísio Teixeira. Programa de Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brasil
| | - Poliana Cardoso Martins
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdePrograma de Pós-Graduação em Saúde ColetivaVitória da ConquistaBABrasil Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Campus Anísio Teixeira. Programa de Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brasil
| | - Nília Maria de Brito Lima Prado
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdePrograma de Pós-Graduação em Saúde ColetivaVitória da ConquistaBABrasil Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Campus Anísio Teixeira. Programa de Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brasil
| |
Collapse
|
214
|
Biccard BM, Thomson D, Miller M, Taylor EH, Gopalan PD. Critically ill COVID-19 patients in Africa: it is time for quality registry data - Authors' reply. Lancet 2021; 398:486-487. [PMID: 34364516 PMCID: PMC8341819 DOI: 10.1016/s0140-6736(21)01545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town 7925, South Africa.
| | - David Thomson
- Division of Critical Care, University of Cape Town, Cape Town 7925, South Africa
| | - Malcolm Miller
- Division of Critical Care, University of Cape Town, Cape Town 7925, South Africa
| | - Elliott H Taylor
- Groote Schuur Hospital, Faculty of Health Sciences, and Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town 7925, South Africa; Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - P Dean Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| |
Collapse
|
215
|
Jassat W, Cohen C, Tempia S, Masha M, Goldstein S, Kufa T, Murangandi P, Savulescu D, Walaza S, Bam JL, Davies MA, Prozesky HW, Naude J, Mnguni AT, Lawrence CA, Mathema HT, Zamparini J, Black J, Mehta R, Parker A, Chikobvu P, Dawood H, Muvhango N, Strydom R, Adelekan T, Mdlovu B, Moodley N, Namavhandu EL, Rheeder P, Venturas J, Magula N, Blumberg L. Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study. Lancet HIV 2021; 8:e554-e567. [PMID: 34363789 PMCID: PMC8336996 DOI: 10.1016/s2352-3018(21)00151-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
Background The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding South African National Government.
Collapse
Affiliation(s)
- Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MassGenics, Duluth, GA, USA
| | | | - Susan Goldstein
- South Africa Medical Research Council Centre for Health Economics and Decision Science-PRICELESS SA, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pelagia Murangandi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Dana Savulescu
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Jamy-Lee Bam
- Western Cape Department of Health, Cape Town, South Africa
| | | | - Hans W Prozesky
- Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa
| | - Jonathan Naude
- Mitchells Plain District Hospital, Cape Town, South Africa
| | | | | | - Hlengani T Mathema
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Jarrod Zamparini
- Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - John Black
- Livingstone Hospital, Walter Sisulu University, Nelson Mandela Bay, South Africa
| | - Ruchika Mehta
- Klerksdorp-Tshepong Hospital, University of Witwatersrand, Klerksdorp, South Africa
| | - Arifa Parker
- Tygerberg Hospital and Division of Infectious Disease, University of Stellenbosch, Cape Town, South Africa
| | | | | | | | - Riaan Strydom
- Northern Cape Department of Health, Kimberley, South Africa
| | | | | | - Nirvasha Moodley
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | | | - Paul Rheeder
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jacqueline Venturas
- Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nombulelo Magula
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| |
Collapse
|
216
|
Su Z, McDonnell D, Cheshmehzangi A, Li X, Maestro D, Šegalo S, Ahmad J, Hao X. With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines. JMIR Public Health Surveill 2021; 7:e26111. [PMID: 33560997 PMCID: PMC8341090 DOI: 10.2196/26111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Although COVID-19 vaccines are becoming increasingly available, their ability to effectively control and contain the spread of the COVID-19 pandemic is highly contingent on an array of factors. This paper discusses how limitations to vaccine accessibility, issues associated with vaccine side effects, concerns regarding vaccine efficacy, along with the persistent prevalence of vaccine hesitancy among the public, including health care professionals, might impact the potential of COVID-19 vaccines to curb the pandemic. We draw insights from the literature to identify practical solutions that could boost people’s adoption of COVID-19 vaccines and their accessibility. We conclude with a discussion on health experts’ and government officials’ moral and ethical responsibilities to the public, even in light of the urgency to adopt and endorse “the greatest amount of good for the greatest number” utilitarian philosophy in controlling and managing the spread of COVID-19.
Collapse
Affiliation(s)
- Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Ali Cheshmehzangi
- Department of Architecture and Built Environment, University of Nottingham Ningbo China, Ningbo, China.,Hiroshima University, Hiroshima, Japan
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Daniel Maestro
- Department of Environmental Health, Institute for Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Sabina Šegalo
- Department of Microbiology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Junaid Ahmad
- Prime Institute of Public Health, Peshawar Medical College, Peshawar, Pakistan
| | - Xiaoning Hao
- Division of Health Security Research, China National Health Development Research Center, National Health Commission, P.R. China, Beijing, China
| |
Collapse
|
217
|
Costa GJ, de Azevedo CRAS, Júnior JIC, Bergmann A, Thuler LCS. Higher severity and risk of in-hospital mortality for COVID-19 patients with cancer during the year 2020 in Brazil: A countrywide analysis of secondary data. Cancer 2021; 127:4240-4248. [PMID: 34343344 PMCID: PMC8426714 DOI: 10.1002/cncr.33832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) and cancer are serious public health problems worldwide. However, little is known about the risk factors of in-hospital mortality among COVID-19 patients with and without cancer in Brazil. The objective of this study was to evaluate the risk factors of in-hospital mortality among COVID-19 patients with and without cancer and to compare mortality according to gender and topography during the year 2020 in Brazil. METHODS This was a secondary data study of hospitalized adult patients with a diagnosis of COVID-19 by real-time polymerase chain reaction testing in Brazil. The data were collected from the Influenza Epidemiological Surveillance Information System. RESULTS This study analyzed data from 322,817 patients. The prevalence of cancer in patients with COVID-19 was 2.3%. COVID-19 patients with neurological diseases and cancer had the most lethal comorbidities in both sexes. COVID-19 patients with cancer were more likely to be older (median age, 67 vs 62 years; P < .001), to have a longer hospital stay (13.1 vs 11.5 days; P < .001), to be admitted to the intensive care unit (45.3% vs 39.6%; P < .001), to receive more invasive mechanical ventilation (27.1% vs 21.9%), and to have a higher risk of death (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.83-2.06; P < .001) than those without cancer. Patients with hematological neoplasia (aOR, 2.85; 95% CI, 2.41-3.38; P < .001) had a higher risk of mortality than those with solid tumors (aOR, 1.83; 95% CI, 1.72-1.95; P < .001) in both sexes. CONCLUSIONS Brazilian COVID-19 patients with cancer have higher disease severity and a higher risk of mortality than those without cancer.
Collapse
Affiliation(s)
- Guilherme Jorge Costa
- Department of Teaching and Research, Pernambuco Cancer Hospital, Recife, Brazil.,Department of Pneumology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | - José Iran Costa Júnior
- Department of Oncology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,Oncologia D'Or, Recife, Brazil
| | - Anke Bergmann
- Clinical Epidemiology Program, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | | |
Collapse
|
218
|
Victora PC, Castro PMC, Gurzenda S, Medeiros AC, França GV, Barros PAJ. Estimating the early impact of vaccination against COVID-19 on deaths among elderly people in Brazil: Analyses of routinely-collected data on vaccine coverage and mortality. EClinicalMedicine 2021; 38:101036. [PMID: 34308302 PMCID: PMC8283303 DOI: 10.1016/j.eclinm.2021.101036] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Vaccination against COVID-19 in Brazil started in January 2021, with health workers and the elderly as the priority groups. We assessed whether there was an impact of vaccinations on the mortality of elderly individuals in a context of wide transmission of the SARS-CoV-2 gamma (P.1) variant. Methods: By May 15, 2021, 238,414 COVID-19 deaths had been reported to the Brazilian Mortality Information System. Denominators for mortality rates were calculated by correcting population estimates for all-cause deaths reported in 2020. Proportionate mortality at ages 70-79 and 80+ years relative to deaths at all ages were calculated for deaths due to COVID-19 and to other causes, as were COVID-19 mortality rate ratios relative to individuals aged 0-69 years. Vaccine coverage data were obtained from the Ministry of Health. All results were tabulated by epidemiological weeks 1-19, 2021. Findings: The proportion of all COVID-19 deaths at ages 80+ years was over 25% in weeks 1-6 and declined rapidly to 12.4% in week 19, whereas proportionate COVID-19 mortality for individuals aged 70-79 years started to decline by week 15. Trends in proportionate mortality due to other causes remained stable. Mortality rates were over 13 times higher in the 80+ years age group compared to that of 0-69 year olds up to week 6, and declined to 5.0 times in week 19. Vaccination coverage (first dose) of 90% was reached by week 9 for individuals aged 80+ years and by week 13 for those aged 70-79 years. Coronavac accounted for 65.4% and AstraZeneca for 29.8% of all doses administered in weeks 1-4, compared to 36.5% and 53.3% in weeks 15-19, respectively. Interpretation: Rapid scaling up of vaccination coverage among elderly Brazilians was associated with important declines in relative mortality compared to younger individuals, in a setting where the gamma variant predominates. Had mortality rates among the elderly remained proportionate to what was observed up to week 6, an estimated additional 43,802 COVID-related deaths would have been expected up to week 19. Funding: CGV and AJDB are funded by the Todos pela Saúde (São Paulo, Brazil) initiative.
Collapse
Affiliation(s)
- Prof Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Corresponding author at: International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil
| | - Prof Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Susie Gurzenda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Arnaldo C. Medeiros
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, DF, Brazil
| | | | | |
Collapse
|
219
|
Cristelli MP, Sandes-Freitas TVD, Viana LA, Requião-Moura LR, Andrade LGMD, Tedesco-Silva H, Medina-Pestana J. Migratory pattern of the coronavirus disease 2019 and high fatality rates among kidney transplant recipients: report from the Brazilian Multicenter Cohort Study. ACTA ACUST UNITED AC 2021; 44:428-433. [PMID: 34328168 PMCID: PMC9518611 DOI: 10.1590/2175-8239-jbn-2021-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/18/2021] [Indexed: 12/04/2022]
Abstract
Introduction: The unprecedented coronavirus disease 2019 (COVID-19) pandemic has affected kidney transplant (KT) recipients, with worldwide fatality rates around 25%. Considering the well-known Brazilian socio-demographic disparities, this report describes for the first time the main outcomes of COVID-19 in KT recipients according to Brazilian geographic regions. Methods: This multicenter national retrospective analysis included data from KT recipients with confirmed COVID-19 between March and November 2020. Results: Thirty-five of the 81 centers (57% of KT activity in Brazil) reported 1,680 patients with COVID-19. The Northeast was the first to reach the peak in the number of infections. The Southeast, due to its population density, contributed with the largest number of patients. Patients had a median age of 52 years, 76% had hypertension and 34% diabetes, 75% were recipients of a deceased donor, and the time interval between diagnosis and transplantation was 5.9 years. In 53% of patients, immunosuppression was adjusted, and clinical support varied according to geographic region. Hospitalization was required for 65% of the patients, 35% of them needed intensive care, 25% mechanical ventilation, and 23% renal replacement therapy. The 90-day overall fatality was 21%, being 23% in the Southeast, 16% in the Northeast, and 19% in the Central-west and South regions. Conclusion: The migratory pattern of the pandemic among KT recipients followed that of the general population and the outcomes were influenced by regional features. COVID-19 in KT recipients was associated with high utilization of health-care resources and higher fatality rates than those reported in the general population.
Collapse
Affiliation(s)
| | - Tainá Veras de Sandes-Freitas
- Universidade Federal do Ceara, Departamento de Medicina Clínica, Fortaleza, CE, Brasil.,Hospital Geral de Fortaleza, Papicu, Fortaleza, CE, Brasil
| | | | - Lúcio R Requião-Moura
- Universidade Federal de São Paulo, Hospital do Rim, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, Transplant Division, São Paulo, SP, Brasil
| | | | | | | |
Collapse
|
220
|
Requião-Moura LR, de Sandes-Freitas TV, Viana LA, Cristelli MP, de Andrade LGM, Garcia VD, de Oliveira CMC, Esmeraldo RDM, Abbud Filho M, Pacheco-Silva A, Sousa KC, Vicari AR, Costa KMAH, Simão DR, de Sousa MV, Campos JB, Almeida RAMDB, Deboni LM, Neto MM, Zanocco JA, Tedesco-Silva H, Medina-Pestana J. High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: Results from the Brazilian multicenter cohort study. PLoS One 2021; 16:e0254822. [PMID: 34320005 PMCID: PMC8318290 DOI: 10.1371/journal.pone.0254822] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patients died, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.
Collapse
Affiliation(s)
- Lúcio R. Requião-Moura
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Laila Almeida Viana
- Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
| | | | | | | | | | | | - Mario Abbud Filho
- Hospital de Base, Medical School FAMERP, São José do Rio Preto, SP, Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Alessandra Rosa Vicari
- Hospital de Clínicas de Porto Alegre, Federal Univertisy of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Marcos Vinicius de Sousa
- Division of Nephrology, Renal Transplant Unit, Renal Transplant Research Laboratory, School of Medical Sciences, University of Campinas–UNICAP, Campinas, SP, Brazil
| | | | | | | | - Miguel Moysés Neto
- Division of Nephrology, School of Medicine of Ribeirão Preto, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | | | - Helio Tedesco-Silva
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
| | - José Medina-Pestana
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
| | | |
Collapse
|
221
|
Márquez-González H, Méndez-Galván JF, Reyes-López A, Klünder-Klünder M, Jiménez-Juárez R, Garduño-Espinosa J, Solórzano-Santos F. Coronavirus Disease-2019 Survival in Mexico: A Cohort Study on the Interaction of the Associated Factors. Front Public Health 2021; 9:660114. [PMID: 34386471 PMCID: PMC8353107 DOI: 10.3389/fpubh.2021.660114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
The pandemic caused by the new coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently affecting more than 200 countries. The most lethal clinical presentation is respiratory insufficiency, requiring attention in intensive care units (ICU). The most susceptible people are over 60 years old with comorbidities. The health systems organization may represent a transcendental role in survival. Objective: To analyze the correlation of sociodemographic factors, comorbidities and health system organization variables with survival in cases infected by SARS-CoV-2 during the first 7 months of the pandemic in Mexico. Methods: The cohort study was performed in a health system public basis from March 1st to September 30th, 2020. The included subjects were positive for the SARS-CoV-2 test, and the target variable was mortality in 60 days. The risk variables studied were: age, sex, geographic distribution, comorbidities, health system, hospitalization, and access to ICU. Bivariate statistics (X2-test), calculation of fatality rates, survival analyses and adjustment of confusing variables with Cox proportional-hazards were performed. Results: A total of 753,090 subjects were analyzed, of which the 52% were men. There were 78,492 deaths (10.3% of general fatality and 43% inpatient). The variables associated with a higher risk of hospital mortality were age (from 60 years onwards), care in public sectors, geographic areas with higher numbers of infection and endotracheal intubation without management in the ICU. Conclusions: The variables associated with a lower survival in cases affected by SARS-CoV-2 were age, comorbidities, and respiratory insufficiency (with endotracheal intubation without care in the ICU). Additionally, an interaction was observed between the geographic location and health sector where they were treated.
Collapse
Affiliation(s)
- Horacio Márquez-González
- Department of Clinical Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Jorge F. Méndez-Galván
- Centre for Research in Emerging Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Alfonso Reyes-López
- Centre for Health Economics, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Rodolfo Jiménez-Juárez
- Clinical Infectious Disease Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Clinical Research Direction, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Fortino Solórzano-Santos
- Infectious Diseases Research Department, Hospital Infantil de México Federico GómezMéxico Federico Gómez, Mexico City, Mexico
| |
Collapse
|
222
|
Menezes MCS, Veiga ADM, Martins de Lima T, Kunimi Kubo Ariga S, Vieira Barbeiro H, de Lucena Moreira C, Pinto AAS, Brandao RA, Marchini JF, Alencar JC, Marino LO, Gomez LM, Olsen Saraiva Camara N, Souza HP. Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients. Sci Rep 2021; 11:15223. [PMID: 34315957 PMCID: PMC8316546 DOI: 10.1038/s41598-021-94624-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
The role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5–9 days, and between 10–15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.
Collapse
Affiliation(s)
- Maria Clara Saad Menezes
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil.
| | - Alicia Dudy Müller Veiga
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Thais Martins de Lima
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Suely Kunimi Kubo Ariga
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Hermes Vieira Barbeiro
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Claudia de Lucena Moreira
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Agnes Araujo Sardinha Pinto
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Rodrigo Antonio Brandao
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Julio Flavio Marchini
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Julio Cesar Alencar
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Lucas Oliveira Marino
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Luz Marina Gomez
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| | - Niels Olsen Saraiva Camara
- Department of Immunology, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil
| | - Heraldo P Souza
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Arnaldo, 455, São Paulo, Brazil
| |
Collapse
|
223
|
Effectiveness of CoronaVac among healthcare workers in the setting of high SARS-CoV-2 Gamma variant transmission in Manaus, Brazil: A test-negative case-control study. ACTA ACUST UNITED AC 2021; 1:100025. [PMID: 34386791 PMCID: PMC8310555 DOI: 10.1016/j.lana.2021.100025] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, Gamma, emerged in the city of Manaus in late 2020 during a large resurgence of coronavirus disease (COVID-19), and has spread throughout Brazil. The effectiveness of vaccines in settings with widespread Gamma variant transmission has not been reported. Methods We performed a matched test-negative case-control study to estimate the effectiveness of an inactivated vaccine, CoronaVac, in healthcare workers (HCWs) in Manaus, where the Gamma variant accounted for 86% of genotyped SARS-CoV-2 samples at the peak of its epidemic. We performed an early analysis of effectiveness following administration of at least one vaccine dose and an analysis of effectiveness of the two-dose schedule. The primary outcome was symptomatic SARS-CoV-2 infection. Findings For the early at-least-one-dose and two-dose analyses the study population was, respectively, 53,176 and 53,153 HCWs residing in Manaus and aged 18 years or older, with complete information on age, residence, and vaccination status. Among 53,153 HCWs eligible for the two-dose analysis, 47,170 (89%) received at least one dose of CoronaVac and 2,656 individuals (5%) underwent RT-PCR testing from 19 January, 2021 to 13 April, 2021. Of 3,195 RT-PCR tests, 885 (28%) were positive. 393 and 418 case-control pairs were selected for the early and two-dose analyses, respectively, matched on calendar time, age, and neighbourhood. Among those who had received both vaccine doses before the RT-PCR sample collection date, the average time from second dose to sample collection date was 14 days (IQR 7-24). In the early analysis, vaccination with at least one dose was associated with a 0.50-fold reduction (adjusted vaccine effectiveness (VE), 49.6%, 95% CI 11.3 to 71.4) in the odds of symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the first dose. However, we estimated low effectiveness (adjusted VE 36.8%, 95% CI -54.9 to 74.2) of the two-dose schedule against symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the second dose. A finding that vaccinated individuals were much more likely to be infected than unvaccinated individuals in the period 0-13 days after first dose (aOR 2.11, 95% CI 1.36-3.27) suggests that unmeasured confounding led to downward bias in the vaccine effectiveness estimate. Interpretation Evidence from this test-negative study of the effectiveness of CoronaVac was mixed, and likely affected by bias in this setting. Administration of at least one vaccine dose showed effectiveness against symptomatic SARS-CoV-2 infection in the setting of epidemic Gamma variant transmission. However, the low estimated effectiveness of the two-dose schedule underscores the need to maintain non-pharmaceutical interventions while vaccination campaigns with CoronaVac are being implemented. Funding Fundação Oswaldo Cruz (Fiocruz); Municipal Health Secretary of Manaus; Fundação de Vigilância em Saúde do Amazonas
Collapse
|
224
|
Achilleos S, Quattrocchi A, Gabel J, Heraclides A, Kolokotroni O, Constantinou C, Pagola Ugarte M, Nicolaou N, Rodriguez-Llanes JM, Bennett CM, Bogatyreva E, Schernhammer E, Zimmermann C, Costa AJL, Lobato JCP, Fernandes NM, Semedo-Aguiar AP, Jaramillo Ramirez GI, Martin Garzon OD, Mortensen LH, Critchley JA, Goldsmith LP, Denissov G, Rüütel K, Le Meur N, Kandelaki L, Tsiklauri S, O'Donnell J, Oza A, Kaufman Z, Zucker I, Ambrosio G, Stracci F, Hagen TP, Erzen I, Klepac P, Arcos González P, Fernández Camporro Á, Burström B, Pidmurniak N, Verstiuk O, Huang Q, Mehta NK, Polemitis A, Charalambous A, Demetriou CA. Excess all-cause mortality and COVID-19-related mortality: a temporal analysis in 22 countries, from January until August 2020. Int J Epidemiol 2021; 51:35-53. [PMID: 34282450 PMCID: PMC8344815 DOI: 10.1093/ije/dyab123] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background This study aimed to investigate overall and sex-specific excess all-cause mortality since the inception of the COVID-19 pandemic until August 2020 among 22 countries. Methods Countries reported weekly or monthly all-cause mortality from January 2015 until the end of June or August 2020. Weekly or monthly COVID-19 deaths were reported for 2020. Excess mortality for 2020 was calculated by comparing weekly or monthly 2020 mortality (observed deaths) against a baseline mortality obtained from 2015–2019 data for the same week or month using two methods: (i) difference in observed mortality rates between 2020 and the 2015–2019 average and (ii) difference between observed and expected 2020 deaths. Results Brazil, France, Italy, Spain, Sweden, the UK (England, Wales, Northern Ireland and Scotland) and the USA demonstrated excess all-cause mortality, whereas Australia, Denmark and Georgia experienced a decrease in all-cause mortality. Israel, Ukraine and Ireland demonstrated sex-specific changes in all-cause mortality. Conclusions All-cause mortality up to August 2020 was higher than in previous years in some, but not all, participating countries. Geographical location and seasonality of each country, as well as the prompt application of high-stringency control measures, may explain the observed variability in mortality changes.
Collapse
Affiliation(s)
- Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Alexandros Heraclides
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Ourania Kolokotroni
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Nicoletta Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | | | - Ekaterina Bogatyreva
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Zimmermann
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Antonio Jose Leal Costa
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ana Paula Semedo-Aguiar
- Nature, Life and Environment Sciences Department, University Jean Piaget of Cape Verde, Praia, Cape Verde
| | | | | | - Laust Hvas Mortensen
- Department of Public Health, University of Copenhagen, Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Gleb Denissov
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Kristi Rüütel
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Nolwenn Le Meur
- University of Rennes, EHESP, REPERES-EA 7449, Rennes, France
| | - Levan Kandelaki
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Joan O'Donnell
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ajay Oza
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Zalman Kaufman
- Israel Center of Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- Israel Center of Disease Control, Ministry of Health, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giuseppe Ambrosio
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.,CERICLET- Interdepartmental Center for Clinical and Translational Research, University of Perugia School of Medicine, Perugia, Italy
| | - Fabrizio Stracci
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Ivan Erzen
- Public Health School, National Institute of Public Health, Ljubljana, Slovenia
| | - Petra Klepac
- Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | | | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Olesia Verstiuk
- Faculty of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Qian Huang
- SC Center for Rural and Primary Health Care and Department of Geography, University of South Carolina, Columbia, SC, USA
| | - Neil Kishor Mehta
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| |
Collapse
|
225
|
Zimmermann IR, Sanchez MN, Frio GS, Alves LC, Pereira CCDA, Lima RTDS, Machado C, Santos LMP, da Silva EN. Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020. PLoS One 2021; 16:e0254633. [PMID: 34270568 PMCID: PMC8284655 DOI: 10.1371/journal.pone.0254633] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. CONCLUSIONS The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.
Collapse
Affiliation(s)
- Ivan Ricardo Zimmermann
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Mauro Niskier Sanchez
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Gustavo Saraiva Frio
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Layana Costa Alves
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Institute of Collective Health (ISC) at the Federal University of Bahia, Salvador, Brazil
| | | | | | - Carla Machado
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Everton Nunes da Silva
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Collective Health Course, Faculty of Ceilândia, University of Brasilia, Brasilia, Brazil
| |
Collapse
|
226
|
Bastos LS, Ranzani OT, Souza TML, Hamacher S, Bozza FA. COVID-19 hospital admissions: Brazil's first and second waves compared. THE LANCET RESPIRATORY MEDICINE 2021; 9:e82-e83. [PMID: 34273268 PMCID: PMC8279962 DOI: 10.1016/s2213-2600(21)00287-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Leonardo Sl Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Moreno L Souza
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations, Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- Critical Care Lab, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, RJ 21040-900, Brazil.
| |
Collapse
|
227
|
Guimarães RM, Portela MC, Villela DAM, Correa Matta G, de Freitas CM. Younger Brazilians hit by COVID-19 - What are the implications? ACTA ACUST UNITED AC 2021; 1:100014. [PMID: 34386787 PMCID: PMC8277979 DOI: 10.1016/j.lana.2021.100014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Raphael Mendonça Guimarães
- Fiocruz COVID-19 Observatory, Oswaldo Cruz Foundation, Brazil
- Corresponding Author. Raphael Mendonça Guimarães, Oswaldo Cruz Foundation, Avenida Brasil, 4365 – Manguinho,s Rio de Janeiro/RJ, Zipcode: 21041-960
| | | | | | | | | |
Collapse
|
228
|
Fonseca LM, de Sousa DS, Cardoso JC, Severino P, Cano A, Souto EB, Lima SO, de Oliveira CCC, Reis FP. Epidemiology of COVID-19 in the State of Sergipe/Brazil and Its Relationship with Social Indicators. EPIDEMIOLOGIA 2021; 2:262-270. [PMID: 36417225 PMCID: PMC9620914 DOI: 10.3390/epidemiologia2030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
A pandemic is capable of generating a great impact, not only from the point of view of health, but also socioeconomically. In March 2020, the World Health Organization (WHO) declared that a new pandemic situation had arisen, due to the SARS-CoV-2 virus, whose probable origin was zoonotic. The largest number of cases of this disease is concentrated in the United States of America (USA), India, and Brazil. The mortality rate is estimated at 3.4%, but regional differences may exist, and places with a high demographic density have become true epicentres and may be related to higher rates of transmission. In addition to the above, lower human development indexes (HDI) can be related to worse outcomes, especially in the North and Northeast regions of Brazil since they are the least developed places. The Northeast region is the second-most-affected place in the number of COVID-19 cases in Brazil. An analytical observational study of an ecological type was carried out from April to October 2020 to assess the epidemiological situation of COVID-19 in the state of Sergipe and specifically to analyse the incidence of cases and deaths resulting from COVID-19 in the different health regions of the state of Sergipe, in relation to the values of the HDI and demographic density. During the study period, 84,325 cases of COVID-19 were identified, in which 2205 resulted in death. In most of the regions studied, there was a positive association between the number of cases and deaths and the greater the demographic density, but there was no increase in the risk of becoming ill, nor of dying the lower the HDI. Large and crowded cities are places of greatest vulnerability to illness, due to their greater capacity of transmitting the virus; however, further studies are needed to identify other factors that are decisive in the outcomes of this new disease.
Collapse
Affiliation(s)
- Larissa M. Fonseca
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
| | - Derijuli S. de Sousa
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
| | - Juliana C. Cardoso
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
- Institute of Technology and Research (ITP), University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil;
| | - Patricia Severino
- Institute of Technology and Research (ITP), University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil;
- Post-Graduation Program in Biotechnology, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil
| | - Amanda Cano
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain;
- Networking Research Centre of Neurodegenerative Disease (CIBERNED), Instituto de Salud Juan Carlos III, 28031 Madrid, Spain
| | - Eliana B. Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- CEB—Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal
| | - Sônia O. Lima
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
- Institute of Technology and Research (ITP), University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil;
| | - Cristiane C. C. de Oliveira
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
- Institute of Technology and Research (ITP), University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil;
| | - Francisco P. Reis
- Post-Graduation Program in Health and Environment, University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil; (L.M.F.); (D.S.d.S.); (J.C.C.); (S.O.L.); (C.C.C.d.O.)
- Institute of Technology and Research (ITP), University of Tiradentes, Aracaju 49010-390, Sergipe, Brazil;
| |
Collapse
|
229
|
Jassat W, Mudara C, Ozougwu L, Tempia S, Blumberg L, Davies MA, Pillay Y, Carter T, Morewane R, Wolmarans M, von Gottberg A, Bhiman JN, Walaza S, Cohen C. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study. LANCET GLOBAL HEALTH 2021; 9:e1216-e1225. [PMID: 34252381 PMCID: PMC8270522 DOI: 10.1016/s2214-109x(21)00289-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Background The first wave of COVID-19 in South Africa peaked in July, 2020, and a larger second wave peaked in January, 2021, in which the SARS-CoV-2 501Y.V2 (Beta) lineage predominated. We aimed to compare in-hospital mortality and other patient characteristics between the first and second waves. Methods In this prospective cohort study, we analysed data from the DATCOV national active surveillance system for COVID-19 admissions to hospital from March 5, 2020, to March 27, 2021. The system contained data from all hospitals in South Africa that have admitted a patient with COVID-19. We used incidence risk for admission to hospital and determined cutoff dates to define five wave periods: pre-wave 1, wave 1, post-wave 1, wave 2, and post-wave 2. We compared the characteristics of patients with COVID-19 who were admitted to hospital in wave 1 and wave 2, and risk factors for in-hospital mortality accounting for wave period using random-effect multivariable logistic regression. Findings Peak rates of COVID-19 cases, admissions, and in-hospital deaths in the second wave exceeded rates in the first wave: COVID-19 cases, 240·4 cases per 100 000 people vs 136·0 cases per 100 000 people; admissions, 27·9 admissions per 100 000 people vs 16·1 admissions per 100 000 people; deaths, 8·3 deaths per 100 000 people vs 3·6 deaths per 100 000 people. The weekly average growth rate in hospital admissions was 20% in wave 1 and 43% in wave 2 (ratio of growth rate in wave 2 compared with wave 1 was 1·19, 95% CI 1·18–1·20). Compared with the first wave, individuals admitted to hospital in the second wave were more likely to be age 40–64 years (adjusted odds ratio [aOR] 1·22, 95% CI 1·14–1·31), and older than 65 years (aOR 1·38, 1·25–1·52), compared with younger than 40 years; of Mixed race (aOR 1·21, 1·06–1·38) compared with White race; and admitted in the public sector (aOR 1·65, 1·41–1·92); and less likely to be Black (aOR 0·53, 0·47–0·60) and Indian (aOR 0·77, 0·66–0·91), compared with White; and have a comorbid condition (aOR 0·60, 0·55–0·67). For multivariable analysis, after adjusting for weekly COVID-19 hospital admissions, there was a 31% increased risk of in-hospital mortality in the second wave (aOR 1·31, 95% CI 1·28–1·35). In-hospital case-fatality risk increased from 17·7% in weeks of low admission (<3500 admissions) to 26·9% in weeks of very high admission (>8000 admissions; aOR 1·24, 1·17–1·32). Interpretation In South Africa, the second wave was associated with higher incidence of COVID-19, more rapid increase in admissions to hospital, and increased in-hospital mortality. Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage. Funding DATCOV as a national surveillance system is funded by the National Institute for Communicable Diseases and the South African National Government.
Collapse
Affiliation(s)
- Waasila Jassat
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Caroline Mudara
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lovelyn Ozougwu
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lucille Blumberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mary-Ann Davies
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Terence Carter
- Clinton Health Access Initiative, Pretoria, South Africa
| | | | | | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
230
|
Filho TR, Mendes J, Chow C, Phillips J, Cordeiro A, Scorza F, Almeida AC, Moret M. Attack rate and the price of SARS-CoV-2 herd immunity in Brazil. RESEARCH SQUARE 2021:rs.3.rs-659187. [PMID: 34268503 PMCID: PMC8282102 DOI: 10.21203/rs.3.rs-659187/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We introduce a compartmental model with age structure to study the dynamics of the SARS-COV-2 pandemic. The contagion matrix in the model is given by the product of a probability per contact with a contact matrix explicitly taking into account the contact structure among different age groups. The probability of contagion per contact is considered as time dependent to represent non-pharmaceutical interventions, and is fitted from the time series of deaths. The approach is used to study the evolution of the COVID-19 pandemic in the main Brazilian cities and compared to two good quality serological surveys. We also discuss with some detail the case of the city of Manaus which raised special attention due to a previous report of three-quarters attack rate by the end of 2020. We discuss estimates for Manaus and all Brazilian cities with a total population of more than one million. We also estimate the attack rate with respect to the total population, in each Brazilian state by January, 1st 2021 and May, 23 2021.
Collapse
Affiliation(s)
| | | | | | | | - Antônio Cordeiro
- Centro Universitário SENAI CIMATEC and Instituto Federal de Educação, Ciência e Tecnologia da Bahia and Unopar Candeias
| | | | | | | |
Collapse
|
231
|
Chisale MRO, Ramazanu S, Mwale SE, Kumwenda P, Chipeta M, Kaminga AC, Nkhata O, Nyambalo B, Chavura E, Mbakaya BC. Seroprevalence of anti-SARS-CoV-2 antibodies in Africa: A systematic review and meta-analysis. Rev Med Virol 2021; 32:e2271. [PMID: 34228851 PMCID: PMC8420234 DOI: 10.1002/rmv.2271] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022]
Abstract
We estimated the seroprevalence of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre‐prints that reported anti‐SARS‐CoV‐2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty‐three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti‐SARS‐CoV‐2 antibodies in Africa was 22% (95%CI: 14–31) with very high heterogeneity (I2 = 100%, p < 0.001). Seroprevalence was highest in studies conducted in Central Africa compared to Southern Africa, West Africa, North Africa and East Africa respectively. The number of days between the first reported coronavirus disease 2019 case in each country and when a seroprevalence study was conducted was a significant moderator of seroprevalence. Seropositivity was numerically influenced by gender and age of the participants with males and those aged below 50 years being most affected with SARS‐CoV‐2 infection. The highest pooled seroprevalence in Africa reported in this review should be interpreted cautiously due to high heterogeneity between studies. Continued seroprevalence surveillance is warranted to establish Africa's transition towards herd immunity.
Collapse
Affiliation(s)
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Saul Eric Mwale
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - Pizga Kumwenda
- Biomedical Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - Mep Chipeta
- Nursing and Midwifery Department, Mzuzu University, Mzuzu, Malawi
| | | | - Obed Nkhata
- St John's Institute for Health, Mzuzu, Malawi
| | | | - Elton Chavura
- Department of Public Health, University of Livingstonia, Mzuzu, Malawi
| | - Balwani C Mbakaya
- Department of Public Health, University of Livingstonia, Mzuzu, Malawi
| |
Collapse
|
232
|
Freitas ARR, Beckedorff OA, Cavalcanti LPDG, Siqueira AM, Castro DBD, Costa CFD, Lemos DRQ, Barros EN. The emergence of novel SARS-CoV-2 variant P.1 in Amazonas (Brazil) was temporally associated with a change in the age and sex profile of COVID-19 mortality: A population based ecological study. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100021. [PMID: 34514463 PMCID: PMC8421758 DOI: 10.1016/j.lana.2021.100021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the end of 2020, there has been a great deal of international concern about the variants of SARS-COV-2 B.1.1.7, identified in the United Kingdom; B.1.351 discovered in South Africa and P.1, originating from the Brazilian state of Amazonas. The three variants were associated with an increase in transmissibility and worsening of the epidemiological situation in the places where they expanded. The lineage B.1.1.7 was associated with the increase in case fatality rate in the United Kingdom. There are still no studies on the case fatality rate of the other two variants. The aim of this study was to analyze the mortality profile before and after the emergence of the P.1 strain in the Amazonas state. METHODS We analyzed data from the Influenza Epidemiological Surveillance Information System, SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe), comparing two distinct epidemiological periods: during the peak of the first wave, between April and May 2020, and in January 2021 (the second wave), the month in which the new variant came to predominate. We calculated mortality rates, overall case fatality rate and case fatality rate among hospitalized patients; all rates were calculated by age and gender and 95% confidence intervals (95% CI) were determined. FINDINGS We observed that in the second wave there were a higher incidence and an increase in the proportion of cases of COVID-19 in the younger age groups. There was also an increase in the proportion of women among Severe Acute Respiratory Infection (SARI) cases from 40% (2,709) in the first wave to 47% (2,898) in the second wave and in the proportion of deaths due to COVID-19 between the two periods varying from 34% (1,051) to 47% (1,724), respectively. In addition, the proportion of deaths among people between 20 and 59 years old has increased in both sexes. The case fatality rate among those hospitalized in the population between 20 and 39 years old during the second wave was 2.7 times the rate observed in the first wave (female rate ratio = 2.71; 95% CI: 1.9-3.9], p <0.0001; male rate ratio = 2.70, 95%CI:2.0-3.7), and in the general population the rate ratios were 1.15 (95% CI: 1.1-1.2) in females and 0.78 (95% CI: 0.7-0.8) in males]. INTERPRETATION Based on this prompt analysis of the epidemiological scenario in the Amazonas state, the observed changes in the pattern of mortality due to COVID-19 between age groups and gender simultaneously with the emergence of the P.1 strain suggest changes in the pathogenicity and virulence profile of this new variant. Further studies are needed to better understanding of SARS-CoV-2 variants profile and their impact for the health population. FUNDING There was no funding for this study.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Eliana N.C. Barros
- Centro de Farmacovigilância, Segurança Clínica e Gestao de Risco do Instituto Butantan, Brazil
| |
Collapse
|
233
|
Estenssoro E, Loudet CI, Ríos FG, Kanoore Edul VS, Plotnikow G, Andrian M, Romero I, Piezny D, Bezzi M, Mandich V, Groer C, Torres S, Orlandi C, Rubatto Birri PN, Valenti MF, Cunto E, Sáenz MG, Tiribelli N, Aphalo V, Reina R, Dubin A. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study. THE LANCET RESPIRATORY MEDICINE 2021; 9:989-998. [PMID: 34224674 PMCID: PMC8253540 DOI: 10.1016/s2213-2600(21)00229-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. METHODS In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov, NCT04611269, and is complete. FINDINGS Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52-70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7-22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0-7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H2O (8-12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was 160 (IQR 111-218), respiratory system compliance 36 mL/cm H2O (29-44), driving pressure 12 cm H2O (10-14), and FiO2 0·60 (0·45-0·80) on day 1. Acute respiratory distress syndrome developed in 1672 (87·6%) of patients; 1176 (61·6%) received prone positioning. In-hospital mortality was 57·7% (1101/1909 patients) and ICU mortality was 57·0% (1088/1909 patients); 462 (43·8%) patients died of refractory hypoxaemia, frequently overlapping with septic shock (n=174). Cox regression identified age (hazard ratio 1·02 [95% CI 1·01-1·03]), Charlson score (1·16 [1·11-1·23]), endotracheal intubation outside of the ICU (ie, before ICU admission; 1·37 [1·10-1·71]), vasopressor use on day 1 (1·29 [1·07-1·55]), D-dimer concentration (1·02 [1·01-1·03]), PaO2/FiO2 on day 1 (0·998 [0·997-0·999]), arterial pH on day 1 (1·01 [1·00-1·01]), driving pressure on day 1 (1·05 [1·03-1·08]), acute kidney injury (1·66 [1·36-2·03]), and month of admission (1·10 [1·03-1·18]) as independent predictors of mortality. INTERPRETATION In patients with COVID-19 who required invasive mechanical ventilation, lung-protective ventilation was widely used but mortality was high. Predictors of mortality in our study broadly agreed with those identified in studies of invasively ventilated patients in high-income countries. The sustained burden of COVID-19 on scarce health-care personnel might have contributed to high mortality over the course of our study in Argentina. These data might help to identify points for improvement in the management of patients in middle-income countries and elsewhere. FUNDING None. TRANSLATION For the Spanish translation of the Summary see Supplementary Materials section.
Collapse
Affiliation(s)
- Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, Buenos Aires, Argentina.
| | - Cecilia I Loudet
- Hospital Interzonal de Agudos General San Martín, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Marco Bezzi
- Hospital Santojanni, Buenos Aires, Argentina
| | | | - Carla Groer
- Hospital Juan A Fernández, Buenos Aires, Argentina
| | | | | | | | | | | | - María G Sáenz
- Hospital Interzonal de Agudos General San Martín, Buenos Aires, Argentina
| | - Norberto Tiribelli
- Complejo Médico de la Policía Federal Argentina Churruca Visca, Buenos Aires, Argentina
| | | | - Rosa Reina
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | | | | |
Collapse
|
234
|
Dallmeier K, Meyfroidt G, Neyts J. COVID-19 and the intensive care unit: vaccines to the rescue. Intensive Care Med 2021; 47:786-789. [PMID: 34031699 PMCID: PMC8143986 DOI: 10.1007/s00134-021-06414-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/15/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Kai Dallmeier
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, B-3000, Leuven, Belgium
| | - Geert Meyfroidt
- Intensive Care Medicine, University Hospitals Leuven, B-3000, Leuven, Belgium.
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, B-3000, Leuven, Belgium
| |
Collapse
|
235
|
Barberia LG, Costa SF, Sabino EC. Brazil needs a coordinated and cooperative approach to tackle COVID-19. Nat Med 2021; 27:1133-1134. [PMID: 34155412 DOI: 10.1038/s41591-021-01423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Lorena G Barberia
- Department of Political Science, Universidade de São Paulo, São Paulo, Brazil.
| | - Silvia Figueiredo Costa
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ester C Sabino
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
236
|
Busatto GF, de Araújo AL, Duarte AJDS, Levin AS, Guedes BF, Kallas EG, Pinna FR, de Souza HP, da Silva KR, Sawamura MVY, Seelaender M, Imamura M, Garcia ML, Forlenza OV, Nitrini R, Damiano RF, Rocha VG, Batisttella LR, Carvalho CRRD. Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil. BMJ Open 2021; 11:e051706. [PMID: 34193506 PMCID: PMC8249176 DOI: 10.1136/bmjopen-2021-051706] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity. METHODS AND ANALYSES We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1-2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6-9 months and 12-15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics. ETHICS AND DISSEMINATION All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples. TRIAL REGISTRATION NUMBER RBR-8z7v5wc; Pre-results.
Collapse
Affiliation(s)
- Geraldo Filho Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Alberto José da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, Sao Paulo, Brazil
| | - Anna Sara Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Fukelmann Guedes
- Instituto Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, Sao Paulo, Brazil
| | - Esper Georges Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Departamento de Clínica Médica, Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Fabio Rezende Pinna
- Instituto Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, Sao Paulo, Brazil
- Departamento de Oftalmologia e Otorrinolaringologia, Laboratório de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Laboratório de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Katia Regina da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Marilia Seelaender
- Departamento de Cirurgia, Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marta Imamura
- Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Michelle Louvaes Garcia
- Departamento de Cardio-Pneumologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Orestes Vicente Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Vanderson Geraldo Rocha
- Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Linamara Rizzo Batisttella
- Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | |
Collapse
|
237
|
Scheler CA, Discacciati MG, Vale DB, Lajos GJ, Surita F, Teixeira JC. Mortality in pregnancy and the postpartum period in women with severe acute respiratory distress syndrome related to COVID-19 in Brazil, 2020. Int J Gynaecol Obstet 2021; 155:475-482. [PMID: 34185314 PMCID: PMC9087770 DOI: 10.1002/ijgo.13804] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate fatality rates due to severe acute respiratory distress syndrome (ARDS) related to COVID-19 in Brazilian women, comparing pregnant and postpartum women with nonpregnant women. METHODS A cross-sectional study of 12 566 pregnant and postpartum women (obstetric group) and 90 025 nonpregnant women (nonobstetric group) aged 15-49 years reported with severe ARDS in 2020. The Brazilian ARDS Surveillance System was used to compare the outcome (death or cure) between the groups, considering age, race, or comorbidities. RESULTS The mortality rate related to ARDS/COVID-19 in the obstetric group was 7.8% (377/4853) compared with 13.9% (5946/42 915) in the nonobstetric group. Comorbidity was associated with increased fatality cases for both groups, but higher in the nonobstetric group (22.8% vs 13.3%). In the obstetric group, deaths related to COVID-19 were concentrated in the third trimester or postpartum period. If comorbidity was present, deaths by COVID-19 were 4.4 times higher than ARDS due to other etiologies, and twice higher in women who self-reported as black (13.7%) than white women (6.7%). Considering ADRS etiology, deaths by COVID-19 were 3.4-6.7 times higher than any other etiology. CONCLUSION ARDS related to COVID-19 in obstetric patients was an important factor for worse clinical outcomes, with 3-6 times higher death rates than other ARDS etiologies. Pregnant and postpartum women with severe ARDS related to COVID-19 had a lower fatality rate than nonpregnant women, even with associated comorbidity.
Collapse
Affiliation(s)
- Carlos A Scheler
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Michelle G Discacciati
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| |
Collapse
|
238
|
The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients. Ir J Med Sci 2021; 191:997-1003. [PMID: 34184206 PMCID: PMC8238476 DOI: 10.1007/s11845-021-02696-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/19/2021] [Indexed: 01/08/2023]
Abstract
Background It is necessary to identify critical patients requiring hospitalization early due to the rapid increase in the number of COVID-19 cases. Aim This study aims to evaluate the effectiveness of scoring systems such as emergency department triage early warning score (TREWS) and modified early warning score (MEWS) in predicting mortality in COVID-19 patients. Methods In this retrospective cohort study, PCR positive patients evaluated for COVID-19 and decided to be hospitalized were evaluated. During the first evaluation, MEWS and TREWS scores of the patients were calculated. Intensive care needs as well as 24-h and 28-day mortality rates were evaluated. Results A total of 339 patients were included in the study. While 30 (8.8%) patients were hospitalized in the intensive care unit, 4 (1.2%) died in the emergency. The number of patients who died within 28 days was found to be 57 (16.8%). In 24-h mortality, the median MEWS value was found to be 7 (IQR 25–75) while the TREWS value was 11.5 (IQR 25–75). In the ROC analysis made for the diagnostic value of 28-day mortality of MEWS and TREWS scores, the area under the curve (AUC) for the MEWS score was found to be 0.833 (95% CI 0.777–0.888, p < 0.001) while it was identified as 0.823 (95% CI 0.764–0.882, p < 0.001) for the TREWS. Conclusion MEWS and TREWS calculated at emergency services are effective in predicting 28-day mortality in patients requiring hospitalization due to COVID-19.
Collapse
|
239
|
Estofolete CF, Banho CA, Campos GRF, Marques BDC, Sacchetto L, Ullmann LS, Possebon FS, Machado LF, Syrio JD, Araújo Junior JP, Bittar C, Rahal P, Lobo SMA, Ferreira HL, Vasilakis N, Nogueira ML. Case Study of Two Post Vaccination SARS-CoV-2 Infections with P1 Variants in CoronaVac Vaccinees in Brazil. Viruses 2021; 13:1237. [PMID: 34206727 PMCID: PMC8309964 DOI: 10.3390/v13071237] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
The rapid development of efficacious and safe vaccines against coronavirus disease 2019 (COVID-19) has been instrumental in mitigating the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Moreover, the emergence of SARS-CoV-2 variants raised concerns on the efficacy of these vaccines. Herein, we report two cases of breakthrough infections with the P1 variant in patients vaccinated with CoronaVac, which is one of the two vaccines authorized for emergency use in the Brazilian immunization program. Our observations suggest that the vaccine reduced the severity of the disease and highlight the potential risk of illness following vaccination and subsequent infection with the P1 variant as well as for continued efforts to prevent and diagnose infection in vaccinated persons.
Collapse
Affiliation(s)
- Cassia F. Estofolete
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
- Hospital de Base, São José do Rio Preto, São Paulo 15090-000, Brazil; (L.F.M.); (J.D.S.); (S.M.A.L.)
| | - Cecilia A. Banho
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
| | - Guilherme R. F. Campos
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
| | - Beatriz de C. Marques
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
| | - Livia Sacchetto
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
| | - Leila S. Ullmann
- Biotecnology Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18607-440, Brazil; (L.S.U.); (F.S.P.); (J.P.A.J.)
| | - Fabio S. Possebon
- Biotecnology Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18607-440, Brazil; (L.S.U.); (F.S.P.); (J.P.A.J.)
| | - Luana F. Machado
- Hospital de Base, São José do Rio Preto, São Paulo 15090-000, Brazil; (L.F.M.); (J.D.S.); (S.M.A.L.)
| | - Juliana D. Syrio
- Hospital de Base, São José do Rio Preto, São Paulo 15090-000, Brazil; (L.F.M.); (J.D.S.); (S.M.A.L.)
| | - João P. Araújo Junior
- Biotecnology Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18607-440, Brazil; (L.S.U.); (F.S.P.); (J.P.A.J.)
| | - Cintia Bittar
- Intitute of Biosciences, Languages and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo 15054-000, Brazil; (C.B.); (P.R.)
| | - Paula Rahal
- Intitute of Biosciences, Languages and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo 15054-000, Brazil; (C.B.); (P.R.)
| | - Suzana M. A. Lobo
- Hospital de Base, São José do Rio Preto, São Paulo 15090-000, Brazil; (L.F.M.); (J.D.S.); (S.M.A.L.)
| | - Helena Lage Ferreira
- Department of Veterinary Medicine FZEA-USP, University of São Paulo (USP), Pirassununga, São Paulo 13635-900, Brazil;
| | - Nikos Vasilakis
- Department of Pathology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
- Sealy Center for Vector-Borne and Zoonotic Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Center for Tropical Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Institute for Human Infection and Immunity, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Mauricio L. Nogueira
- Laboratório de Pesquisas em Virologia (LPV), Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil; (C.F.E.); (C.A.B.); (G.R.F.C.); (B.d.C.M.); (L.S.)
- Hospital de Base, São José do Rio Preto, São Paulo 15090-000, Brazil; (L.F.M.); (J.D.S.); (S.M.A.L.)
| |
Collapse
|
240
|
Senegaglia AC, Rebelatto CLK, Franck CL, Lima JS, Boldrini-Leite LM, Daga DR, Leitão CA, Shigunov P, de Azambuja AP, Bana E, Marsaro DB, Schaidt B, Micosky A, Jamur VR, Schluga Y, Vaz IM, Ribeiro LL, Correa A, Brofman EPRS. Combined Use of Tocilizumab and Mesenchymal Stromal Cells in the Treatment of Severe Covid-19: Case Report. Cell Transplant 2021; 30:9636897211021008. [PMID: 34074163 PMCID: PMC8175829 DOI: 10.1177/09636897211021008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus pandemic is one of the most significant public health events in recent history. Currently, no specific treatment is available. Some drugs and cell-based therapy have been tested as alternatives to decrease the disease's symptoms, length of hospital stay, and mortality. We reported the case of a patient with a severe manifestation of COVID-19 in critical condition who did not respond to the standard procedures used, including six liters of O2 supplementation under a nasal catheter and treatment with dexamethasone and enoxaparin in prophylactic dose. The patient was treated with tocilizumab and an advanced therapy product based on umbilical cord-derived mesenchymal stromal cells (UC-MSC). The combination of tocilizumab and UC-MSC proved to be safe, with no adverse effects, and the results of this case report prove to be a promising alternative in the treatment of patients with severe acute respiratory syndrome due to SARS-CoV-2.
Collapse
Affiliation(s)
- Alexandra Cristina Senegaglia
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Carmen Lúcia Kuniyoshi Rebelatto
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Claudio Luciano Franck
- Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Lidiane Maria Boldrini-Leite
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Debora Regina Daga
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Cleverson Alex Leitão
- Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Patrícia Shigunov
- National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil.,Laboratory of Basic Biology of Stem Cells - Carlos Chagas Institute - Fiocruz-Paraná, Curitiba, Paraná, Brazil
| | - Ana Paula de Azambuja
- Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Elisa Bana
- Hospital Nossa Senhora do Pilar, Curitiba, Paraná, Brazil
| | - Daniela Boscaro Marsaro
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Bruna Schaidt
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Andressa Micosky
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Valderez Ravaglio Jamur
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | - Yara Schluga
- Complexo Hospital de Clínicas - 274922Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Isadora May Vaz
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| | | | - Alejandro Correa
- National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil.,Laboratory of Basic Biology of Stem Cells - Carlos Chagas Institute - Fiocruz-Paraná, Curitiba, Paraná, Brazil
| | - E Paulo Roberto Slud Brofman
- Core for Cell Technology - School of Medicine - 28100Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.,National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Brazil
| |
Collapse
|
241
|
Oliveira EA, Colosimo EA, Simões E Silva AC, Mak RH, Martelli DB, Silva LR, Martelli-Júnior H, Oliveira MCL. Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:559-568. [PMID: 34119027 PMCID: PMC8192298 DOI: 10.1016/s2352-4642(21)00134-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. Methods We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. Findings Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3–15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94–2·88]) or adolescents aged 12–19 years (2·23 [1·84–2·71]) relative to children aged 2–11 years; those of Indigenous ethnicity (3·36 [2·15–5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68–2·52]) or North region (1·55 [1·22–1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52–3·47]), two (4·96 [3·80–6·48]), or three or more (7·28 [4·56–11·6]) pre-existing medical conditions relative to those with none. Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil. Funding National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.
Collapse
Affiliation(s)
- Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla, CA, USA
| | - Daniella B Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros, Montes Claros, Brazil
| | - Ludmila R Silva
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros, Montes Claros, Brazil
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
242
|
Ferreira JC, Ho YL, Besen BAMP, Malbouisson LMS, Taniguchi LU, Mendes PV, Costa ELV, Park M, Daltro-Oliveira R, Roepke RML, Silva-Jr JM, Carmona MJC, Carvalho CRR. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care 2021; 11:92. [PMID: 34097145 PMCID: PMC8182738 DOI: 10.1186/s13613-021-00882-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4–40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57–0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00882-w.
Collapse
Affiliation(s)
- Juliana C Ferreira
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. .,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Yeh-Li Ho
- Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sa Malbouisson
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leandro Utino Taniguchi
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Vitale Mendes
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Leite Vieira Costa
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marcelo Park
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Daltro-Oliveira
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberta M L Roepke
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,UTI Emergencias Cirurgicas E Trauma, Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joao M Silva-Jr
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Jose Carvalho Carmona
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos R R Carvalho
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | |
Collapse
|
243
|
Radovanovic D, Santus P, Coppola S, Saad M, Pini S, Giuliani F, Mondoni M, Chiumello DA. Characteristics, outcomes and global trends of respiratory support in patients hospitalized with COVID-19 pneumonia: a scoping review. Minerva Anestesiol 2021; 87:915-926. [PMID: 34036769 DOI: 10.23736/s0375-9393.21.15486-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To date, a shared international consensus on treatment of Coronavirus Disease 2019 (COVID-19) with invasive or non-invasive respiratory support is lacking. Patients' management and outcomes, especially in severe and critical cases, can vary depending on regional standard operating procedures and local guidance. EVIDENCE ACQUISITION Rapid review methodology was applied to include all the studies published on PubMed and Embase between December 15th 2019 and February 28th 2021, reporting in-hospital and respiratory support-related mortality in adult patients hospitalized with COVID-19 that underwent either continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Only English language studies with ≥100 patients and reporting data on respiratory failure were included. Data on comorbidities, ventilatory parameters and hospital-related complications were registered. EVIDENCE SYNTHESIS Fifty-two studies (287359 patients - 57.5% males, mean age 64 years (range 24-98)) from 17 different countries were included in the final analysis. 33.3% of patients were hospitalized in intensive care units. 44.2% had hypertension, 26.1% had diabetes, and 7.1% a chronic respiratory disease. 55% of patients underwent respiratory support (36% IMV, 62% NIV and 2% CPAP). Without considering a study with the highest number of patients treated with NIV (n=96729), prevalence of NIV and CPAP use was 12.5% and 13.5% respectively. Globally, invasive and non-invasive approaches were heterogeneously applied. In-hospital mortality was 33.7%, and IMV-related mortality was 72.6% (range: 4.3%-99%). Specific mortality in patients treated with CPAP or NIV was available for 53% of studies, and was 29% (range: 7.2%-100%). The median length of hospital stay was 13 days (range: 6-63). The most frequent hospital-related complication was acute kidney injury being reported in up to 55.7% of enrolled patients. CONCLUSIONS Global employment of respiratory supports and related outcomes are very heterogeneous. The most frequent respiratory support in patients with COVID-19 pneumonia is IMV, while NIV and CPAP are less frequently and equally applied, the latter especially in Europe, while data on NIV/CPAP-related mortality is often under-reported. Integrated and comprehensive reporting is desirable and needed to construct evidence-based recommendations.
Collapse
Affiliation(s)
- Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Marina Saad
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Stefano Pini
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Fabio Giuliani
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Davide A Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy - .,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
244
|
Brehm TT, Heyer A, Roedl K, Jarczak D, Nierhaus A, Nentwich MF, van der Meirschen M, Schultze A, Christner M, Fiedler W, Kröger N, Huber TB, Klose H, Sterneck M, Jordan S, Kreuels B, Schmiedel S, Addo MM, Huber S, Lohse AW, Kluge S, Schulze zur Wiesch J. Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020. J Clin Med 2021; 10:2274. [PMID: 34073928 PMCID: PMC8197386 DOI: 10.3390/jcm10112274] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
In this study, we directly compared coronavirus disease 2019 (COVID-19) patients hospitalized during the first (27 February-28 July 2020) and second (29 July-31 December 2020) wave of the pandemic at a large tertiary center in northern Germany. Patients who presented during the first (n = 174) and second (n = 331) wave did not differ in age (median [IQR], 59 years [46, 71] vs. 58 years [42, 73]; p = 0.82) or age-adjusted Charlson Comorbidity Index (median [IQR], 2 [1, 4] vs. 2 [0, 4]; p = 0.50). During the second wave, a higher proportion of patients were treated as outpatients (11% [n = 20] vs. 20% [n = 67]), fewer patients were admitted to the intensive care unit (43% [n = 75] vs. 29% [n = 96]), and duration of hospitalization was significantly shorter (median days [IQR], 14 [8, 34] vs. 11 [5, 19]; p < 0.001). However, in-hospital mortality was high throughout the pandemic and did not differ between the two periods (16% [n = 27] vs. 16% [n = 54]; p = 0.89). While novel treatment strategies and increased knowledge about the clinical management of COVID-19 may have resulted in a less severe disease course in some patients, in-hospital mortality remained unaltered at a high level. These findings highlight the unabated need for efforts to hamper severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, to increase vaccination coverage, and to develop novel treatment strategies to prevent mortality and decrease morbidity.
Collapse
Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Andreas Heyer
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.R.); (D.J.); (A.N.); (M.F.N.); (S.K.)
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.R.); (D.J.); (A.N.); (M.F.N.); (S.K.)
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.R.); (D.J.); (A.N.); (M.F.N.); (S.K.)
| | - Michael F Nentwich
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.R.); (D.J.); (A.N.); (M.F.N.); (S.K.)
| | - Marc van der Meirschen
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (W.F.); (H.K.)
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Hans Klose
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (W.F.); (H.K.)
| | - Martina Sterneck
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Sabine Jordan
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Benno Kreuels
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Samuel Huber
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
| | - Ansgar W Lohse
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.R.); (D.J.); (A.N.); (M.F.N.); (S.K.)
| | - Julian Schulze zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (A.H.); (M.v.d.M.); (M.S.); (S.J.); (B.K.); (S.S.); (M.M.A.); (S.H.); (A.W.L.); (J.S.z.W.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| |
Collapse
|
245
|
Association of physical activity levels and the prevalence of COVID-19-associated hospitalization. J Sci Med Sport 2021; 24:913-918. [PMID: 34090826 PMCID: PMC8141261 DOI: 10.1016/j.jsams.2021.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023]
Abstract
Objectives We compared physical activity levels before the outbreak and quarantine measures with COVID-19-associated hospitalization prevalence in surviving patients infected with SARS-CoV-2. Additionally, we investigated the association of physical activity levels with symptoms of the disease, length of hospital stay, and mechanical ventilation. Design Observational, cross-sectional. Methods Between June 2020 and August 2020, we invited Brazilian survivors and fully recovered patients infected with SARS-CoV-2 to respond to an online questionnaire. We shared the electronic link to the questionnaire on the internet. We collected data about clinical outcomes (symptoms, medications, hospitalization, and length of hospital stay) and cofactors, such as age, sex, ethnicity, preexisting diseases, socioeconomic and educational, and physical activity levels using the International Physical Activity Questionnaire (IPAQ short version). Results Out of 938 patients, 91 (9.7%) were hospitalized due to COVID-19. In a univariate analysis, sex, age, and BMI were all associated with hospitalizations due to COVID-19. Men had a higher prevalence of hospitalization (66.6%, p = 0.013). Patients older than 65 years, obese, and with preexisting disease had a higher prevalence of COVID-19-related hospitalizations. In a multivariate regression model, performance of at least 150 min/wk (moderate) and/or 75 min/wk (vigorous) physical activity was associated with a lower prevalence of hospitalizations after adjustment for age, sex, BMI, and preexisting diseases (PR = 0.657; p = 0.046). Conclusions Sufficient physical activity levels were associated with a lower prevalence of COVID-19-related hospitalizations. Performing at least 150 min a week of moderate-intensity, or 75 min a week of vigorous-intensity physical activity was associated with 34.3% reduction in prevalence.
Collapse
|
246
|
Fungal and bacterial coinfections increase mortality of severely ill COVID-19 patients. J Hosp Infect 2021; 113:145-154. [PMID: 33852950 PMCID: PMC8056850 DOI: 10.1016/j.jhin.2021.04.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
Background SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary. Aim To analyse death risk due to coinfections in COVID-19 patients. Methods The odds of death of 212 severely ill COVID-19 patients were evaluated, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization. Findings The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of whom 83.14% died. Coinfected patients stayed hospitalized longer and had an increased odds of dying (odds ratio (OR): 13.45; R2 = 0.31). The risk of death was increased by bacterial (OR: 11.28) and fungal (OR: 5.97) coinfections, with increased levels of creatinine, leucocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffered from cardiovascular disease (OR: 11.53), diabetes (OR: 6.00) or obesity (OR: 5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for coagulase-negative Staphylococcus (OR: 25.39), Candida non-albicans (OR: 11.12), S. aureus (OR: 10.72), Acinetobacter spp. (OR: 6.88), Pseudomonas spp. (OR: 4.77), and C. albicans (OR: 3.97). The high-risk sites of infection were blood, tracheal aspirate, and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures. Conclusion Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.
Collapse
|
247
|
Castro MC, Kim S, Barberia L, Ribeiro AF, Gurzenda S, Ribeiro KB, Abbott E, Blossom J, Rache B, Singer BH. Spatiotemporal pattern of COVID-19 spread in Brazil. Science 2021; 372:821-826. [PMID: 33853971 DOI: 10.1126/science.abh1558] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 01/06/2023]
Abstract
Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We used daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures, show that although no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Sun Kim
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lorena Barberia
- Department of Political Science, University of São Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Freitas Ribeiro
- Universidade Nove de Julho, São Paulo, SP, Brazil.,Universidade Municipal de São Caetano do Sul, São Cetano do Sul, SP, Brazil
| | - Susie Gurzenda
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, SP, Brazil
| | - Erin Abbott
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Jeffrey Blossom
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Beatriz Rache
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
248
|
Kurtz P, Bastos LSL, Dantas LF, Zampieri FG, Soares M, Hamacher S, Salluh JIF, Bozza FA. Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months. Intensive Care Med 2021; 47:538-548. [PMID: 33852032 PMCID: PMC8044656 DOI: 10.1007/s00134-021-06388-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. METHODS A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27th and October 28th, 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting. RESULTS Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54-0.65], p < 0.001). CONCLUSION Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data.
Collapse
Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Hospital Copa Star, Rio de Janeiro, RJ, Brazil.,Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Leila F Dantas
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando G Zampieri
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Research Institute, Hospital Do Coração (HCor), São Paulo, Brazil.,Center for Epidemiological Research, Southern Denmark University, Odense, Denmark
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. .,National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
249
|
Vicente VA, Lustosa BPR, Grisolia ME, Pavini Beato C, Balsanelli E, de Souza Gubert Fruet V, Bordignon Nogueira M, Raboni SM, Carvalho KAT, Flôr IC, Ferreira Voidaleski M, Etchepare RG, Meis JF, Soccol VT, Souza EM. Environmental Detection of SARS-CoV-2 Virus RNA in Health Facilities in Brazil and a Systematic Review on Contamination Sources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3824. [PMID: 33917465 PMCID: PMC8038740 DOI: 10.3390/ijerph18073824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2 environmental monitoring can track the rate of viral contamination and can be used to establish preventive measures. This study aimed to detect by RT-PCR the presence of SARS-CoV-2 from inert surface samples in public health settings with a literature review about surface contamination and its burden on spread virus. Samples were collected from health settings in Curitiba, Brazil, between July and December 2020. A literature review was conducted using PRISMA. A total of 711 environmental surface samples were collected from outpatient areas, dental units, doctors' offices, COVID-19 evaluation areas, and hospital units, of which 35 (4.9%) were positive for SARS-CoV-2 RNA. The frequency of environmental contamination was higher in primary care units than in hospital settings. The virus was detected on doctors' personal items. Remarkably, the previously disinfected dental chair samples tested positive. These findings agree with those of other studies in which SARS-CoV-2 was found on inanimate surfaces. Detection of SARS-CoV-2 RNA on surfaces in public health settings, including those not meant to treat COVID-19, indicates widespread environmental contamination. Therefore, the intensification of disinfection measures for external hospital areas may be important for controlling community COVID-19 dissemination.
Collapse
Affiliation(s)
- Vania Aparecida Vicente
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (B.P.R.L.); (M.E.G.); (J.F.M.); (V.T.S.)
- Microbiology, Parasitology and Pathology Graduate Program, Department of Basic Pathology, Microbiology, Federal University of Paraná, Curitiba 81530-000, Brazil; (I.C.F.); (M.F.V.)
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Bruno Paulo Rodrigues Lustosa
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (B.P.R.L.); (M.E.G.); (J.F.M.); (V.T.S.)
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Maria Eduarda Grisolia
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (B.P.R.L.); (M.E.G.); (J.F.M.); (V.T.S.)
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Caroline Pavini Beato
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Eduardo Balsanelli
- Department of Biochemistry and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | | | - Meri Bordignon Nogueira
- Virology Laboratory, Clinical Hospital, Federal University of Paraná, Curitiba 80060-900, Brazil; (M.B.N.); (S.M.R.)
| | - Sonia Maria Raboni
- Virology Laboratory, Clinical Hospital, Federal University of Paraná, Curitiba 80060-900, Brazil; (M.B.N.); (S.M.R.)
| | - Katherine Athayde Teixeira Carvalho
- The Pelé Pequeno Príncipe Institute, Child and Adolescent Health Research & Pequeno Príncipe Faculties and Pequeno Príncipe Hospital, Curitiba 802450-0260, Brazil;
| | - Izadora Cervelin Flôr
- Microbiology, Parasitology and Pathology Graduate Program, Department of Basic Pathology, Microbiology, Federal University of Paraná, Curitiba 81530-000, Brazil; (I.C.F.); (M.F.V.)
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Morgana Ferreira Voidaleski
- Microbiology, Parasitology and Pathology Graduate Program, Department of Basic Pathology, Microbiology, Federal University of Paraná, Curitiba 81530-000, Brazil; (I.C.F.); (M.F.V.)
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Ramiro Gonçalves Etchepare
- Technology Sector, Department of Hydraulics and Sanitation, Federal University of Paraná, Curitiba 81530-000, Brazil;
| | - Jacques F. Meis
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (B.P.R.L.); (M.E.G.); (J.F.M.); (V.T.S.)
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6525GA Nijmegen, The Netherlands
| | - Vanete Thomaz Soccol
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (B.P.R.L.); (M.E.G.); (J.F.M.); (V.T.S.)
| | - Emanuel Maltempi Souza
- Department of Biochemistry and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, Brazil;
| |
Collapse
|
250
|
Carson G. Research priorities for Long Covid: refined through an international multi-stakeholder forum. BMC Med 2021; 19:84. [PMID: 33785027 PMCID: PMC8009733 DOI: 10.1186/s12916-021-01947-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gail Carson
- University of Oxford, ISARIC and GloPID R Secretariat, Oxford, UK.
| |
Collapse
|