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El-Ghitany EM, Hashish MH, Farghaly AG, Omran EA, Osman NA, Fekry MM. Asymptomatic versus symptomatic SARS-CoV-2 infection: a cross-sectional seroprevalence study. Trop Med Health 2022; 50:98. [PMID: 36575501 PMCID: PMC9792933 DOI: 10.1186/s41182-022-00490-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although symptomatic SARS-CoV-2 infection predisposes patients to develop complications, the asymptomatic SARS-CoV-2 infection state is of public health importance being a hidden source of infection. Moreover, the asymptomatic state may camouflage the actual burden of the disease. METHODS Data of 1434 seropositive participants for SARS-CoV-2 spike (anti-S) and/or nucleocapsid antibodies (anti-N) were retrieved from a larger cross-sectional survey on COVID-19. Relevant data were retrieved from records including socio-demographic, medical, and behavioral characteristics of seropositive participants as well as history of COVID-19 symptoms during the last 6 months. Symptomatic/asymptomatic SARS-CoV-2 infection was categorized based on the history of the presence or absence of COVID-19 symptoms. RESULTS The rate of asymptomatic SARS-CoV-2 infection was 34.9%. There was a statistically significant difference between symptomatic and asymptomatic participants regarding age, residence, medical conditions, habits, and infection control measures. The number of symptoms was positively correlated with anti-S titer and both were positively correlated with adult body mass index. Slum areas residence, client-facing occupation or being a healthcare worker, having lung disease, having blood group type A, never practicing exercise or social distancing, never using soap for hand washing, and minimal engagement in online working/studying were independent factors associated with the symptomatic state. Patients having less than three symptoms were less likely to be diagnosed by any means. CONCLUSIONS One-third of SARS-CoV-2 infections in our study were asymptomatic. This mandates applying proper measures to prevent transmission even from apparently healthy individuals. Modifiable factors associated with symptomatic infection should be controlled to reduce the risk of COVID-19 complications.
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Affiliation(s)
- Engy Mohamed El-Ghitany
- grid.7155.60000 0001 2260 6941Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Mona H. Hashish
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Azza Galal Farghaly
- grid.7155.60000 0001 2260 6941Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Eman A. Omran
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Nermin A. Osman
- grid.7155.60000 0001 2260 6941Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Marwa M. Fekry
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Rodrigues NCP, de Noronha Andrade MK, Netto JT, Monteiro DLM, Lino VTS, Almeida EGR. Applying fuzzy qualitative comparative analysis to identify typical symptoms of COVID-19 infection in a primary care unit, Rio de Janeiro, Brazil. Sci Rep 2022; 12:22319. [PMID: 36566326 PMCID: PMC9789733 DOI: 10.1038/s41598-022-26283-y] [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: 06/11/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
This study aims to identify a set of symptoms that could be predictive of SARS-CoV-2 cases in the triage of Primary Care services with the contribution of Qualitative Comparative Analysis (QCA) using Fuzzy Sets (fsQCA). A cross-sectional study was carried out in a Primary Health Care Unit/FIOCRUZ from 09/17/2020 to 05/05/2021. The study population was suspect cases that performed diagnostic tests for COVID-19. We collected information about the symptoms to identify which configurations are associated with positive and negative cases. For analysis, we used fsQCA to explain the outcomes "being a positive case" and "not being a positive case". The solution term "loss of taste or smell and no headache" showed the highest degree of association with the positive result (consistency = 0.81). The solution term "absence of loss of taste or smell combined with the absence of fever" showed the highest degree of association (consistency = 0,79) and is the one that proportionally best explains the negative result. Our results may be useful to the presumptive clinical diagnosis of COVID-19 in scenarios where access to diagnostic tests is not available. We used an innovative method used in complex problems in Public Health, the fsQCA.
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Affiliation(s)
- Nádia Cristina Pinheiro Rodrigues
- grid.418854.40000 0004 0602 9605Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, Rua Leopoldo Bulhões, 1480, 21041210 Brazil ,grid.412211.50000 0004 4687 5267Instituto de Medicina Social Hesio Cordeiro/Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524-7th floor, Block D, Rio de Janeiro, CEP: 21041-210 Brazil
| | - Mônica Kramer de Noronha Andrade
- grid.418854.40000 0004 0602 9605Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, Rua Leopoldo Bulhões, 1480, 21041210 Brazil
| | - Joaquim Teixeira Netto
- grid.418854.40000 0004 0602 9605Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, Rua Leopoldo Bulhões, 1480, 21041210 Brazil
| | - Denise Leite Maia Monteiro
- grid.412211.50000 0004 4687 5267Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Av. Prof. Manuel de Abreu, 444-2º Andar, Rio de Janeiro, RJ CEP: 20550-170 Brazil
| | - Valéria Teresa Saraiva Lino
- grid.418854.40000 0004 0602 9605Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, Rua Leopoldo Bulhões, 1480, 21041210 Brazil
| | - Eric Gustavo Ramos Almeida
- grid.412211.50000 0004 4687 5267Instituto de Medicina Social Hesio Cordeiro/Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524-7th floor, Block D, Rio de Janeiro, CEP: 21041-210 Brazil
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Bastiani L, Fortunato L, Pieroni S, Bianchi F, Adorni F, Prinelli F, Giacomelli A, Pagani G, Maggi S, Trevisan C, Noale M, Jesuthasan N, Sojic A, Pettenati C, Andreoni M, Antonelli Incalzi R, Galli M, Molinaro S. Rapid COVID-19 Screening Based on Self-Reported Symptoms: Psychometric Assessment and Validation of the EPICOVID19 Short Diagnostic Scale. J Med Internet Res 2021; 23:e23897. [PMID: 33320825 PMCID: PMC7790735 DOI: 10.2196/23897] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Confirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16 million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak of COVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining such individuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection in the general population. OBJECTIVE We evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals who need to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score. METHODS Our study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included a convenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focused on the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPS tests. RESULTS Of 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects who underwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6% (49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever (421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough (352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjects had a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs 71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factor solution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07 for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most important symptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoff score was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%). CONCLUSIONS We developed a short diagnostic scale to detect subjects with symptoms that were potentially associated with COVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals who require immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scale could be optimized and tested as a screening tool for future similar pandemics.
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Affiliation(s)
- Luca Bastiani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Loredana Fortunato
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefania Pieroni
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Fabrizio Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Fulvio Adorni
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Federica Prinelli
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy
| | - Gabriele Pagani
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, National Research Council, Padova, Italy
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marianna Noale
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Aleksandra Sojic
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Carla Pettenati
- Institute of Biomedical Technologies, National Research Council, Milano, Italy
| | - Massimo Andreoni
- Infectious Diseases Clinic, Department of System Medicine, Tor Vergata University of Rome, Rome, Italy
| | | | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Chirwa GC, Dulani B, Sithole L, Chunga JJ, Alfonso W, Tengatenga J. Malawi at the Crossroads: Does the Fear of Contracting COVID-19 Affect the Propensity to Vote? THE EUROPEAN JOURNAL OF DEVELOPMENT RESEARCH 2021; 34:409-431. [PMID: 33424140 PMCID: PMC7781184 DOI: 10.1057/s41287-020-00353-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 05/30/2023]
Abstract
The new coronavirus disease (COVID-19) has paralysed many sectors of human life, including economic, social-cultural and political processes. In the political arena, several countries have postponed elections due to the COVID-19 pandemic. Other countries, including Malawi, went ahead with their planned elections. Malawi held a presidential election at a time when the number of COVID-19 cases was increasing rapidly. In this paper, we assess the effect of the perceived risk of catching COVID-19 on willingness to vote in the Malawi presidential election that was held on 23 June 2020. Turn out in this election was ten percentage points lower than in the general elections that were held a year earlier. The paper draws on a nationally representative survey of adult Malawians (n = 1155). In our main analysis, we use instrumental variables to account for potential endogeneity. We find that nearly two thirds of Malawians thought that they were likely to catch COVID-19 at some point. Notwithstanding the COVID-19 risk, 86% of the country's citizens were willing to vote. Our analysis shows that an individual's perceived risk of catching COVID-19 is associated with a lower likelihood of voting (β = - 0.096; p < 0.05). This suggests that voter turnout in Malawi's fresh presidential election may have been highly affected by the perceived risk of catching COVID-19. The policy implication is that instituting and enforcing primary preventive measures may help reduce the perceived risk of catching COVID-19 and mitigate voter apathy.
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Affiliation(s)
| | - Boniface Dulani
- Chancellor College, Political and Administrative Studies Department, University of Malawi, Zomba, Malawi
| | - Lonjezo Sithole
- Chancellor College, Economics Department, University of Malawi, Zomba, Malawi
| | - Joseph J. Chunga
- Center for Social Research, University of Malawi, Zomba, Malawi
- Institute of Public Opinion and Research, Zomba, Malawi
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Stellefson M, Paige S, Wang MQ, Chaney BH. Competency-Based Recommendations for Health Education Specialists to Prevent the Spread of COVID-19 among Adults with COPD. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1851825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Tancheva L, Petralia MC, Miteva S, Dragomanova S, Solak A, Kalfin R, Lazarova M, Yarkov D, Ciurleo R, Cavalli E, Bramanti A, Nicoletti F. Emerging Neurological and Psychobiological Aspects of COVID-19 Infection. Brain Sci 2020; 10:E852. [PMID: 33198412 PMCID: PMC7696269 DOI: 10.3390/brainsci10110852] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022] Open
Abstract
The SARS-CoV-2 virus, first reported in December 2019 in China, is the causative agent of the current COVID-19 pandemic that, at the time of writing (1 November 2020) has infected almost 43 million people and caused the death of more than 1 million people. The spectrum of clinical manifestations observed during COVID-19 infection varies from asymptomatic to critical life-threatening clinical conditions. Emerging evidence shows that COVID-19 affects far more organs than just the respiratory system, including the heart, kidneys, blood vessels, liver, as well as the central nervous system (CNS) and the peripheral nervous system (PNS). It is also becoming clear that the neurological and psychological disturbances that occur during the acute phase of the infection may persist well beyond the recovery. The aim of this review is to propel further this emerging and relevant field of research related to the pathophysiology of neurological manifestation of COVID-19 infection (Neuro-COVID). We will summarize the PNS and CNS symptoms experienced by people with COVID-19 both during infection and in the recovery phase. Diagnostic and pharmacological findings in this field of study are strongly warranted to address the neurological and psychological symptoms of COVID-19.
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Affiliation(s)
- Lyubka Tancheva
- Department of Behavior Neurobiology, Institute of Neurobiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (L.T.); (S.M.); (S.D.); (R.K.); (M.L.)
| | - Maria Cristina Petralia
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.C.P.); (R.C.); (A.B.)
| | - Simona Miteva
- Department of Behavior Neurobiology, Institute of Neurobiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (L.T.); (S.M.); (S.D.); (R.K.); (M.L.)
| | - Stela Dragomanova
- Department of Behavior Neurobiology, Institute of Neurobiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (L.T.); (S.M.); (S.D.); (R.K.); (M.L.)
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University, 9002 Varna, Bulgaria
| | - Ayten Solak
- Institute of Cryobiology and food technologies, Agricultural Academy, 1407 Sofia, Bulgaria;
| | - Reni Kalfin
- Department of Behavior Neurobiology, Institute of Neurobiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (L.T.); (S.M.); (S.D.); (R.K.); (M.L.)
| | - Maria Lazarova
- Department of Behavior Neurobiology, Institute of Neurobiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (L.T.); (S.M.); (S.D.); (R.K.); (M.L.)
| | - Dobri Yarkov
- Faculty of Veterinary Medicine, Trakia University, 6000 Stara Zagora, Bulgaria;
| | - Rosella Ciurleo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.C.P.); (R.C.); (A.B.)
| | - Eugenio Cavalli
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy;
| | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.C.P.); (R.C.); (A.B.)
| | - Ferdinando Nicoletti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy;
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Wilkinson A. Local response in health emergencies: key considerations for COVID-19 in informal urban settlements. ENVIRONMENT AND URBANIZATION 2020; 32:503-522. [PMID: 36438604 PMCID: PMC7613852 DOI: 10.1177/0956247820922843] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There are further challenges to do with the lack of reliable data and the social, political and economic contexts in each setting that will influence vulnerability and possibilities for action. The potential health impacts of COVID-19 are immense in informal settlements, but if control measures are poorly executed these could also have deep negative impacts. Public health interventions must be balanced with social and economic interventions, especially in relation to the informal economy upon which many poor urban residents depend. Local residents, leaders and community-based groups must be engaged and resourced to develop locally appropriate control strategies, in partnership with local governments and authorities. Historically, informal settlements and their residents have been stigmatized, blamed, and subjected to rules and regulations that are unaffordable or unfeasible to adhere to. Responses to COVID-19 should not repeat these mistakes. Priorities for enabling effective control measures include: collaborating with local residents who have unsurpassed knowledge of relevant spatial and social infrastructures, strengthening coordination with local governments, and investing in improved data for monitoring the response in informal settlements.
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Jani BD, Pell JP, McGagh D, Liyanage H, Kelly D, de Lusignan S, Weatherburn CJ, Burns R, Sullivan FM, Mair FS. Recording COVID-19 consultations: review of symptoms, risk factors, and proposed SNOMED CT terms. BJGP Open 2020; 4:bjgpopen20X101125. [PMID: 32843331 PMCID: PMC7606148 DOI: 10.3399/bjgpopen20x101125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is an urgent need for epidemiological research in primary care to develop risk assessment processes for patients presenting with COVID-19, but lack of a standardised approach to data collection is a significant barrier to implementation. AIM To collate a list of relevant symptoms, assessment items, demographics, and lifestyle and health conditions associated with COVID-19, and match these data items with corresponding SNOMED CT clinical terms to support the development and implementation of consultation templates. DESIGN & SETTING Published and preprint literature for systematic reviews, meta-analyses, and clinical guidelines describing the symptoms, assessment items, demographics, and/or lifestyle and health conditions associated with COVID-19 and its complications were reviewed. Corresponding clinical concepts from SNOMED CT, a widely used structured clinical vocabulary for electronic primary care health records, were identified. METHOD Guidelines and published and unpublished reviews (N = 61) were utilised to collate a list of relevant data items for COVID-19 consultations. The NHS Digital SNOMED CT Browser was used to identify concept and descriptive identifiers. Key implementation challenges were conceptualised through a Normalisation Process Theory (NPT) lens. RESULTS In total, 32 symptoms, eight demographic and lifestyle features, 25 health conditions, and 20 assessment items relevant to COVID-19 were identified, with proposed corresponding SNOMED CT concepts. These data items can be adapted into a consultation template for COVID-19. Key implementation challenges include: 1) engaging with key stakeholders to achieve 'buy in'; and 2) ensuring any template is usable within practice settings. CONCLUSION Consultation templates for COVID-19 are needed to standardise data collection, facilitate research and learning, and potentially improve quality of care for COVID-19.
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Affiliation(s)
- Bhautesh Dinesh Jani
- Clinical Senior Lecturer in General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Henry Mechan Professor of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dylan McGagh
- Medical Sciences Divison, University of Oxford, Oxford, UK
| | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dave Kelly
- Albasoft Limited, Centre for Health Science, Inverness, UK
| | - Simon de Lusignan
- Professor of Primary Care and Clinical Informatics, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ronnie Burns
- McKenzie Burns Practice, Parkhead Health Centre, Glasgow, UK
| | - Frank M Sullivan
- Professor of Primary Care Medicine, Medical School, University of St Andrews, St Andrews, UK
| | - Frances S Mair
- Norie Miller Professor of General Practice, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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9
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Schurr TG. Host genetic factors and susceptibility toSARS‐CoV‐2 infection. Am J Hum Biol 2020; 32:e23497. [DOI: 10.1002/ajhb.23497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Theodore G. Schurr
- Department of Anthropology University of Pennsylvania Philadelphia Pennsylvania USA
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10
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Ali Z, Goneppanavar U, Dongare PA, Garg R, Kannan S, Harsoor SS, Bhaskar SB. Development of a preoperative Early Warning Scoring System to identify highly suspect COVID-19 patients. J Anaesthesiol Clin Pharmacol 2020; 36:S62-S74. [PMID: 33100649 PMCID: PMC7573990 DOI: 10.4103/joacp.joacp_274_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) is spreading at an unprecedented speed. Lack of resources to test every patient scheduled for surgery and false negative test results contribute to considerable stress to anesthesiologists, along with health risks to both caregivers and other patients. The study aimed to develop an early warning screening tool to rapidly detect 'highly suspect' among the patients scheduled for surgery. METHODS Review of literature was conducted using terms 'coronavirus' OR 'nCoV 2019' OR 'SARS-CoV-2' OR 'COVID-19' AND 'clinical characteristics' in PUBMED and MedRxiv. Suitable articles were analysed for symptoms and investigations commonly found in COVID-19 patients. Additionally, COVID-19 patient's symptomatology and investigation profiles were obtained through a survey from 20 COVID-19 facilities in India. Based on literature evidence and the survey information, an Early Warning Scoring System was developed. RESULTS Literature search yielded 3737 publications, of which 195 were considered relevant. Of these 195 studies, those already included in the meta-analyses were not considered for independent assessment. Based on the combined data from meta-analyses and survey, risk factors of COVID-19 disease identified were as follows: history of exposure, fever, cough, myalgias, lymphocytopaenia, elevated C-reactive protein (CRP)/lactate dehydrogenase (LDH) and radiographic infiltrates. CONCLUSION Development of this Early Warning Scoring System for preoperative screening of patients may help in identifying 'highly suspect' COVID-19 patients, alerting the physician and other healthcare workers on the need for adequate personal protection and also to implement necessary measures to prevent cross infection and contamination during the perioperative period.
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Affiliation(s)
- Zulfiqar Ali
- Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Umesh Goneppanavar
- Professor of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
| | | | - Rakesh Garg
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, Dr BRA IRCH, AIIMS, Ansari Nagar, New Delhi, India
| | - Sudheesh Kannan
- Professor of Anaesthesiology, BMCRI, Bangalore, Karnataka, India
| | - S. S. Harsoor
- Professor of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bangalore, Karnataka, India
| | - S. Bala Bhaskar
- Professor of Anaesthesiology, Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India
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11
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Barrantes FJ. While We Wait for a Vaccine Against SARS-CoV-2, Why Not Think About Available Drugs? Front Physiol 2020; 11:820. [PMID: 32719619 PMCID: PMC7350707 DOI: 10.3389/fphys.2020.00820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/19/2020] [Indexed: 01/18/2023] Open
Abstract
At the time of reception of this article (April 2, 2020), efforts to develop a specific vaccine against SARS-Cov-2, the causative agent of the coronavirus disease 2019 (COVID-19), had just begun trial phase 1, but full validation of this and other current developments is likely to take many more months to reach completion. The ongoing pandemic constitutes a major health burden of world proportions that is also having a devastating impact on whole economies worldwide, the knock-on effects of which could be catastrophic especially in poorer countries. Alternative measures to ameliorate the impact and hamper or minimally slow down disease progression are urgently called for. This review discusses past and currently evolving data on the etiological agent of the current pandemic, SARS-CoV-2, and its host cell receptors with a view to disclosing alternative drugs for palliative or therapeutic approaches. Firstly, SARS-CoV-2 exhibits marked tropism for cells that harbor the membrane-bound metalloprotease angiotensin-converting enzyme 2 (ACE2) at their plasmalemma, predominantly in cells lining the oral cavity, upper respiratory tract, and bronchoalveolar cells, making these epithelial mucosae the most likely viral receptor cell targets and entry routes. Secondly, the crystal structures of several coronavirus spike proteins in complex with their cell host target receptors, and of SARS-Cov-2 in complex with an inhibitor, are now available at atomic resolution through X-ray diffraction and cryo-electron microscopy studies. Thirdly, viral entry of other viruses has been successfully blocked by inhibiting viral endogenous proteases or clathrin/dynamin-dependent endocytosis, the same internalization pathway followed by ACE2 and some viruses. Fourthly, the target cell-surface receptor molecules and SARS-CoV-2 possess other putative sites for drugs potentially modulating receptor activity or virus processing. A multi-pronged pharmacological approach attacking more than one flank of the viral-receptor interactions is worth considering as a front-line strategy.
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Affiliation(s)
- Francisco J. Barrantes
- Biomedical Research Institute (BIOMED), Argentina Pontifical Catholic University of Argentina (UCA) and National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Nguyen A, David JK, Maden SK, Wood MA, Weeder BR, Nellore A, Thompson RF. Human Leukocyte Antigen Susceptibility Map for Severe Acute Respiratory Syndrome Coronavirus 2. J Virol 2020; 94:e00510-20. [PMID: 32303592 PMCID: PMC7307149 DOI: 10.1128/jvi.00510-20] [Citation(s) in RCA: 350] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
Genetic variability across the three major histocompatibility complex (MHC) class I genes (human leukocyte antigen A [HLA-A], -B, and -C genes) may affect susceptibility to and severity of the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19). We performed a comprehensive in silico analysis of viral peptide-MHC class I binding affinity across 145 HLA-A, -B, and -C genotypes for all SARS-CoV-2 peptides. We further explored the potential for cross-protective immunity conferred by prior exposure to four common human coronaviruses. The SARS-CoV-2 proteome was successfully sampled and was represented by a diversity of HLA alleles. However, we found that HLA-B*46:01 had the fewest predicted binding peptides for SARS-CoV-2, suggesting that individuals with this allele may be particularly vulnerable to COVID-19, as they were previously shown to be for SARS (M. Lin, H.-T. Tseng, J. A. Trejaut, H.-L. Lee, et al., BMC Med Genet 4:9, 2003, https://bmcmedgenet.biomedcentral.com/articles/10.1186/1471-2350-4-9). Conversely, we found that HLA-B*15:03 showed the greatest capacity to present highly conserved SARS-CoV-2 peptides that are shared among common human coronaviruses, suggesting that it could enable cross-protective T-cell-based immunity. Finally, we reported global distributions of HLA types with potential epidemiological ramifications in the setting of the current pandemic.IMPORTANCE Individual genetic variation may help to explain different immune responses to a virus across a population. In particular, understanding how variation in HLA may affect the course of COVID-19 could help identify individuals at higher risk from the disease. HLA typing can be fast and inexpensive. Pairing HLA typing with COVID-19 testing where feasible could improve assessment of severity of viral disease in the population. Following the development of a vaccine against SARS-CoV-2, the virus that causes COVID-19, individuals with high-risk HLA types could be prioritized for vaccination.
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Affiliation(s)
- Austin Nguyen
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Julianne K David
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Sean K Maden
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Mary A Wood
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Portland VA Research Foundation, Portland, Oregon, USA
| | - Benjamin R Weeder
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Abhinav Nellore
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Reid F Thompson
- Computational Biology Program, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Division of Hospital and Specialty Medicine, VA Portland Healthcare System, Portland, Oregon, USA
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Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health 2020; 65:533-546. [PMID: 32451563 PMCID: PMC7246302 DOI: 10.1007/s00038-020-01390-7] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES COVID-19 has a varied clinical presentation. Elderly patients with comorbidities are more vulnerable to severe disease. This study identifies specific symptoms and comorbidities predicting severe COVID-19 and intensive care unit (ICU) admission. METHODS A literature search identified studies indexed in MEDLINE, EMBASE and Global Health before 5th March 2020. Two reviewers independently screened the literature and extracted data. Quality appraisal was performed using STROBE criteria. Random effects meta-analysis identified symptoms and comorbidities associated with severe COVID-19 or ICU admission. RESULTS Seven studies (including 1813 COVID-19 patients) were included. ICU patients were older (62.4 years) than non-ICU (46 years), with a greater proportion of males. Dyspnoea was the only symptom predictive for severe disease (pOR 3.70, 95% CI 1.83-7.46) and ICU admission (pOR 6.55, 95% CI 4.28-10.0). COPD was the strongest predictive comorbidity for severe disease (pOR 6.42, 95% CI 2.44-16.9) and ICU admission (pOR 17.8, 95% CI 6.56-48.2), followed by cardiovascular disease and hypertension. CONCLUSIONS Dyspnoea was the only symptom predictive for severe COVID-19 and ICU admission. Patients with COPD, cardiovascular disease and hypertension were at higher risk of severe illness and ICU admission.
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Affiliation(s)
- Vageesh Jain
- Public Health England, London, UK
- Institute for Global Health, University College London, London, UK
| | - Jin-Min Yuan
- Public Health, London Boroughs of Camden & Islington, London, UK
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Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis. PLoS One 2020; 15:e0235653. [PMID: 32649661 PMCID: PMC7351172 DOI: 10.1371/journal.pone.0235653] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/20/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The rate of ICU admission among patients with coronavirus varied from 3% to 100% and the mortality was as high as 86% of admitted patients. The objective of the systematic review was to investigate the rate of ICU admission, mortality, morbidity, and complications among patients with coronavirus. METHODS A comprehensive strategy was conducted in PubMed/Medline; Science direct and LILACS from December 2002 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting rate of ICU admission, the prevalence of mortality and its determinants among ICU admitted patients with coronavirus were included and the rest were excluded. RESULT A total of 646 articles were identified from different databases and 50 articles were selected for evaluation. Thirty-seven Articles with 24983 participants were included. The rate of ICU admission was 32% (95% CI: 26 to 38, 37 studies and 32, 741 participants). The Meta-Analysis revealed that the pooled prevalence of mortality in patients with coronavirus disease in ICU was 39% (95% CI: 34 to 43, 37 studies and 24, 983 participants). CONCLUSION The Meta-Analysis revealed that approximately one-third of patients admitted to ICU with severe Coronavirus disease and more than thirty percent of patients admitted to ICU with a severe form of COVID-19 for better care died which warns the health care stakeholders to give attention to intensive care patients. REGISTRATION This Systematic review and Meta-Analysis was registered in Prospero international prospective register of systemic reviews (CRD42020177095) on April 9/2020.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Siraj Ahmed Ali
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bahiru Mantfardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Medicine, University of Calcutta, Calcutta, India
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