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Silva GS, Avila GO, Lubianca FN, Lubianca JPN, Michelon VMDM, Kalil DP, Maestri LF, Lengler AD, Lima GP, Lubianca Neto JF. Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:206-211. [PMID: 35239883 DOI: 10.1590/1806-9282.20211114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.
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Affiliation(s)
- Gabriela Salzano Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, School of Medicine - Porto Alegre (RS), Brazil
| | - Georgia Oliveira Avila
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Medicine - Porto Alegre (RS), Brazil
| | | | | | | | - Diogo Pereira Kalil
- Universidade Federal do Rio Grande do Sul, School of Medicine - Porto Alegre (RS), Brazil
| | - Lorenzo Feldman Maestri
- Universidade Federal de Ciências da Saúde de Porto Alegre, School of Medicine - Porto Alegre (RS), Brazil
| | | | | | - José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Graduate Program in Pediatrics at UFCSPA, Chief of Othorinolaryngology Service at Hospital Santa Casa de Misericórdia - Porto Alegre (RS), Brazil
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A Prospective, Longitudinal Evaluation of SARS-CoV-2 COVID-19 Exposure, Use of Protective Equipment and Social Distancing in a Group of Community Physicians. Healthcare (Basel) 2022; 10:healthcare10020285. [PMID: 35206899 PMCID: PMC8871673 DOI: 10.3390/healthcare10020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Healthcare workers experience a significant risk of exposure to and infection from SARS-CoV-2, COVID-19. Nonetheless, little research has focused on physicians’ use of personal protective equipment (PPE), their concerns about becoming infected and their social distancing maneuvers. Methods: All staff physicians at Advocate Lutheran General Hospital were invited to participate. Their COVID-19 IgG antibody level was measured and an online questionnaire was completed. The questionnaire assessed the risk of COVID-19 exposure, PPE usage, concern for contracting COVID-19, the performance of high-risk procedures, work in high-risk settings, and social distancing practices. Testing was performed in September (T0), and December 2020 (T1) at the height of the global pandemic. Results: A total of 481 (26.7%) of 1800 AGLH physicians were enrolled at T0 and 458 (95% of the original group) at T1. A total of 21 (4.3%) and 39 (8.5%) participants had antibodies at T0 and T1. A total of 63 (13.8%) worked in high-risk settings and 111 (24.2%) performed high-risk procedures. Participants working in high-risk settings had increased exposure to COVID-19 infected patients (OR = 4.464 (CI = 2.522–8.459, p < 0.001). Participants were highly adherent to the use of PPE and social distancing practices including mask-wearing in public (86%, 82.1%), avoiding crowds (85.1%, 85.6%), six feet distancing (83.8%, 83.4%), and avoiding public transportation (78%, 83.8%). A total of 251 (55.4%) participants expressed moderate to extreme concern about becoming infected with COVID-19. Conclusions and Relevance: Among a group of community physicians, consistent PPE use and social distancing practices were common. These practices were associated with a low level of initial acquisition of COVID-19 infections and a relatively low longitudinal risk of infection.
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Yaghoubi M, Salimi M, Meskarpour-Amiri M. Systematic review of productivity loss among healthcare workers due to Covid-19. Int J Health Plann Manage 2021; 37:94-111. [PMID: 34655098 PMCID: PMC8652830 DOI: 10.1002/hpm.3351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To assess existing evidence on the effects of COVID‐19 on healthcare workers (HCWs) using the health‐related productivity loss approach. Methods A systematic search of online databases including PubMed, Scopus, Ovid, Web of Science, and EMBASE was conducted up to 25 August 2020. Following two screening stages, studies related to the effects of COVID‐19 on healthcare workers were included in the study. Results 82 studies were included in the analysis. The COVID‐19 related death rate among HCWs ranged from 0.00‐0.7%, while the positive test incidence varied between 0.00 and 24.4%. 39 evidences assessed psychological disorders. A wide range of psychological disorders observed among HCWs: 5.2 to 71.2% in anxiety, 1.00 to 88.3% in stress, 8.27 to 61.67% in insomnia, and 4.5 to 50.4% in depression. Conclusions The early evidence suggests that healthcare workers are one of the most vulnerable groups when it comes to positive COVID‐19 infection, mortality, and mental illness.
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Affiliation(s)
- Maryam Yaghoubi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Salimi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Murongazvombo AS, Jones RS, Rayment M, Mughal N, Azadian B, Donaldson H, Davies GW, Moore LSP, Aiken AM. Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study. Infect Prev Pract 2021; 3:100157. [PMID: 34316587 PMCID: PMC8217738 DOI: 10.1016/j.infpip.2021.100157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patient-facing (frontline) health-care workers (HCWs) are at high risk of repeated exposure to SARS-CoV-2. AIM We sought to determine the association between levels of frontline exposure and likelihood of SARS-CoV-2 seropositivity amongst HCW. METHODS A cross-sectional study was undertaken using purposefully collected data from HCWs at two hospitals in London, United Kingdom (UK) over eight weeks in May-June 2020. Information on sociodemographic, clinical and occupational characteristics was collected using an anonymised questionnaire. Serology was performed using split SARS-CoV-2 IgM/IgG lateral flow immunoassays. Exposure risk was categorised into five pre-defined ordered grades. Multivariable logistic regression was used to examine the association between being frontline and SARS-CoV-2 seropositivity after controlling for other risks of infection. FINDINGS 615 HCWs participated in the study. 250/615 (40.7%) were SARS-CoV-2 IgM and/or IgG positive. After controlling for other exposures, there was non-significant evidence of a modest association between being a frontline HCW (any level) and SARS-CoV-2 seropositivity compared to non-frontline status (OR 1.39, 95% CI 0.84-2.30, P=0.200). There was 15% increase in the odds of SARS-CoV-2 seropositivity for each step along the frontline exposure gradient (OR 1.15, 95% CI 1.00-1.32, P=0.043). CONCLUSION We found a high SARS-CoV-2 IgM/IgG seropositivity with modest evidence for a dose-response association between increasing levels of frontline exposure risk and seropositivity. Even in well-resourced hospital settings, appropriate use of personal protective equipment, in addition to other transmission-based precautions for inpatient care of SARS-CoV-2 patients could reduce the risk of hospital-acquired SARS-CoV-2 infection among frontline HCW.
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Affiliation(s)
| | - Rachael S. Jones
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Michael Rayment
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Nabeela Mughal
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Berge Azadian
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Hugo Donaldson
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Gary W. Davies
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Luke SP. Moore
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Du Cane Road, London, W12 0NN, UK
| | - Alexander M. Aiken
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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COVID-19 in otolaryngologists: a cross-sectional multicenter study. Braz J Otorhinolaryngol 2021; 88 Suppl 5:S4-S11. [PMID: 34364822 PMCID: PMC8286868 DOI: 10.1016/j.bjorl.2021.06.007] [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: 01/27/2021] [Revised: 05/04/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers. OBJECTIVE To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period. METHODS In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied. RESULTS We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively. CONCLUSION Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.
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Hemida MG. The next-generation coronavirus diagnostic techniques with particular emphasis on the SARS-CoV-2. J Med Virol 2021; 93:4219-4241. [PMID: 33751621 PMCID: PMC8207115 DOI: 10.1002/jmv.26926] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022]
Abstract
The potential zoonotic coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) are of global health concerns. Early diagnosis is the milestone in their mitigation, control, and eradication. Many diagnostic techniques are showing great success and have many advantages, such as the rapid turnover of the results, high accuracy, and high specificity and sensitivity. However, some of these techniques have several pitfalls if samples were not collected, processed, and transported in the standard ways and if these techniques were not practiced with extreme caution and precision. This may lead to false-negative/positive results. This may affect the downstream management of the affected cases. These techniques require regular fine-tuning, upgrading, and optimization. The continuous evolution of new strains and viruses belong to the coronaviruses is hampering the success of many classical techniques. There are urgent needs for next generations of coronaviruses diagnostic assays that overcome these pitfalls. This new generation of diagnostic tests should be able to do simultaneous, multiplex, and high-throughput detection of various coronavirus in one reaction. Furthermore, the development of novel assays and techniques that enable the in situ detection of the virus on the environmental samples, especially air, water, and surfaces, should be given considerable attention in the future. These approaches will have a substantial positive impact on the mitigation and eradication of coronaviruses, including the current SARS-CoV-2 pandemic.
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Affiliation(s)
- Maged G. Hemida
- Department of Microbiology, College of Veterinary MedicineKing Faisal UniversityAl AhsaSaudi Arabia
- Department of Virology, Faculty of Veterinary MedicineKafrelsheikh UniversityKafr ElsheikhEgypt
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Garay E, Serrano-Coll H, Rivero R, Gastelbondo B, Faccini-Martínez Á, Berrocal J, Pérez A, Badillo M, Martínez-Bravo C, Botero Y, Arrieta G, Calderón A, Galeano K, López Y, Miranda J, Guzmán C, Contreras V, Arosemena A, Contreras H, Brango-Tarra E, Oviedo M, Mattar S. SARS-CoV-2 in eight municipalities of the Colombian tropics: high immunity, clinical and sociodemographic outcomes. Trans R Soc Trop Med Hyg 2021; 116:139-147. [PMID: 34185868 PMCID: PMC8344518 DOI: 10.1093/trstmh/trab094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/19/2021] [Accepted: 06/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background Serological evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an alternative that allows us to determine the prevalence and dynamics of this infection in populations. The goal of this study was to determine the clinical and sociodemographic dynamics of SARS-CoV-2 infection in a region of the Colombian Caribbean. Methods Between July and November 2020, a cross-sectional observational study was carried out in Córdoba, located in northeast Colombia in the Caribbean area. Eight municipalities with the largest populations were chosen and 2564 blood samples were taken. A commercial enzyme-linked immunosorbent assay was used with the recombinant protein antigen N of SARS-CoV-2. The people included in the study were asked for sociodemographic and clinical data, which were analysed by statistical methods. Results A seroprevalence of 40.8% was obtained for SARS-CoV-2 in the Córdoba region. In the bivariate analysis, no differences were observed in seropositivity against SARS-CoV-2 for gender or age range (p>0.05). Higher seropositivity was found in low socio-economic status and symptomatic patients (p<0.0001). A total of 30.7% of the asymptomatic patients were seropositive for SARS-CoV-2, which could be linked to the spread of this infection. In the multivariate analysis, seroconversion was related to poverty and clinical manifestations such as anosmia and ageusia (p<0.05). Conclusions The high seropositivity in Córdoba is due to widespread SARS-CoV-2 in this population. The relationship between seropositivity and socio-economic status suggests a higher exposure risk to the virus caused by informal economic activities in low-income groups. Clinical manifestations such as anosmia and ageusia could be clinical predictors of infection by the new emergent coronavirus.
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Affiliation(s)
- Evelin Garay
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Héctor Serrano-Coll
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Ricardo Rivero
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Bertha Gastelbondo
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Álvaro Faccini-Martínez
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - José Berrocal
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Alejandra Pérez
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - María Badillo
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Caty Martínez-Bravo
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Yesica Botero
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Germán Arrieta
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia.,Clínica Salud Social, Sincelejo, Sucre Colombia
| | - Alfonso Calderón
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Ketty Galeano
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Yesica López
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Jorge Miranda
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Camilo Guzmán
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Verónica Contreras
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Alejandra Arosemena
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | - Héctor Contreras
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
| | | | - Misael Oviedo
- Corporación Colombiana de Investigación Agropecuaria - Agrosavia, Centro de investigación Turipaná, Cereté, Córdoba, Colombia
| | - Salim Mattar
- Instituto de Investigaciones Biológicas del Trópico, Colombia-Universidad de Córdoba, Montería, Colombia
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Bernstein K, Landau R. Management of maternal COVID-19: considerations for anesthesiologists. Curr Opin Anaesthesiol 2021; 34:246-253. [PMID: 33867458 DOI: 10.1097/aco.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe updates to pragmatic recommendations that were published during the first coronavirus disease 2019 (COVID-19) surge, including the current thinking about whether pregnancy worsens the severity of COVID-19. RECENT FINDINGS Although a majority of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain asymptomatic or paucisymptomatic, pregnancy puts women at higher risk of severe COVID-19 and adverse birth outcomes. Pregnant and recently pregnant women are more likely to be admitted to intensive care units and receive mechanical ventilation than nonpregnant patients with COVID-19, although preexisting maternal comorbidities are significant risk factors.Early provision of neuraxial labor analgesia with a functional indwelling epidural catheter has been universally promoted, with the goal to reduce avoidable general anesthesia for cesarean delivery and mitigate risks for healthcare workers during airway manipulation. This recommendation, along with updated workflow models of anesthesia coverage, may contribute to a reduction in general anesthesia rates. SUMMARY Initial recommendations to provide early neuraxial labor analgesia and avoid general anesthesia for cesarean delivery have not changed over time. Although workflows have significantly changed to allow continued patient and healthcare workers' safety, clinical anesthesia protocols for labor and delivery are essentially the same.
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Affiliation(s)
- Kyra Bernstein
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
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Abstract
BACKGROUND Asymptomatic infection seems to be a notable feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), but the prevalence is uncertain. PURPOSE To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms. DATA SOURCES Searches of Google News, Google Scholar, medRxiv, and PubMed using the keywords antibodies, asymptomatic, coronavirus, COVID-19, PCR, seroprevalence, and SARS-CoV-2. STUDY SELECTION Observational, descriptive studies and reports of mass screening for SARS-CoV-2 that were either cross-sectional or longitudinal in design; were published through 17 November 2020; and involved SARS-CoV-2 nucleic acid or antibody testing of a target population, regardless of current symptomatic status, over a defined period. DATA EXTRACTION The authors collaboratively extracted data on the study design, type of testing performed, number of participants, criteria for determining symptomatic status, testing results, and setting. DATA SYNTHESIS Sixty-one eligible studies and reports were identified, of which 43 used polymerase chain reaction (PCR) testing of nasopharyngeal swabs to detect current SARS-CoV-2 infection and 18 used antibody testing to detect current or prior infection. In the 14 studies with longitudinal data that reported information on the evolution of symptomatic status, nearly three quarters of persons who tested positive but had no symptoms at the time of testing remained asymptomatic. The highest-quality evidence comes from nationwide, representative serosurveys of England (n = 365 104) and Spain (n = 61 075), which suggest that at least one third of SARS-CoV-2 infections are asymptomatic. LIMITATION For PCR-based studies, data are limited to distinguish presymptomatic from asymptomatic infection. Heterogeneity precluded formal quantitative syntheses. CONCLUSION Available data suggest that at least one third of SARS-CoV-2 infections are asymptomatic. Longitudinal studies suggest that nearly three quarters of persons who receive a positive PCR test result but have no symptoms at the time of testing will remain asymptomatic. Control strategies for COVID-19 should be altered, taking into account the prevalence and transmission risk of asymptomatic SARS-CoV-2 infection. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Daniel P Oran
- Scripps Research Translational Institute, La Jolla, California (D.P.O., E.J.T.)
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, California (D.P.O., E.J.T.)
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Hossain A, Nasrullah SM, Tasnim Z, Hasan M, Hasan M. Seroprevalence of SARS-CoV-2 IgG antibodies among health care workers prior to vaccine administration in Europe, the USA and East Asia: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100770. [PMID: 33718853 PMCID: PMC7938754 DOI: 10.1016/j.eclinm.2021.100770] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Knowing the seroprevalence of SARS-CoV-2 IgG antibodies across geographic regions before vaccine administration is one key piece of knowledge to achieve herd immunity. While people of all ages, occupations, and communities are at risk of getting infected with SARS-CoV-2, the health care workers (HCWs) are possibly at the highest risk. Most seroprevalence surveys with HCWs conducted worldwide have been limited to Europe, North America, and East Asia. We aimed to understand how the seroprevalence of SARS-CoV-2 IgG antibodies varied across these geographic regions among HCWs based on the available evidences. METHODS By searching through PubMed, ScienceDirect, and Google Scholar databases, eligible studies published from January 1, 2020 to January 15, 2021 were included for the systematic review and meta-analysis. The random-effects model was used to estimate the pooled proportion of IgG seropositive HCWs. Publication bias was assessed by funnel plot and confirmed by Egger's test. Heterogeneity was quantified using I2 statistics. We performed sensitivity analyses based on sample size, diagnostic method and publication status. The study protocol was registered with PROSPERO (CRD42020219086). FINDINGS A total of 53 peer-reviewed articles were selected, including 173,353 HCWs (32.7% male) from the United States, ten European, and three East Asian countries. The overall seropositive prevalence rate of IgG antibodies was 8.6% in these regions (95% CI= 7.2-9.9%). Pooled seroprevalence of IgG antibodies was higher in studies conducted in the USA (12.4%, 95% CI= 7.8-17%) than in Europe (7.7%, 95% CI=6.3-9.2%) and East Asia (4.8%, 95% CI=2.9-6.7%). The subgroup study also estimated that male HCWs had 9.4% (95% CI= 7.2-11.6%) IgG seroconversion, and female HCWs had 7.8% (95% CI=5.9-9.7%). The study exhibits a high prevalence of IgG antibodies among HCWs under 40 years in the USA, conversely, it was high in older HCWs (≥40 years of age) in Europe and East Asia. In the months February-April 2020, the estimated pooled seroprevalence was 5.7% (4.0-7.4%) that increased to 8·2% (6.2-10%) in April-May and further to 9.9% (6.9-12.9%) in the May-September time-period. INTERPRETATION In the view of all evidence to date, a significant variation in the prevalence of SARS-CoV-2 antibodies in HCWs is observed in regions of Europe, the United States, and East Asia. The patterns of IgG antibodies by time, age, and gender suggest noticeable regional differences in transmission of the virus. Based on the insights driven from the analysis, priority is required for effective vaccination for older HCWs from Europe and East Asia. A considerable high seroprevalence of IgG among HCWs from the USA suggests a high rate of past infection that indicates the need to take adequate measures to prevent hospital spread. Moreover, the seroprevalence trend was not substantially changed after May 2020, suggesting a slow progression of long-term SARS-CoV-2 immunity. Routine testing of HCWs for SARS-CoV-2 should be considered even after the rollout of vaccination to identify the areas of increased transmission. FUNDING None.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Dhaka, Bangladesh
- Global Health Institute, North South University, Dhaka, Bangladesh
- Health Management BD Foundation, Dhaka, Bangladesh
| | | | - Zarrin Tasnim
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md.Kamrul Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
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Abella BS, Jolkovsky EL, Biney BT, Uspal JE, Hyman MC, Frank I, Hensley SE, Gill S, Vogl DT, Maillard I, Babushok DV, Huang AC, Nasta SD, Walsh JC, Wiletyo EP, Gimotty PA, Milone MC, Amaravadi RK. Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:195-202. [PMID: 33001138 PMCID: PMC7527945 DOI: 10.1001/jamainternmed.2020.6319] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) are at risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, to our knowledge, there is no effective pharmacologic prophylaxis for individuals at risk. OBJECTIVE To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy. DESIGN, SETTING, AND PARTICIPANTS This randomized, double-blind, placebo-controlled clinical trial (the Prevention and Treatment of COVID-19 With Hydroxychloroquine Study) was conducted at 2 tertiary urban hospitals, with enrollment from April 9, 2020, to July 14, 2020; follow-up ended August 4, 2020. The trial randomized 132 full-time, hospital-based HCWs (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists), of whom 125 were initially asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab. The trial was terminated early for futility before reaching a planned enrollment of 200 participants. INTERVENTIONS Hydroxychloroquine, 600 mg, daily, or size-matched placebo taken orally for 8 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of SARS-CoV-2 infection as determined by a nasopharyngeal swab during the 8 weeks of treatment. Secondary outcomes included adverse effects, treatment discontinuation, presence of SARS-CoV-2 antibodies, frequency of QTc prolongation, and clinical outcomes for SARS-CoV-2-positive participants. RESULTS Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, -9 to 17; vs placebo: 3 milliseconds; 95% CI, -5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04329923.
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Affiliation(s)
- Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Eliana L Jolkovsky
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Barbara T Biney
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Julie E Uspal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Matthew C Hyman
- Division of Cardiology, Department of Medicine University of Pennsylvania, Philadelphia
| | - Ian Frank
- Division of Infectious Disease, Department of Medicine University of Pennsylvania, Philadelphia
| | - Scott E Hensley
- Department of Microbiology, University of Pennsylvania, Philadelphia
| | - Saar Gill
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Dan T Vogl
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Ivan Maillard
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Daria V Babushok
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander C Huang
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Sunita D Nasta
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer C Walsh
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - E Paul Wiletyo
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Phyllis A Gimotty
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Michael C Milone
- Department of Pathology, University of Pennsylvania, Philadelphia
| | - Ravi K Amaravadi
- Abramson Cancer Center and Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
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12
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Myles PS, Wallace S, Story DA, Brown W, Cheng AC, Forbes A, Sidiropoulos S, Davidson A, Tan N, Jeffreys A, Hodgson R, Scott DA, Radnor J. COVID-19 risk in elective surgery during a second wave: a prospective cohort study. ANZ J Surg 2021; 91:22-26. [PMID: 33230886 PMCID: PMC7753725 DOI: 10.1111/ans.16464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023]
Abstract
Background The COVID‐19 pandemic has greatly affected access to elective surgery, largely because of concerns for patients and healthcare workers. A return to normal surgery workflow depends on the prevalence and transmission of coronavirus in elective surgical patients. The aim of this study was to determine the prevalence of active SARS‐coronavirus‐2 infection during a second wave among patients admitted to hospital for elective surgery in Victoria. Methods Prospective cohort study across eight hospitals in Victoria during July–August 2020 was conducted enrolling adults and children admitted to hospital for elective surgery or interventional procedure requiring general anaesthesia. Study outcomes included a positive polymerase chain reaction (PCR) test for SARS‐CoV‐2 in the preoperative period (primary outcome), and for those with a negative test preoperatively, the incidence of a positive PCR test for SARS‐CoV‐2 in the post‐operative period. Results We enrolled 4965 elective adult and paediatric surgical patients from 15 July to 31 August 2020. Four patients screened negative on questionnaire but had a positive PCR test for coronavirus, resulting in a Bayesian estimated prevalence of 0.12% (95% probability interval 0–0.26%). There were no reports of healthcare worker infections linked to elective surgery during and up to 2 weeks after the study period. Conclusion The prevalence of SARS‐CoV‐2 in asymptomatic elective surgical patients during a second wave was approximately 1 in 833. Given the very low likelihood of coronavirus transmission, and with existing current hospital capacity, recommencement of elective surgery should be considered. A coronavirus screening checklist should be mandated for surgical patients.
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Affiliation(s)
- Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sophie Wallace
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David A Story
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
| | - Wendy Brown
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sofia Sidiropoulos
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
| | - Andrew Davidson
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Niki Tan
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Visiting Anaesthetist, Epworth Richmond, Melbourne, Victoria, Australia
| | - Andrew Jeffreys
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, Victoria, Australia
| | - Russell Hodgson
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,General Surgery, Northern Health, Melbourne, Victoria, Australia
| | - David A Scott
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jade Radnor
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Northeast Health Wangaratta, Melbourne, Victoria, Australia
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Rafael RDMR, Correia LM, Mello ASD, Prata JA, Gallasch CH, Pérez Junior EF, Silva FVCE, Penna LHG, Morera JC, Breda KL, David HMSL. Segurança e educação durante a COVID-19: prevalência, fatores associados e planos de reabertura da Faculdade de Enfermagem. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo analisar a prevalência e os fatores associados à triagem da COVID-19 e propor as estratégias necessárias para a reabertura das Escolas de Enfermagem universitárias para as aulas presenciais. Métodos um estudo transversal foi projetado a partir da linha de base de uma pesquisa longitudinal baseada na Internet de uma Escola Brasileira de Enfermagem. Com o resultado ordinal (classificação operacional COVID-19), a análise de dados foi conduzida usando um modelo de regressão multinomial. Resultados um total de 498 participantes foi incluído na análise e revelou 67,27% de casos suspeitos e 11,65% de casos confirmados de COVID-19. O uso de máscaras, o transporte público e fazer parte da linha de frente dos trabalhadores da saúde foram estatisticamente associados a um histórico positivo para a COVID-19. Conclusão os planos de reabertura de Escolas de Enfermagem devem integrar o uso de equipamentos de proteção pessoal, o transporte público e a triagem da COVID-19 na educação.
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14
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Dimeglio C, Herin F, Miedougé M, Cambus JP, Abravanel F, Mansuy JM, Soulat JM, Izopet J. Screening for SARS-CoV-2 antibodies among healthcare workers in a university hospital in southern France. J Infect 2021; 82:e29-e32. [PMID: 33010259 PMCID: PMC7526656 DOI: 10.1016/j.jinf.2020.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Chloé Dimeglio
- Virology Laboratory, CHU Toulouse, Hôpital Purpan, 330 av de Grande Bretagne, 31300 France; UMR Inserm, U1043, UMR CNRS, U5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse 31300, France.
| | - Fabrice Herin
- Occupational Diseases Department, Toulouse-Purpan University Hospital, Toulouse 31000, France; Epidemiology, Health Economics and Public Health, UMR1027 INSERM, Toulouse, France
| | - Marcel Miedougé
- Virology Laboratory, CHU Toulouse, Hôpital Purpan, 330 av de Grande Bretagne, 31300 France
| | | | - Florence Abravanel
- Virology Laboratory, CHU Toulouse, Hôpital Purpan, 330 av de Grande Bretagne, 31300 France; UMR Inserm, U1043, UMR CNRS, U5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse 31300, France
| | - Jean-Michel Mansuy
- Virology Laboratory, CHU Toulouse, Hôpital Purpan, 330 av de Grande Bretagne, 31300 France
| | - Jean-Marc Soulat
- Occupational Diseases Department, Toulouse-Purpan University Hospital, Toulouse 31000, France; Epidemiology, Health Economics and Public Health, UMR1027 INSERM, Toulouse, France
| | - Jacques Izopet
- Virology Laboratory, CHU Toulouse, Hôpital Purpan, 330 av de Grande Bretagne, 31300 France; UMR Inserm, U1043, UMR CNRS, U5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse 31300, France
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15
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Lu L, Zhang H, Zhan M, Jiang J, Yin H, Dauphars DJ, Li SY, Li Y, He YW. Antibody response and therapy in COVID-19 patients: what can be learned for vaccine development? SCIENCE CHINA-LIFE SCIENCES 2020; 63:1833-1849. [PMID: 33355886 PMCID: PMC7756132 DOI: 10.1007/s11427-020-1859-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023]
Abstract
The newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people and caused tremendous morbidity and mortality worldwide. Effective treatment for coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection is lacking, and different therapeutic strategies are under testing. Host humoral and cellular immunity to SARS-CoV-2 infection is a critical determinant for patients’ outcomes. SARS-CoV-2 infection results in seroconversion and production of anti-SARS-CoV-2 antibodies. The antibodies may suppress viral replication through neutralization but might also participate in COVID-19 pathogenesis through a process termed antibody-dependent enhancement. Rapid progress has been made in the research of antibody response and therapy in COVID-19 patients, including characterization of the clinical features of antibody responses in different populations infected by SARS-CoV-2, treatment of COVID-19 patients with convalescent plasma and intravenous immunoglobin products, isolation and characterization of a large panel of monoclonal neutralizing antibodies and early clinical testing, as well as clinical results from several COVID-19 vaccine candidates. In this review, we summarize the recent progress and discuss the implications of these findings in vaccine development.
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Affiliation(s)
- Ligong Lu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, China.
| | - Hui Zhang
- First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Meixiao Zhan
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, China
| | - Jun Jiang
- tricision Biotherapeutic Inc., Zhuhai, 519041, China
| | - Hua Yin
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, China
| | - Danielle J Dauphars
- Department of Immunology, Duke University Medical University Medical Center, Durham, NC, 27710, USA
| | - Shi-You Li
- tricision Biotherapeutic Inc., Zhuhai, 519041, China
| | - Yong Li
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, China
| | - You-Wen He
- Department of Immunology, Duke University Medical University Medical Center, Durham, NC, 27710, USA.
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16
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Clinical characteristics and persistence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG antibodies in 4,607 French healthcare workers: Comparison with European countries. Infect Control Hosp Epidemiol 2020; 42:1406-1408. [PMID: 33143811 PMCID: PMC7684179 DOI: 10.1017/ice.2020.1309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Van Zundert TCRV, Barach P, Van Zundert AAJ. Revisiting safe airway management and patient care by anaesthetists during the COVID-19 pandemic. Br J Anaesth 2020; 125:863-867. [PMID: 32972715 PMCID: PMC7834300 DOI: 10.1016/j.bja.2020.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Tom C R V Van Zundert
- Department of Anaesthesia and Critical Care, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Paul Barach
- Department of Anaesthesia, Children's Research Center of Michigan, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA; University of Queensland, Brisbane, Queensland, Australia
| | - André A J Van Zundert
- University of Queensland, Brisbane, Queensland, Australia; Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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