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The presence of polybrominated diphenyl ethers (PBDEs) in consumer products, waste treatment processes, and treated ashes poses a significant environmental threat. Due to the lack of research on the removal of PBDEs during waste incineration, this study investigated the effectiveness of a Hazardous Waste Thermal Treatment System (HAWTTS) utilizing reburning of sludge and fly ash (SFA) with gasification-moderate or intense low-oxygen dilution (GASMILD) combustion for PBDE removal. The closed-loop treatment of sludge and ash within the HAWTTS provides a potential pathway for near-zero PBDE emissions. The GASMILD combustion addresses potential combustion issues associated with fly ash recirculation. The system achieved an impressive overall removal efficiency of 98.4% for PBDEs, with minimal stack emissions (2.45 ng/Nm³) and a negative net discharge rate (-1.02 µg/h). GASMILD combustion played a crucial role (92.7%-97.6% destruction) in addressing challenges associated with high-moisture feedstocks and SFA residues. Debromination of highly brominated PBDEs occurred within the incinerator, resulting in an increased proportion of lower brominated PBDEs in the bottom slag compared to the feedstock. Air Pollution Control Devices (APCDs) achieved a total PBDE removal efficiency of 74.4%. However, the hydrophobic nature of PBDEs limited removal efficiency in scrubbers (36.0%) and cyclonic demisters (37.86%). This study demonstrates that reintroducing SFA into the GASMILD combustion process offers an effective and environmentally sustainable strategy for reducing net PBDE levels in hazardous waste. This approach also provides additional benefits such as energy conservation, reduced carbon emissions, and lower operating costs associated with secondary treatment of thermally treated byproducts.
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Emissions of the inhalable particle (dp < 10 µm, PM10) and their harmful compositions from combustion sources have high potential on health risk with nearly no regulation. This study investigates the particle size distribution (PSD), as well as the removal mechanism of PM10 and fine particle (FP)-bound polycyclic aromatic hydrocarbons (PAHs) from the flue gas of a hazardous waste thermal treatment system. It has ultralow regulated emission and becomes a candidate of power generation module. A series of the advanced scrubbers, cyclonic demister, and baghouse was equipped for multi-pollutant control. The moderate or intense low oxygen dilution (MILD) combustion effectively inhibited the PM2.5 generation by volumetric oxidation. Advanced scrubbers removed PM1, PM2.5, and PM10 by 85.24, 68.68, and 97.60%, respectively, which achieved by local supersaturation, heterogeneous condensation of water vapor, and the growth of fine PM. Moreover, the scrubbers effectively scavenged the course PM10 containing the high-molecular-weight PAH homologs onto the water phase but promoted the condensation and absorption of the lighter homologs onto the fine particle surface (dp â¼5.3 µm). The size window (dp = 0.3-1.0 µm) of the minimum efficiency reporting value of a BH filtration led to the peak of FP-PAH mass and BaP equivalent (BaPeq) toxicity at dp = 0.1-0.4 and 0.1-0.8 µm, respectively. Consequently, the synergy of MILD combustion and the SCB-CYC-BH system effectively inhibited the PM2.5, PM10, PM2.5-PAHs, and FP-PAH levels from a waste thermal treatment process and further mitigated the potential health risk.
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Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Atmosféricos/toxicidade , Poluentes Atmosféricos/análise , Material Particulado/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Monitoramento Ambiental , Centrais Elétricas , Tamanho da PartículaRESUMO
OBJECTIVES: The SARS-CoV-2 Omicron variant pandemic struck Taiwan in April 2022. Rapid antigen tests (RATs) play an important role in providing rapid results during a pandemic. However, self-collected samples by the children's caregivers without the supervision of medical personnel raise some concerns. METHODS: This study was performed to investigate household transmission, clinical characteristics, and antigen performance in a special COVID-19 family clinic in a children's hospital. The performance of at-home RATs was evaluated based on reverse transcription-polymerase chain reaction. RESULTS: We included 627 patients in our study between May 11 and June 10, 2022. The COVID-19 full vaccination rate was significantly higher in adults (98.5%) than in children (5.9%, P <0.001). The transmission rate was significantly higher in children (91.3%) than in adults (76.6%, P <0.001). Infected children had more incidents of fever (82.4% vs 22.4%, P <0.001) and a higher peak fever than adults. Based on the reverse transcription-polymerase chain reaction, the negative predictive rate of the home RAT was only 38.7% (95% confidence interval: 31.9-46.0%) in children. The cycle threshold value of those with false-negative antigen tests was significantly lower in children. CONCLUSION: Children had a higher transmission rate, more fever, and higher peak fever than adults. Home RAT has a suboptimal negative predictive rate in children.
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COVID-19 , SARS-CoV-2 , Criança , Humanos , Pandemias , Instituições de Assistência Ambulatorial , FebreRESUMO
The particulate polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) of various sizes produced from the waste incinerators might have different toxicities, deposition characteristics, and potential health effects in the respiratory system, and their total toxicity equivalent (TEQ) concentration has been strictly regulated in recent years. There is a knowledge gap on the effects of air pollution control devices on particle size distributions (PSDs) of PCDD/Fs and their TEQ deposition. A hazardous waste thermal treatment plant equipped with an advanced scrubber, a cyclone demister, and activated carbon adsorption coupled with a baghouse filtration was investigated in this study. An 8-stage impactor was used to collect the particle distribution of PM10 and bounded PCDD/Fs from the gas stream at four sampling points located before and after each control unit. A "TEQDE" index is defined for the toxicity deposition of PM10-PCDD/F in the respiratory system. The advanced scrubbers significantly reduced the PM10-PCDD/F levels, especially for those with sizes ≥0.6 and ≤ 0.4 µm. Additionally, the cyclone also showed a better performance than the general dry gas treatment but had an efficiency drop with 1.5-4 µm particles. The PM10-PCDD/F loads in the final adsorption-filtration unit were eased and effectively removed the PM10-PCDD/Fs to sizes ≤0.5 or≥1.5 µm. The total TEQDE was 0.00052 ng WHO-TEQ Nm-3 and had a peak level of 0.000157 ng WHO-TEQ Nm-3 at 1.2 µm. PSDs were more sensitive to the PSDs of PM mass at high PM levels but strongly correlated with the PSDs of "PM10-PCDD/Fs/PM10" at low PM10 loads. Consequently, the advanced control system could effectively remove the PM10-PCDD/Fs and might extend the adsorption-filtration lifetime. However, the PM10-PCDD/Fs ≤ 0.4 µm had a higher TEQ deposition rate and should be further considered in emissions and ambient air quality evaluations.
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Poluentes Atmosféricos , Benzofuranos , Dibenzodioxinas Policloradas , Poluentes Atmosféricos/análise , Benzofuranos/análise , Dibenzofuranos , Dibenzofuranos Policlorados , Poeira , Monitoramento Ambiental , Resíduos Perigosos , Incineração , Dibenzodioxinas Policloradas/análise , Sistema RespiratórioRESUMO
BACKGROUND: In Taiwan, the vaccination program started in March 2021, with ChAdOx1-S being the first available WHO-approved COVID-19 vaccine, followed by Moderna vaccine. This study aimed to investigate the immunogenicity and safety of homologous and heterologous prime-boost regimens with ChAdOx1-S and mRNA-1273. METHODS: From March to November 2021, homologous or heterologous regimens with ChAdOx1-S and mRNA-1273 vaccination (ChAdOx1-S/ChAdOx1-S, mRNA-1273/mRNA-1273, ChAdOx1-S/mRNA-1273) were given to 945 healthy participants. Serum samples were collected at designated time points. The anti-RBD/S1 antibody titers and neutralizing ability were measured by three different immunoassays: Elecsys® Anti-SARS-CoV-2 S (Roche Diagnostics, Mannheim, Germany), AdviseDx SARS-CoV-2 IgG II (Abbott Diagnostics Division, Sligo, Ireland), and cPass™ SARS-CoV-2 Neutralization Antibody Detection Kit (GenScript, New Jersey, USA). RESULTS: We found that heterologous vaccination with ChAdOx1-S/mRNA-1273 had an acceptable safety profile and induced higher total anti-RBD/S1 antibody production (p < 0.0001), yet lower anti-RBD/S1 IgG titer (p < 0.0001) and neutralizing ability (p = 0.0101) than mRNA-1273/mRNA-1273 group. Both regimens showed higher antibody titers and superior neutralizing abilities than ChAdOx1-S/ChAdOx1-S. An age-dependent antibody response to ChAdOx1-S/mRNA-1273 was shown after both the priming and the booster doses. Younger age was associated with higher antibody production and neutralizing ability. CONCLUSIONS: Heterologous ChAdOx1-S/mRNA-1273 vaccination regimen is generally safe and induces a robust humoral immune response that is non-inferior to that of mRNA-1273/mRNA-1273.
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Vacina de mRNA-1273 contra 2019-nCoV , COVID-19 , ChAdOx1 nCoV-19 , Imunogenicidade da Vacina , Vacina de mRNA-1273 contra 2019-nCoV/efeitos adversos , Vacina de mRNA-1273 contra 2019-nCoV/imunologia , Adulto , Anticorpos Antivirais , COVID-19/prevenção & controle , ChAdOx1 nCoV-19/efeitos adversos , ChAdOx1 nCoV-19/imunologia , Humanos , Imunoglobulina G , SARS-CoV-2 , Taiwan , VacinaçãoRESUMO
BACKGROUND: The COVID-19 frontline nurses' stress-reduction programme by the cooperation of manager with the nurses is not-well developed. AIM: This study aimed to examine the effect of an emergency nurse-led stress-reduction project on reducing stress levels during the COVID-19 pandemic. METHODS: The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress and needs at the 50th, 80th and 110th days of the pandemic from March to May 2020. RESULTS: The numbers of nurses participating in three-time survey were 160, 166 and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from personal protective equipment (PPE), information about infection control and family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information and a forum for sharing experiences of COVID-19 care decreased whereas needs of allowing more days off increased. CONCLUSIONS: The stress-reduction project targeting at nurses' views of their needs can reduce their stress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.
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COVID-19 , COVID-19/epidemiologia , Estudos Transversais , Humanos , Papel do Profissional de Enfermagem , Pandemias , SARS-CoV-2 , Taiwan/epidemiologiaRESUMO
An integrated gasification-flameless combustion-melting process was approached by a twin-cyclonic flow in a hazardous waste thermal treatment plant. A series of advanced scrubber, cyclonic demister, activated carbon adsorption, and baghouse processes were equipped for the end-of-pipe treatment. The untreated filterable particulate matter, CO, and NOx levels were only 283, 47.1, and 15.9 mg/Nm3, indicating the flameless combustion inhibited their formation by narrowing the post-combustion zone. The filterable particle mass-size distribution was equally contributed by nucleation, accumulation, and coarse formations, while their number concentration was predominated by nucleation (99.6%). That could enhance the adsorption of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) on ultrafine particles. Both total mass and toxic equivalent concentrations of PCDD/Fs were reduced 99.9% by the new air pollution control system when a slight reformation occurred during scrubbing. However, the escaped PCDD/Fs were mainly distributed on the ultrafine particles, which should be further inhibited by either increasing their sizes or equipping backup filtrations. Finally, the new process concentrates the PCDD/Fs into the scrubbing sludge, which could be recirculated back into the thermal process. This study not only reveals the emission risk of the ultrafine particle-bound PCDD/Fs, but also provides an effective process to remove them for industrial application.
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Poluentes Atmosféricos , Benzofuranos , Dibenzodioxinas Policloradas , Poluentes Atmosféricos/análise , Dibenzofuranos , Dibenzofuranos Policlorados/análise , Monitoramento Ambiental , Resíduos Perigosos/análise , Incineração , Tamanho da Partícula , Dibenzodioxinas Policloradas/análiseRESUMO
Accurate detection of anti-SARS-CoV-2 antibodies provides a more accurate estimation of incident cases, epidemic dynamics, and risk of community transmission. We conducted a cross-sectional seroprevalence study specifically targeting different populations to examine the performance of pandemic control in Taiwan: symptomatic patients with epidemiological risk and negative qRT-PCR test (Group P), frontline healthcare workers (Group H), healthy adult citizens (Group C), and participants with prior virologically-confirmed severe acute respiratory syndrome (SARS) infection in 2003 (Group S). The presence of anti-SARS-CoV-2 total and IgG antibodies in all participants were determined by Roche Elecsys® Anti-SARS-CoV-2 test and Abbott SARS-CoV-2 IgG assay, respectively. Sera that showed positive results by the two chemiluminescent immunoassays were further tested by three anti-SARS-CoV-2 lateral flow immunoassays and line immunoassay (MIKROGEN recomLine SARS-CoV-2 IgG). Between June 29 and July 25, 2020, sera of 2,115 participates, including 499 Group P participants, 464 Group H participants, 1,142 Group C participants, and 10 Group S participants, were tested. After excluding six false-positive samples, SARS-CoV-2 seroprevalence were 0.4, 0, and 0% in Groups P, H, and C, respectively. Cross-reactivity with SARS-CoV-2 antibodies was observed in 80.0% of recovered SARS participants. Our study showed that rigorous exclusion of false-positive testing results is imperative for an accurate estimate of seroprevalence in countries with previous SARS outbreak and low COVID-19 prevalence. The overall SARS-CoV-2 seroprevalence was extremely low among populations of different exposure risk of contracting SARS-CoV-2 in Taiwan, supporting the importance of integrated countermeasures in containing the spread of SARS-CoV-2 before effective COVID-19 vaccines available.
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Anticorpos Antivirais/sangue , COVID-19/epidemiologia , SARS-CoV-2/imunologia , Síndrome Respiratória Aguda Grave/epidemiologia , Adulto , Anticorpos Antivirais/imunologia , COVID-19/imunologia , Reações Cruzadas , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Síndrome Respiratória Aguda Grave/imunologia , Taiwan/epidemiologiaRESUMO
This is the first study integrate the flameless oxidation (FO) and in-chamber melting (ICM) processes in a primary chamber of a laboratory waste incinerator to improve energy and emission performances. Two liquid burners created a twin-cyclonic fluid field that achieved the FO and ICM in the same chamber. The first cyclone provided a well-mixed and lower temperature FO to reduce auxiliary diesel consumption, NOx and PM emissions by 25.8%, 30.9%, and 79.2%, respectively, from the original system. The hot gases produced by FO enhance the ICM process and transformed the bottom ashes to stabler slags, in turn meeting the regulations for nonhazardous wastes. The other cyclone enhanced the drying and water-gas shift reaction in the drying zone by recirculating the CO and enthalpy from FO and ICM. Eventually, the residual CO, hydrocarbons, and H2 were sent to the secondary chamber for further oxidation. A computational fluid dynamic simulation supported the fluid field assumption posed in this study. Moreover, advanced scrubbers were employed after thermal treatments to reduce HCl and SO2 by 81.8% and 38.8% and further retarded the corrosion rate in the baghouse supporting cage by 87.7%. The precursors of condensable particulate matter were reduced by condensation and finally removed in the baghouse. Nevertheless, the emissions of the high- and mid-molecular-weight polycyclic aromatic hydrocarbons were greatly reduced by 60.8-93.1% and 80.2-99.9%, respectively. Consequently, the new system reduced annual emissions by 40.7-87.6% and operating costs by 41.5%, allowing recovery of the remodification investment in 20.5 months.
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Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Atmosféricos/análise , Incineração , Laboratórios , Material Particulado/análise , Emissões de Veículos/análiseRESUMO
BACKGROUND/PURPOSE: Our study goals were to evaluate the diagnostic performance of four anti-SARS-CoV-2 antibodies tests and the differences in dynamic immune responses between COVID-19 patients with and without pneumonia. METHODS: We collected 184 serum samples from 70 consecutively qRT-PCR-confirmed COVID-19 patients at four participating hospitals from 23 January 2020 to 30 September 2020. COVID-19 pneumonia was defined as the presence of new pulmonary infiltration. Serum samples were grouped by the duration after symptom onset on a weekly basis for antibody testing and analysis. The four immunoassays: Beckman SARS-CoV-2 IgG/IgM (Beckman Test), Siemens (ADVIA Centaur®) SARS-CoV-2 Total (COV2T) (Siemens Test), SBC COVID-19 IgG ELISA (SBC Test) and EliA SARS-CoV-2-Sp1 IgG/IgM/IgA P2 Research (EliA Test) were used for detecting the SARS-CoV-2 specific antibodies. RESULTS: The sensitivity of all tests reached 100% after 42 days of symptom onset. Siemens Test, the only test detecting total anti-SARS-CoV-2 antibodies, had the best performance in the early diagnosis of COVID-19 infection (day 0-7: 77%; day 8-14: 95%) compared to the other 3 serological tests. All tests showed 100% specificity except SBC Test (98%). COVID-19 patients with pneumonia had significantly higher testing signal values than patients without pneumonia (all p values < 0.05, except EliA IgM Test). However, Siemens Test and SBC Test had highest probability in early prediction of the presence of COVID-19 pneumonia. CONCLUSION: Chronological analysis of immune response among COVID-19 patients with different serological tests provides important information in the early diagnosis of SARS-CoV-2 infection and prediction of the risk of pneumonia after infection.
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Teste para COVID-19/métodos , COVID-19/diagnóstico , Imunoensaio/métodos , Pneumonia/diagnóstico , SARS-CoV-2/isolamento & purificação , Adulto , Anticorpos Antivirais/sangue , Formação de Anticorpos , Diagnóstico Precoce , Ensaio de Imunoadsorção Enzimática , Reações Falso-Positivas , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Testes Sorológicos , TaiwanRESUMO
An innovative method for utilizing synthetic calcium fluoride (CaF2), recovered from fluoride-containing semiconductor wastewater, and waste sulfuric acid (H2SO4) to produce hydrofluoric acid (HF) was investigated. The research was set to study the low-temperature production of HF via reaction of synthetic CaF2 and waste H2SO4. The impact of four factors, including H2SO4 concentration, total volume (H2SO4 + H2O)/CaF2 ratio, drying temperature of synthetic CaF2, and reaction carried out under different temperature, on HF productivity was investigated in this study. HF yield increased with increasing H2SO4 concentration and total volume/CaF2 ratio under room temperature. Generally, reactions carried out under low-temperature (< 100 °C) had a positive impact on HF yield. The higher temperature led to an increase in absorbed-HF but a decrease in total-HF. The reaction of commercial CaF2 and 70% H2SO4 had a higher absorbed-HF yield of 61.7% than synthetic CaF2 and 70% waste H2SO4, which had a yield of 36%. This was due to the higher purity of the commercial CaF2 and fewer interference ions in H2SO4. HF productivity was lowered by CaSO4, which hindered the reaction of reactants and also the generation of fluorosulfuric acid.
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Fluoreto de Cálcio , Ácido Fluorídrico , Eletrônica , Reciclagem , Ácidos SulfúricosRESUMO
In this study, the dielectric barrier discharge (DBD) induced by nonthermal plasma (NTP) technology was used for isopropanol (IPA) degradation. IPA, intermediate, final product, and ozone concentrations were analyzed using GC-MS, carbon dioxide detector, and ozone detector. The experimental flow rate and concentration were fixed to 1 L/min and 1200 ppm ± 10%, respectively. Different reaction procedures were proposed for self-made metal catalyst combined with a plasma system (plasma alone and γ-Al2O3 combined with plasma, Cu (5 wt%)/γ-Al2O3 combined with plasma, Mn (3 wt%)-Cu (5 wt%)/γ-Al2O3 combined with plasma). In addition, the effect of the carrier gas oxygen content (0%, 20%, and 100%) on IPA conversion and intermediate and carbon dioxide selectivity was also investigated. The results revealed that the Mn (F)-Cu/γ-Al2O3 combined with plasma exhibited more efficient IPA conversion. In the 100% oxygen environment, the IPA conversion rate increased from 79.32 to 99.99%, and carbon dioxide selectivity increased from 3.82 to 50.23%. IPA was completely converted after 60 min of plasma treatment with the acetone selectivity, carbon dioxide selectivity, and tail ozone concentration of 26.71% ± 1.27%, 50.23% ± 0.56%, and 1761 ± 11 ppm, respectively. This study proved that the current single planar DBD configuration is an effective advanced treatment technology for the decomposition of VOCs.
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2-Propanol , Ozônio , Acetona , Dióxido de Carbono , CatáliseRESUMO
This multicenter, retrospective study included 346 serum samples from 74 patients with coronavirus disease 2019 (COVID-19) and 194 serum samples from non-COVID-19 patients to evaluate the performance of five anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests, i.e. two chemiluminescence immunoassays (CLIAs): Roche Elecsys® Anti-SARS-CoV-2 Test (Roche Test) and Abbott SARS-CoV-2 IgG (Abbott Test), and three lateral flow immunoassays (LFIAs): Wondfo SARS-CoV-2 Antibody Test (Wondfo Test), ASK COVID-19 IgG/IgM Rapid Test (ASK Test), and Dynamiker 2019-nCoV IgG/IgM Rapid Test (Dynamiker Test). We found high diagnostic sensitivities (%, 95% confidence interval [CI]) for the Roche Test (97.4%, 93.4-99.0%), Abbott Test (94.0%, 89.1-96.8%), Wondfo Test (91.4%, 85.8-94.9%), ASK Test (97.4%, 93.4-99.0%), and Dynamiker Test (90.1%, 84.3-94.0%) after >21 days of symptom onset. Meanwhile, the diagnostic specificity was 99.0% (95% CI, 96.3-99.7%) for the Roche Test, 97.9% (95% CI, 94.8-99.2%) for the Abbott Test, and 100.0% (95% CI, 98.1-100.0%) for the three LFIAs. Cross-reactivity was observed in sera containing anti-cytomegalovirus (CMV) IgG/IgM antibodies and autoantibodies. No difference was observed in the time to seroconversion detection of the five serological tests. Specimens from patients with COVID-19 pneumonia demonstrated a shorter seroconversion time and higher chemiluminescent signal than those without pneumonia. Our data suggested that understanding the dynamic antibody response after COVID-19 infection and performance characteristics of different serological test are crucial for the appropriate interpretation of serological test result for the diagnosis and risk assessment of patient with COVID-19 infection.
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Anticorpos Antivirais/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Imunoensaio/métodos , Medições Luminescentes/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Adulto , Idoso , Anticorpos Antivirais/sangue , Betacoronavirus/genética , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Reações Cruzadas/imunologia , Feminino , Humanos , Imunoensaio/normas , Medições Luminescentes/normas , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reprodutibilidade dos Testes , SARS-CoV-2 , Soroconversão , Testes Sorológicos , Índice de Gravidade de Doença , Taiwan/epidemiologiaRESUMO
OBJECTIVES: We aimed to evaluate the role of rapid serological tests in the management of coronavirus disease 2019 (COVID-19) patients. METHODS: This retrospective study enrolled 16 real-time reverse transcription polymerase chain reaction-confirmed symptomatic patients with COVID-19 and 58 COVID-19 negative patients at a medical center in Taiwan over a 3-month period. Serial serum samples were collected and tested for antibody response using four point-of-care (POC) lateral flow immunoassays (LFIA) (ALLTEST 2019-nCoV IgG/IgM Rapid Test, Dynamiker 2019-nCoV IgG/IgM Rapid Test, ASK COVID-19 IgG/IgM Rapid Test, and Wondfo SARS-CoV-2 Antibody Test). Time-dependent detection sensitivity and timeliness of seroconversion were determined and compared between the four POC rapid tests. RESULTS: The overall sensitivity and specificity of the four tests for detecting anti-SARS-CoV-2 antibodies after 3 weeks of symptom onset were 100% and 100%, respectively. There was no significant difference between the rapid tests used for detection of IgM and IgG separately and those used for detection of combined total antibody (mainly IgM/IgG). There was no significant difference between the four POC rapid tests in terms of time required for determining seroconversion of COVID-19. Patients with COVID-19 with pneumonia demonstrated shorter seroconversion time than those without pneumonia. CONCLUSION: Though the POC antibody rapid tests based on LFIA showed reliable performance in the detection of SARS-CoV-2-specific antibodies, the results of these tests should be interpreted and applied appropriately in the context of antibody dynamic of COVID-19 infection. COVID-19 patients complicated with pneumonia exhibited earlier anti-SARS-CoV-2 antibody response than COVID-19 patients without pneumonia.
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Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Imunoensaio/métodos , Pneumonia Viral/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Testes Sorológicos/métodos , Adulto , COVID-19 , Estudos de Casos e Controles , Infecções por Coronavirus/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Estudos Retrospectivos , SARS-CoV-2 , Sensibilidade e Especificidade , Eliminação de Partículas ViraisRESUMO
BACKGROUND: Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. OBJECTIVE: The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). METHODS: In this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers' exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians' total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. RESULTS: The final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95% CI -5.7 to -3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95% CI -1.6 to -4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points). CONCLUSIONS: The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control.
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Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Triagem/métodos , Adulto , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Estudos de Viabilidade , Feminino , Pessoal de Saúde , Humanos , Controle de Infecções/normas , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estudos Retrospectivos , SARS-CoV-2 , Taiwan/epidemiologiaRESUMO
BACKGROUND/PURPOSE: Current studies on pediatric coronavirus disease 2019 (COVID-19) are rare. The clinical characteristics and spectrum are still unknown. Facing this unknown and emerging pathogen, we aimed to collect current evidence about COVID-19 in children. METHODS: We performed a systematic review in PubMed and Embase to find relevant case series. Because some reports were published in Chinese journals, the journals and publications of the Chinese Medical Association related to COVID-19 were completely reviewed. A random effects model was used to pool clinical data in the meta-analysis. RESULTS: Nine case series were included. In the pooled data, most of patients (75%) had a household contact history. The disease severity was mainly mild to moderate (98%). Only 2 children (2%) received intensive care. Fever occurred in 59% of the patients, while cough in 46%. Gastrointestinal symptoms (12%) were uncommon. There are 26% children are asymptomatic. The most common radiographic finding was ground glass opacities (48%). Currently, there is no evidence of vertical transmission to neonates born to mothers with COVID-19. Compared with the most relevant virus, SARS-CoV, SARS-CoV-2 causes less severe disease. CONCLUSION: COVID-19 has distinct features in children. The disease severity is mild. Current diagnosis is based mainly on typical ground glass opacities on chest CT, epidemiological suspicion and contact tracing.