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1.
Trends Biochem Sci ; 45(10): 823-825, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32792175

RESUMO

The interplay between academics and society within the environment of the COVID-19 pandemic has impacted on scientists across the world, prompting reevaluation of how virtual toolboxes can be used to support responsible collaborative research practices. We provide awareness of virtual resources and activities that enable scientific discovery using safe and efficient practices.


Assuntos
Pesquisa Biomédica/organização & administração , COVID-19/epidemiologia , COVID-19/psicologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Práticas Interdisciplinares/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Interface Usuário-Computador , Betacoronavirus/patogenicidade , COVID-19/transmissão , COVID-19/virologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Disseminação de Informação , Distanciamento Físico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Saúde Pública , SARS-CoV-2 , Mídias Sociais
2.
Proc Natl Acad Sci U S A ; 117(40): 24640-24642, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32963092

RESUMO

Are voters as polarized as political leaders when it comes to their preferences about how to cast their ballots in November 2020 and their policy positions on how elections should be run in light of the COVID-19 outbreak? Prior research has shown little party divide on voting by mail, with nearly equal percentages of voters in both parties choosing to vote this way where it is an option. Has a divide opened up this year in how voters aligned with the Democratic and Republican parties prefer to cast a ballot? We address these questions with two nationally diverse, online surveys fielded from April 8 to 10 and June 11 to 13, of 5,612 and 5,818 eligible voters, respectively, with an embedded experiment providing treated respondents with scientific projections about the COVID-19 outbreak. We find a nearly 10 percentage point difference between Democrats and Republicans in their preference for voting by mail in April, which had doubled in size to nearly 20 percentage points in June. This partisan gap is wider still for those exposed to scientific projections about the pandemic. We also find that support for national legislation requiring states to offer no-excuse absentee ballots has emerged as an increasingly polarized issue.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Política , COVID-19 , Humanos , Pandemias , Estados Unidos
3.
Proc Natl Acad Sci U S A ; 117(32): 19116-19121, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32699150

RESUMO

The severe acute respiratory syndrome coronavirus 2 originated in Wuhan, China at the end of 2019 and rapidly spread in more than 100 countries. Researchers in different fields have been working on finding explanations for the unequal impact of the virus and deaths from the associated coronavirus disease 2019 (COVID-19) across geographical areas. Demographers and other social scientists have hinted at the importance of demographic factors, such as age structure and intergenerational relationships. Our aim is to reflect on the possible link between intergenerational relationships and spread and lethality of COVID-19 in a critical way. We show that with available aggregate data it is not possible to draw robust evidence to support these links. In fact, despite a higher prevalence of intergenerational coresidence and contacts that is broadly positively associated with COVID-19 case fatality rates at the country level, the opposite is generally true at the subnational level. While this inconsistent evidence demonstrates neither the existence nor the absence of a causal link between intergenerational relationships and the severity of COVID-19, we warn against simplistic interpretations of the available data, which suffer from many shortcomings. We conclude by arguing that intergenerational relationships are not only about physical contacts between family members. Theoretically, different forms of intergenerational relationships may have causal effects of opposite sign on the diffusion of COVID-19. Policies should also take into account that intergenerational ties are a source of instrumental and emotional support, which may favor compliance to the lockdown and "phase-2" restrictions and may buffer their negative consequences on mental health.


Assuntos
Infecções por Coronavirus/epidemiologia , Relação entre Gerações , Pneumonia Viral/epidemiologia , COVID-19 , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/psicologia , Europa (Continente) , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/psicologia
4.
Proc Natl Acad Sci U S A ; 117(41): 25429-25433, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-32973100

RESUMO

COVID-19 has emerged as one of the deadliest and most disruptive events in recent human history. Drawing from political science and psychological theories, we examine the effects of daily confirmed cases in a country on citizens' support for the political leader through the first 120 d of 2020. Using three unique datasets which comprise daily approval ratings of head of government (n = 1,411,200) across 11 world leaders (Australia, Brazil, Canada, France, Germany, Hong Kong, India, Japan, Mexico, the United Kingdom, and the United States) and weekly approval ratings of governors across the 50 states in the United States (n = 912,048), we find a strong and significant positive association between new daily confirmed and total confirmed COVID-19 cases in the country and support for the heads of government. These analyses show that political leaders received a boost in approval in the early months of the COVID-19 pandemic. Moreover, these findings suggest that the previously documented "rally 'round the flag" effect applies beyond just intergroup conflict.


Assuntos
Infecções por Coronavirus/epidemiologia , Liderança , Pneumonia Viral/epidemiologia , Política , Betacoronavirus , COVID-19 , Infecções por Coronavirus/psicologia , Governo , Humanos , Pandemias , Pneumonia Viral/psicologia , Teoria Psicológica , SARS-CoV-2
5.
Proc Natl Acad Sci U S A ; 117(30): 17667-17674, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32651280

RESUMO

Noncompliance with social distancing during the early stage of the coronavirus disease 2019 (COVID-19) pandemic poses a great challenge to the public health system. These noncompliance behaviors partly reflect people's concerns for the inherent costs of social distancing while discounting its public health benefits. We propose that this oversight may be associated with the limitation in one's mental capacity to simultaneously retain multiple pieces of information in working memory (WM) for rational decision making that leads to social-distancing compliance. We tested this hypothesis in 850 United States residents during the first 2 wk following the presidential declaration of national emergency because of the COVID-19 pandemic. We found that participants' social-distancing compliance at this initial stage could be predicted by individual differences in WM capacity, partly due to increased awareness of benefits over costs of social distancing among higher WM capacity individuals. Critically, the unique contribution of WM capacity to the individual differences in social-distancing compliance could not be explained by other psychological and socioeconomic factors (e.g., moods, personality, education, and income levels). Furthermore, the critical role of WM capacity in social-distancing compliance can be generalized to the compliance with another set of rules for social interactions, namely the fairness norm, in Western cultures. Collectively, our data reveal contributions of a core cognitive process underlying social-distancing compliance during the early stage of the COVID-19 pandemic, highlighting a potential cognitive venue for developing strategies to mitigate a public health crisis.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Tomada de Decisões , Individualidade , Relações Interpessoais , Memória de Curto Prazo/fisiologia , Distanciamento Físico , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Betacoronavirus/isolamento & purificação , COVID-19 , Cognição , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2 , Estados Unidos/epidemiologia
6.
Proc Natl Acad Sci U S A ; 117(44): 27285-27291, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33060298

RESUMO

The initial public health response to the breakout of COVID-19 required fundamental changes in individual behavior, such as isolation at home or wearing masks. The effectiveness of these policies hinges on generalized public obedience. Yet, people's level of compliance may depend on their beliefs regarding the pandemic. We use original data from two waves of a survey conducted in March and April 2020 in eight Organisation for Economic Co-operation and Development countries (n = 21,649) to study gender differences in COVID-19-related beliefs and behaviors. We show that women are more likely to perceive COVID-19 as a very serious health problem, to agree with restraining public policy measures, and to comply with them. Gender differences in attitudes and behavior are sizable in all countries. They are accounted for neither by sociodemographic and employment characteristics nor by psychological and behavioral factors. They are only partially mitigated for individuals who cohabit or have direct exposure to the virus. We show that our results are not due to differential social desirability bias. This evidence has important implications for public health policies and communication on COVID-19, which may need to be gender based, and it unveils a domain of gender differences: behavioral changes in response to a new risk.


Assuntos
Infecções por Coronavirus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/psicologia , Fatores Sexuais , Adulto , Betacoronavirus , COVID-19 , Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Cooperação do Paciente , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Inquéritos e Questionários
7.
Proc Natl Acad Sci U S A ; 117(44): 27277-27284, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33046648

RESUMO

The COVID-19 economic crash is idiosyncratic because of its virtual standstill of economic activity. We therefore ask how individual labor market experiences are related to the development of mental health complaints in the spring of 2020. As clinical data collection was compromised during the lockdowns, standardized surveys of the European labor force provide an opportunity to observe mental health complaints as the crisis unfolded. Data are representative of active members of the labor force of six European nations that contained varying levels of COVID-19 burdens in terms of mortality and lockdown measures. We document a steep occupational prestige level gradient on the probability of facing economic hardship during the lockdowns-looming job loss, income loss, and workload decline-which evidently exacerbate socioeconomic inequalities. Analyses indicate a striking positive relationship between instantaneous economic hardships during the COVID-19 lockdown and expressing feelings of depression and health anxiety. Importantly, the magnitude of the association between such hardships and indicators of mental health deterioration is highly dependent on workers' occupational standing, revealing a second layer of exacerbating inequality.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/psicologia , Emprego , Saúde Mental , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/psicologia , Fatores Socioeconômicos , Adulto , Ansiedade/epidemiologia , Betacoronavirus , COVID-19 , Depressão/epidemiologia , Europa (Continente) , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
8.
Proc Natl Acad Sci U S A ; 117(33): 19658-19660, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32727905

RESUMO

In the absence of a vaccine, social distancing measures are one of the primary tools to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which causes coronavirus disease 2019 (COVID-19). We show that social distancing following US state-level emergency declarations substantially varies by income. Using mobility measures derived from mobile device location pings, we find that wealthier areas decreased mobility significantly more than poorer areas, and this general pattern holds across income quantiles, data sources, and mobility measures. Using an event study design focusing on behavior subsequent to state emergency orders, we document a reversal in the ordering of social distancing by income: Wealthy areas went from most mobile before the pandemic to least mobile, while, for multiple measures, the poorest areas went from least mobile to most. Previous research has shown that lower income communities have higher levels of preexisting health conditions and lower access to healthcare. Combining this with our core finding-that lower income communities exhibit less social distancing-suggests a double burden of the COVID-19 pandemic with stark distributional implications.


Assuntos
Atitude , COVID-19/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Renda , Pandemias/prevenção & controle , Distanciamento Físico , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , COVID-19/psicologia , Infecções por Coronavirus/psicologia , Humanos , Modelos Teóricos , Pneumonia Viral/psicologia , Quarentena/legislação & jurisprudência , Quarentena/métodos , Estados Unidos
10.
Mol Psychiatry ; 25(10): 2214-2219, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32681098

RESUMO

The COVID-19 pandemic has transformed the face of psychiatry over a very short time period. Given the detrimental impact of the pandemic on mental health and the economy, more difficult days are ahead for psychiatry. The rising public health burden of mental illnesses will inevitably exceed the capacity of psychiatric services in the United States and worldwide. The pandemic has also profoundly affected psychiatric research due to safety concerns and containment efforts. Intermediate and long-term ramifications may even be more serious. In addition to the effects of the economic downturn on available research funding, existing research tools and protocols may not meet the emerging needs in the post-COVID-19 era. This paper discusses potential trends and challenges that psychiatric practice and research may encounter in this period from the viewpoint of workers in the field. We outline some measures that clinicians and researchers can implement to adapt to the emerging changes in psychiatry and to mitigate the forthcoming effects of the crisis.


Assuntos
Infecções por Coronavirus/psicologia , Transtornos Mentais/etiologia , Pneumonia Viral/psicologia , Psiquiatria/tendências , Psicoterapia , Pesquisa Biomédica , COVID-19 , Humanos , Pandemias , Psicoterapia/tendências , Apoio à Pesquisa como Assunto
11.
Paediatr Respir Rev ; 39: 16-21, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34229965

RESUMO

The disruption of daily life resulting from COVID-19 and its precautions has taken an enormous emotional toll on children and families. The consequences of disrupted schooling, changed social interactions and altered family dynamics has had some unanticipated positives such as improved on-line educational upskilling and personal resilience. However, the potential longer term implications for educational outcomes, economic impacts of job loss and prolonged financial insecurity, physical wellbeing and mental health remain unclear. The potential for post-traumatic stress disorders from what is experienced by children with imposed isolation from friends and extended family, domestic violence and death of relatives remains concerning. Confronting images and stories relayed through social media and the popular press will challenge children's views of safety, security, trust and potentially rob them of much of the innocence of youth. In an overwhelming global response to the "adult" problems of the COVID-19 pandemic, this article reflects on the consequences of trauma, loss and grief through the perspective of children and how they may alter their view of the world.


Assuntos
Luto , COVID-19/psicologia , Pesar , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adaptação Psicológica , Adolescente , COVID-19/epidemiologia , Criança , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Quarentena/psicologia , Resiliência Psicológica , SARS-CoV-2
15.
Am J Respir Crit Care Med ; 202(10): 1388-1398, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32866409

RESUMO

Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity.Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs.Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified.Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42-0.79], 0.57 [95% confidence interval, 0.39-0.82], and 0.49 [95% confidence interval, 0.34-0.72], respectively). HCPs working in non-university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions.Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.


Assuntos
Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/terapia , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Pneumonia Viral/terapia , Transtornos de Estresse Traumático/epidemiologia , Adulto , COVID-19 , Infecções por Coronavirus/psicologia , Cuidados Críticos/psicologia , Estudos Transversais , Feminino , França , Humanos , Masculino , Pandemias , Pneumonia Viral/psicologia , Prevalência , SARS-CoV-2 , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
16.
Ann Intern Med ; 173(2): 100-109, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32271861

RESUMO

BACKGROUND: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. OBJECTIVE: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. DESIGN: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. SETTING: 5 academic internal medicine practices and 2 federally qualified health centers. PATIENTS: 630 adults aged 23 to 88 years living with 1 or more chronic conditions. MEASUREMENTS: Self-reported knowledge, attitudes, and behaviors related to COVID-19. RESULTS: A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response. LIMITATION: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. CONCLUSION: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities. PRIMARY FUNDING SOURCE: National Institutes of Health.


Assuntos
Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Populações Vulneráveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Autorrelato , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Clin Infect Dis ; 71(15): 703-705, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32282038

RESUMO

Since the COVID-19 pandemic first hit Wuhan, China, in December 2019, scientists have been racing to develop and test novel vaccines to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The speed of scientific discovery related to COVID-19 is unprecedented. With several vaccine candidates already being tested in clinical trials, we pose the question: what will the vaccine hesitant do in the face of this pandemic?


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Programas de Imunização/legislação & jurisprudência , Legislação de Medicamentos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Recusa de Vacinação , Vacinas Virais/farmacologia , COVID-19 , Vacinas contra COVID-19 , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/psicologia , Humanos , Educação de Pacientes como Assunto/legislação & jurisprudência , Pneumonia Viral/imunologia , Pneumonia Viral/psicologia , SARS-CoV-2 , Estados Unidos/epidemiologia , Recusa de Vacinação/psicologia
18.
Emerg Infect Dis ; 26(7): 1616-1618, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32202993

RESUMO

The 2019 novel coronavirus disease emerged in China in late 2019-early 2020 and spread rapidly. China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist. Public mental health interventions should be formally integrated into public health preparedness and emergency response plans.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Saúde Mental , Pneumonia Viral/epidemiologia , Saúde Pública , COVID-19 , Infecções por Coronavirus/psicologia , Humanos , Pandemias , Pneumonia Viral/psicologia , SARS-CoV-2
19.
Emerg Infect Dis ; 26(10): 2482-2484, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32620177

RESUMO

Public mental health response to coronavirus disease is essential. After reviewing systemic and local efforts in China, we found efficient coordination and human resources. We recommend better symptom assessment, monitoring of organizations, and basic needs protection. This recommendation can inform how other countries can overcome mental health challenges during this pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Universidades , Betacoronavirus , COVID-19 , China/epidemiologia , Órgãos Governamentais , Hospitais , Linhas Diretas , Humanos , Transtornos Mentais/virologia , Organizações sem Fins Lucrativos , Saúde Pública , Alocação de Recursos , SARS-CoV-2 , Sociedades Médicas , Avaliação de Sintomas
20.
PLoS Med ; 17(9): e1003293, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941437

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. METHODS AND FINDINGS: This is the first edition of a living systematic review of randomized clinical trials comparing the effects of all treatment interventions for participants in all age groups with COVID-19. We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane guidelines, and our 8-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and nonserious adverse events. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until August 7, 2020. Two reviewers independently extracted data and assessed trial methodology. We included 33 randomized clinical trials enrolling a total of 13,312 participants. All trials were at overall high risk of bias. We identified one trial randomizing 6,425 participants to dexamethasone versus standard care. This trial showed evidence of a beneficial effect of dexamethasone on all-cause mortality (rate ratio 0.83; 95% confidence interval [CI] 0.75-0.93; p < 0.001; low certainty) and on mechanical ventilation (risk ratio [RR] 0.77; 95% CI 0.62-0.95; p = 0.021; low certainty). It was possible to perform meta-analysis of 10 comparisons. Meta-analysis showed no evidence of a difference between remdesivir versus placebo on all-cause mortality (RR 0.74; 95% CI 0.40-1.37; p = 0.34, I2 = 58%; 2 trials; very low certainty) or nonserious adverse events (RR 0.94; 95% CI 0.80-1.11; p = 0.48, I2 = 29%; 2 trials; low certainty). Meta-analysis showed evidence of a beneficial effect of remdesivir versus placebo on serious adverse events (RR 0.77; 95% CI 0.63-0.94; p = 0.009, I2 = 0%; 2 trials; very low certainty) mainly driven by respiratory failure in one trial. Meta-analyses and trial sequential analyses showed that we could exclude the possibility that hydroxychloroquine versus standard care reduced the risk of all-cause mortality (RR 1.07; 95% CI 0.97-1.19; p = 0.17; I2 = 0%; 7 trials; low certainty) and serious adverse events (RR 1.07; 95% CI 0.96-1.18; p = 0.21; I2 = 0%; 7 trials; low certainty) by 20% or more, and meta-analysis showed evidence of a harmful effect on nonserious adverse events (RR 2.40; 95% CI 2.01-2.87; p < 0.00001; I2 = 90%; 6 trials; very low certainty). Meta-analysis showed no evidence of a difference between lopinavir-ritonavir versus standard care on serious adverse events (RR 0.64; 95% CI 0.39-1.04; p = 0.07, I2 = 0%; 2 trials; very low certainty) or nonserious adverse events (RR 1.14; 95% CI 0.85-1.53; p = 0.38, I2 = 75%; 2 trials; very low certainty). Meta-analysis showed no evidence of a difference between convalescent plasma versus standard care on all-cause mortality (RR 0.60; 95% CI 0.33-1.10; p = 0.10, I2 = 0%; 2 trials; very low certainty). Five single trials showed statistically significant results but were underpowered to confirm or reject realistic intervention effects. None of the remaining trials showed evidence of a difference on our predefined outcomes. Because of the lack of relevant data, it was not possible to perform other meta-analyses, network meta-analysis, or individual patient data meta-analyses. The main limitation of this living review is the paucity of data currently available. Furthermore, the included trials were all at risks of systematic errors and random errors. CONCLUSIONS: Our results show that dexamethasone and remdesivir might be beneficial for COVID-19 patients, but the certainty of the evidence was low to very low, so more trials are needed. We can exclude the possibility of hydroxychloroquine versus standard care reducing the risk of death and serious adverse events by 20% or more. Otherwise, no evidence-based treatment for COVID-19 currently exists. This review will continuously inform best practice in treatment and clinical research of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Gerenciamento Clínico , Pandemias , Pneumonia Viral/terapia , Qualidade de Vida , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Hospitalização/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , SARS-CoV-2
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