Development, Histological, and Ultrastructural Evaluation of Sheep Hyperimmune Serum Therapy for COVID-19 / Desarrollo, Evaluación Histológica y Ultraestructural de la Terapia con Suero Hiperinmune de Oveja para COVID-19

SUMMARY: In response to the threat posed by new variants of SARS-CoV-2 and the urgent need for effective treatments in the absence of vaccines, the aim of this study was to develop a rapid and cost-effective hyperimmune serum (HS) derived from sheep and assess its efficacy. The utilization of a halal-certified, easily maintained in certain geographic regions, easy-to-handle animal such as sheep could provide a viable alternative to the expensive option of horses. Sheep were immunized with a whole inactivated SARS-CoV- 2 antigen to produce HS, which was evaluated for neutralizing potency using the PRNT50 assay. K18-hACE2 transgenic mice (n=35) were divided into three groups: control, SARS-CoV-2 exposure through inhalation, and SARS-CoV-2 exposed mice treated with HS. HS efficacy was assessed through serum proinflammatory cytokine levels, qRT-PCR analysis, histopathological examination of lungs and hearts, and transmission electron microscopy. Purified HS exhibited significant neutralizing activity (1/24,576). The SARS-CoV-2+HS group showed lower levels of TNF-α, IL-10, and IL-6 (P<0.01) and relatively lower levels of MCP-1 compared to the SARS-CoV-2 group. HS prevented death, reduced viral RNA levels in the lungs and hearts, protected against severe interstitial pneumonia, preserved lung tissue integrity, and prevented myocyte damage, while the SARS-CoV-2 group exhibited viral presence in the lungs. This study successfully developed a sheep-derived HS against the entire SARS-CoV-2 virus, resulting in a significant reduction in infection severity, inflammation, and systemic cytokine production. The findings hold promise for treating severe COVID-19 cases, including emerging viral variants, and immunocompromised patients.

En respuesta a la amenaza que suponen las nuevas variantes del SARS-CoV-2 y la urgente necesidad de tratamientos eficaces en ausencia de vacunas, el objetivo de este estudio fue desarrollar un suero hiperinmune (HS) rápido y rentable derivado de ovejas. y evaluar su eficacia. La utilización de un animal con certificación halal, de fácil mantenimiento en determinadas regiones geográficas y de fácil manejo, como las ovejas, podría proporcionar una alternativa viable a la costosa opción de los caballos. Las ovejas fueron inmunizadas con un antígeno de SARS-CoV-2 completamente inactivado para producir HS, cuya potencia neutralizante se evaluó mediante el ensayo PRNT50. Los ratones transgénicos K18-hACE2 (n = 35) se dividieron en tres grupos: control, exposición al SARS-CoV-2 mediante inhalación y ratones expuestos al SARS-CoV-2 tratados con HS. La eficacia de HS se evaluó mediante niveles de citoquinas proinflamatorias en suero, análisis qRT-PCR, examen histopatológico de pulmones y corazones y microscopía electrónica de transmisión. El HS purificado exhibió una actividad neutralizante significativa (1/24,576). El grupo SARS-CoV-2+HS mostró niveles más bajos de TNF-α, IL-10 e IL-6 (P<0,01) y niveles relativamente más bajos de MCP-1 en comparación con el grupo SARS-CoV-2. HS evitó la muerte, redujo los niveles de ARN viral en los pulmones y el corazón, protegió contra la neumonía intersticial grave, preservó la integridad del tejido pulmonar y evitó el daño de los miocitos, mientras que el grupo SARS-CoV-2 exhibió presencia viral en los pulmones. Este estudio desarrolló con éxito un HS derivado de ovejas contra todo el virus SARS-CoV-2, lo que resultó en una reducción significativa de la gravedad de la infección, la inflamación y la producción sistémica de citocinas. Los hallazgos son prometedores para el tratamiento de casos graves de COVID- 19, incluidas las variantes virales emergentes y los pacientes inmunocomprometidos.

Interacciones farmacocinéticas de la azitromicina e implicación clínica / Pharmacokinetic interactions of azithromycin and clinical implication

Introducción: El síndrome respiratorio agudo grave (por la COVID-19) es en la actualidad la primera causa de muerte en el Perú, por lo que se requiere de fármacos eficaces y seguros para mitigar la enfermedad. Se realizó una búsqueda bibliográfica en SciELO y PubMed/ Medline; se seleccionaron 37 de 58 artículos sobre el tema. Objetivos: Revisar e integrar la información sobre las interacciones farmacocinéticas de la azitromicina que se prescriben en el tratamiento ambulatorio de la COVID-19 en el Perú, y evaluar su implicación clínica. Desarrollo: La azitromicina es usada en la COVID-19, por su actividad antiinflamatoria, al inhibir a las interleucinas (IL1, 6, 8 y TNF-α), y a las moléculas de adhesión intracelular 1 (ICAM1); y por inducir la producción de interferón tipo I (IFN-α, IFN-β) y III (IFN-λ) en células de pacientes con enfermedad pulmonar obstructiva crónica. Los estudios de tres brazos, aleatorizado y abierto, indican que la azitromicina no genera cambios en los parámetros farmacocinéticos de la ivermectina, sildenafilo, rupatadina y desloratadina; los estudios de un solo centro, abierto, sin ayuno y de dos períodos, evidencian que la azitromicina influye en los parámetros farmacocinéticos de venetoclax y de los psicotrópicos. Conclusiones: Basado en la evidencia de los estudios clínicos revisados e integrados, se concluye que estas son limitadas y de poca relevancia clínica, sin embargo, se propone usar el antibiótico bajo el criterio científico del médico, para evitar las interacciones farmacocinéticas y las reacciones adversas de los fármacos(AU)

Introduction: The severe acute respiratory syndrome (due to COVID-19) is currently the leading cause of death in Peru, so effective and safe drugs are required to mitigate the disease. A bibliographic search was carried out in SciELO and PubMed/Medline; 37 of 58 articles on the topic were selected. Objectives: Review and integrate the information on the pharmacokinetic interactions of azithromycin that are prescribed in the outpatient treatment of COVID-19 in Peru, and evaluate their clinical implication. Development: Azithromycin is used in COVID-19, due to its anti-inflammatory activity, by inhibiting interleukins (IL1, 6, 8 and TNF-α), and intracellular adhesion molecules 1 (ICAM1); and by inducing the production of type I interferon (IFN-α, IFN-β) and III (IFN-λ) in cells of patients with chronic obstructive pulmonary disease. The three-arm, randomized and open-label studies indicate that azithromycin does not cause changes in the pharmacokinetic parameters of ivermectin, sildenafil, rupatadine, and desloratadine; single-center, open-label, non-fasting, and two-period studies show that azithromycin influences the pharmacokinetic parameters of venetoclax and psychotropics. Conclusions: Based on the evidence from the reviewed and integrated clinical studies, it is concluded that these are limited and of little clinical relevance, however, it is proposed to use the antibiotic under the scientific criteria of the doctor, to avoid pharmacokinetic interactions and adverse reactions of drugs(AU)

Caracterización de pacientes con COVID-19 en una unidad cuidados intensivos / Characterization of COVID-19 patients in an intensive care unit

Introducción: A finales del 2019, un nuevo coronavirus provocó una epidemia de enfermedad respiratoria aguda en Wuhan, China. La Organización Mundial de la Salud nombró a esta enfermedad coronavirus disease 2019, el 11 de marzo de 2020 la declaró como pandemia, y se diagnosticaban los tres primeros casos de COVID-19 en Cuba. Objetivo: Describir el comportamiento de 20 casos positivos a SARS CoV-2 en una unidad de cuidados intensivos. Métodos: Estudio observacional, descriptivo, de cohorte y prospectivo, aplicado entre marzo y julio del 2020, en la Unidad de Cuidados Intensivos del Hospital Clínico-Quirúrgico Dr. Salvador Allende, La Habana, Cuba. La población estuvo conformada por la totalidad de pacientes ingresados positivos a SARS CoV-2 (n= 20). Resultados: La edad promedio fue de 64,35 ± 15,21 años. El sexo masculino sobresalió. La estadía media fue 10,05 ± 5,5 días. El APACHE II medio fue de 16,6 ± 8,9. Los síntomas predominantes fueron la fiebre (55 por ciento), la tos (25 por ciento) y la disnea (20 por ciento). Conclusiones: La mortalidad en pacientes con COVID-19 se asoció con la edad, con el aumento de la estadía en Unidad de Cuidados Intensivos, elevados puntajes APACHE II, disminución de los valores de eritrosedimentación y del recuento linfocitario. La hipertensión fue el antecedente patológico más recurrente(AU)

Introduction: At the end of 2019 a new coronavirus caused an epidemic of acute respiratory disease in Wuhan, China. The World Health Organization called this condition "coronavirus disease 2019" and declared it pandemic on 11 March 2020. On that same date the first three COVID-19 cases were diagnosed in Cuba. Objective: Describe the behavior of 20 SARS-CoV-2 positive cases in an intensive care unit. Methods: An observational descriptive prospective cohort study was conducted from March to July 2020 at the Intensive Care Unit of Dr Salvador Allende Clinical Surgical Hospital in Havana, Cuba. The study population was all the patients admitted for positive SARS-CoV-2 (n= 20). Results: Mean age was 64.35 ± 15.21 years. Male sex prevailed. Mean hospital stay was 10.05 ± 5.5 days. Mean APACHE II was 16.6 ± 8.9. The prevailing symptoms were fever (55 percent), coughing (25 percent) and dyspnea (20 percent). Conclusions: Mortality of COVID-19 patients was associated to age, a longer stay in the intensive care unit, high APACHE II scores, reduced erythrosedimentation values and lymphocyte count. Hypertension was the most common pathological antecedent(AU)

Ministério da Saúde orienta estados sobre medidas preventivas em função de nova variante do SARS-CoV-2

O Ministério da Saúde emitiu nesta terça-feira (2) Nota Técnica para os Estados e Distrito Federal sobre a nova variante do SARS-CoV-2 identificada no Brasil. O documento traz informações sobre as características da nova variante do Amazonas (VOC P.1) e orientações e recomendações de medidas que devem ser adotadas e intensificadas pelas secretarias de saúde estaduais, a fim de monitorar e evitar a propagação da nova variante.

Towards a pharmacochemical hypothesis of the prophylaxis of SARS-CoV-2 by psychoactive substances.

An increasing body of evidence suggests a protective effect of some psychoactive substances against SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus type 2). Recent findings suggest that patients with psychiatric disorders are less affected by SARS-CoV-2 than their caregivers, which may seem surprising given some of the frequent risk factors for an unfavorable course of the disease (e.g., obesity, diabetes, cardiovascular and pulmonary diseases). We propose here a mixed pharmacoepidemiological and pharmacochemical hypothesis to explain these findings. A number of psychotropic drugs exhibit activities against coronaviruses (Middle East Respiratory Syndrome coronavirus (MERS-CoV), the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-1) and the Infectious Bronchitis Virus (IBV)) and have been put forward as potentially anti-SARS-CoV-2. These treatments include numerous mee-too drugs (chemically and pharmacologically linked to those which have demonstrated anti-SARS-CoV-2 efficacy) which are frequently prescribed in psychiatric settings. Taken alone or in polypharmacy, these drugs could have a prophylactic anti-SARS-CoV-2 effect, explaining the unexpectedly low proportion of patients with psychiatric disorders and COVID-19. Associated factors such as nicotine can also be considered in the context of a broad chemoprophylactic hypothesis in patients with psychiatric disorders taking different psychoactive substances.

COVID-19, microthromboses, inflammation, and platelet activating factor.

Recent articles report elevated markers of coagulation, endothelial injury, and microthromboses in lungs from deceased COVID-19 patients. However, there has been no discussion of what may induce intravascular coagulation. Platelets are critical in the formation of thrombi and their most potent trigger is platelet activating factor (PAF), first characterized by Demopoulos and colleagues in 1979. PAF is produced by cells involved in host defense and its biological actions bear similarities with COVID-19 disease manifestations. PAF can also stimulate perivascular mast cell activation, leading to inflammation implicated in severe acute respiratory syndrome (SARS). Mast cells are plentiful in the lungs and are a rich source of PAF and of inflammatory cytokines, such as IL-1ß and IL-6, which may contribute to COVID-19 and especially SARS. The histamine-1 receptor antagonist rupatadine was developed to have anti-PAF activity, and also inhibits activation of human mast cells in response to PAF. Rupatadine could be repurposed for COVID-19 prophylaxis alone or together with other PAF-inhibitors of natural origin such as the flavonoids quercetin and luteolin, which have antiviral, anti-inflammatory, and anti-PAF actions.

Coronavirus Disease-19 and Otology/Neurotology.

The severe acute respiratory syndrome corona virus 2, responsible for the worldwide COVID-19 pandemic, has caused unprecedented changes to society as we know it. The effects have been particularly palpable in the practice of medicine. The field of otolaryngology has not been spared. We have had to significantly alter the way we provide care to patients, changes that are likely to become a new norm for the foreseeable future. This article highlights some of the changes as they apply to otology/neurotology. Although this is written from the perspective of an academic physician, it is also applicable to private practice colleagues.

Yeast-expressed SARS-CoV recombinant receptor-binding domain (RBD219-N1) formulated with aluminum hydroxide induces protective immunity and reduces immune enhancement.

We developed a severe acute respiratory syndrome (SARS) subunit recombinant protein vaccine candidate based on a high-yielding, yeast-engineered, receptor-binding domain (RBD219-N1) of the SARS beta-coronavirus (SARS-CoV) spike (S) protein. When formulated with Alhydrogel®, RBD219-N1 induced high levels of neutralizing antibodies against both pseudotyped virus and a clinical (mouse-adapted) isolate of SARS-CoV. Here, we report that mice immunized with RBD219-N1/Alhydrogel® were fully protected from lethal SARS-CoV challenge (0% mortality), compared to ~30% mortality in mice immunized with the SARS S protein formulated with Alhydrogel®, and 100% mortality in negative controls. An RBD219-N1 formulation with Alhydrogel® was also superior to the S protein, unadjuvanted RBD, and AddaVax (MF59-like adjuvant)-formulated RBD in inducing specific antibodies and preventing cellular infiltrates in the lungs upon SARS-CoV challenge. Specifically, a formulation with a 1:25 ratio of RBD219-N1 to Alhydrogel® provided high neutralizing antibody titers, 100% protection with non-detectable viral loads with minimal or no eosinophilic pulmonary infiltrates. As a result, this vaccine formulation is under consideration for further development against SARS-CoV and potentially other emerging and re-emerging beta-CoVs such as SARS-CoV-2.

SARS-CoV-2: previous coronaviruses, immune response, and development of vaccines / SARS-CoV-2: coronavirus previos, respuesta inmune y desarrollo de vacunas

Abstract Since the emergence of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China at the end of 2019, when its characteristics were practically unknown, one aspect was evident: its high contagion rate. This high infection rate resulted in the spread of the virus in China, Europe, and, eventually, the rest of the world, including Mexico. At present, around 9 million people are infected, and around 470,000 have died worldwide. In this context, the need to generate protective immunity, and especially the generation of a vaccine that can protect the world population against infection in the shortest possible time, is a challenge that is being addressed in different countries using different strategies in multiple clinical trials. This opinion article will present the evidence of the induction of immune response in some of the viruses of the coronavirus family before COVID-19, such as SARS-CoV and MERS-CoV (Middle East respiratory syndrome coronavirus). The information collected about the induction of an immune response by SARS-CoV-2 will be presented, as well as a description of the vaccine candidates reported to date in the various ongoing clinical trials. Finally, an opinion based on the evidence presented will be issued on the potential success of developing vaccine prototypes.

Resumen Desde el surgimiento del nuevo coronavirus SARS-CoV-2 (coronavirus tipo 2 del síndrome respiratorio agudo severo) en China a finales del año 2019, cuando todavía era desconocido prácticamente en todos los aspectos, una característica era evidente: el alto índice de contagio entre la población. Esto resultó en la expansión del virus en China, Europa y, finalmente, en el resto del mundo, incluyendo México. Actualmente, alrededor de 9 millones de personas están infectadas, y han muerto cerca de 500,000 en todo el mundo. En este contexto, la necesidad de generar inmunidad protectora y, sobre todo, el desarrollo de una vacuna que pueda proteger a la población mundial contra la infección en el menor tiempo posible, es un reto que se está abordando en distintos países utilizando diversas estrategias en múltiples ensayos clínicos. En este artículo de opinión se presentan las evidencias de la inducción de respuesta inmunitaria con algunos de los virus de la familia de coronavirus previos al SARS-CoV-2, como el SARS-CoV (coronavirus del síndrome respiratorio agudo severo) y el MERS-CoV (síndrome respiratorio por coronavirus de Oriente Medio). Además, se presenta lo reportado hasta el momento acerca de la inducción de respuesta inmunitaria por el SARS-CoV-2, así como una descripción de los candidatos a vacunas informados hasta el momento en los distintos ensayos clínicos en curso. Finalmente se emite una opinión, basada en las evidencias presentadas, acerca del éxito potencial de los prototipos de vacunas en desarrollo.

Refusal of viral testing during the SARS-CoV-2 pandemic.

Widespread testing for the respiratory syndrome coronavirus-2 (SARS-CoV-2) will represent an important part of any strategy designed to safely reopen societies from lockdown. Healthcare settings have the potential to become reservoirs of infectivity, and therefore many hospital trusts are beginning to carry out routine screening of staff and patients. This could promote the effective cohorting of patients and reduce the rate of nosocomial infection. However, for various reasons, some individuals may refuse this testing. Here we highlight this as an emergent ethicolegal issue which we expect to become increasingly relevant as testing becomes ubiquitous. We explore this position from an ethical and legal perspective, determining whether refusal of testing is acceptable under UK law. Individual patients refusing testing could undermine a hospital's testing strategy; therefore clinicians and policy makers must prospectively determine the best course of action if this were to occur.

Ministério da Saúde disponibiliza plataforma interativa para acompanhar dados de COVID-19

O Ministério da Saúde lançou nesta sexta-feira (12) uma nova plataforma para divulgar o cenário de casos e óbitos relacionados à Covid-19

SARS-CoV-2 infection and overactivation of Nlrp3 inflammasome as a trigger of cytokine "storm" and risk factor for damage of hematopoietic stem cells.

The scientific community faces an unexpected and urgent challenge related to the SARS-CoV-2 pandemic and is investigating the role of receptors involved in entry of this virus into cells as well as pathomechanisms leading to a cytokine "storm," which in many cases ends in severe acute respiratory syndrome, fulminant myocarditis and kidney injury. An important question is if it may also damage hematopoietic stem progenitor cells?

Fiocruz Minas participa de estudo para vacina contra Covid-19

Pesquisadores da Fiocruz Minas estão integrando uma rede do Instituto Nacional de Ciência e Tecnologia em Vacinas (INCTV) para o desenvolvimento de uma vacina contra o novo coronavírus (Sars-CoV-2). O estudo terá como base uma técnica elaborada pelo Grupo de Imunologia de Doenças Virais da Fiocruz Minas, que utiliza o vírus da influenza para gerar resposta imunológica contra o novo coronavírus.

COVID-19 in Children: Clinical Approach and Management.

COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health crisis threatening humanity at this point in time. Transmission of the infection occurs by inhalation of infected droplets or direct contact with soiled surfaces and fomites. It should be suspected in all symptomatic children who have undertaken international travel in the last 14 d, all hospitalized children with severe acute respiratory illness, and asymptomatic direct and high-risk contacts of a confirmed case. Clinical symptoms are similar to any acute respiratory viral infection with less pronounced nasal symptoms. Disease seems to be milder in children, but situation appears to be changing. Infants and young children had relatively more severe illness than older children. The case fatality rate is low in children. Diagnosis can be confirmed by Reverse transcriptase - Polymerase chain reaction (RT-PCR) on respiratory specimen (commonly nasopharyngeal and oropharyngeal swab). Rapid progress is being made to develop rapid diagnostic tests, which will help ramp up the capacity to test and also reduce the time to getting test results. Management is mainly supportive care. In severe pneumonia and critically ill children, trial of hydroxychloroquine or lopinavir/ritonavir should be considered. As per current policy, children with mild disease also need to be hospitalized; if this is not feasible, these children may be managed on ambulatory basis with strict home isolation. Pneumonia, severe disease and critical illness require admission and aggressive management for acute lung injury and shock and/or multiorgan dysfunction, if present. An early intubation is preferred over non-invasive ventilation or heated, humidified, high flow nasal cannula oxygen, as these may generate aerosols increasing the risk of infection in health care personnel. To prevent post discharge dissemination of infection, home isolation for 1-2 wk may be advised. As of now, no vaccine or specific chemotherapeutic agents are approved for children.

Recomendações técnicas para a configuração de uma área de triagem de pacientes com sintomas respiratórios. Documento preliminar 2.3 (5 de abril de 2020) / Recomendaciones técnicas para configuración de una zona de triaje de pacientes con síntomas respiratorios / Technical recommendations for setting up a screening area for patients with respiratory symptoms. Preliminary document 2.3 (April 5, 2020)

A área de triagem possibilita uma avaliação clínica rápida dos pacientes com sintomas respiratórios, para detectar casos que preencham os critérios para internação ou encaminhamento para outro nível de atenção. Principais características: A área de triagem de pacientes com sintomas respiratórios fica localizada em uma unidade de saúde, ou próxima a uma unidade de saúde, e seu objetivo é garantir: (i) a identificação precoce de pacientes com sinais e sintomas de doença respiratória aguda grave; (ii) o isolamento da possível fonte, com a implantação de medidas de controle e prevenção de infecções; e (iii) redução do risco de transmissão hospitalar do agente infeccioso. A área de triagem pode ser instalada em estruturas móveis (tendas, contêineres) ou em estruturas dentro da unidade de saúde designadas e reorganizadas para este fim. As equipes de saúde de emergência podem utilizar as áreas de triagem em colaboração com as unidades de saúde. Essa área de triagem deve funcionar 24 horas por dia, sete dias por semana, e deve ter capacidade de expansão suficiente para atender a demanda por seus serviços. Considerações especiais: A triagem de pacientes com sintomas respiratórios é organizada de acordo com as necessidades e o contexto da unidade de saúde, considerando as ações necessárias para prevenir a transmissão da doença entre pacientes, familiares e profissionais da saúde. Um sistema de encaminhamento deve ser implantado para garantir que os pacientes sejam imediatamente encaminhados ao destino apropriado (internação hospitalar, tratamento ambulatorial, transferência ou domicílio), minimizando o risco de transmissão.

El área de detección permite una evaluación clínica rápida de pacientes con síntomas respiratorios, para detectar casos que cumplen con los criterios de hospitalización o derivación a otro nivel de atención. Características principales: El área de detección para pacientes con síntomas respiratorios se encuentra en una unidad de salud, o cerca de una unidad de salud, y su objetivo es asegurar: (i) la identificación temprana de pacientes con signos y síntomas de enfermedad respiratoria aguda serio (ii) el aislamiento de la posible fuente, con la implementación de medidas de prevención y control de infecciones; y (iii) reducir el riesgo de transmisión hospitalaria del agente infeccioso. El área de detección puede instalarse en estructuras móviles (carpas, contenedores) o en estructuras dentro de la unidad de salud designada y reorganizada para este propósito. Los equipos de salud de emergencia pueden usar las áreas de detección en colaboración con las unidades de salud. Esta área de clasificación debe operar las 24 horas del día, los siete días de la semana, y debe tener suficiente capacidad de expansión para satisfacer la demanda de sus servicios. Consideraciones especiales: la detección de pacientes con síntomas respiratorios se organiza de acuerdo con las necesidades y el contexto de la unidad de salud, considerando las acciones necesarias para prevenir la transmisión de la enfermedad entre pacientes, familiares y profesionales de la salud. Se debe establecer un sistema de derivación para garantizar que los pacientes sean remitidos de inmediato al destino apropiado (ingreso hospitalario, tratamiento ambulatorio, traslado u hogar), minimizando el riesgo de transmisión.

Recomendações técnicas para a configuração de uma Unidade de Saúde de Emergência especializada para o tratamento de Síndrome Respiratória Aguda Grave (SRAG) / Recomendaciones técnicas para configuración de un Equipo Médico de Emergencia especializado de tratamiento de Infección Respiratoria Aguda Grave (IRAG) / Technical recommendations for the configuration of a specialized Emergency Medical Team for the treatment of Serious Acute Respiratory Infection (SARI)

Oferecer atendimento de saúde especializado para o tratamento de pacientes críticos com síndrome respiratória aguda grave (SRAG), encaminhados principalmente de unidades de saúde onde a capacidade das unidades de terapia intensiva tem sido sobrecarregada pelo alto volume de pacientes. A estrutura flexível de uma Equipe de Saúde de Emergência para SRAG também permite a configuração de leitos para tartar pacientes gravemente doentes que precisem de oxigenoterapia. Equipes de Saúde de Emergência para SRAG utilizam estruturas portáteis que variam de tendas a contêineres. Eles também podem ser implantados dentro de estruturas fechadas alternativas usando módulos pré-fabricados. Unidades de Saúde de Emergência para SRAG podem oferecer até 30 leitos para pacientes críticos ou gravemente doentes (10 leitos para casos críticos com suspeita de COVID-19, 10 leitos para casos críticos com COVID-19 confirmada, e 10 leitos para casos graves). Unidades de Saúde de Emergência para SRAG possuem um centro de comando para a coordenação das operações do dia a dia. Esse é um sistema modular que pode ser expandido conforme necessário, adicionando unidades de 10 leitos, o que aumenta sua resposta conforme as necessidades e os recursos existentes.

Ofrecer atención médica especializada para el tratamiento de pacientes críticos con síndrome respiratorio agudo severo (SRAS), referidos principalmente desde unidades de salud donde la capacidad de las unidades de cuidados intensivos ha sido abrumada por el alto volumen de pacientes. La estructura flexible de un Equipo de Salud de Emergencia para SRAG también permite la configuración de camas para tratar pacientes críticos que necesitan oxigenoterapia. Los equipos de salud de emergencia para SRAG utilizan estructuras portátiles que van desde carpas hasta contenedores. También se pueden implementar dentro de estructuras cerradas alternativas utilizando módulos prefabricados. Las Unidades de Salud de Emergencia para SRAG pueden ofrecer hasta 30 camas para pacientes críticos o enfermos críticos (10 camas para casos críticos con sospecha de COVID-19, 10 camas para casos críticos con COVID-19 confirmado y 10 camas para casos graves). Las Unidades de Salud de Emergencia para SRAG tienen un centro de comando para la coordinación de las operaciones diarias. Este es un sistema modular que se puede ampliar según sea necesario agregando unidades de 10 camas, lo que aumenta su respuesta de acuerdo con las necesidades y recursos existentes.

Atención inicial de personas con infección respiratoria aguda (IRA) en el contexto de la infección por coronavirus (COVID-19) en establecimientos de salud: evaluar el riesgo, aislar, referir. Recomendaciones provisionales, versión 1 (12 de abril de 2020) / Initial care of persons with acute respiratory illness (ARI) in the context of coronavirus disease (COVID-19) in healthcare facilities: assess the risk, isolate, refer. Interim recommendations, version 1 (12 April 2020)

Objetivo: Brindar recomendaciones sobre la atención inicial de personas con enfermedad respiratoria aguda (ERA) en el contexto de la infección por coronavirus (COVID-19) en establecimientos de salud basado en flujograma de toma de decisiones. Estas recomendaciones son preliminares y están sujetas a revisión a medida que se tengan nuevas evidencias.* Las recomendaciones proporcionadas en este documento se aplican a adultos mayores de 18 años. Audiencias específicas, como los bebés, los niños y las mujeres embarazadas, se abordarán en un documento separado.

To provide recommendations on the initial care of persons with acute respiratory illness (ARI) in the context of coronavirus disease (COVID-19) in healthcare facilities based on a decision-making process flowchart. These recommendations are preliminary and subject to review as new evidence becomes available. The recommendations provided in this document apply for adults olden than 18 years old. Specific audiences, such as infants, children and pregnant women will be addressed on a separate document.