Congenital and Intrapartum SARS-CoV-2 Infection in Neonates: Hypotheses, Evidence and Perspectives.

INTRODUCTION: Both intrauterine and intrapartum mother-to-child transmission of SARS-CoV-2 have been reported. However, there is still disagreement as to the likelihood and frequency of such vertical transmission. OBJECTIVE: Summarize and analyze the published evidence on forms of SARS-CoV-2 vertical transmission (either intrauterine or intrapartum). EVIDENCE ACQUISITION: We carried out a review of literature published in English and Spanish from January 1, 2020 through October 30, 2020. Search engines included PubMed/MEDLINE, SciELO, LILACS, Cochrane, Google Scholar, ResearchGate and medRxiv. There were no restrictions concerning type of study. The review included 48 original research articles, 11 review articles, a meta-analysis, 2 pre-published articles, 15 systematic reviews, and 10 editorials or comments. DEVELOPMENT: Medical thinking on congenital or intrapartum maternal-fetal/neonatal transmission of SARS-CoV-2 has evolved from preliminary evidence that was divided as to whether these forms of vertical transmission were even possible to current evidence support ing both forms of transmission and hypothesizing as to the mechanisms that guide them. The presence of the SARS-CoV-2 virus in maternal, placental, fetal or neonatal tissues has been demonstrated by RT-PCR, specific immunoglobulin detection tests, immunostaining and in-situ hybridization. It is estimated that infections acquired either congenitally or intrapartum occur in 1.8%-8.0% of newborns born to women who test positive for COVID-19 at the end of their pregnancies. This review found 53 neonates who were diagnosed with COVID-19 in the first 48 hours of life by either RT-PCR or specific IgM tests. According to criteria outlined in this review, the timing of infection corresponded to congenital or intrapartum transmission in 39.6% (21/53) of COVID-19-positive newborns, to postpartum transmission in 15.1% (8/53) and remains unspecified in 45.3% (24/53). CONCLUSIONS: Congenital and intrapartum SARS-CoV-2 infection in the fetus/newborn is possible, but rare. International collaborative studies using common epidemiological surveillance instruments would allow for a more precise specification of the frequency of congenital and intrapartum SARS-CoV-2 infection at the population level.

La COVID-19: comunicado conjunto sobre el nuevo coronavirus y los perros y gatos / COVID-19. Joint statement on the new coronavirus and cats and dogs

El Centro Panamericano de Fiebre Aftosa y Salud Pública Veterinaria de la Organización Panamericana de la Salud / Organización Mundial de la Salud (PANAFTOSA-OPS/OMS) y la Protección Animal Mundial (PAM) comunican al público en general los aspectos referentes al COVID-19 y la relación con las mascotas (perros y gatos).

Medidas para Prevenir el COVID-19 en el Consultorio Dental / Measures to Prevent COVID-19 in the Dental Office

RESUMEN: El 11 de marzo del 2020, la OMS reconoció al COVID-19 como pandemia mundial. El coronavirus (COVID-19) ha desafiado a los sistemas de salud y demanda una rápida reacción de respuesta, ante el aumento de infectados. El ámbito del trabajo odontológico, está sujeto a un riesgo significativo de contaminación cruzada y difusión de esta enfermedad, siendo muy importante las estrictas medidas de protección. El objetivo de esta revisión es informar sobre las medidas que se deben realizar durante los tratamientos dentro del consultorio dental para prevenir la propagación del COVID-19.

ABSTRACT: On March 11, 2020, the WHO recognized COVID-19 as a global pandemic. The coronavirus (COVID-19) has challenged health systems and demands a quick response reaction, due to the increase in infected people. The field of dental work is subject to a significant risk of cross contamination and spread of this disease, with strict protection measures being very important. The aim of this review is to inform about the measures that must be carried out during treatments in the dental office to prevent the spread of COVID-19.

Recomendaciones en la Atención de Pacientes en Cirugía Maxilofacial Durante la Pandemia de COVID-19 (SARS-CoV-2) / Recommendations in the Care of Patients in Maxillofacial Surgery During the COVID-19 Pandemic (SARS-CoV-2)

RESUMEN: La nueva enfermedad por coronavirus 2019 (COVID-19) es la última patología de preocupación internacional. Originada en Wuhan, China, se extendió rápidamente a nivel mundial, razón por la cual fue declarada una emergencia de salud pública. Sus síntomas principales son fiebre, tos, dolor de garganta, dificultad respiratoria, fatiga, malestar general y la anosmia, que ha sido incorporada recientemente. Sin embargo, también se han descrito múltiples casos asintomáticos que han alarmado a la población general. Esta enfermedad, se caracteriza por su alta tasa de contagio y su mecanismo de propagación es el contacto cercano entre personas y a través de fluidos corporales como la saliva y secreciones de las vías aéreas. El personal de salud es especialmente vulnerable a la infección debido a su gran exposición a las secreciones oronasales de los pacientes, sobre todo, aquellas especialidades médicas y odontológicas cuyo campo de acción se centra en estas áreas, siendo la cirugía oral y maxilofacial una de ellas, teniendo un alto riesgo de transmisión de SARS-CoV-2. Por lo tanto, es fundamental para este personal, seguir protocolos de prevención y control de infecciones, junto con una correcta anamnesis, examen y diagnóstico de los pacientes que permita establecer una priorización en las atenciones quirúrgicas, disminuyendo la propagación del virus. El objetivo de esta revisión es conocer las recomendaciones básicas para la priorización de pacientes y el cuidado en los procedimientos quirúrgicos por parte del equipo de cirugía maxilofacial durante la pandemia por COVID-19.

ABSTRACT: The new coronavirus disease 2019 (COVID-19) is the latest pathology of international concern. Originating in Wuhan, China, it spread rapidly worldwide, which is why it was declared a public health emergency. Its main symptoms are fever, cough, sore throat, shortness of breath, fatigue, general discomfort, and anosmia, which has been recently incorporated. However, multiple asymptomatic cases have also been described that have alarmed the general population. This disease is characterized by its high contagion rate and its propagation mechanism is close contact between people and through bodily fluids such as saliva and airway secretions. Health personnel are especially vulnerable to infection due to their high exposure to patients' oronasal secretions, especially those medical and dental specialties whose field of action focuses on these areas, oral and maxillofacial surgery being one of them, having a high risk of transmission of SARS-CoV-2. Therefore, it is essential for these personnel to follow infection prevention and control protocols, together with a correct anamnesis, examination, and diagnosis of patients, which allows prioritizing surgical care, reducing the spread of the virus. The objective of this review is to know the basic recommendations for patient prioritization and care in surgical procedures by the maxillofacial surgery team during the COVID-19 pandemic.

Legislación y Normas Atingentes a la Atención Odontológica y el COVID-19. Una Perspectiva Desde las Clínicas Universitarias / Lesgislation and Norms Related to Dental Care and the COVID-19. A Perspective from University Clinics

RESUMEN: La enfermedad por coronavirus 2019 (COVID-19) es una enfermedad infecciosa causada por el Coronavirus 2 del Síndrome Respiratorio Agudo Grave (SARS-CoV-2). La mayoría de los pacientes infectados con SARS-CoV-2 tiene una evolución asintomática o leve. Sin embargo, una parte de los infectados presentará un deterioro en su condición de salud, desarrollando una neumonía aguda grave, que puede producir la muerte. Las personas vinculadas a las clínicas odontológicas están en riesgo de infección por SARS-CoV-2, pues la saliva es un importante método de transmisión del virus. Por su naturaleza, la atención odontológica se realiza a corta distancia del paciente, con constante exposición a saliva, sangre y otros fluidos corporales, y es frecuente el manejo de instrumentos cortopunzantes. Por consiguiente, los elementos de protección personal cobran gran importancia y las reglamentaciones de la autoridad sanitaria en el contexto de la pandemia que actualmente se vive deben cumplirse a cabalidad, debido a obligaciones éticas y legales. En esta revisión narrativa se revisa y discute la reglamentación de la autoridad sanitaria que involucra las prestaciones odontológicas en el contexto del COVID-19, cómo se aplicará en las clínicas universitarias y cómo complementar la normativa con la evidencia científica disponible.

ABSTRACT: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by Coronavirus 2 of Severe Acute Respiratory Syndrome (SARS-CoV-2). The majority of patients infected with SARS-CoV-2 have an asymptomatic or mild evolution. However, a part of those infected will present a deterioration in their health condition, developing severe acute pneumonia, which can lead to death. People linked to dental clinics are at risk of SARS-CoV-2 infection, since saliva is an important method of transmission of the virus. Due to its nature, dental care is performed at a short distance from the patient, with constant exposure to saliva, blood and other body fluids, and the use of sharp instruments is frequent. Consequently, the elements of personal protection are very important and the regulations of the health authority in the context of the current pandemic must be fully complied with, due to ethical and legalobligations. This narrative review reviews and discusses the regulation of the health authority that involves dental services in the context of COVID-19, how it will be applied in university clinics and how to complement the regulations with the available scientific evidence.

COVID-19 and the gastrointestinal tract: what do we already know?

The new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.

Neonatal late-onset infection with SARS CoV-2 / [Sepsis neonatal tardía por SARS CoV-2].

During the SARS COV-2 pandemic, the vast majority of infected patients are showing symptoms related to lung damage. At pediatric ages, especially newborns, symptoms from other organ systems without respiratory illness could make COVID-19 hard to diagnose. We are reporting three cases of newborns who were attended in the course of the mitigation phase in the emergency service of a maternal hospital in Barranquilla, Colombia, for high temperature and general compromised condition. During their clinical course, they developed gastrointestinal symptoms without showing any respiratory manifestations. They were not epidemiologically linked to a contact suspected to be a COVID-19 case and their mothers had had no respiratory symptoms since the public health emergency in our country was declared 45 days before. The absence of clinical respiratory manifestations in this group of patients with COVID-19 should draw clinicians' attention to the need to suspect SARS CoV-2 infection in febrile newborns.

Durante la pandemia por SARS CoV-2 la gran mayoría de pacientes ha presentado afectación pulmonar como síntoma cardinal. En los niños, especialmente en recién nacidos, la sintomatología debida al efecto en otros sistemas diferentes al respiratorio puede dificultar el diagnóstico. Se reportan tres casos de recién nacidos atendidos durante la fase de mitigación de la pandemia por SARS CoV-2 en el servicio de urgencias de un hospital materno-infantil en Barranquilla, Colombia, por presentar cuadros febriles que afectaban su estado general. En su evolución clínica predominó la sintomatología gastrointestinal sin que desarrollaran nunca manifestaciones respiratorias. La investigación epidemiológica no evidenció contacto con casos sospechosos o positivos para COVID-19. Sus madres no habían tenido síntomas respiratorios en los 45 días transcurridos desde la declaración de la emergencia en salud pública en el país. La ausencia de manifestaciones clínicas respiratorias en este grupo de pacientes con COVID-19 debe llamar la atención de los clínicos sobre la necesidad de sospechar la infección por SARS CoV-2 en recién nacidos con estados febriles.

Epidemiology of self-care beyond the individual and the sanitary spheres / [Epidemiología del autocuidado más allá de lo individual y lo sanitario].

Amid the global pandemic crisis, international concern has centered on the control and prevention measures aimed at reducing the speed of the virus transmission while a more radical sanitary measure, such as vaccines, is achieved. Governmental and social efforts have had great impact on various sectors of society and their consequences have exceeded the sphere of health. This essay discusses the scope of specific measures in the sense of the appropriation of risk control measures and proposes the epidemiological method as an alternative that goes beyond the quantification of risks and the attribution of responsibilities. To conclude, the emphasis is placed on the need to promote information about socialization processes to better understand the consequences of individual acts favoring alternatives other than pandemic control based on the use of coercive measures.

En medio de la crisis pandémica a nivel global, la preocupación internacional ha girado en torno a la adopción de medidas de control y prevención orientadas a la reducción de la velocidad de propagación del virus en espera de que se disponga de una medida sanitaria radical como la vacuna. El esfuerzo gubernamental y social ha tenido un gran impacto en diversos sectores de la sociedad y las consecuencias han superado el ámbito sanitario. En este ensayo se discute su alcance en el sentido de la apropiación de las medidas de control del riesgo y se propone el método epidemiológico como una alternativa que va más allá de la cuantificación de los riesgos y la atribución de responsabilidades. Por último, se plantea la necesidad de fomentar procesos de socialización de la información que ayuden a la comprensión de las consecuencias de los actos individuales y favorezcan la superación de la expectativa de control pandémico únicamente basada en el uso de medidas coercitivas.

Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia / [Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia].

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos. Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.

Long but Unreal Lockdowns in Latin America. Comment on Chen, Y.T.; Yen, Y.F.; Yu, S.H.; Su, E.C. An Examination on the Transmission of COVID-19 and the Effect of Response Strategies: A Comparative Analysis. Int. J. Environ. Res. Public Health 2020, 17, E5687.

Lockdowns have been important elements of epidemic control over time. During the COVID-19 pandemic, they have been implemented in many countries, at very different times, and accompanied by school or workplace closures, restrictions on mass gatherings, and public transport closure in different combinations. Recent evidence published in the International Journal of Environmental Research and Public Health suggests that SARS-CoV-19 transmission is diminished when strict lockdowns, contact tracing, and good public cooperation are implemented. However, in Latin America, not all lockdowns are real, and rapid increases in a few weeks in the number of infected, hospitalized, and deceased populations have been observed. In these cases, the effect of lockdowns is weakening of democracy.

Lima soundscape before confinement and during curfew. Airplane flights suppressions because of Peruvian lockdown.

Peru declared a state of emergency on March 16 in order to prevent SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmissions; thus, the International Airport was closed and the soundscape of urban zones under the flight tracks have been changed in view of the fact that airplane traffic was suspended. The authors have been conducting noise monitoring since February and because of that sufficient noise data for knowing the soundscape before and during the lockdown were obtained. This article presents a case of aircraft annoyance noise in one of Lima's city districts, which is near the aircraft climbing curve, toward the ocean on departure from Lima.

Dynamic quarantine: a comparative analysis of the Chilean public health response to COVID-19.

In this study, an analysis of the Chilean public health response to mitigate the spread of COVID-19 is presented. The analysis is based on the daily transmission rate (DTR). The Chilean response has been based on dynamic quarantines, which are established, lifted or prolonged based on the percentage of infected individuals in the fundamental administrative sections, called communes. This analysis is performed at a national level, at the level of the Metropolitan Region (MR) and at the commune level in the MR according to whether the commune did or did not enter quarantine between late March and mid-May of 2020. The analysis shows a certain degree of efficacy in controlling the pandemic using the dynamic quarantine strategy. However, it also shows that apparent control has only been partially achieved to date. With this policy, the control of the DTR partially falls to 4%, where it settles, and the MR is the primary vector of infection at the country level. For this reason, we can conclude that the MR has not managed to control the disease, with variable results within its own territory.

Transmisión sexual del virus SARS-CoV-2 y su rol en la propagación de COVID-19: protocolo de una revisión sistemática viva / Sexual transmission of SARS-CoV-2 virus and its role in the spread of COVID-19: a living systematic review protocol

Objetivo Proporcionar una revisión de la literatura sobre la presencia de SARS-CoV-2 en los fluidos sexuales de pacientes con COVID-19 y su posible transmisión sexual de manera oportuna, rigurosa y continuamente actualizada. Fuentes de datos Realizaremos búsquedas en PubMed / Medline, Embase, Registro Cochrane Central de Ensayos Controlados (CENTRAL), literatura gris y en un repositorio centralizado en L · OVE (Living OVerview of Evidence). L · OVE es una plataforma que mapea las preguntas PICO a la evidencia de la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L · OVE se adaptó para ampliar el rango de evidencia que cubre y se personalizó para agrupar todas las pruebas de COVID-19 en un solo lugar. La búsqueda cubrirá el período hasta el día anterior al envío a una revista. Criterios de elegibilidad para la selección de estudios y métodos Adaptamos un protocolo común ya publicado para múltiples revisiones sistemáticas paralelas a las especificidades de esta pregunta. Incluiremos ensayos aleatorios que evalúen la transmisión sexual del virus SARS-CoV-2. Se buscarán ensayos aleatorizados que evalúen la transmisión sexual de otros coronavirus, como MERS-CoV y SARS-CoV, y estudios no aleatorizados en COVID-19 en caso de que no se encuentre evidencia directa de ensayos aleatorizados, o si la evidencia directa proporciona una - o certeza muy baja para resultados críticos. Dos revisores evaluarán de forma independiente la elegibilidad de cada estudio, extraerán datos y evaluarán el riesgo de sesgo. Realizaremos metanálisis de efectos aleatorios y utilizaremos GRADE para evaluar la certeza de la evidencia para cada resultado. Una versión viva basada en la web de esta revisión estará disponible abiertamente durante la pandemia de COVID-19. Lo volveremos a enviar si las conclusiones cambian o hay actualizaciones sustanciales Registro PROSPERO (CRD42020189368).

Nursing actions in human milk banks in times of COVID-19.

OBJECTIVE: To analyze the actions of the Human Milk Banks coordination to favor the continuity of breastfeeding in the COVID-19 pandemic. METHODS: Descriptive study, of qualitative approach, with theoretical-methodological reference of Pierre Bourdieu. Data collection was done through interviews between March and April, with five coordinations and results organized by thematic analysis. RESULTS: Two categories were produced: the actions of strategies for the maintenance of Human Milk Banks services by digital means as a way to ensure social distancing and breastfeeding in times of pandemic of the new coronavirus; and the actions of promotion, protection and support in strategies for maintenance of breastfeeding during the pandemic. FINAL CONSIDERATIONS: The benefits of breastfeeding outweigh any potential risks of transmission of the new coronavirus. The importance of systematic nursing practices in the quality and safety of the process of Protection, Promotion and Support of Breastfeeding is evident.

Multimodal strategy for hand hygiene in field hospitals of COVID-19.

OBJECTIVE: Reflect and propose adaptations to the Multimodal Hand Hygiene Strategy for field hospitals, in the context of the COVID-19 pandemic. METHOD: Reflective study, carried out in April 2020, based on the recommendations of the World Health Organization and the guide for the implementation of the five components of the Multimodal Strategy: system change related to infrastructure; training/education; evaluation and feedback; reminders in the workplace; and institutional security climate. RESULTS: The Multimodal Strategy, proposed for hospitals in general, can be adapted for field hospitals in order to reduce the transmission of the SARS-CoV-2 virus. Investments to adapt the infrastructure and education of workers require foresight and speed and are of special relevance to promote hand hygiene in this care context. FINAL CONSIDERATIONS: Adjusting the Multimodal Strategy, especially for the reduced time in the execution of each component, is necessary for field hospitals with a view to preventing COVID-19.

A discrete-time-evolution model to forecast progress of Covid-19 outbreak.

Here we present a discrete-time-evolution model with one day interval to forecast the propagation of Covid-19. The proposed model can be easily implemented with daily updated data sets of the pandemic publicly available by distinct online sources. It has only two adjustable parameters and it predicts the evolution of the total number of infected people in a country for the next 14 days if parameters do not change during the analyzed period. The model incorporates the main aspects of the disease such as the fact that there are asymptomatic and symptomatic phases (both capable of propagating the virus), and that these phases take almost two weeks before the infected person status evolves to the next (asymptomatic becomes symptomatic or symptomatic becomes either recovered or dead). A striking advantage of the model for its implementation by the health sector is that it gives directly the number of total infected people in each day (in thousands, tens of thousands or hundred of thousands). Here, the model is tested with data from Brazil, UK and South Korea, presenting low error rates on the prediction of the evolution of the disease in all analyzed countries. We hope this model may be a useful tool to estimate the propagation of the disease.