Healthcare institutions' recommendation regarding the use of FFP-2 masks and SARS-CoV-2 seropositivity among healthcare workers: a multicenter longitudinal cohort study.

BACKGROUND: Health care workers (HCW) are heavily exposed to SARS-CoV-2 from the beginning of the pandemic. We aimed to analyze risk factors for SARS-CoV-2 seroconversion among HCW with a special emphasis on the respective healthcare institutions' recommendation regarding the use of FFP-2 masks. METHODS: We recruited HCW from 13 health care institutions (HCI) with different mask policies (type IIR surgical face masks vs. FFP-2 masks) in Southeastern Switzerland (canton of Grisons). Sera of participants were analyzed for the presence of SARS-CoV-2 antibodies 6 months apart, after the first and during the second pandemic wave using an electro-chemiluminescence immunoassay (ECLIA, Roche Diagnostics). We captured risk factors for SARS-CoV-2 infection by using an online questionnaire at both time points. The effects of individual COVID-19 exposure, regional incidence and FFP-2 mask policy on the probability of seroconversion were evaluated with univariable and multivariable logistic regression. RESULTS: SARS-CoV-2 antibodies were detected in 99 of 2794 (3.5%) HCW at baseline and in 376 of 2315 (16.2%) participants 6 months later. In multivariable analyses the strongest association for seroconversion was exposure to a household member with known COVID-19 (aOR: 19.82, 95% CI 8.11-48.43, p < 0.001 at baseline and aOR: 8.68, 95% CI 6.13-12.29, p < 0.001 at follow-up). Significant occupational risk factors at baseline included exposure to COVID-19 patients (aOR: 2.79, 95% CI 1.28-6.09, p = 0.010) and to SARS-CoV-2 infected co-workers (aOR: 2.50, 95% CI 1.52-4.12, p < 0.001). At follow up 6 months later, non-occupational exposure to SARS-CoV-2 infected individuals (aOR: 2.54, 95% CI 1.66-3.89 p < 0.001) and the local COVID-19 incidence of the corresponding HCI (aOR: 1.98, 95% CI 1.30-3.02, p = 0.001) were associated with seroconversion. The healthcare institutions' mask policy (surgical masks during usual exposure vs. general use of FFP-2 masks) did not affect seroconversion rates of HCW during the first and the second pandemic wave. CONCLUSION: Contact with SARS-CoV-2 infected household members was the most important risk factor for seroconversion among HCW. The strongest occupational risk factor was exposure to COVID-19 patients. During this pandemic, with heavy non-occupational exposure to SARS-CoV-2, the mask policy of HCIs did not affect the seroconversion rate of HCWs.

Non-pharmaceutical interventions during the COVID-19 epidemic changed detection rates of other circulating respiratory pathogens in Japan.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has circulated worldwide and causes coronavirus disease 2019 (COVID-19). At the onset of the COVID-19 pandemic, infection control measures were taken, such as hand washing, mask wearing, and behavioral restrictions. However, it is not fully clear how the effects of these non-pharmaceutical interventions changed the prevalence of other pathogens associated with respiratory infections. In this study, we collected 3,508 nasopharyngeal swab samples from 3,249 patients who visited the Yamanashi Central Hospital in Japan from March 1, 2020 to February 28, 2021. We performed multiplex polymerase chain reaction (PCR) using the FilmArray Respiratory Panel and singleplex quantitative reverse transcription PCR targeting SARS-CoV-2 to detect respiratory disease-associated pathogens. At least one pathogen was detected in 246 (7.0%) of the 3,508 samples. Eleven types of pathogens were detected in the samples collected from March-May 2020, during which non-pharmaceutical interventions were not well implemented. In contrast, after non-pharmaceutical interventions were thoroughly implemented, only five types of pathogens were detected, and the majority were SARS-CoV-2, adenoviruses, or human rhinoviruses / enteroviruses. The 0-9 year age group had a higher prevalence of infection with adenoviruses and human rhinoviruses / enteroviruses compared with those 10 years and older, while those 10 years and older had a higher prevalence of infection with SARS-CoV-2 and other pathogens. These results indicated that non-pharmaceutical interventions likely reduced the diversity of circulating pathogens. Moreover, differences in the prevalence of pathogens were observed among the different age groups.

Management of donations of personal protective equipment in response to the massive shortage during the COVID-19 health crisis: providing quality equipment to health care workers.

BACKGROUND: In the COVID-19 pandemic context, a massive shortage of personal protective equipment occurred. To increase the available stocks, several countries appealed for donations from individuals or industries. While national and international standards to evaluate personal protective equipment exist, none of the previous research studied how to evaluate personal protective equipment coming from donations to healthcare establishments. Our aim was to evaluate the quality and possible use of the personal protective equipment donations delivered to our health care establishment in order to avoid a shortage and to protect health care workers throughout the COVID-19 crisis. METHODS: Our intervention focused on evaluation of the quality of donations for medical use through creation of a set of assessment criteria and analysis of the economic impact of these donations. RESULTS: Between 20th March 2020 and 11th May 2020, we received 239 donations including respirators, gloves, coveralls, face masks, gowns, hats, overshoes, alcohol-based hand rubs, face shields, goggles and aprons. A total of 448,666 (86.3%) products out of the 519,618 initially received were validated and distributed in health care units, equivalent to 126 (52.7%) donations out of the 239 received. The budgetary value of the validated donations was 32,872 euros according to the pre COVID-19 prices and 122,178 euros according to the current COVID-19 prices, representing an increase of 371.7%. CONCLUSIONS: By ensuring a constant influx of personal protective equipment and proper stock management, shortages were avoided. Procurement and distribution of controlled and validated personal protective equipment is the key to providing quality care while guaranteeing health care worker safety.

Efectividad del uso de doble mascarilla para prevenir la transmisión de del SARS-CoV-2 / Effectiveness of the use of double masks to prevent the transmission of SARS-CoV-2

ANTECEDENTES: Este informe se efectúa en atención a la solicitud de la Jefatura del Instituto Nacional de Salud. El objetivo es sintetizar la evidencia científica publicada respecto a la efectividad del uso de doble mascarilla o combinación de una mascarilla y respirador KN95 en un entorno comunitario. El respirador KN95 fue incluido, ya que está disponible para su uso en la comunidad. MÉTODOS: Pregunta PICO abordada: ¿Cuál es la efectividad del uso de doble mascarilla o combinación de una mascarilla y respirador KN95 para prevenir la transmisión de del SARS-CoV-2? Criterios de elegibilidad: Los criterios de selección de los estudios fueron los siguientes: Estudios que corresponden a la pregunta PICO y que reporten resultados para al menos uno de los desenlaces considerados. Se incluyeron estudios publicados en idioma inglés y español. Diseño de estudios a incluir: ensayos clínicos, ensayos de campo, estudios de cohorte y en ausencia de éstos, estudios preclínicos (simulaciones bajo condiciones de laboratorio). Se excluyeron cartas al editor, revisiones narrativas y artículos de opinión. Métodos de búsqueda: Se realizó una búsqueda sistemática hasta el 21 de octubre de 2021 en COVID-END, MEDLINE/ PubMed, MedRxiv y en la Plataforma Living Overview of the Evidence (L·OVE) de la Fundación Epistemonikos, incluyendo términos en lenguaje natural y lenguaje estructurado (Tesauros) según cada base de datos para COVID-19 ó SARS-CoV-2 y "doble mascarilla". Selección de evidencia, extracción de datos y análisis: La selección de estudios consideró una fase inicial de lectura de títulos y resúmenes, seguida de una fase de lectura del texto completo de las referencias potencialmente relevantes identificadas. La selección y extracción de los datos fue realizada por un solo revisor. Se realizó una síntesis narrativa de los datos extraídos. Este informe no incluye una evaluación de riesgo de sesgo de los estudios incluidos. RESULTADOS: Efectividad del uso de doble mascarilla o de la combinación de mascarilla y respirador KN95. No se encontraron estudios que hayan evaluado la efectividad de usar doble mascarilla o combinar mascarilla más el respirador KN95 en entornos comunitarios. Evidencia procedente de estudios experimentales. Eficiencia de la filtración de partículas. Pruebas de ajuste. Eficiencia de control de la fuente. Reducción de la exposición en el receptor. CONCLUSIONES: El objetivo del informe fue sintetizar la evidencia científica publicada respecto a la efectividad del uso de doble mascarilla o combinación de una mascarilla y respirador KN95 en un entorno comunitario. No se encontraron estudios clínicos que hayan evaluado la efectividad de usar doble mascarilla o combinar mascarilla más el respirador KN95 en entornos comunitarios. Se identificaron 5 estudios de simulación experimental que evaluaron a) la capacidad de filtración de partículas de los materiales utilizados por las mascarillas, b) el factor de ajuste, c) la eficiencia en el control de la fuente, referido a la capacidad para bloquear las partículas emitidas por un simulador (fuente) durante una tos o respiración simulada o d) la reducción de la exposición a los aerosoles en el receptor. Los estudios utilizaron métodos distintos para las simulaciones y medición de sus desenlaces. Respecto a la eficiencia en la filtración de partículas, existe inconsistencia en los resultados para la combinación de una mascarilla de tela encima de la mascarilla quirúrgica o de procedimientos médicos, ya que uno de los estudios observó un aumento de la eficiencia de filtración (66% a 81% con la combinación frente a 55% con solo una mascarilla quirúrgica) mientras que un estudio adicional no observó cambios en los resultados luego de usar doble mascarilla. Los estudios si coincidieron en mostrar que la eficiencia de las mascarillas de tela es pobre, usar doble mascarilla quirúrgica disminuyó la eficiencia de filtración y no se observaron mejoras con usar doble mascarilla de tela o usar la mascarilla quirúrgica encima de la mascarilla de tela. El uso de doble mascarilla (mascarilla de tela de algodón de 3 capas encima de mascarilla quirúrgica) aumentó el factor de ajuste pero en menor grado a lo logrado con modificaciones para optimizar el ajuste a una sola mascarilla quirúrgica o de procedimientos médico, consistentes en usar un accesorio tipo abrazadera para fijar la mascarilla ó la técnica de nudos y pliegues "Knotted & tucked" que consiste en anudar las bandas para las orejas donde se unen con el borde de la mascarilla, luego doblar y plegar el material sobrante debajo de los bordes. En comparación a usar una sola mascarilla quirúrgica o de procedimientos médicos o una sola mascarilla de tela, el uso de doble mascarilla incrementó la eficiencia en el control de la fuente (85% a 92%). La combinación consistió en una mascarilla de tela de algodón de 3 capas encima de una mascarilla quirúrgica o similar. Esta mejora también fue observada con el uso de un accesorio tipo abrazadera para fijar la mascarilla (95% a 99%) o con la técnica de nudos y pliegues (74%). Frente a sólo usar un respirador KN95, el uso de una mascarilla quirúrgica encima de un respirador KN95 aumenta la protección respiratoria de quien los usa (reducción de la exposición del 89%), aunque una modificación al respirador que optimice su ajuste como la adición de ligas elastoméricas para ajuste en la cabeza obtuvo mejores resultados (reducción del 97%). Si conjuntamente la fuente generadora de los aerosoles como el receptor usaban doble mascarilla, la reducción de la exposición fue del 96%, cuando la combinación consistió en una mascarilla de tela de algodón de 3 capas encima de una mascarilla quirúrgica. Resultados similares se obtuvieron si conjuntamente la fuente como el receptor usaban mascarillas quirúrgicas modificadas con la técnica de nudos y pliegues. Basados en la evidencia disponible, los mejores resultados, a partir de simulaciones en laboratorio, se observaron con el uso de doble mascarilla (mascarilla de tela de algodón de al menos 3 capas encima de una mascarilla quirúrgica), la combinación de una mascarilla quirúrgica encima de un respirador KN95 o con las modificaciones que optimicen el ajuste al rostro, como adicionar ligas elastoméricas para ajustar el respirador KN95 a la cabeza, emplear la técnica de nudos o pliegues en las mascarillas quirúrgicas o adicionar un accesorio de tipo abrazadera para fijar la mascarilla. No es posible establecer en qué medida estos resultados se traducirían con niveles de protección respiratoria en situaciones reales.

A Statewide Voluntary Movement Addressing the Shortage of Medical Supplies During the COVID-19 Pandemic.

During the COVID-19 pandemic, a shortage of personal protective equipment compromised efficient patient care and provider safety. Volunteers from many different backgrounds worked to meet these demands. Additive manufacturing, laser cutting, and alternative supply chains were used to produce, test, and deliver essential equipment for health care workers and first responders. Distributed equipment included ear guards, face shields, and masks. Contingent designs were created for powered air-purifying respirator hoods, filtered air pumps, intubation shields, and N95 masks.

Uso de Mascarillas Venturi vs Máscaras con reservorio en pacientes hospitalizados con COVID-19 en proceso de destete / Use of Venturi Masks vs Masks with a reservoir in hospitalized patients with COVID-19 in the weaning process

ANTECEDENTES: El presente informe se efectúa en atención a la solicitud de la Dirección General de Intervenciones Estratégicas en Salud Pública del Ministerio de Salud. El objetivo del presente informe es: Describir el proceso para la elaboración de recomendaciones por el grupo de trabajo designado por el Ministerio de Salud. Trasladar las Recomendaciones efectuadas por dicho grupo de trabajo en atención a la toma decisión del uso de mascarillas venturi en pacientes hospitalizados con COVID-19 en proceso de destete, según el formato de pregunta PICO (P: Población, I:Intervención, C:Comparador, O: Outcome o desenlaces). La metodología considerada para elaborar la recomendación fue el Marco de Evidencia a la Decisión/Recomendación desarrollado por el Grupo de Trabajo GRADE(1,2). METODOS: Pregunta PICO validada: El grupo de trabajó formuló y validó la pregunta PICO sobre el uso de las mascarillas venturi. PICO: En pacientes diagnosticados con COVID-19 hospitalizados en proceso de destete de CAF o VM ¿Es preferible el uso de mascarilla venturi vs máscara de reservorio para evitar el retorno a VM o CF (fracaso al destete) / Evitar la transmisión intrahospitalaria de aerosoles? Revisión de Guías de Práctica Clínica (GPC) que hayan abordado la pregunta PICO: Primeramente, se revisaron las guías elaboradas recientemente en Perú. La GPC del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de ESSALUD, Perú. Asimismo, se empleó la herramienta eCovid RecMap1 disponible en https://covid19.recmap.org/, Platafoma L-OVE, con el fin de identificar alguna GPC que haya abordado la pregunta PICO. Diálogo Deliberativo para la valoración de los criterios del Marco EtD y elaboración de las recomendaciones: La sesión de diálogo deliberativo se llevó a cabo el día 22 de julio de 2021 reunión virtual a través de la Plataforma Zoom, con la participación de: Profesionales del Grupo de trabajo designado por el Ministerio de Salud, en su calidad de panel de expertos, habilitados para emitir los juicios para cada criterio, votar en caso de ser necesario y elaborar la recomendación. Representantes del Ministerio de Salud quienes convocan a la reunión o son moderadores de la misma, en calidad de observadores del proceso. Representantes de la Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP) del INS, quienes elaboraron la revisión de la evidencia presentada ante los expertos, en calidad de facilitadores y conductores de los aspectos metodológicos de la reunión. RECOMENDACIONES: Se sugiere el uso de mascarillas venturi, como punto de buena práctica clínica en función de la necesidad del paciente, considerando adicionar una mascarilla quirúrgica para la disminución de la formación de aerosoles; tomando en cuenta que han pasado un mínimo de 15 días con la enfermedad, disminuyendo así la probabilidad de contagio. En tal sentido, en el escenario del paciente en proceso de destete se ha observado que el virus es prácticamente inexistente, a pesar del resultado positivo en las pruebas PCR. Por otro lado, el personal de salud posee los equipos de protección apropiados, lo cual reduce significativamente el riesgo de contagio.

AFN Acessibilidade - Semana de 07/06 a 11/06

Com o objetivo de ampliar a divulgação de notícias sobre Covid-19 para pessoas com deficiências auditivas, a Coordenação de Comunicação Social (CCS/Fiocruz) lançou um programa semanal que reúne as principais notícias publicadas na Agência Fiocruz de Notícias (AFN) traduzidas para a Língua Brasileira de Sinais (Libras) e com áudio em português.

Homemade facemasks: particle filtration, breathability, fit, and other performance characteristics.

Homemade cloth masks and other improvised face coverings have become widespread during the COVID-19 pandemic driven by severe shortages of personal protective equipment. In this study, various alternative (mostly common household) materials, which have not traditionally been used in respiratory protective devices, were tested for particle filtration performance and breathability. Most of these materials were found of some-but rather limited-utility in facemasks. At a breathing flow rate of 30 L min-1, 17 out of 19 tested materials demonstrated collection efficiency below 50%; at 85 L min-1, only one material featured particle collection efficiency above 50%. Pressure drop values were mostly below 4 mm w.g. (observed in 89% of cases for the two flow rates), which provides comfortable breathing. Only for one fabric material (silk) tested at 85 L min-1 did the pressure drop reach 11 mm w.g. Based on these results, a three-layer facemask prototype was designed and fabricated comprised of the best performing materials. Additional tests were conducted to examine possible particle detachment/shedding from the materials used in the newly developed facemask, but no such phenomenon was observed. The prototype was evaluated on 10 human subjects using the standard OSHA-approved quantitative fit testing protocol. The mask protection level, determined as an adopted fit factor, was found to lie between that of the two commercial surgical/medical masks tested for comparison. A 10-cycle washing of the mask prototype lowered its collection efficiency across the particle size range; however, washing did not substantially affect mask breathability. The study revealed that although homemade masks offer a certain level of protection to a wearer, one should not expect them to provide the same respiratory protection as high-end commercial surgical/medical masks or-by any means-NIOSH-certified N95 filtering facepieces.

COVID-19 pandemic: A review of the global lockdown and its far-reaching effects.

COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) on the 11th of March 2020, leading to some form of lockdown across almost all countries of the world. The extent of the global pandemic due to COVID-19 has a significant impact on our lives that must be studied carefully to combat it. This study highlights the impacts of the COVID-19 pandemic lockdown on crucial aspects of daily life globally, including; Food security, Global economy, Education, Tourism, hospitality, sports and leisure, Gender Relation, Domestic Violence/Abuse, Mental Health and Environmental air pollution through a systematic search of the literature. The COVID-19 global lockdown was initiated to stem the spread of the virus and 'flatten the curve' of the pandemic. However, the impact of the lockdown has had far-reaching effects in different strata of life, including; changes in the accessibility and structure of education delivery to students, food insecurity as a result of unavailability and fluctuation in prices, the depression of the global economy, increase in mental health challenges, wellbeing and quality of life amongst others. This review article highlights the impacts of the COVID-19 pandemic lockdown across the globe. As the global lockdown is being lifted in a phased manner in various countries of the world, it is necessary to explore its impacts to understand its consequences comprehensively. This will guide future decisions that will be made in a possible future wave of the COVID-19 pandemic or other global disease outbreak.

Not far enough: Public health policies to combat COVID-19 in Mexico's states.

BACKGROUND: Mexican state governments' actions are essential to control the COVID-19 pandemic within the country. However, the type, rigor and pace of implementation of public policies have varied considerably between states. Little is known about the subnational (state) variation policy response to the COVID-19 pandemic in Mexico. MATERIAL AND METHODS: We collected daily information on public policies designed to inform the public, as well as to promote distancing, and mask use. The policies analyzed were: School Closure, Workplace Closure, Cancellation of Public Events, Restrictions on Gatherings, Stay at Home Order, Public Transit Suspensions, Information Campaigns, Internal Travel Controls, International Travel Controls, Use of Face Masks We use these data to create a composite index to evaluate the adoption of these policies in the 32 states. We then assess the timeliness and rigor of the policies across the country, from the date of the first case, February 27, 2020. RESULTS: The national average in the index during the 143 days of the pandemic was 41.1 out of a possible 100 points on our index. Nuevo León achieved the highest performance (50.4); San Luis Potosí the lowest (34.1). The differential between the highest versus the lowest performance was 47.4%. CONCLUSIONS: The study identifies variability and heterogeneity in how and when Mexican states implemented policies to contain COVID-19. We demonstrate the absence of a uniform national response and widely varying stringency of state responses. We also show how these responses are not based on testing and do not reflect the local burden of disease. National health system stewardship and a coordinated, timely, rigorous response to the pandemic did not occur in Mexico but is desirable to contain COVID-19.

The effect of the synchronized multi-dimensional policies on imported COVID-19 curtailment in China.

As countries are lifting restrictions and resuming international travels, the rising risk of COVID-19 importation remains concerning, given that the SARS-CoV-2 virus could be transmitted unintentionally through the global transportation network. To explore and assess the effective strategies for curtailing the epidemic risk from international importation nationwide, we evaluated "the joint prevention and control" mechanism, which made up of 19 containment policies, on how it impacted the change of medical observation and detection time from border arrival to laboratory confirmation of COVID-19 in its burst in China. Based on 1,314 epidemiological-survey cases from February 29 to May 25, 2020, we found that the synchronized approach of implementing multi-dimensional interventional policies, such as a centralized quarantine and nucleic acid testing (NAT), flight service adjustment and border closure, effectively facilitate early identification of infected case. Specifically, the implementation of the international flight service reduction was found to be associated with a reduction of the mean intervals of diagnosis from arrival to lab-confirmation by 0.44 days maximally, and the border closure was associated with a reduction of the diagnosis interval of imported cases by 0.69 days, from arrival to laboratory confirmation. The study suggests that a timely and synchronized implementation of multi-dimensional policies is compelling in preventing domestic spreading from importation.

Masks for at-risk population: nursing promoting biosafety in pandemic times.

OBJECTIVE: To describe a proposal for making and distributing masks for population in risk, with guidance on the stages of making them and the care in handling them based on the development of educational video and infographic. METHOD: Experience report on the stages of the process of training people to make fabric masks for the population at risk, between March and June 2020, in a city in the interior of São Paulo. RESULTS: 1,650 masks were made and distributed to vulnerable population groups from different contexts and tutorial video and infographic were elaborated and released to enable people to make their own masks with resources available at home. FINAL CONSIDERATIONS: It was possible to manufacture and distribute masks for the population at risk and develop educational actions to contain the disease, given the advance of confirmed cases and deaths by Covid-19, corroborating the role of nursing in health education.

Coletiva de imprensa OPAS COVID-19 - 31/03/2021

Coletiva de Imprensa OPAS COVID-19 31 de março de 2021 - áudio em Português.

Sesión informativa para la prensa sobre la COVID-19 en las Américas - 31/03/2021

Sesión informativa para la prensa sobre la COVID-19 en las Américas - audio Español.

PAHO press briefing on COVID-19 in the Americas - 03/31/2021

PAHO press briefing on COVID-19 in the Americas - 03/31/2021 - audio em English.

Conferencia de prensa de la OPS sobre COVID-19 - 31/03/2021

Conferencia de prensa de la OPS sobre COVID-19 / PAHO’s virtual press briefing on COVID-19 - audio original.

PAHO press briefing on COVID-19 - 03/31/2021

PAHO press briefing on COVID-19 - 03/31/2021 - audio French