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2.
BMC Public Health ; 21(1): 54, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407302

RESUMEN

BACKGROUND: The COVID-19 outbreak is a global pandemic, during which the community preventive and protective behaviors play a crucial role in the containment and control of infection. This study was designed to contribute to the existing knowledge on how risk communication (RC) and risk perception (RP) affect protective and preventive behaviors (PPB) during the COVID-19 outbreak. METHODS: The required data were extracted from a national online survey of Iranian adults aged 15 and older during March 15-19, 2020 (n=3213). Data analysis was performed using structural equation modeling. RESULTS: The study findings reveal that RC has direct and indirect positive effects on PB. Furthermore, this study also provides new evidence indicating that RP mediates the relationship between RC and PB and there is a two-way relationship between RC and RP. These interactions may have impact on risk communication strategies which should be adopted during this pandemic. CONCLUSION: The study findings have remarkable implications for informing future communications as well as interventions during this ongoing outbreak and subsequent national risk events.


Asunto(s)
/prevención & control , Comunicación , Brotes de Enfermedades , Riesgo , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad
3.
BMC Public Health ; 21(1): 58, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407321

RESUMEN

BACKGROUND: To date, there is no effective treatment for COVID-19, which is a pandemic disease, caused by a novel coronavirus called SARS-CoV-2. In Togo, where four in five people practice self-medication, the absence of a cure for COVID-19 and the constant progression of the disease requires an assessment of self-medication patterns in the context of the pandemic. This study aimed to estimate the prevalence of self-medication to prevent COVID-19 and its associated factors in Lomé, Togo. METHODS: A cross-sectional study was conducted in Lomé, the capital city of Togo, from April 23rd to May 8th, 2020, with a sample of participants from five sectors: the healthcare, air transport, police, road transport and informal sectors. The participants were invited to provide information about their self-medication practices to prevent COVID-19 in the 2 weeks preceding the survey. RESULTS: A total of 955 participants (71.6% men) with a median age of 36 (IQR 32-43) were included. Approximately 22.1% were in the air transport sector, 20.5% were in the police sector, and 38.7% were in the health sector. The overall prevalence of self-medication to prevent COVID-19 was 34.2% (95% CI: 31.2-37.3%). The most commonly used products were vitamin C (27.6%) and traditional medicine (10.2%). Only 2.0% of participants reported using chloroquine/hydroxychloroquine. Female sex (aOR=1.90; p< 0.001), work in the health sector (aOR=1.89; p= 0.001), secondary education level (aOR= 2.28; p= 0.043) and university education level (aOR= 5.11; p< 0.001) were associated with self-medication. CONCLUSION: One-third of the individuals in high-risk populations in Lomé practiced self-medication. Intensifying awareness campaigns is crucial to fight misinformation about alleged COVID-19 prevention products on social media.


Asunto(s)
/prevención & control , Brotes de Enfermedades , Automedicación/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Togo/epidemiología
4.
BMC Public Health ; 21(1): 83, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413218

RESUMEN

BACKGROUND: During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities. METHODS: The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively. RESULTS: Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia. CONCLUSIONS: This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.


Asunto(s)
/epidemiología , Instituciones de Salud , Personal de Salud/estadística & datos numéricos , Instituciones Residenciales , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Enfermedad Crónica , Comorbilidad , Diabetes Mellitus/epidemiología , Brotes de Enfermedades , Femenino , Hogares para Ancianos , Hospitales , Humanos , Vida Independiente/estadística & datos numéricos , Lactante , Italia/epidemiología , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Pandemias , Distribución por Sexo , Adulto Joven
5.
BMC Public Health ; 21(1): 79, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413224

RESUMEN

BACKGROUND: About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS: In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS: Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS: The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.


Asunto(s)
Adaptación Psicológica , Empleo/psicología , Resiliencia Psicológica , Factores Sexuales , Estrés Psicológico/psicología , Adulto , Factores de Edad , China/epidemiología , Estudios Transversales , Brotes de Enfermedades , Emociones , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Salud Mental , Servicios de Salud Mental , Persona de Mediana Edad , Evaluación de Necesidades , Pandemias , Factores de Riesgo , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios
6.
PLoS One ; 16(1): e0245101, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33417605

RESUMEN

In December 2019, the outbreak of a new coronavirus-caused pneumonia (COVID-19) in Wuhan attracted close attention in China and the world. The Chinese government took strong national intervention measures on January 23 to control the spread of the epidemic. We are trying to show the impact of these controls on the spread of the epidemic. We proposed an SEIR(Susceptible-Exposed-Infectious-Removed) model to analyze the epidemic trend in Wuhan and use the AI model to analyze the epidemic trend in non-Wuhan areas. We found that if the closure was lifted, the outbreak in non-Wuhan areas of mainland China would double in size. Our SEIR and AI model was effective in predicting the COVID-19 epidemic peaks and sizes. The epidemic control measures taken by the Chinese government, especially the city closure measures, reduced the scale of the COVID-19 epidemic.


Asunto(s)
/epidemiología , Modelos Estadísticos , /prevención & control , China , Brotes de Enfermedades , Epidemias , Humanos
7.
Int J Biol Sci ; 17(1): 1-7, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33390828

RESUMEN

Objective: Since December 2019, an outbreak of coronavirus disease 2019 (COVID 19) has been experienced from Wuhan, China to the world. A retrospective cohort study was conducted to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors affecting the disease duration in Jiangan Fangcang shelter hospital, Wuhan, China. Methods: Clinical characteristics of 409 patients with COVID-19 were retrospectively analyzed. We describe the clinical characteristics and distribution of discharge time or transfer time for each patient. Then we performed univariate and multivariate Cox regression analysis to identify potential risk factors for progression from non-severe to severe COVID-19 or death. Results: The median disease duration of all patients was 23 days (IQR 19-28). The main symptoms of the patient were fever (95.6%), cough (74.3%), tiredness (21.5%), and so on. Comorbidities mainly included hypertension (30.6%) diabetes (17.6%) and heart disease (12.5%). The univariate Cox regression analysis showed that old age, number of symptoms, the combination of hypertension, heart disease and pulmonary disease were associated with the progression of disease. The multivariate Cox regression analysis showed that old age (HR: 7.294; 95% CI: 1.442-36.888; P = 0.016), the combination of hypertension (HR: 2.230; 95% CI: 1.090-4.562; P = 0.028) and heart disease (HR: 2.650; 95% CI: 1.079-6.510; P = 0.034) were independent risk factors for progression of COVID-19. Conclusions: The age of the patient, the combination of hypertension and heart disease were independent risk factors for the progression of COVID-19. Cautions should be raised for patients with these risk factors.


Asunto(s)
/patología , /epidemiología , /virología , China/epidemiología , Brotes de Enfermedades , Progresión de la Enfermedad , Humanos , Estudios Retrospectivos , Factores de Riesgo , /aislamiento & purificación
8.
Int J Biol Sci ; 17(1): 97-106, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33390836

RESUMEN

The outbreak of the coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic apparently started in December 2019 in Wuhan, China, and has since affected many countries worldwide, turning into a major global threat. Chinese researchers reported that SARS-CoV-2 could be classified into two major variants. They suggest that investigating the variations and characteristics of these variants might help assess risks and develop better treatment and prevention strategies. The two variants were named L-type and S-type, in which L-type was prevailed in an initial outbreak in Wuhan, Central China's Hubei Province, and S-type was phylogenetically older than L-type and less prevalent at an early stage, but with a later increase in frequency in Wuhan. There were 149 mutations in 103 sequenced SARS-CoV-2 genomes, 83 of which were nonsynonymous, leading to alteration in the amino acid sequence of proteins. Much effort is currently being devoted to elucidate whether or not these mutations affect viral transmissibility and virulence. In this review, we summarize the mutations in SARS-CoV-2 during the early phase of virus evolution and discuss the significance of the gene alterations in infections.


Asunto(s)
/virología , Mutación , Pandemias , /genética , Adaptación Fisiológica , China/epidemiología , Brotes de Enfermedades , Genoma Viral , Humanos , Filogenia , Recombinación Genética , /fisiología
9.
Chin J Integr Med ; 27(1): 3-6, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33420601

RESUMEN

Covid-19 pandemic has caused hundreds of thousands deaths and millions of infections and continued spreading violently. Although researchers are racing to find or develop effective drugs or vaccines, no drugs from modern medical system have been proven effective and the high mutant rates of the virus may lead it resistant to whatever drugs or vaccines developed following modern drug development procedure. Current evidence has demonstrated impressive healing effects of several Chinese medicines (CMs) for Covid-19, which urges us to reflect on the role of CM in the era of modern medicine. Undoubtedly, CM could be promising resources for developing drug candidates for the treatment of Covid-19 in a way similar to the development of artemisinin. But the theory that builds CM, like the emphasis of driving away exogenous pathogen (virus, etc.) by restoring self-healing capacity rather than killing the pathogen directly from the inside and the 'black-box' mode of diagnosing and treating patients, is as important, yet often ignored, an treasure as CM herbs and should be incorporated into modern medicine for future advancement and innovation of medical science.


Asunto(s)
/terapia , Medicamentos Herbarios Chinos/uso terapéutico , Medicina China Tradicional , Antivirales/farmacología , Antivirales/uso terapéutico , Brotes de Enfermedades , Desarrollo de Medicamentos/métodos , Desarrollo de Medicamentos/normas , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/farmacología , Humanos , Medicina China Tradicional/métodos , Medicina China Tradicional/tendencias , Tasa de Mutación , Pandemias , Fitoterapia/métodos , /fisiología
10.
Nat Commun ; 12(1): 232, 2021 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431829

RESUMEN

Contact tracing is critical to controlling COVID-19, but most protocols only "forward-trace" to notify people who were recently exposed. Using a stochastic branching-process model, we find that "bidirectional" tracing to identify infector individuals and their other infectees robustly improves outbreak control. In our model, bidirectional tracing more than doubles the reduction in effective reproduction number (Reff) achieved by forward-tracing alone, while dramatically increasing resilience to low case ascertainment and test sensitivity. The greatest gains are realised by expanding the manual tracing window from 2 to 6 days pre-symptom-onset or, alternatively, by implementing high-uptake smartphone-based exposure notification; however, to achieve the performance of the former approach, the latter requires nearly all smartphones to detect exposure events. With or without exposure notification, our results suggest that implementing bidirectional tracing could dramatically improve COVID-19 control.


Asunto(s)
/prevención & control , Trazado de Contacto/métodos , Brotes de Enfermedades/prevención & control , /diagnóstico , Simulación por Computador , Humanos , Aplicaciones Móviles , Sensibilidad y Especificidad , Teléfono Inteligente
11.
Nat Commun ; 12(1): 222, 2021 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431854

RESUMEN

Infectious disease prevention, control and forecasting rely on sentinel observations; however, many locations lack the capacity for routine surveillance. Here we show that, by using data from multiple sites collectively, accurate estimation and forecasting of respiratory diseases for locations without surveillance is feasible. We develop a framework to optimize surveillance sites that suppresses uncertainty propagation in a networked disease transmission model. Using influenza outbreaks from 35 US states, the optimized system generates better near-term predictions than alternate systems designed using population and human mobility. We also find that monitoring regional population centers serves as a reasonable proxy for the optimized network and could direct surveillance for diseases with limited records. The  proxy method is validated using model simulations for 3,108 US counties and historical data for two other respiratory pathogens - human metapneumovirus and seasonal coronavirus - from 35 US states and can be used to guide systemic allocation of surveillance efforts.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Vigilancia de la Población/métodos , Incertidumbre , Infecciones por Coronavirus/epidemiología , Predicción , Humanos , Gripe Humana/epidemiología , Modelos Estadísticos
12.
J Korean Med Sci ; 36(1): e12, 2021 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-33398946

RESUMEN

BACKGROUND: A coronavirus disease 2019 (COVID-19) outbreak started in February 2020 and was controlled at the end of March 2020 in Daegu, the epicenter of the coronavirus outbreak in Korea. The aim of this study was to describe the clinical course and outcomes of patients with COVID-19 in Daegu. METHODS: In collaboration with Daegu Metropolitan City and Korean Center for Diseases Control, we conducted a retrospective, multicenter cohort study. Demographic, clinical, treatment, and laboratory data, including viral RNA detection, were obtained from the electronic medical records and cohort database and compared between survivors and non-survivors. We used univariate and multi-variable logistic regression methods and Cox regression model and performed Kaplan-Meier analysis to determine the risk factors associated with the 28-day mortality and release from isolation among the patients. RESULTS: In this study, 7,057 laboratory-confirmed patients with COVID-19 (total cohort) who had been diagnosed from February 18 to July 10, 2020 were included. Of the total cohort, 5,467 were asymptomatic to mild patients (77.4%) (asymptomatic 30.6% and mild 46.8%), 985 moderate (14.0%), 380 severe (5.4%), and 225 critical (3.2%). The mortality of the patients was 2.5% (179/7,057). The Cox regression hazard model for the patients with available clinical information (core cohort) (n = 2,254) showed the risk factors for 28-day mortality: age > 70 (hazard ratio [HR], 4.219, P = 0.002), need for O2 supply at admission (HR, 2.995; P = 0.001), fever (> 37.5°C) (HR, 2.808; P = 0.001), diabetes (HR, 2.119; P = 0.008), cancer (HR, 3.043; P = 0.011), dementia (HR, 5.252; P = 0.008), neurological disease (HR, 2.084; P = 0.039), heart failure (HR, 3.234; P = 0.012), and hypertension (HR, 2.160; P = 0.017). The median duration for release from isolation was 33 days (interquartile range, 24.0-46.0) in survivors. The Cox proportional hazard model for the long duration of isolation included severity, age > 70, and dementia. CONCLUSION: Overall, asymptomatic to mild patients were approximately 77% of the total cohort (asymptomatic, 30.6%). The case fatality rate was 2.5%. Risk factors, including older age, need for O2 supply, dementia, and neurological disorder at admission, could help clinicians to identify COVID-19 patients with poor prognosis at an early stage.


Asunto(s)
/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , Niño , Preescolar , Brotes de Enfermedades , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , República de Corea/epidemiología , Estudios Retrospectivos , Adulto Joven
13.
Antimicrob Resist Infect Control ; 10(1): 7, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407833

RESUMEN

OBJECTIVES: To compile current published reports on nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evaluate the role of healthcare workers (HCWs) in transmission, and evaluate outbreak management practices. METHODS: Narrative literature review. SHORT CONCLUSION: The coronavirus disease 2019 (COVID-19) pandemic has placed a large burden on hospitals and healthcare providers worldwide, which increases the risk of nosocomial transmission and outbreaks to "non-COVID" patients or residents, who represent the highest-risk population in terms of mortality, as well as HCWs. To date, there are several reports on nosocomial outbreaks of SARS-CoV-2, and although the attack rate is variable, it can be as high as 60%, with high mortality. There is currently little evidence on transmission dynamics, particularly using genomic sequencing, and the role of HCWs in initiating or amplifying nosocomial outbreaks is not elucidated. There has been a paradigm shift in management practices of viral respiratory outbreaks, that includes widespread testing of patients (or residents) and HCWs, including asymptomatic individuals. These expanded testing criteria appear to be crucial in identifying and controlling outbreaks.


Asunto(s)
/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Brotes de Enfermedades , Personal de Salud , /prevención & control , Infección Hospitalaria/virología , Instituciones de Salud , Hospitalización , Humanos , Vigilancia de la Población , Investigación
14.
BMC Psychiatry ; 21(1): 19, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33419411

RESUMEN

BACKGROUND: The 2019 coronavirus disease (COVID-19) has disrupted millions of lives and commerce. We investigated psychological reactions and insomnia during the COVID-19 outbreak in adults with mental health disorders (MDs). METHODS: A self-reported psychological and sleep online survey was conducted in China between February 5th to 19th, 2020. A total of 244 adults with MDs and 1116 controls matched for age, gender and sites were included. Worsened symptoms of anxiety, depressive and insomnia were defined when severity levels shifted to a more severe category compared to pre-COVID-19. RESULTS: During the COVID-19 outbreak, we found significantly increased prevalence of anxiety (MDs: 54.9% vs. 49.6%, controls: 25.5% vs. 14.3%), depression (MDs: 63.9% vs. 61.5%, controls: 29.9% vs. 21.2%) and insomnia (MDs: 66.0% vs. 57.8%, controls: 31.5% vs. 24.8%) compared to pre-COVID-19 period (all P-value < 0.001). Furthermore, adults with MDs had higher odds for developing COVID-19-related stress (OR = 3.41, 95% CI 2.49 ~ 4.67), worsened anxiety (OR = 1.95, 95% CI 1.38 ~ 2.76), depression (OR = 2.04, 95% CI 1.43 ~ 2.93) and insomnia (OR = 2.22, 95% CI 1.53 ~ 3.21) during the COVID-19 outbreak compared to controls. Moreover, higher COVID-19-related stress and lower levels of pre-COVID-19 anxiety, depressive and insomnia symptoms were predictors for worsened anxiety, depression and insomnia in adults with MDs, respectively. CONCLUSIONS: Our findings suggest that adverse psychological reactions and insomnia are more pronounced in adults with mental health disorders during the COVID-19 outbreak, thus more attention need to be provided.


Asunto(s)
Coronavirus , Trastornos del Inicio y del Mantenimiento del Sueño , Adulto , Ansiedad/epidemiología , China/epidemiología , Estudios Transversales , Depresión , Brotes de Enfermedades , Humanos , Salud Mental , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Estrés Psicológico
15.
Commun Biol ; 4(1): 60, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33402722

RESUMEN

The basic reproduction number, R0, determines the rate of spread of a communicable disease and therefore gives fundamental information needed to plan public health interventions. Using mortality records, we estimated the rate of spread of COVID-19 among 160 counties and county-aggregates in the USA at the start of the epidemic. We show that most of the high among-county variance is explained by four factors (R2 = 0.70): the timing of outbreak, population size, population density, and spatial location. For predictions of future spread, population density and spatial location are important, and for the latter we show that SARS-CoV-2 strains containing the G614 mutation to the spike gene are associated with higher rates of spread. Finally, the high predictability of R0 allows extending estimates to all 3109 counties in the conterminous 48 states. The high variation of R0 argues for public health policies enacted at the county level for controlling COVID-19.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Modelos Estadísticos , /virología , Análisis Factorial , Geografía Médica , Humanos , Densidad de Población , Vigilancia de la Población , Estados Unidos/epidemiología
16.
J R Soc Interface ; 18(174): 20200657, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33404371

RESUMEN

COVID-19 is highly transmissible and containing outbreaks requires a rapid and effective response. Because infection may be spread by people who are pre-symptomatic or asymptomatic, substantial undetected transmission is likely to occur before clinical cases are diagnosed. Thus, when outbreaks occur there is a need to anticipate which populations and locations are at heightened risk of exposure. In this work, we evaluate the utility of aggregate human mobility data for estimating the geographical distribution of transmission risk. We present a simple procedure for producing spatial transmission risk assessments from near-real-time population mobility data. We validate our estimates against three well-documented COVID-19 outbreaks in Australia. Two of these were well-defined transmission clusters and one was a community transmission scenario. Our results indicate that mobility data can be a good predictor of geographical patterns of exposure risk from transmission centres, particularly in outbreaks involving workplaces or other environments associated with habitual travel patterns. For community transmission scenarios, our results demonstrate that mobility data add the most value to risk predictions when case counts are low and spatially clustered. Our method could assist health systems in the allocation of testing resources, and potentially guide the implementation of geographically targeted restrictions on movement and social interaction.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Salud Pública , Viaje , Australia/epidemiología , Trazado de Contacto , Demografía , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Humanos , Modelos Biológicos , Medición de Riesgo
17.
PLoS One ; 16(1): e0244706, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33406106

RESUMEN

Without vaccines and treatments, societies must rely on non-pharmaceutical intervention strategies to control the spread of emerging diseases such as COVID-19. Though complete lockdown is epidemiologically effective, because it eliminates infectious contacts, it comes with significant costs. Several recent studies have suggested that a plausible compromise strategy for minimizing epidemic risk is periodic closure, in which populations oscillate between wide-spread social restrictions and relaxation. However, no underlying theory has been proposed to predict and explain optimal closure periods as a function of epidemiological and social parameters. In this work we develop such an analytical theory for SEIR-like model diseases, showing how characteristic closure periods emerge that minimize the total outbreak, and increase predictably with the reproductive number and incubation periods of a disease- as long as both are within predictable limits. Using our approach we demonstrate a sweet-spot effect in which optimal periodic closure is maximally effective for diseases with similar incubation and recovery periods. Our results compare well to numerical simulations, including in COVID-19 models where infectivity and recovery show significant variation.


Asunto(s)
Brotes de Enfermedades/prevención & control , Cuarentena/métodos , Gestión de Riesgos/métodos , /prevención & control , Control de Enfermedades Transmisibles/métodos , Enfermedades Transmisibles/psicología , Brotes de Enfermedades/estadística & datos numéricos , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Humanos , Modelos Teóricos , /patogenicidad
18.
PLoS One ; 16(1): e0244937, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33406122

RESUMEN

BACKGROUND: The impact of SARS-CoV-2 in regions endemic for both Dengue and Chikungunya is still not fully understood. Considering that symptoms/clinical features displayed during Dengue, Chikungunya and SARS-CoV-2 acute infections are similar, undiagnosed cases of SARS-CoV-2 in co-endemic areas may be more prevalent than expected. This study was conducted to assess the prevalence of covert cases of SARS-CoV-2 among samples from patients with clinical symptoms compatible with either Dengue or Chikungunya viral infection in the state of Espírito Santo, Brazil. METHODS: Presence of immunoglobulin G (IgG) antibody specific to SARS-CoV-2 nucleoprotein was detected using a chemiluminescent microparticle immunoassay in samples from 7,370 patients, without previous history of COVID-19 diagnosis, suspected of having either Dengue (n = 1,700) or Chikungunya (n = 7,349) from December 1st, 2019 to June 30th, 2020. FINDINGS: Covert cases of SARS-CoV-2 were detected in 210 (2.85%) out of the 7,370 serum samples tested. The earliest undiagnosed missed case of COVID-19 dated back to a sample collected on December 18, 2019, also positive for Dengue Virus. Cross-reactivity with either Dengue virus or other common coronaviruses were not observed. INTERPRETATION: Our findings demonstrate that concomitant Dengue or Chikungunya outbreaks may difficult the diagnosis of SARS-CoV-2 infections. To our knowledge, this is the first study to demonstrate, with a robust sample size (n = 7,370) and using highly specific and sensitive chemiluminescent microparticle immunoassay method, that covert SARS-CoV-2 infections are more frequent than previously expected in Dengue and Chikungunya hyperendemic regions. Moreover, our results suggest that SAR-CoV-2 cases were occurring prior to February, 2020, and that these undiagnosed missed cases may have contributed to the fast expansion of SARS-CoV-2 outbreak in Brazil. Data presented here demonstrate that in arboviral endemic regions, SARS-CoV-2 infection must be always considered, regardless of the existence of a previous positive diagnosis for Dengue or Chikungunya.


Asunto(s)
/epidemiología , Fiebre Chikungunya/epidemiología , Dengue/epidemiología , Adulto , Anticuerpos Antivirales/sangre , Brasil/epidemiología , Virus Chikungunya/patogenicidad , Coinfección/epidemiología , Virus del Dengue/patogenicidad , Errores Diagnósticos/tendencias , Brotes de Enfermedades , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Prevalencia , /patogenicidad
19.
BMC Public Health ; 21(1): 125, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33430832

RESUMEN

BACKGROUND: School testing for SARS-CoV-2 infection has become an important policy and planning issue as schools were reopened after the summer season and as the COVID-19 pandemic continues. Decisions to test or not to test and, if testing, how many tests, how often and for how long, are complex decisions that need to be taken under uncertainty and conflicting pressures from various stakeholders. METHOD: We have developed an agent-based model and simulation tool that can be used to analyze the outcomes and effectiveness of different testing strategies and scenarios in schools with various number of classrooms and class sizes. We have applied a modified version of a standard SEIR disease transmission model that includes symptomatic and asymptomatic infectious populations, and that incorporates feasible public health measures. We also incorporated a pre-symptomatic phase for symptomatic cases. Every day, a random number of students in each class are tested. If they tested positive, they are placed in self-isolation at home when the test results are provided. Last but not least, we have included options to allow for full testing or complete self-isolation of a classroom with a positive case. RESULTS: We present sample simulation results for parameter values based on schools and disease related information, in the Province of Ontario, Canada. The findings show that testing can be an effective method in controlling the SARS-CoV-2 infection in schools if taken frequently, with expedited test results and self-isolation of infected students at home. CONCLUSIONS: Our findings show that while testing cannot eliminate the risk and has its own challenges, it can significantly control outbreaks when combined with other measures, such as masks and other protective measures.


Asunto(s)
/prevención & control , Brotes de Enfermedades/prevención & control , Políticas , Instituciones Académicas , /epidemiología , Simulación por Computador , Humanos , Ontario/epidemiología
20.
BMJ Open Qual ; 10(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33408099

RESUMEN

Patients admitted to the isolation ward during the COVID-19 outbreak face multiple psychosocial stressors including the disruptive experience of being in quarantine, anxiety over contracting a newly emerging infectious disease and limited access to their healthcare team. This quality improvement project aims to leverage on technology to improve patients' access to, and experience of, care while in isolation.Patients admitted to two isolation wards in Singapore General Hospital (SGH) between 28 February and 19 March 2020 were each provided an iPad loaded with the MyCare application (app), curated materials and mobile games. During this period, 83 of them accessed the device and the app. MyCare app is an app developed by the nursing team in SGH as part of an existing interprofessional collaboration to help patients navigate their care during their inpatient stay. In response to COVID-19, MyCare app was supplemented with materials to address affected patients' informational and psychosocial needs. These materials included an information sheet on COVID-19, interviews with previous severe acute respiratory syndrome survivors, psychosocial support materials, and uplifting literature, illustrated storybooks and artwork.This paper describes the process of planning for, and executing, the intervention and reports the initial results of its effect. Initial feedback indicated a positive response to the intervention. 9 out of 10 respondents (90%) rated their hospital experience with a maximum of five stars and all 10 respondents (100%) rated the psychosocial support materials with five stars. Doctors managing the patients also observed a reduction in the number of commonly asked questions following the deployment of the iPad.This quality improvement project is ongoing with plans for further research to determine how to better support the psychosocial needs of patients in isolation during a novel disease outbreak. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.


Asunto(s)
Acceso a la Información , Comportamiento del Consumidor , Accesibilidad a los Servicios de Salud , Hospitalización , Aplicaciones Móviles , Cuarentena/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Brotes de Enfermedades , Empoderamiento , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Singapur , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Adulto Joven
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