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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 990-993, 2020 Jul 10.
Artículo en Chino | MEDLINE | ID: mdl-32741160

RESUMEN

The COVID-19 outbreak in China has been gradually controlled. At present, the management and risk assessment of asymptomatic infected cases has become an urgent problem to be addressed. Asymptomatic case is mainly detected by close contact screening, cluster epidemic investigation, infection source tracking investigation, and active detection of target population. Currently, research on the spread risk from asymptomatic cases was limited, and lacking the data relates to the distribution of asymptomatic cases in large community population. Pathogen detection using PCR is suitable for screening in close contacts of confirmed cases and should be started as early as possible. The antibody test is more suitable for screening in general population where the source of infection is unclear. The management of asymptomatic cases now in China focuses on isolation and medical observation according to the guideline of "early detection, early report, early isolation and early treatment" .


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , China/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología
2.
PLoS Comput Biol ; 16(7): e1008031, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32614817

RESUMEN

The 2019-2020 pandemic of atypical pneumonia (COVID-19) caused by the virus SARS-CoV-2 has spread globally and has the potential to infect large numbers of people in every country. Estimating the country-specific basic reproductive ratio is a vital first step in public-health planning. The basic reproductive ratio (R0) is determined by both the nature of pathogen and the network of human contacts through which the disease can spread, which is itself dependent on population age structure and household composition. Here we introduce a transmission model combining age-stratified contact frequencies with age-dependent susceptibility, probability of clinical symptoms, and transmission from asymptomatic (or mild) cases, which we use to estimate the country-specific basic reproductive ratio of COVID-19 for 152 countries. Using early outbreak data from China and a synthetic contact matrix, we estimate an age-stratified transmission structure which can then be extrapolated to 151 other countries for which synthetic contact matrices also exist. This defines a set of country-specific transmission structures from which we can calculate the basic reproductive ratio for each country. Our predicted R0 is critically sensitive to the intensity of transmission from asymptomatic cases; with low asymptomatic transmission the highest values are predicted across Eastern Europe and Japan and the lowest across Africa, Central America and South-Western Asia. This pattern is largely driven by the ratio of children to older adults in each country and the observed propensity of clinical cases in the elderly. If asymptomatic cases have comparable transmission to detected cases, the pattern is reversed. Our results demonstrate the importance of age-specific heterogeneities going beyond contact structure to the spread of COVID-19. These heterogeneities give COVID-19 the capacity to spread particularly quickly in countries with older populations, and that intensive control measures are likely to be necessary to impede its progress in these countries.


Asunto(s)
Trazado de Contacto/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Predicción/métodos , Modelos Estadísticos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Factores de Edad , Infecciones Asintomáticas/epidemiología , Betacoronavirus/aislamiento & purificación , Betacoronavirus/fisiología , China/epidemiología , Biología Computacional/métodos , Brotes de Enfermedades/prevención & control , Humanos , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Replicación Viral/fisiología
3.
BMC Infect Dis ; 20(1): 526, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32689956

RESUMEN

BACKGROUND: With the spread of SARS-CoV-2 worldwide, understanding the basic epidemiological parameter values of COVID-19 from real-world data in mega-cities is essential for disease prevention and control. METHODS: To investigate the epidemiological parameters in SARS-CoV-2 infected cases in Beijing, we studied all confirmed cases and close contacts in Beijing from Jan 1st to Apr 3rd 2020. The epidemiological and virological characteristics of SARS-CoV-2 were analyzed. RESULTS: A total of 602 cases were positive for SARS-CoV-2, including 585 confirmed patients and 17 asymptomatic infections. The imported cases were mainly from Wuhan initially and then from abroad. Among 585 confirmed case-patients, the median age was 39 years old. The mean incubation period was 6.3 days. The secondary attack rate among households was higher than social contacts (15.6 vs 4.6%). The secondary attack rate of healthcare workers (HCWs) was higher than non-HCWs' (7.3 vs 4.2%). The basic reproduction number was 2.0, and the average serial interval was 7.6 days. No significant genetic variant was identified. CONCLUSIONS: The transmissibility of SARS-CoV-2 was relatively high, especially among households and from HCWs, which draws specific public health attention. So far, no evidence of widespread circulation of SARS-CoV-2 in communities in Beijing was found.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adulto , Infecciones Asintomáticas/epidemiología , Número Básico de Reproducción/estadística & datos numéricos , Beijing/epidemiología , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Ciudades/estadística & datos numéricos , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Composición Familiar , Salud de la Familia/estadística & datos numéricos , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Pandemias , Neumonía Viral/transmisión , Neumonía Viral/virología , Factores de Tiempo
4.
BMC Infect Dis ; 20(1): 486, 2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-32641070

RESUMEN

BACKGROUND: Asymptomatic screening for gonorrhoea in heterosexual men is currently not recommended in many countries including Australia, given the prevalence is relatively low in the heterosexual population. We aimed to determine the proportion of urethral gonorrhoea cases among heterosexual men attending a sexual health clinic that was asymptomatic and symptomatic, the time since last sexual contact to the onset of symptoms and the time to clinic presentation following the onset of symptoms. METHODS: This was a cross-sectional study that included heterosexual men aged 16 years or above attending the Melbourne Sexual Health Centre (MSHC) in Australia between August 2017 and August 2018. Gonorrhoea cases were diagnosed by nucleic acid amplification testing (NAAT) and/or culture. Descriptive analyses were conducted for all gonorrhoea cases including demographic characteristics, recent sexual practices, reported urethral symptoms and duration, sexual contact with a person diagnosed with gonorrhoea, investigations performed and laboratory results. RESULTS: There were 116 confirmed cases of urethral gonorrhoea in heterosexual men over the study period of which 6.0% (95% CI: 2.7-12.1%) were asymptomatic. Typical urethral discharge was present in 80.2% (95% CI: 71.9-86.5%) of men. The mean time between last sexual contact and the onset of symptoms was 7.0 days, and between the onset of symptoms to presentation to the clinic was 5.6 days. CONCLUSIONS: A small proportion of heterosexual men with urethral gonorrhoea do not have any symptoms. Heterosexual men with urethral symptoms usually seek for healthcare within a week, prompting rapid healthcare-seeking behaviour.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Heterosexualidad , Neisseria gonorrhoeae/genética , Salud Sexual , Enfermedades Uretrales/diagnóstico , Enfermedades Uretrales/epidemiología , Adolescente , Adulto , Australia/epidemiología , Estudios Transversales , Gonorrea/microbiología , Gonorrea/fisiopatología , Humanos , Masculino , Técnicas de Amplificación de Ácido Nucleico/métodos , Prevalencia , Enfermedades Uretrales/microbiología , Adulto Joven
6.
Indian J Med Res ; 151(5): 424-437, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32611914

RESUMEN

Background & objectives: India has been reporting the cases of coronavirus disease 2019 (COVID-19) since January 30, 2020. The Indian Council of Medical Research (ICMR) formulated and established laboratory surveillance for COVID-19. In this study, an analysis of the surveillance data was done to describe the testing performance and descriptive epidemiology of COVID-19 cases by time, place and person. Methods: The data were extracted from January 22 to April 30, 2020. The frequencies of testing performance were described over time and by place. We described cases by time (epidemic curve by date of specimen collection; seven-day moving average), place (area map) and person (attack rate by age, sex and contact status), and trends were represented along with public health measures and events. Results: Between January 22 and April 30, 2020, a total of 1,021,518 individuals were tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Testing increased from about 250 individuals per day in the beginning of March to 50,000 specimens per day by the end of April 2020. Overall, 40,184 (3.9%) tests were reported positive. The proportion of positive cases was highest among symptomatic and asymptomatic contacts, 2-3-fold higher than among those with severe acute respiratory infection, or those with an international travel history or healthcare workers. The attack rate (per million) by age was highest among those aged 50-69 yr (63.3) and was lowest among those under 10 yr (6.1). The attack rate was higher among males (41.6) than females (24.3). The secondary attack rate was 6.0 per cent. Overall, 99.0 per cent of 736 districts reported testing and 71.1 per cent reported COVID-19 cases. Interpretation & conclusions: The coverage and frequency of ICMR's laboratory surveillance for SARS-CoV-2 improved over time. COVID-19 was reported from most parts of India, and the attack rate was more among men and the elderly and common among close contacts. Analysis of the data indicates that for further insight, additional surveillance tools and strategies at the national and sub-national levels are needed.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Betacoronavirus , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Vigilancia de la Población , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Técnicas de Laboratorio Clínico/tendencias , Infecciones por Coronavirus/diagnóstico , Mapeo Geográfico , Humanos , India/epidemiología , Lactante , Recién Nacido , Laboratorios/estadística & datos numéricos , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Factores Sexuales , Análisis Espacio-Temporal , Factores de Tiempo , Adulto Joven
7.
Nat Commun ; 11(1): 3500, 2020 07 08.
Artículo en Inglés | MEDLINE | ID: mdl-32641730

RESUMEN

Health care workers (HCW) are a high-risk population to acquire SARS-CoV-2 infection from patients or other fellow HCW. This study aims at estimating the seroprevalence against SARS-CoV-2 in a random sample of HCW from a large hospital in Spain. Of the 578 participants recruited from 28 March to 9 April 2020, 54 (9.3%, 95% CI: 7.1-12.0) were seropositive for IgM and/or IgG and/or IgA against SARS-CoV-2. The cumulative prevalence of SARS-CoV-2 infection (presence of antibodies or past or current positive rRT-PCR) was 11.2% (65/578, 95% CI: 8.8-14.1). Among those with evidence of past or current infection, 40.0% (26/65) had not been previously diagnosed with COVID-19. Here we report a relatively low seroprevalence of antibodies among HCW at the peak of the COVID-19 epidemic in Spain. A large proportion of HCW with past or present infection had not been previously diagnosed with COVID-19, which calls for active periodic rRT-PCR testing in hospital settings.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Infecciones por Coronavirus/epidemiología , Personal de Salud , Neumonía Viral/epidemiología , Adulto , Infecciones Asintomáticas/epidemiología , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Salud Laboral , Pandemias , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , ARN Viral/sangre , Factores de Riesgo , Estudios Seroepidemiológicos , España/epidemiología
8.
mSphere ; 5(3)2020 06 24.
Artículo en Inglés | MEDLINE | ID: mdl-32581071

RESUMEN

The contamination of patients' surroundings by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains understudied. We sampled the surroundings and the air of six negative-pressure non-intensive care unit (non-ICU) rooms in a designated isolation ward in Chengdu, China, that were occupied by 13 laboratory-confirmed coronavirus disease 2019 (COVID-19) patients who had returned from overseas travel, including 2 asymptomatic patients. A total of 44 of 112 (39.3%) surface samples were positive for SARS-CoV-2 as detected by real-time PCR, suggesting extensive contamination, although all of the air samples were negative. In particular, in a single room occupied by an asymptomatic patient, four sites were SARS-CoV-2 positive, highlighting that asymptomatic COVID-19 patients do contaminate their surroundings and impose risks for others with close contact. Placement of COVID-19 patients in rooms with negative pressure may bring a false feeling of safety, and the importance of rigorous environment cleaning should be emphasized.IMPORTANCE Although it has been well recognized that the virus SARS-CoV-2, the causative agent of COVID-19, can be acquired by exposure to fomites, surprisingly, the contamination of patients' surroundings by SARS-CoV-2 is largely unknown, as there have been few studies. We performed an environmental sampling study for 13 laboratory-confirmed COVID-19 patients and found extensive contamination of patients' surroundings. In particular, we found that asymptomatic COVID-19 patients contaminated their surroundings and therefore imposed risks for other people. Environment cleaning should be emphasized in negative-pressure rooms. The findings may be useful to guide infection control practice to protect health care workers.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Exposición a Riesgos Ambientales , Microbiología Ambiental , Neumonía Viral/epidemiología , Contención de Riesgos Biológicos/métodos , Infecciones por Coronavirus/patología , Ambiente , Humanos , Pandemias , Neumonía Viral/patología
9.
J Biol Dyn ; 14(1): 389-408, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32498655

RESUMEN

We formulate a deterministic epidemic model for the spread of Corona Virus Disease (COVID-19). We have included asymptomatic, quarantine and isolation compartments in the model, as studies have stressed upon the importance of these population groups on the transmission of the disease. We calculate the basic reproduction number [Formula: see text] and show that for [Formula: see text] the disease dies out and for [Formula: see text] the disease is endemic. Using sensitivity analysis we establish that [Formula: see text] is most sensitive to the rate of quarantine and isolation and that a high level of quarantine needs to be maintained as well as isolation to control the disease. Based on this we devise optimal quarantine and isolation strategies, noting that high levels need to be maintained during the early stages of the outbreak. Using data from the Wuhan outbreak, which has nearly run its course we estimate that [Formula: see text] which while in agreement with other estimates in the literature is on the lower side.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Betacoronavirus/fisiología , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , Cuarentena , Número Básico de Reproducción , Simulación por Computador , Humanos , Modelos Biológicos , Pandemias , Incertidumbre
10.
Indian J Med Res ; 151(5): 438-443, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32474558

RESUMEN

Background & objectives: A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India. We report here the epidemiological, clinical, radiological and laboratory findings of the first cluster of SARS-CoV-2 infection among the tourists. Methods: Information was collected on demographic details, travel and exposure history, comorbidities, timelines of events, date of symptom onset and duration of hospitalization from the 16 Italian tourists and an Indian with laboratory-confirmed SARS-CoV-2 infection. The clinical, laboratory, radiologic and treatment data was abstracted from their medical records and all tourists were followed up till their recovery or discharge or death. Throat and deep nasal swab specimens were collected on days 3, 8, 15, 18, 23 and 25 to evaluate viral clearance. Results: A group of 23 Italian tourists reached New Delhi, India, on February 21, 2020 and along with three Indians visited several tourist places in Rajasthan. By March 3, 2020, 17 of the 26 (attack rate: 65.4%) had become positive for SARS-CoV-2 infection. Of these 17 patients, nine were symptomatic, while eight did not show any symptoms. Of the nine who developed symptoms, six were mild, one was severe and two were critically ill. The median duration between the day of confirmation for COVID-19 and RT-PCR negativity was 18 days (range: 12-23 days). Two patients died with a case fatality of 11.8 per cent. Interpretation & conclusions: This study reconfirms higher rates of transmission among close contacts and therefore, public health measures such as physical distancing, personal hygiene and infection control measures are necessary to prevent transmission.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Anciano , Betacoronavirus/genética , Análisis por Conglomerados , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Enfermedad Crítica , Resultado Fatal , Femenino , Humanos , India/epidemiología , Italia/etnología , Masculino , Cavidad Nasal/virología , Pandemias , Gravedad del Paciente , Faringe/virología , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , ARN Viral/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Viaje
11.
Epidemiol Infect ; 148: e116, 2020 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-32525469

RESUMEN

At the present time, COVID-19 is spreading rapidly [1]. The global prevention and control of COVID-19 is focused on the estimation of the relevant incubation period, basic reproduction number (R0), effective reproduction number (Rt) and death risk. Although the prevention and control of COVID-19 requires a reliable estimation of the relevant incubation period, R0, Rt and death risk. Another key epidemiological parameter-asymptomatic ratio that provides strength and range for social alienation strategies of COVID-19, which is widely defined as the proportion of asymptomatic infections among all disease infections. In fact, the ratio of asymptomatic infection is a useful indicator of the burden of disease and a better measurement of the transmissibility of the virus. So far, people have not paid enough attention to asymptomatic carriers. The asymptomatic carriers discussed in this study are recessive infections, that is, those who have never shown symptoms after onset of infection. We will discuss three aspects: detection, infectivity and proportion of healthy carriers.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , China/epidemiología , Trazado de Contacto , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología
12.
Cien Saude Colet ; 25(suppl 1): 2395-2401, 2020 Jun.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32520284

RESUMEN

COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Betacoronavirus , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Vigilancia de Guardia , Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Brasil/epidemiología , Técnicas de Laboratorio Clínico/ética , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Humanos , Neumonía Viral/transmisión , Prevalencia , Factores de Tiempo
13.
Environ Microbiol ; 22(7): 2445-2456, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32510748

RESUMEN

In the absence of an efficient drug treatment or a vaccine, the control of the COVID-19 pandemic relies on classic infection control measures. Since these means are socially disruptive and come with substantial economic loss for societies, a better knowledge of the epidemiology of the new coronavirus epidemic is crucial to achieve control at a sustainable cost and within tolerable restrictions of civil rights.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Niño , China/epidemiología , Coronavirus , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Europa (Continente)/epidemiología , Humanos , Inmunidad Colectiva , Máscaras , Modelos Teóricos , Epidemiología Molecular/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Trastornos del Olfato/virología , Pandemias/prevención & control , Neumonía Viral/mortalidad , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Salud Pública , Factores de Riesgo , Estudios Seroepidemiológicos , Singapur , Estados Unidos/epidemiología
14.
Chaos ; 30(5): 051107, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32491888

RESUMEN

Despite the importance of having robust estimates of the time-asymptotic total number of infections, early estimates of COVID-19 show enormous fluctuations. Using COVID-19 data from different countries, we show that predictions are extremely sensitive to the reporting protocol and crucially depend on the last available data point before the maximum number of daily infections is reached. We propose a physical explanation for this sensitivity, using a susceptible-exposed-infected-recovered model, where the parameters are stochastically perturbed to simulate the difficulty in detecting patients, different confinement measures taken by different countries, as well as changes in the virus characteristics. Our results suggest that there are physical and statistical reasons to assign low confidence to statistical and dynamical fits, despite their apparently good statistical scores. These considerations are general and can be applied to other epidemics.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Neumonía Viral/epidemiología , Neumonía Viral/virología , Procesos Estocásticos , Betacoronavirus , China , Salud Global , Humanos , Modelos Estadísticos , Dinámicas no Lineales , Pandemias
15.
Artículo en Inglés | MEDLINE | ID: mdl-32574282

RESUMEN

To investigate the early epidemic of COVID-19, a total of 176 confirmed COVID-19 cases in Shiyan city, Hubei province, China were surveyed. Our data indicated that the rate of emergence of early confirmed COVID-19 cases in Hubei province outside Wuhan was dependent on migration population, and the second-generation of patients were family clusters originating from Wuhan travelers. Epidemiological investigation indicated that the reproductive number (R0) under containment strategies was 1.81, and asymptomatic SARS-CoV-2 carriers were contagious with a transmission rate of 10.7%. Among the 176 patients, 53 were admitted to the Renmin Hospital of Hubei University of Medicine. The clinical characteristics of these 53 patients were collected and compared based on a positive RT-PCR test and presence of pneumonia. Clinical data showed that 47.2% (25/53) of COVID-19 patients were co-infected with Mycoplasma pneumoniae, and COVID-19 patients coinfected with M. pneumoniae had a higher percentage of monocytes (P < 0.0044) and a lower neutrophils percentage (P < 0.0264). Therefore, it is important to assess the transmissibility of infected asymptomatic individuals for SARS-CoV-2 transmission; moreover, clinicians should be alert to the high incidence of co-infection with M. pneumoniae in COVID-19 patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , Recuento de Células Sanguíneas , Portador Sano/epidemiología , Niño , Preescolar , China/epidemiología , Coinfección/epidemiología , Trazado de Contacto , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Lactante , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía por Mycoplasma/complicaciones , Neumonía Viral/complicaciones , Neumonía Viral/transmisión , Tomografía Computarizada por Rayos X , Viaje , Adulto Joven
16.
Nefrología (Madrid) ; 40(3): 279-286, mayo-jun. 2020.
Artículo en Español | IBECS | ID: ibc-187875

RESUMEN

Los pacientes en diálisis son un grupo de riesgo de sufrir la infección por el SARS-CoV2 y posiblemente de tener más complicaciones, pero la información con la que contamos es escasa. El objetivo de este trabajo es describir la experiencia del primer mes de pandemia por SARS-Cov2 en una unidad hospitalaria de hemodiálisis (HD) que atiende al 2º distrito madrileño con más en incidencia de COVID19 (casi 1000 pacientes en 100000 h). Se presenta mediante un diario las acciones llevadas a cabo, la incidencia de COVID19 en pacientes y en el personal sanitario, algunas características clínicas y el resultado de un cribado entre todos los pacientes de la unidad. Al inicio, teníamos 90 pacientes en HD: 37(41,1%) han tenido COVID19, de los que 17 (45,9%) fueron diagnosticado spor síntomas detectados en el triaje o durante la sesión y 15 (40,5%) en un cribado realizado a posteriori en los que no se había hecho test diagnóstico por PCR-SARS-Cov2 hasta ese momento. El síntoma más frecuente fue la fiebre, el 50% presentó linfopenia y el 18,4% saturación de O2 < 95%. Precisaron ingreso hospitalario 16 (43,2%) y 6 fallecieron (16,2%). Encontramos un agrupamiento de contagio por turnos y también en aquellos que usaban transporte colectivo. En cuanto al personal, de las 44 personas involucradas, 15 (34%) presentaron sintomatología compatible y 4 (9%) tuvieron PCR SARS-Cov-2 positiva determinada por Salud Laboral y 9 (20%) precisaron algún periodo de Incapacidad Laboral Transitoria (ILT), y 5 fueron considerados casos probables


Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% < 95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health,9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID19 with a high percentage detected byscreening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19


Asunto(s)
Humanos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Pandemias , Infecciones Asintomáticas/epidemiología , Unidades de Hemodiálisis en Hospital/normas , Diálisis Renal/estadística & datos numéricos , Diálisis Renal/normas , Grupos de Riesgo , Prevalencia , Incidencia
17.
Thorax ; 75(8): 693-694, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32461231

RESUMEN

We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription-PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Navíos , Viaje , Anciano , Infecciones Asintomáticas/epidemiología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Femenino , Vacaciones y Feriados , Humanos , Masculino , Medicina Naval/estadística & datos numéricos , Pandemias , Neumonía Viral/diagnóstico , Prevalencia
19.
Euro Surveill ; 25(17)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32372755

RESUMEN

BackgroundEstimating key infectious disease parameters from the coronavirus disease (COVID-19) outbreak is essential for modelling studies and guiding intervention strategies.AimWe estimate the generation interval, serial interval, proportion of pre-symptomatic transmission and effective reproduction number of COVID-19. We illustrate that reproduction numbers calculated based on serial interval estimates can be biased.MethodsWe used outbreak data from clusters in Singapore and Tianjin, China to estimate the generation interval from symptom onset data while acknowledging uncertainty about the incubation period distribution and the underlying transmission network. From those estimates, we obtained the serial interval, proportions of pre-symptomatic transmission and reproduction numbers.ResultsThe mean generation interval was 5.20 days (95% credible interval (CrI): 3.78-6.78) for Singapore and 3.95 days (95% CrI: 3.01-4.91) for Tianjin. The proportion of pre-symptomatic transmission was 48% (95% CrI: 32-67) for Singapore and 62% (95% CrI: 50-76) for Tianjin. Reproduction number estimates based on the generation interval distribution were slightly higher than those based on the serial interval distribution. Sensitivity analyses showed that estimating these quantities from outbreak data requires detailed contact tracing information.ConclusionHigh estimates of the proportion of pre-symptomatic transmission imply that case finding and contact tracing need to be supplemented by physical distancing measures in order to control the COVID-19 outbreak. Notably, quarantine and other containment measures were already in place at the time of data collection, which may inflate the proportion of infections from pre-symptomatic individuals.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Betacoronavirus , China/epidemiología , Coronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Cuarentena , Singapur/epidemiología , Factores de Tiempo
20.
Nature ; 583(7816): 437-440, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32434211

RESUMEN

In December 2019, coronavirus disease 2019 (COVID-19), which is caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan (Hubei province, China)1; it soon spread across the world. In this ongoing pandemic, public health concerns and the urgent need for effective therapeutic measures require a deep understanding of the epidemiology, transmissibility and pathogenesis of COVID-19. Here we analysed clinical, molecular and immunological data from 326 patients with confirmed SARS-CoV-2 infection in Shanghai. The genomic sequences of SARS-CoV-2, assembled from 112 high-quality samples together with sequences in the Global Initiative on Sharing All Influenza Data (GISAID) dataset, showed a stable evolution and suggested that there were two major lineages with differential exposure history during the early phase of the outbreak in Wuhan. Nevertheless, they exhibited similar virulence and clinical outcomes. Lymphocytopenia, especially reduced CD4+ and CD8+ T cell counts upon hospital admission, was predictive of disease progression. High levels of interleukin (IL)-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age and lymphocytopenia (and its associated cytokine storm), whereas viral genetic variation did not significantly affect outcomes.


Asunto(s)
Betacoronavirus/genética , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Interacciones Huésped-Patógeno/inmunología , Linfopenia/virología , Neumonía Viral/inmunología , Neumonía Viral/virología , Síndrome de Dificultad Respiratoria del Adulto/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento , Animales , Infecciones Asintomáticas/epidemiología , Betacoronavirus/clasificación , Betacoronavirus/aislamiento & purificación , China/epidemiología , Estudios de Cohortes , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica/epidemiología , Progresión de la Enfermedad , Evolución Molecular , Femenino , Variación Genética , Genoma Viral/genética , Hospitalización/estadística & datos numéricos , Humanos , Mediadores de Inflamación/inmunología , Interleucina-6/sangre , Interleucina-6/inmunología , Interleucina-8/sangre , Interleucina-8/inmunología , Recuento de Linfocitos , Linfopenia/complicaciones , Masculino , Persona de Mediana Edad , Pandemias , Filogenia , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/complicaciones , Linfocitos T/citología , Linfocitos T/inmunología , Factores de Tiempo , Resultado del Tratamiento , Virulencia/genética , Esparcimiento de Virus , Adulto Joven , Zoonosis/transmisión , Zoonosis/virología
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