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2.
S Afr Fam Pract (2004) ; 63(1): e1-e3, 2021 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-34212751

RESUMEN

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the links between poor hygiene, unclean environments and human health cannot be overemphasised, particularly in South Africa with its high incidence of infectious diseases and overburdened health system. One very controllable factor that is often overlooked is the poor disposal of litter and waste management and its adverse effects on public health. By wearing masks, regular handwashing and sanitising, as well as making sure that neighbourhoods and public spaces are clean and safe, the spread of COVID-19 and other diseases can be prevented.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles/organización & administración , Salud Ambiental/organización & administración , Restauración y Remediación Ambiental , Salud Pública/métodos , COVID-19/epidemiología , COVID-19/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Higiene/normas , Condiciones Sociales , Determinantes Sociales de la Salud , Sudáfrica/epidemiología
3.
S Afr Fam Pract (2004) ; 63(1): e1-e3, 2021 06 28.
Artículo en Inglés | MEDLINE | ID: mdl-34212752

RESUMEN

The use of hand sanitisers is common practice to prevent the spread of coronavirus disease 2019 (COVID-19). However, the safety thereof requires consideration as this may be hazardous in children. Recent studies have shown that the misuse and increased unsupervised availability of alcohol-based hand sanitisers may result in adverse events in children such as skin irritation, dryness, cracking and peeling. Unintentional or intentional ingestion of hand sanitisers in children under the age of 12 years may occur because of the colour, smell and flavour added to it. Consumption of alcohol in children may result in hypoglycaemia, apnoea and acidosis. This allows the invasion of other bacterial and viral infections. Children may also rub their eyes with sanitised hands and cause ocular injury. Therefore, the use of hand sanitisers in general needs to be revised in both children and adults. Other interventions on lowering the risk of adverse events because of misuse of hand sanitiser should be practised more often. These include promoting washing of hands over sanitisers where possible, training children on how to use hand sanitisers and creating awareness of the dangers if ingested or in contact with the eyes.


Asunto(s)
COVID-19 , Transmisión de Enfermedad Infecciosa/prevención & control , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Desinfectantes para las Manos , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Niño , Salud del Niño , Control de Enfermedades Transmisibles/métodos , Abuso de Medicamentos/efectos adversos , Abuso de Medicamentos/prevención & control , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Oftalmopatías/inducido químicamente , Oftalmopatías/prevención & control , Desinfección de las Manos/métodos , Desinfectantes para las Manos/farmacología , Desinfectantes para las Manos/toxicidad , Humanos , Ajuste de Riesgo/métodos , SARS-CoV-2/efectos de los fármacos , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/prevención & control
4.
Drug Deliv ; 28(1): 1496-1500, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34259091

RESUMEN

COVID-19 can cause serious respiratory complications resulting in the need for invasive ventilatory support and concurrent aerosol therapy. Aerosol therapy is considered a high risk procedure for the transmission of patient derived infectious aerosol droplets. Critical-care workers are considered to be at a high risk of inhaling such infectious droplets. The objective of this work was to use noninvasive optical methods to visualize the potential release of aerosol droplets during aerosol therapy in a model of an invasively ventilated adult patient. The noninvasive Schlieren imaging technique was used to visualize the movement of air and aerosol. Three different aerosol delivery devices: (i) a pressurized metered dose inhaler (pMDI), (ii) a compressed air driven jet nebulizer (JN), and (iii) a vibrating mesh nebulizer (VMN), were used to deliver an aerosolized therapeutic at two different positions: (i) on the inspiratory limb at the wye and (ii) on the patient side of the wye, between the wye and endotracheal tube, to a simulated intubated adult patient. Irrespective of position, there was a significant release of air and aerosol from the ventilator circuit during aerosol delivery with the pMDI and the compressed air driven JN. There was no such release when aerosol therapy was delivered with a closed-circuit VMN. Selection of aerosol delivery device is a major determining factor in the release of infectious patient derived bioaerosol from an invasively mechanically ventilated patient receiving aerosol therapy.


Asunto(s)
Aerosoles , COVID-19 , Transmisión de Enfermedad Infecciosa/prevención & control , Inhaladores de Dosis Medida , Nebulizadores y Vaporizadores , Respiración Artificial/métodos , Terapia Respiratoria , Aerosoles/administración & dosificación , Aerosoles/efectos adversos , COVID-19/fisiopatología , COVID-19/terapia , COVID-19/transmisión , Terapia Combinada , Sistemas de Liberación de Medicamentos/instrumentación , Sistemas de Liberación de Medicamentos/métodos , Sistemas de Liberación de Medicamentos/normas , Humanos , Exposición Profesional/prevención & control , Proyectos de Investigación , Terapia Respiratoria/efectos adversos , Terapia Respiratoria/instrumentación , Terapia Respiratoria/métodos , Gestión de Riesgos , SARS-CoV-2
5.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34061203

RESUMEN

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Asunto(s)
Vacunas contra la COVID-19/farmacología , COVID-19 , Control de Enfermedades Transmisibles , Vacunación Masiva , Cobertura de Vacunación , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/estadística & datos numéricos , Simulación por Computador , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Vacunación Masiva/organización & administración , Vacunación Masiva/estadística & datos numéricos , Mortalidad , North Carolina/epidemiología , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , SARS-CoV-2 , Resultado del Tratamiento , Cobertura de Vacunación/organización & administración , Cobertura de Vacunación/estadística & datos numéricos
10.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1248672

RESUMEN

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Asunto(s)
Vacunas contra la COVID-19/farmacología , COVID-19 , Control de Enfermedades Transmisibles , Vacunación Masiva , Cobertura de Vacunación , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/estadística & datos numéricos , Simulación por Computador , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Vacunación Masiva/organización & administración , Vacunación Masiva/estadística & datos numéricos , Mortalidad , North Carolina/epidemiología , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , SARS-CoV-2 , Resultado del Tratamiento , Cobertura de Vacunación/organización & administración , Cobertura de Vacunación/estadística & datos numéricos
13.
Nat Commun ; 12(1): 3560, 2021 06 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1265953

RESUMEN

Non-pharmaceutical interventions (NPIs) remain the only widely available tool for controlling the ongoing SARS-CoV-2 pandemic. We estimated weekly values of the effective basic reproductive number (Reff) using a mechanistic metapopulation model and associated these with county-level characteristics and NPIs in the United States (US). Interventions that included school and leisure activities closure and nursing home visiting bans were all associated with a median Reff below 1 when combined with either stay at home orders (median Reff 0.97, 95% confidence interval (CI) 0.58-1.39) or face masks (median Reff 0.97, 95% CI 0.58-1.39). While direct causal effects of interventions remain unclear, our results suggest that relaxation of some NPIs will need to be counterbalanced by continuation and/or implementation of others.


Asunto(s)
COVID-19/prevención & control , COVID-19/transmisión , Política de Salud , Control de Infecciones/métodos , Número Básico de Reproducción , COVID-19/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Actividades Recreativas , Máscaras , Historia Natural , Pandemias , Cuarentena , SARS-CoV-2/aislamiento & purificación , Instituciones Académicas , Estados Unidos/epidemiología
16.
Public Health ; 195: 158-160, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34130002

RESUMEN

OBJECTIVES: Schools in the Republic of Ireland reopened to students and staff in late August 2020. We sought to determine the test positivity rate of close contacts of cases of coronavirus disease 2019 (COVID-19) in schools during the first half-term of the 2020/2021 academic year. METHODS: National-level data from the schools' testing pathway were interrogated to determine the positivity rate of close contacts of cases of COVID-19 in Irish primary, postprimary and special schools during the first half-term of 2020/2021 academic year. The positivity rates among adult and child close contacts were compared and the proportion of national cases of COVID-19 who were aged 4-18 years during the observation period was calculated to assess whether this proportion increased after schools reopened. RESULTS: Of all, 15,533 adult and child close contacts were tested for COVID-19 through the schools' testing pathway during the first half-term of the 2020/2021 academic year. Three hundred and ninety-nine close contacts tested positive, indicating a positivity rate of 2.6% (95% confidence interval: 2.3-2.8%). The positivity rates of child and adult close contacts were similarly low (2.6% vs 2.7%, P = 0.7). The proportion of all national cases of COVID-19 who were aged 4-18 years did not increase during the first half-term of the 2020/2021 school year. CONCLUSIONS: The low positivity rate of close contacts of cases of COVID-19 in schools indicate that transmission of COVID-19 in Irish schools during the first half-term of the 2020/2021 academic year was low. These findings support policies to keep schools open during the pandemic.


Asunto(s)
COVID-19/epidemiología , COVID-19/transmisión , Trazado de Contacto , Brotes de Enfermedades/prevención & control , Pandemias , Estudiantes/estadística & datos numéricos , Adulto , COVID-19/prevención & control , Niño , Transmisión de Enfermedad Infecciosa/prevención & control , Familia , Humanos , Irlanda/epidemiología , Masculino , SARS-CoV-2 , Instituciones Académicas
17.
Crit Care Med ; 49(7): e693-e700, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1276256

RESUMEN

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 is transmitted through aerosols and droplets. Nasal high-flow therapy could possibly increase the spreading of exhalates from patients. The aim of this study is to investigate whether nasal high-flow therapy affects the range of the expiratory plume compared with spontaneous breathing. DESIGN: Interventional experiment on single breaths of a healthy volunteer. SETTING: Research laboratory at the Bauhaus-University Weimar. SUBJECTS: A male subject. INTERVENTIONS: Videos and images from a schlieren optical system were analyzed during spontaneous breathing and different nasal high-flow rates. MEASUREMENTS AND MAIN RESULTS: The maximal exhalation spread was 0.99, 2.18, 2.92, and 4.1 m during spontaneous breathing, nasal high-flow of 20 L/min, nasal high-flow of 40 L/min, and nasal high-flow of 60 L/min, respectively. Spreading of the expiratory plume in the sagittal plane can completely be blocked with a surgical mask. CONCLUSIONS: Nasal high-flow therapy increases the range of the expiratory air up to more than 4 meters. The risk to pick up infectious particles could be increased within this range. Attachment of a surgical mask over the nasal high-flow cannula blocks the expiratory airstream.


Asunto(s)
Cánula , Espiración , Terapia por Inhalación de Oxígeno/métodos , Ventilación Pulmonar , Adulto , Transmisión de Enfermedad Infecciosa/prevención & control , Voluntarios Sanos , Humanos , Masculino , Microscopía por Video , Frecuencia Respiratoria , Volumen de Ventilación Pulmonar
19.
Nat Commun ; 12(1): 3737, 2021 06 18.
Artículo en Inglés | MEDLINE | ID: mdl-34145289

RESUMEN

Given the continued burden of COVID-19 worldwide, there is a high unmet need for data on the effect of social distancing and face mask use to mitigate the risk of COVID-19. We examined the association of community-level social distancing measures and individual face mask use with risk of predicted COVID-19 in a large prospective U.S. cohort study of 198,077 participants. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing. Self-reported 'always' use of face mask was associated with a 62% reduced risk of predicted COVID-19 even among individuals living in a community with poor social distancing. These findings provide support for the efficacy of mask-wearing even in settings of poor social distancing in reducing COVID-19 transmission. Despite mass vaccination campaigns in many parts of the world, continued efforts at social distancing and face mask use remain critically important in reducing the spread of COVID-19.


Asunto(s)
COVID-19/prevención & control , Máscaras/estadística & datos numéricos , Distanciamiento Físico , Adulto , Anciano , COVID-19/epidemiología , COVID-19/transmisión , COVID-19/virología , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Salud Pública , SARS-CoV-2/aislamiento & purificación , Estados Unidos/epidemiología
20.
Curr Opin Obstet Gynecol ; 33(4): 262-269, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-34183549

RESUMEN

PURPOSE OF REVIEW: This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS: Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended. SUMMARY: After over a year of the COVID-19 pandemic, effective protocols and precautions have been established to decrease the morbidity and mortality of patients undergoing surgery and to promote the safety of healthcare personnel. Continued investigations are necessary as cases of new, possibly more virulent, strains of the virus arise.


Asunto(s)
COVID-19/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Procedimientos Quirúrgicos Ginecológicos/normas , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , Atención Perioperativa/normas , Guías de Práctica Clínica como Asunto , Femenino , Humanos , Laparoscopía , Equipo de Protección Personal , SARS-CoV-2
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