Risk factors associated with severe COVID-19 outcomes in Jamaica: a cross-sectional study of national surveillance data.

Objectives: To describe the characteristics and outcomes of COVID-19 cases in Jamaica and to explore the risk factors associated with severe COVID-19 from 9 March to 31 December 2020. Methods: A cross-sectional analysis of national surveillance data was conducted using confirmed COVID-19 cases in Jamaica. Definitions of a confirmed case, disease severity, and death were based on World Health Organization guidelines. Chi-square and Fisher exact tests were used to determine association with outcomes. Logistic regression models were used to determine predictors of severe COVID-19. Results: This analysis included 12 169 cases of COVID-19 (median age, 36 years; 6 744 females [ 55.4%]) of which 512 cases (4.2%) presented with severe disease, and of those, 318 patients (62.1%) died (median age at death, 71.5 years). Severe disease was associated with being male (OR 1.4; 95% CI, 1.2-1.7) and 40 years or older (OR, 6.5; 95% CI, 5.1-8.2). COVID-19 death was also associated with being male (OR, 1.4; 95% CI, 1.1-1.7), age 40 years or older (OR, 17.9; 95% CI, 11.6-27.7), and in the Western versus South East Health Region (OR 1.7; 95% CI, 1.2-2.3). Conclusions: The findings of this cross-sectional analysis indicate that confirmed cases of COVID-19 in Jamaica were more likely to be female and younger individuals, whereas COVID-19 deaths occurred more frequently in males and older individuals. There is increased risk of poor COVID-19 outcomes beginning at age 40, with males disproportionately affected. COVID-19 death also varied by geographic region. This evidence could be useful to other countries with similar settings and to policymakers charged with managing outbreaks and health.

Harnessing a real-time location system for contact tracing in a busy emergency department.

BACKGROUND: With the persistent threat of emerging infectious diseases (EIDs), digital contact tracing (CT) tools can augment conventional CT for the prevention of healthcare-associated infectious disease transmission. However, their performance has yet to be evaluated comprehensively in the fast-paced emergency department (ED) setting. OBJECTIVE: This study compared the CT performance of a radiofrequency identification (RFID)-based real-time location system (RTLS) with conventional electronic medical record (EMR) review against continuous direct observation of close contacts ('gold standard') in a busy ED during the coronavirus disease 2019 pandemic period. METHODS: This cross-sectional study was conducted at the ED of a large tertiary care hospital in Singapore from December 2020 to April 2021. CT performance [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and kappa] of the RTLS, EMR review and a combination of the two approaches (hybrid CT) was compared with direct observation. Finally, the mean absolute error (MAE) in the duration of each contact episode found via the RTLS and direct observation was calculated. RESULTS: In comparison with EMR review, both the RTLS and the hybrid CT approach had higher sensitivity (0.955 vs 0.455 for EMR review) and a higher NPV (0.997 vs 0.968 for EMR review). The RTLS had the highest PPV (0.777 vs 0.714 for EMR review vs 0.712 for hybrid CT). The RTLS had the strongest agreement with direct observation (kappa=0.848). The MAE between contact durations of 80 direct observations and their respective RTLS contact times was 1.81 min. CONCLUSION: The RTLS was validated to be a high-performing CT tool, with significantly higher sensitivity than conventional CT via EMR review. The RTLS can be used with confidence in time-strapped EDs for time-sensitive CT for the prevention of healthcare-associated transmission of EIDs.

[Analysis of the stressors and mental status of civil aviation pilots under the background of the major infectious disease].

Objective: To study the stressors and mental status of civil aviation pilots under the background of major infectious disease. Methods: From January to March 2021, a cluster sampling method was used to select 143 airline pilots in service as the research objects. The self-made emotion and stress source questionnaire, Chinese version of stress perception scale (CPSS) , self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to investigate the airline pilot population. 136 valid questionnaires were collected, with an effective recovery rate of 95.1%. The measurement data conform to the normal distribution and are expressed by (x±s) . T-test and analysis of variance are used for comparison between groups, and Pearson correlation is used for correlation analysis. The data that do not conform to the normal distribution are expressed by the median and quartile [M (Q(1), Q(3)) ], and the non parametric test is used for the comparison between groups. Multiple linear stepwise regression was used to analyze the influencing factors of pressure perception. In addition, Amos 23.0 software was used to construct structural equation models of stress perception and negative emotions. Results: Under the background of the epidemic, the main sources of stress for civil aviation pilots are: the risk of possible reduction in income, the risk of contracting COVID-19, the pressure at work, and the risk of possible slow progress of upgrading. Among them, the first co pilot was more worried about the possible reduction of income than the instructor (P=0.009) ; The first co pilot and the captain of the airline were more worried about the possible slowdown of the upgrade progress than the instructor (P<0.001, P=0.014) . The mean pressure perception of pilots was higher than that of Chinese norm (t=3.11, P=0.002) . The standard scores of anxiety and depression were slightly higher than the standard scores of the Chinese norm under the non epidemic situation (t=7.00, 4.07, all P<0.001) . The results of multiple linear stepwise regression analysis showed that stress perception was negatively correlated with good family relations (t=-8.50, P=0.000) , and positively correlated with worries about slow progress of upgrading, COVID-19 infection, lack of interpersonal communication and income reduction (t=3.31、3.86、2.88、2.06, P<0.05) . Pressure perception was positively correlated with negative emotion (all P<0.001) . The results of structural equation model show that stress perception affects pilots' negative emotions directly or indirectly, and its standardized total effects on anxiety, depression, hypochondriac, fear, compulsion and irritability are 0.719, 0.811, 0.403, 0.355, 0.295 and 0.244 respectively. Conclusion: Public health emergencies have an impact on the mental status of pilots. Should pay attention to the stressors and psychological conditions of pilots in time, and consider formulating measures to relieve the stress of pilots.

Viruela del simio: Preocupación por una zoonosis emergente / Monkeypox: Concern about an emerging zoonosis

Introducción: La viruela del simio es una enfermedad zoonótica viral, causada por el poxvirus del mismo nombre; endémica de África central y occidental. Sin embargo, su presencia se ha incrementado en otras regiones del mundo durante la última década en comparación con los 40 años anteriores. Objetivo. Describir y actualizar las características etiológicas, epidemiológicas y clínicas de la viruela del simio, así como discutir el potencial riesgo de diseminación internacional. Material y Métodos. Se realizó una revisión de literatura publicada en los últimos cinco años, utilizando los descriptores Medical Subject Headings. La búsqueda se hizo en las bases de datos MEDLINE / PubMed y LILACS, sin restricciones de idioma. Se excluyeron los estudios duplicados y aquellos que no se ajustaban al objetivo de la investigación, seleccionando 47 artículos. Resultados. El virus de la viruela del simio está emparentado con el de la viruela humana (erradicada en 1979). Se transmite desde un individuo enfermo mediante gotitas de fluido respiratorio, contacto con material de lesión cutánea y fluidos corporales; o mediante fómites contaminados. Después de 6 a 13 días de incubación aparecen los síntomas, semejantes al de la viruela humana: comenzando con un proceso febril agudo y seguido de erupción cutánea en rostro y cuerpo, que cura dejando cicatrices visibles. Conclusiones. Este virus puede ocupar el nicho ecológico dejado por el virus de la viruela humana. Actualmente se ha expandido a Europa y América, por lo que ya no debe considerarse una enfermedad limitada al África, sino una amenaza sanitaria para la salud pública global.

background:Monkeypox is a viral zoonotic disease caused by the poxvirus of the same name, endemic to central and western Africa. However, its presence has increased in other regions of the world during the last decade compared to the previous 40 years.To describe and update the etiologic, Objective.epidemiologic, and clinical features of simian pox, as well as to discuss the potential risk of international spread. . Areview of Material and Methods literature published in the last five years was performed using the descriptors Medical Subject Headings. The search was performed in the MEDLINE/PubMed and LILACS data bases, without language restrictions. Duplicate studies and those that did not fit the research objective were excluded, selecting 47 articles. Results.Simian smallpox virus is related to human smallpox virus (eradicated in 1979). It is transmitted from a sick individual by respiratory fluid droplets, contact with skin lesion material and body fluids; or by contaminated fomites. After 6 to 13 days of incubation, symptoms appear, similar to those of human smallpox: beginning with an acute febrile process and followed by a cutaneous eruption on the face and body, which heals leaving visible scars. This virus may occupy the Conclusions.ecological niche left by the smallpox virus. It has now spread to Europe and America, so it should no longer be considered a disease limited to Africa, but a health threat to global public health

Zoonosis virales emergentes de impacto global / Emerging viral zoonoses of global impact

Objetivo: Analizar las principales zoonosis virales emergentes y su impacto a nivel global en la presentación de epidemias y pandemias que afectan la salud humana. Método: Se desarrolló una revisión sistemática de 15 artículos de la base de datos PubMed. Análisis de los resultados: Considerando que, en la inmensa mayoría de los casos, la intervención o control en la fuente animal podría evitar problemas ulteriores de salud pública, se hace necesario considerar y desarrollar intervenciones integradas, que tengan en cuenta las causas que interactúan y son responsables de los problemas intersectoriales de salud. Conclusión: El impacto humano en la ecología y el clima, junto con un transporte más rápido entre países y regiones, han acelerado la aparición o reaparición de patógenos zoonóticos.

Objective: To analyze the main emerging viral zoonoses and their global impact on the occurrence of epidemics and pandemics affecting human health. Methods: A systematic review of 15 articles from the PubMed database was carried out. Analysis of results: Considering that, in the vast majority of cases, intervention or control at the animal source could prevent further public health problems, it is necessary to consider and develop integrated interventions that take into account the interacting causes responsible for intersectoral health problems. Conclusion: Human impact on ecology and climate, together with more rapid transport between countries and regions, have accelerated the emergence or re-emergence of zoonotic pathogens.

Barriers to the Engagement of Complementary and Integrative Health Providers in Public Health Responses to COVID-19: Recommendations From a Multidisciplinary Expert Panel.

OBJECTIVE: The purpose of this project was to explore barriers to the involvement of complementary and integrative health (CIH) providers in the public health response to COVID-19 and potential solutions for future involvement in public health crises. METHODS: An expert panel of 10 people, which included doctors of chiropractic, naturopathic doctors, public health practitioners, and researchers from the United States, was convened for a day-long online panel discussion. Facilitators asked panelists how CIH practitioners could contribute and be mobilized. We summarized themes and recommendations from the discussion. RESULTS: Despite their skills and resources, few CIH providers participated in public health efforts like testing and contact tracing during the COVID-19 pandemic. Panelists described that CIH professionals may not have participated in those efforts due to the CIH providers possibly not having sufficient public health training and limited contact with public health professionals, as well as policy and financial challenges during the pandemic. Panelists proposed solutions to these barriers, including more public health training, stronger formal relationships between CIH and public health organizations, and improved financial support for both CIH care and public health efforts. CONCLUSION: Through an expert panel discussion, we identified barriers that hindered the involvement of CIH providers in the public health response to the COVID-19 pandemic. During future pandemics in the United States, public health planners should recognize CIH providers as part of the existing labor resource, with clinical expertise and community-level connections that can be called upon in a crisis. During future events, CIH professional leaders should be more proactive in seeking out a supportive role and sharing their knowledge, skills, and expertise.

[Factors Influencing the COVID-19 Vaccination Intentions in Nurses: Korea, February 2021].

PURPOSE: This study aimed to identify the factors influencing COVID-19 vaccination intentions in nurses. METHODS: The participants were 184 nurses in Korea. Data were collected using a Google Form online survey method in February, 2021, and analyzed using an independent t-test, one-way ANOVA, Pearson correlation, and multiple regression analysis with the SPSS/WIN 26.0 program. RESULTS: COVID-19 vaccination intention in nurses was correlated significantly with vaccine hesitancy (r = .58, p < .001), risk perception of COVID-19 (r =.22, p = .003), perception of vaccination as a professional duty (r = .59, p < .001), and attitude towards workplace infection control policies (r = .20, p = .007). Vaccine hesitancy (ß = .40, p < .001) and the perception of vaccination as a professional duty (ß = .44, p < .001) significantly influenced COVID-19 vaccination intention. The model developed in this study explained 50% of the variation in COVID-19 vaccination intention. CONCLUSION: Improving the perception of vaccination as a professional duty and lowering vaccine hesitancy may enhance nurses' COVID-19 vaccination intention. Above all, it is necessary to provide programs to encourage voluntary recognition of vaccination as a professional duty and develop strategies to reduce hesitancy toward COVID-19 vaccinations.

Anisakis and anisakidosis: hosts and case reports in South America. Systematic review / Anisákidos y anisakidosis: reportes de caso y hospedadores en América del Sur. Revisión sistemática

Abstract Introduction: Anisakidosis is a disease caused by the consumption of raw or undercooked seafood parasitized by nematode larvae of the family Anisakidae. Even though it is a public health issue in Europe and Asia, it is relatively unknown in South America. Objective: To present case reports on anisakidosis and the intermediate hosts of Anisakis reported in South America. Materials and methods: A systematic review was conducted in Medline, Cochrane, Embase, LILACS and Scopus using a structured search of MeSH and DeCS descriptors. The search strategy included publication period: inception of each database-September 2018; languages: English, Spanish, and Portuguese; and study types: case reports and observational cross-sectional studies. The review was complemented with an unstructured search in SciELO and Google Scholar. Results: The initial search yielded 172 articles. After removing duplicates and reviewing the inclusion criteria, 69 studies were selected for full analysis: 19 case reports and 50 host records. The most reported form of anisakidosis was gastrointestinal anisakidosis with 45 cases; this infectious disease was caused by a single larva in 41 people (91.1%). Reports of 95 species of fish for human consumption parasitized by larvae of the genera Anisakis, Contracaecum, Pseudoterranova and Hysterothylacium were identified in Argentina (22 fish species), Brazil (34 species), Chile (15 species), Colombia (17 species), Ecuador (8 species), Peru (7 species), Uruguay and Venezuela (2 species each). Conclusion: Anisakidosis is a latent risk in South America, so it is necessary to establish effective regulations for efficiently controlling the appearance of this parasitic disease in the region. Furthermore, the general population should receive more information about the precautions regarding saltwater fish consumption.

Resumen Introducción. La anisakidosis es una parasitosis ocasionada por el consumo de pescado de mar crudo o semicrudo parasitado por larvas de nematodos de la familia Anisakidae. En Europa y Asia es un problema de salud pública; sin embargo, en América del Sur es poco conocida. Objetivo. Identificar los reportes de caso de anisakidosis y los hospedadores intermediarios de anisákidos reportados en América del Sur. Materiales y métodos. Se realizó una revisión sistemática en Medline, Cochrane, Embase, LILACS y Scopus mediante la búsqueda estructurada de términos MeSH y DeCS. Estrategia de búsqueda: periodo de publicación: inicio de cada base de datos-septiembre de 2018; idiomas: inglés, español y portugués; tipos de estudio: reportes de caso y estudios transversales observacionales. La revisión fue complementada con una búsqueda no estructurada en SciELO y Google Scholar. Resultados. La búsqueda inicial arrojó 172 artículos. Una vez removidos los duplicados y revisados los criterios de inclusión, se seleccionaron 69 estudios para análisis completo: 19 reportes de caso y 50 registros de hospedadores. La forma de anisakidosis más reportada fue la gastrointestinal, con 45 casos, donde la parasitosis fue causada por una larva única en 41 casos (91.1%). Se identificaron reportes de 95 especies de peces para consumo humano parasitadas por los géneros Anisakis, Contracaecum, Pseudoterranova e Hysterothylacium en los siguientes países: Argentina (22 especies), Brasil (34 especies), Chile (15 especies), Colombia (17 especies), Ecuador (8 especies), Perú (7 especies), Venezuela (4 especies) y Uruguay (2 especies). Conclusión. La anisakidosis es un riesgo latente para América del Sur, por lo que es necesario instaurar normativas efectivas para controlar su aparición en la región y brindar más información a la población general sobre las precauciones necesarias en relación con el consumo de pescado de agua salada.

Descriptive study of the initial cases of Covid-19 in a city in the interior of Ceará, Brazil / Estudio descriptivo de los casos iniciales de Covid-19 en una ciudad del interior de Ceará, Brasil

Objective: to describe the sociodemographic, epidemiological and clinical characteristics of the initial cases of Covid-19 in the municipality of Sobral, Ceará, Brazil. Materials and methods: descriptive, temporal and quantitative epidemiological study, developed in the municipality of Sobral - Ceará, Brazil, with 110 confirmed cases of Covid-19. Descriptive and analytical analysis was performed, using the Chi-square test and Logistic Regression to verify the association between variables. The level of significance was set at 95% (p≤0.05). Results: it was observed that 60% of cases occurred in women, 74.5% were adults between 20 and 59 years old, 15.5% health workers and the lethality rate was 1.8%. In 58.2% of cases the main reporting unit was the hospital, 10% required hospitalization, and 64.5% were diagnosed with rapid tes. The main symptoms manifested were: cough (58.2%), fever (57.3%), sore throat (36.4%) and difficulty breathing (31.9%). There was an association between age and the presence of fever, cough and sore throat (p=0.05). Conclusion: the results suggest that older people are more susceptible to some symptoms when compared to younger people. Associated with global estimates, this work can provide subsidies for Covid-19 prevention and control actions in small and medium-sized Brazilian municipalities..(Au)

Objectivo: describir las características sociodemográficas, epidemiológicas y clínicas de los casos iniciales de Covid-19 en el municipio de Sobral, Ceará, Brasil. Materiales y métodos: estudio epidemiológico descriptivo, temporal y cuantitativo, desarrollado en el municipio de Sobral - Ceará, Brasil, con 110 casos confirmados de Covid -19. Se realizó análisis descriptivo y analítico, utilizando la prueba de chi-cuadrado y regresión logística para verificar la asociación entre variables. El nivel de significancia se estableció en 95% (p≤0.05). Resultados: se observó que el 60,0% de los casos ocurrieron en mujeres, el 74,5% eran adultos entre 20 y 59 años, el 15,5% trabajadores de la salud y la tasa de letalidad fue del 1,8%. En el 58,2% de los casos la principal unidad de notificación fue el hospital, el 10% requirió hospitalización y el 64,5% fueron diagnosticados con pruebas rápidas. Los principales síntomas manifestados fueron: tos (58,2%), fiebre (57,3%), dolor de garganta (36,4%) y dificultad para respirar (31,9%). Hubo asociación entre la edad y la presencia de fiebre, tos y dolor de garganta (p=0,05). Conclusión: los resultados sugieren que las personas mayores son más susceptibles a algunos síntomas en comparación con las personas más jóvenes. Asociado a estimaciones globales, este trabajo puede proporcionar subsidios para acciones de prevención y control de Covid-19 en municipios brasileños pequeños y medianos..(Au)

Parechovirus Genotype 3 Outbreak Among Young Infants in Portugal.

INTRODUCTION: Human parechovirus type 3 has been recognized as a cause of pediatric infection, occasionally associated with serious illness, including sepsis and meningitis, particularly among young infants. The aim of this study is to report the first known human parechovirus type 3 outbreak in Portugal. MATERIAL AND METHODS: Descriptive study of an outbreak that occurred between the 8th June to the 12th August 2016. Laboratory diagnosis was made by reverse transcription - polymerase chain reaction in the cerebrospinal fluid and/or in stools. Genotyping was made by reverse transcription - polymerase chain reaction and sequencing in stool samples from infants and family members. RESULTS: Human parechovirus type 3 infection was detected in seven infants, of which six were male. Median age was 23 days (5 - 52). One had seizures, with a magnetic resonance imaging scan showing white matter diffusion restriction. The mean duration of admission was 5.6 days (3 - 11), with favourable outcome in all. In three cases there were symptomatic close family members. Human parechovirus type 3 was identified in the stools of three mothers. DISCUSSION: Even though human parechovirus type 3 infection has been well described in the presented age group, most Portuguese hospitals do not have this laboratory diagnosis. Our results are comparable to those obtained in other countries. Besides detection of the virus in the cerebrospinal fluid, there were no raised local or systemic inflammatory markers. CONCLUSION: This study reports the first known outbreak, in infants, of human parechovirus type 3 in Portugal. Although there is no specific treatment, this diagnosis can avoid unnecessary empirical antibiotic treatment and prolonged admissions.

Introdução: O parechovirus humano tipo 3 tem sido reconhecido como causa de infeção em idade pediátrica, ocasionalmente associado a doença grave, incluindo sépsis e meningite, particularmente em pequenos lactentes. Foi objectivo deste estudo descrever o primeiro surto conhecido de infeção por parechovirus humano tipo 3 em Portugal. Material e Métodos: Estudo descritivo de um surto ocorrido entre 8 de junho a 12 de agosto de 2016. O diagnóstico laboratorial foi realizado por transcriptase reversa - reação em cadeia da polimerase no líquido cefalorraquidiano e/ou nas fezes. A genotipagem foi efetuada no Instituto Nacional de Saúde Doutor Ricardo Jorge, por transcriptase reversa - reação em cadeia da polimerase e sequenciação, em amostras de fezes dos lactentes e seus familiares. Resultados: Foi detetada infeção por parechovirus humano tipo 3 em sete lactentes, seis dos quais do sexo masculino, mediana de idade de 23 dias (5 - 52). Uma lactente apresentou convulsões, com múltiplas lesões da substância branca na ressonância magnética nuclear. A duração média de internamento foi de 5,6 dias (3 - 11), com evolução favorável em todos. Em três casos havia familiares próximos sintomáticos. Em três mães foi identificado parechovirus humano tipo 3 nas fezes. Discussão: Embora a infeção por parechovirus humano tipo 3 esteja bem descrita neste grupo etário, a maior parte dos hospitais portugueses não dispõe deste diagnóstico laboratorial. Os resultados obtidos foram semelhantes aos verificados noutros países. Apesar da deteção do vírus no líquido cefalorraquidiano, destaca-se a ausência de resposta inflamatória local ou sistémica. Conclusão: Este estudo reporta o primeiro surto conhecido de infeção por parechovirus humano tipo 3 ocorrido em Portugal em pequenos lactentes. Apesar de não existir tratamento específico, este diagnóstico poderá evitar poderá evitar antibioterapia e internamentos prolongados.

How lessons learned from the 2015 Middle East respiratory syndrome outbreak affected the response to coronavirus disease 2019 in the Republic of Korea.

The Republic of Korea (ROK) experienced a public health crisis due to Middle East respiratory syndrome (MERS) in 2015 and is currently going through the coronavirus disease 2019 (COVID-19) pandemic. Lessons learned from the disastrous MERS outbreak were ref lected in the preparedness system, and the readiness capabilities that were subsequently developed enabled the country to successfully flatten the epidemic curve of COVID-19 in late February and March 2020. In this review, we summarize and compare the epidemiology and response of the ROK to the 2015 MERS outbreak and the COVID-19 epidemic in early 2020. We emphasize that, because further COVID-19 waves seem inevitable, it is urgent to develop comprehensive preparedness and response plans for the worst-case scenarios of the COVID-19 pandemic. Simultaneously strengthening healthcare capacity to endure the peak demand and implementing smart strategies to sustain social distancing and public hygiene are necessary until safe and effective therapeutics and vaccines against COVID-19 are available.

Thoughts on promoting the development of large public hospitals during the period of normal epidemic prevention and control / 中华医院管理杂志

As the main body of providing medical and health services, public hospitals always bear the important responsibility of maintaining people′s life and health.In the period of normal epidemic prevention and control, public hospitals are also facing a series of new situations, including changes in social environment, demands for reform and development and transformation of target functions. It is urgent to solve many problems, such as inadequate capacity building, continuous heavy operational pressure, impact on traditional modes, and constant adjustment of positioning and mode.Therefore, both the state and the government should adhere to the public welfare as the fundamental standpoint, accelerate the implementation of scientific planning and balanced distribution of medical resources, through the fundamental adjustment of the system and mechanism, and actively help public hospitals to choose the appropriate development mode, as soon as possible to relieve pressure rescue; Public hospitals should actively make use of the extensive application of Internet and other technologies and the huge potential contained in scientific and technological innovation to achieve high-quality development goals of improving quality and efficiency, and provide more powerful support for the overall national strategy.

Covid-19 in northeast Brazil: first year of the pandemic and uncertainties to come / Covid-19 no nordeste do Brasil: primeiro ano de pandemia e incertezas que estão por vir

ABSTRACT OBJECTIVE To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals—some at explosive speed—especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.

RESUMO OBJETIVO Analisar a epidemia da covid-19 na região Nordeste do Brasil, uma das mais atingidas por essa virose. MÉTODOS Os dados oficiais para covid-19 dos estados do Nordeste são referentes ao período de março de 2020 a março de 2021. A análise para capitais e estados da série do acumulado semanal de casos e de óbitos confirmados foi feita com emprego do aplicativo JoinPoint Trend Analysis. RESULTADOS Em um ano, o Nordeste acumulou 22,9% dos casos e 21,5% dos óbitos do país pela covid-19. No início da pandemia, todos os estados apresentaram um crescimento sustentável de casos, primeiro nas capitais e depois interior. Em seguida, observam-se decréscimos em todos os estados e suas capitais, porém muitos permanecem com números elevados. Em meados do segundo semestre de 2020, o número de casos começa a crescer nos estados e suas capitais, alguns em velocidade explosiva, em especial no final de 2020 e início de 2021. Padrão similar é observado para os óbitos, os quais ultrapassaram ou aproximam-se do teto observado na primeira onda, na qual todas as capitais e estados do Nordeste adotaram intensas medidas de isolamento. Fortaleza, Recife e Teresina atingiram os maiores índices de isolamento de todas as capitais, perto de 0,60. Esse índice decresce, com tendência leve de crescimento até final de dezembro, voltando a decrescer. Com exceção de Fortaleza e Salvador, as demais capitais caíram para menos de 0,40. CONCLUSÃO O Nordeste brasileiro e o país estão em uma situação sanitária, social e econômica cada vez mais complexa. É necessário acelerar o processo de vacinação e manter as medidas não farmacológicas - constante uso de máscaras faciais, medidas de distanciamento e cuidados de higiene -, além de políticas de proteção aos trabalhadores que perderam as suas rendas e subsídios aos pequenos empresários.

The effect of early-stage public health policies in the transmission of COVID-19 for South American countries.

OBJECTIVES: The analysis of transmission dynamics is crucial to determine whether mitigation or suppression measures reduce the spread of coronavirus disease 2019 (COVID-19). This study sought to estimate the basic (R0 ) and time-varying (Rt ) reproduction number of COVID-19 and contrast the public health measures for ten South American countries. METHODS: Data was obtained from the European Centre for Disease Prevention and Control. Country-specific R0 values during the first two weeks of the outbreak and Rt values after 90 days were estimated. RESULTS: Countries used a combination of isolation, physical distancing, quarantine, and community-wide containment measures to staunch the spread of COVID-19 at different points in time. R0 ranged from 1.52 (95% confidence interval: 1.13-1.99) in Venezuela to 3.83 (3.04-4.75) in Chile, whereas Rt after 90 days ranged from 0.71 (95% credible interval: 0.39-1.05) in Uruguay to 1.20 (1.19-1.20) in Brazil. Different R0 and Rt values may be related to the testing capacity of each country. CONCLUSION: R0 in the early phase of the outbreak varied across the South American countries. The public health measures adopted in the initial period of the pandemic appear to have reduced Rt over time in each country, albeit to different levels.

OBJETIVOS: Estimar el número de reproducción básico (R0 ) y el número de reproducción efectivo (Rt ) de la COVID-19 y contrastarlos con las medidas de salud pública implementadas en diez países de América del Sur. MÉTODOS: Los datos se obtuvieron del Centro Europeo para la Prevención y el Control de las Enfermedades. Se estimó el R0 de cada país durante las dos primeras semanas del brote y el Rt después de 90 días. RESULTADOS: Los países utilizaron una combinación de aislamiento, distanciamiento físico, cuarentena y medidas de contención en toda la comunidad para detener la propagación de la COVID-19 en diferentes momentos. El R0 osciló entre 1,52 (IC95%: 1,13-1,99) en Venezuela y 3,83 (IC95%: 3,04-4,75) en Chile, mientras que el Rt después de 90 días varió entre 0,71 (intervalo de credibilidad 95%: 0,39-1,05) en Uruguay y 1,20 (intervalo de credibilidad 95%: 1,19-1,20) en Brasil. Los diferentes valores de R0 y Rt pueden estar relacionados con la capacidad de llevar a cabo pruebas de detección viral de cada país. CONCLUSIÓN: Los valores del R0 en la fase inicial del brote variaron entre los países sudamericanos. Las medidas de salud pública adoptadas en el período inicial de la pandemia parecen haber reducido el Rt con el tiempo en cada país, aunque en niveles diferentes.

The political management of Covid-19 in Portugal: analytical insights for the international debate / A gestão política da Covid-19 em Portugal: contributos analíticos para o debate internacional

As the SARS-CoV-2 pandemics reaches the entire planet the political responses to deal with the coronavirus disease Covid-19 have flourished. However, not only has the evidence on decision-making and outcomes ­ including the side effects ­ lacked, but also the policy analysis has not been able to overcome an overly descriptive nature that brings too little to the theoretical understanding of the political management of Covid-19. Building on the Portuguese case, this essay aims to contribute to fill in such blanks, notably by contributing to the improvement of political responses and consolidation of the theoretical debate about political decision-making in the context of health crises. The reflection  expands on the need to clarify the goal of the management of contagions (whether the aim is to eradicate, manage, ignore or if there is an inability to manage the transmission chains), on the quality monitoring and limits of international comparisons (different methodologies and the importance of mass screening), and on aspects of leaving with Covid-19 and quest for normality (challenges in the access to vaccination and links with broader social inequalities). The reflection ends by showing how the Portuguese case resonates on some of the key theories of the analysis of public policies cycles.

À medida que a pandemia SARS-CoV-2 alcança a escala planetária multiplicam-se as respostas políticas de combate à doença Covid-19. Contudo, não só persiste a falta de evidência sobre os processos de tomada de decisão e os resultados obtidos ­ incluindo os colaterais ­, como a análise de políticas não tem sido capaz de ultrapassar reportes descritivos que pouco acrescentam à compreensão teórica da gestão política desta doença. Partindo do caso português, este ensaio visa contribuir para corrigir essas lacunas, em concreto: contribuir para a melhoria das respostas políticas e para a consolidação do debate teórico a respeito da tomada de decisão política em contexto de crises sanitárias. A reflexão desenvolve-se em torno da necessidade de clarificar os objetivos de gestão dos contágios (se é erradicar, gerir, ignorar ou se há incapacidade na gestão das cadeias de transmissão), sobre a qualidade da monitorização e limites da comparação internacional (diferenças de metodologias e a importância dos rastreios) e sobre aspetos de como viver com a Covid-19 e a procura de normalidade (desafios no acesso à vacinação e relações com desigualdades sociais). A reflexão termina com a indicação de como o caso português ilustra as principais teorias de análise dos ciclos das políticas públicas.

Pediculosis capitis y transmisión potencial de enfermedades infecciosas reemergentes en Colombia. Revisión de la literatura / Pediculosis capitis and potential transmission of re-emerging infectious diseases in Colombia. Literature review

Resumen Introducción. La infestación por piojos de la cabeza en humanos (Pediculus humanus capitis) se conoce como pediculosis capitis. Estos parásitos pueden ser vectores de enfermedades infecciosas con potencial reemergente. Objetivos. Revisar la literatura actual sobre las enfermedades infecciosas transmitidas por piojos de la cabeza y realizar una breve descripción de sus manifestaciones clínicas. Materiales y métodos. Se realizó una revisión de la literatura en Medline, ScienceDirect, Google Scholar y SciELO mediante la siguiente estrategia de búsqueda: años de publicación: 1938 a 2019; idioma: inglés y español; términos de búsqueda: "Pediculus", "lice infestations", "bacteria", "emerging communicable diseases", "Rickettsia", "Bartonella", "Borrelia", "Acinetobacter", "Yersinia", and "Colombia", y sus equivalentes en español. Resultados. De los 110 artículos incluidos, la mayoría correspondió a investigaciones originales (48.2%). A nivel mundial, numerosos estudios han reportado la transmisión de Rickettsia prowazekii, Bartonella quintana, Borrelia recurrentis, Staphylococcus aureus, Acinetobacter bau-manniiy Yersiniapestis, entre otras bacterias, por los piojos de la cabeza y del cuerpo en humanos. Conclusiones. Aunque las enfermedades infecciosas transmitidas por piojos de la cabeza son raras, guardan potencial reemergente en poblaciones afectadas por migraciones humanas, crisis sociopolíticas, indigencia e inmunosupresión. En Colombia no se han realizado investigaciones sobre la transmisión de estas enfermedades por Pediculus spp., por lo que se sugiere que en estudios futuros se determine la prevalencia y los aspectos epidemiológicos de las enfermedades transmitidas por piojos de la cabeza.

Abstract Introduction: Head lice (Pediculus humanus capitis) infestation in humans is known as pediculosis capitis. These parasites can be vectors of potentially re-emerging infectious diseases. Objective: To review the current literature on infectious diseases transmitted by head lice and provide a brief description of their clinical manifestations. Materials and methods: A literature review was conducted in the Medline, ScienceDirect, Google Scholar and SciELO databases using the following search strategy: Publication time: 1938 to 2019; Publication language: English and Spanish; Search terms: "Pediculus", "lice infestations", "bacteria", "emerging communicable diseases", "Rickettsia", "Bartonella", "Borrelia", "Acinetobacter", "Yersinia", and "Colombia", and their Spanish equivalents. Results: Of the 110 studies included in the review, most of them were original research articles (48.2%). Worldwide, many studies have reported the transmission of Rickettsia prowazekii, Bartonella quintana, Borrelia recurrentis, Staphylococcus aureus, Acinetobacter baumannii and Yersinia pestis, among other bacteria, by head and body lice in humans. Conclusions. Although infectious diseases transmitted by head lice are rare, they have the potential to become re-emerging infectious diseases in population groups affected by human migration processes, socio-political crises, homelessness, and immunosuppression conditions. In Colombia, so far, there are no studies on the transmission of these bacterial diseases by Pediculus spp., so in future studies the prevalence and epidemiological characteristics of human head louse-borne diseases should be determined.