Riesgo de contagio por COVID-19 en función del tipo de contacto y de la renta familiar / Risk of contagion by COVID-19 depending on the type of contact and family income

Introducción: tras una segunda oleada de la pandemia COVID-19 en Zaragoza, se estudian los contactos estrechos con pacientes con COVID-19, con la finalidad de valorar el riesgo de infección tras exposición en función del paciente índice, adulto o niño, y la renta familiar. Material y métodos: se realiza un estudio descriptivo de todos los pacientes pediátricos que han tenido contacto con pacientes con COVID-19 en el centro de salud de Delicias Sur de Zaragoza entre los meses de julio y agosto de 2020 y se valora la aparición de síntomas, consultas en servicio de urgencias, realización de pruebas complementarias, contacto estrecho con adulto o con niño y la renta familiar. Resultados: un total de 292 pacientes fueron contacto estrecho con pacientes con COVID-19, de los cuales 128 fueron positivos para la PCR de SARS-CoV-2. Al analizar el tipo de contacto, se encontró que un 10,94% había mantenido contacto estrecho con un niño y un 89,06% con un adulto. El riesgo de contagio tras sufrir contacto con un niño positivo fue del 34,15%, mientras que, tras contacto con un adulto positivo, el riesgo fue del 45,78%. Asimismo, el riesgo de contagio entre las rentas inferiores a 18 000 € fue de 47,9 frente al 27,6% de aquellos pacientes con rentas superiores a 18 000 €. Conclusiones: el riesgo de contagio de COVID-19 es mayor cuando el contacto estrecho es con un adulto y cuando el nivel de renta familiar es inferior (AU)

Purpose: during the second wave of the COVID-19 pandemic in Zaragoza, we studied the paediatric contacts of COVID-19-positive patients to estimate the risk of infection after exposure to a positive child or adult and the risk of infection based on household income.Methods: we conducted a descriptive study of all paediatric patients that were close contacts of individuals with COVID-19 in the Delicias Sur Primary Care Centre (Zaragoza, Spain) between July and August 2020. We also analysed the most frequent symptoms, visits to the emergency department, diagnostic tests, contact with a child versus an adult with COVID-19 and household income.Results: a total of 292 patients had had close contact with individuals with COVID-19; 218 of them had positive SARS-CoV-2 PCR test results. When we analysed the close contacts, we found that 10.94% of patients that tested positive had been in close contact with a child with COVID-19 and 89.06% with an adult with COVID-19. The estimated risk of infection after exposure was 29.8% in the case of close contact with a child with COVID-19 compared to 46.53% when it came to close contact with an adult case. The risk of infection was higher in patients with an annual household income of less than €18000 (47.9%) compared to patients with a higher annual household income (27.6%).Conclusion: the risk of SARS-CoV-2 infection was higher in patients that had close contact with adult cases and with lower household incomes. (AU)

Two novel human coronavirus OC43 genotypes circulating in hospitalized children with pneumonia in China.

HCoV-OC43 is one of the mildly pathogenic coronaviruses with high infection rates in common population. Here, 43 HCoV-OC43 related cases with pneumonia were reported, corresponding genomes of HCoV-OC43 were obtained. Phylogenetic analyses based on complete genome, orf1ab and spike genes revealed that two novel genotypes of HCoV-OC43 have emerged in China. Obvious recombinant events also can be detected in the analysis of the evolutionary dynamics of novel HCoV-OC43 genotypes. Estimated divergence time analysis indicated that the two novel genotypes had apparently independent evolutionary routes. Efforts should be conducted for further investigation of genomic diversity and evolution analysis of mildly pathogenic coronaviruses.

Reasons for SARS-CoV-2 infection in children and their role in the transmission of infection according to age: a case-control study.

BACKGROUND: The locations where children get exposed to SARS-CoV-2 infection and their contribution in spreading the infection are still not fully understood. Aim of the article is to verify the most frequent reasons for SARS-CoV-2 infection in children and their role in the secondary transmission of the infection. METHODS: A case-control study was performed in all SARS-CoV-2 positive children (n = 81) and an equal number of age- and sex- matched controls who were referred to the S. Camillo-Forlanini Pediatric Walk-in Center of Rome. The results of all SARS-CoV-2 nasopharyngeal swabs performed in children aged < 18 years from October 16 to December 19, 2020 were analyzed. RESULTS: School contacts were more frequent in controls than in cases (OR 0.49; 95% CI: 0.3-0.9), while household contacts were higher in cases (OR 5.09; 95% CI: 2.2-12.0). In both cases and controls, school contacts were significantly less frequent, while on the contrary household contacts seemed to be more frequent in nursery school children compared to primary school or middle/high school children. A multivariate logistic regression showed that the probability of being positive to SARS-CoV-2 was significantly lower in children who had school contacts or who had flu symptoms compared to children who had household contacts. Results showed a 30.6% secondary attack rate for household contacts. CONCLUSION: In our study population, the two most frequent reasons for SARS-CoV-2 infection were school and home contacts. The risk of being positive was 5 times lower in children who had school contacts than in children who had household contacts.

Como cuidar de pacientes da Covid-19 isolados em casa?

A pandemia da Covid-19 altera rotinas e dinâmicas familiares no Brasil desde março de 2020. Muitas vezes, aqueles contaminados pelo vírus precisam realizar o isolamento social dentro da própria casa, nesse caso, as precauções com a higiene e os limites do espaço de convívio são essenciais para que se evite novos contágios, conforme descrito no artigo.

Pessoas assintomáticas podem transmitir Covid-19

A matéria aborda estudos e opiniões de diversos cientistas sobre as pesquisas para compreender as formas de contaminação do novo coronavírus, sendo que alguns estudos já apontam que indivíduos assintomáticos, que não manifestam sintomas, podem infectar outras pessoas.

Clinical characteristics of COVID-19 in family clusters: a systematic review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and reports of children during early epidemic period showed features of family clusters. The aim of this study is to assess clinical profiles of COVID-19 in family clusters with children. METHODS: We performed a systematic literature review of English database (PubMed, Web of Science) and Chinese database (" www.cnki.net ", " www.cqvip.com " and " www.Wanfangdata.com.cn ") to identify papers on family clusters of COVID-19 with children and their family members. RESULTS: Eighteen studies involving 34 children and 98 adults from 28 families were included. Fever, cough and ground-grass opacity change of chest computed tomography (CT) were the dominant features, whereas proportion of asymptomatic infections for children was higher than adults with statistical significance (32.4% and 13.3%, respectively, P < 0.05). Median time of longer incubation period (10 days) and shorter duration of pharyngeal swab nucleic acid test positive period (11 days) were seen in children than adults (7 and 17 days, respectively) with statistical significance (P < 0.05). There were statistically significant differences in lymphopenia, increased C-reactive protein and abnormal chest CT between children and adult patients (P < 0.05). Twenty-seven families reported adults as first case of COVID-19 in family clusters. CONCLUSIONS: The same virus strain can cause milder disease in children compared with their caregivers. Children of COVID-19 were infected by adults in family during the early epidemic period. Asymptomatic patients can transmit the virus.

Impactos da pandemia de covid-19 sobre sistemas de ar condicionado e climatização

Os indícios de que a transmissão do vírus Sars-CoV-2, causador da pandemia de covid-19, pode ser feita por vias aéreas provocaram a necessidade de revisão de práticas e da infraestrutura de climatização de ambientes fechados. Essa matéria apresenta o um estudo publicado pelo Centro de Controle e Prevenção de Doenças de Guangzhou, na China, e uma série de sugestões elaboradas pelos servidores da Universidade Federal de Juiz de Fora (UFJF), campus de Governador Valadares, para minimizar o risco de transmissão em ambientes fechados,

Infectologista explica riscos de reinfecção pelo coronavírus e suas variantes

O primeiro caso de reinfecção do SARS-CoV-2 foi cientificamente comprovada em agosto de 2020. Em dezembro, o Ministério da Saúde confirmou o primeiro caso do tipo no Brasil, quando uma médica de 37 anos voltou a ter diagnóstico positivo de Covid-19 mais de três meses depois de contrair a doença pela primeira vez. Desde então, pesquisadores e profissionais de saúde em todo o mundo confirmaram o risco de infecção repetida pelo coronavírus, especialmente mediante a existência de variantes do vírus.

Crescimento no número de casos pode indicar mais uma onda de contágio de Covid-19

De acordo com a 28ª edição do Boletim Informativo da Covid-19, desenvolvido pela Plataforma JF Salvando Todos, em Juiz de Fora, assim como em Minas Gerais, o número de óbitos continua a apresentar estabilidade, no entanto o índice ainda é muito elevado. O documento registra também o crescimento no número de casos, o que pode indicar o início de mais uma onda de contágio, que torna o cenário ainda mais preocupante com a chegada do inverno. O documento é elaborado por alunos e docentes do curso de Estatística da Universidade Federal de Juiz de Fora (UFJF), com o objetivo mapear a evolução da pandemia do novo coronavírus.

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis.

Importance: Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve. Objective: To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources: EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection: English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and Synthesis: We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and Measures: SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy. Results: Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance: The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.

COVID-19 Outbreak at an Exercise Facility.

The failure of patchwork infection control.

Clínica diferencial en niños infectados por SARS-CoV-2, trazabilidad de contactos y rentabilidad de pruebas diagnósticas: estudio observacional transversal / Differential clinic in children infected by SARS-CoV-2, traceability of contacts and cost-effectiveness of diagnostic tests: Cross-sectional observational study

INTRODUCCIÓN: Ante la posible coexistencia de la infección por el virus SARS-CoV-2 con otras infecciones estacionales, se pretende identificar síntomas diferenciales. Se ha estudiado el papel de los niños en el contagio intrafamiliar y la sensibilidad de la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) en un área con baja transmisión comunitaria. MATERIAL Y MÉTODOS: Estudio observacional transversal. Pacientes entre 0-15 años estudiados por técnica RT-PCR por sospecha clínica de infección por virus SARS-CoV-2 en los meses de marzo-mayo del 2020. Encuesta sobre síntomas y contactos. Determinación de anticuerpos anti-SARS-CoV-2 al menos 21 días después del test RT- PCR. RESULTADOS: Se incluyó a 126 pacientes, 33 con infección confirmada y edad media 8,4 años (IC del 95%, 6,8-10,0) superior a los no infectados. La fiebre fue el síntoma más común y con mayor sensibilidad. Las diferencias encontradas fueron una mayor frecuencia de anosmia (p = 0,029) y cefalea (p = 0,009) entre los niños infectados con una especificidad del 96,7 y el 81,5% respectivamente. No hubo diferencias en la duración de los síntomas. Un 81,8% de los infectados fue probablemente contagiado en el núcleo familiar, en un 85,2% por un progenitor que trabajaba fuera del hogar. La sensibilidad de RT-PCR fue 70,9% y su valor predictivo negativo 91,1%. CONCLUSIONES: El cuadro clínico es inespecífico y los síntomas más específicos difíciles de detectar en niños más pequeños. Los niños tuvieron un papel reducido en la transmisión intrafamiliar. La sensibilidad de la RT-PCR podría estar relacionada con una menor contagiosidad infantil tras una semana de infección

INTRODUCTION: Given the possible coexistence of infection by the SARS-CoV-2 with other seasonal infections, the aim is to identify differential symptoms. I know has studied the role of children in intrafamily contagion and the sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) in an area with low community transmission. MATERIAL AND METHODS: Cross-sectional observational study. Patients between 0-15 years studied by RT-PCR technique due to clinical suspicion of infection by SARS-CoV-2 virus in the months of March-May 2020. Survey on symptoms and contacts. Determination of Anti-SARS-CoV-2 antibodies at least 21 days after the RT-PCR test. RESULTS: 126 patients were included, 33 with confirmed infection and age mean 8.4 years (95% CI 6.8-10,5) higher than not infected. Fever was the most common and with greater sensitivity. The differences found were a greater frequency of anosmia (P = 0.029) and headache (P = .009) among children infected with a specificity of 96.7% and 81.5% respectively. There were no differences in the duration of the symptoms. 81.8% of those infected were probably infected in the nucleus 85.2% by a parent who worked outside the home. The sensitivity of RT-PCR was 70.9% and its negative predictive value 91.1%. CONCLUSIONS: The clinical picture is nonspecific and the symptoms more specific difficult to detect in younger children. Children had a reduced role in the intrafamily transmission. The sensitivity of RT-PCR could be related to a less contagiousness in children after one week of infection

Science in 5: la ventilation durante la COVID-19

¿Qué importancia tiene la ventilación y cómo lo mantiene a salvo del COVID-19? La Dra. Maria Neira de la OMS lo explica en este capitulo. Más información: https://www.paho.org/es/temas/coronav...

Congenital and Intrapartum SARS-CoV-2 Infection in Neonates: Hypotheses, Evidence and Perspectives.

INTRODUCTION: Both intrauterine and intrapartum mother-to-child transmission of SARS-CoV-2 have been reported. However, there is still disagreement as to the likelihood and frequency of such vertical transmission. OBJECTIVE: Summarize and analyze the published evidence on forms of SARS-CoV-2 vertical transmission (either intrauterine or intrapartum). EVIDENCE ACQUISITION: We carried out a review of literature published in English and Spanish from January 1, 2020 through October 30, 2020. Search engines included PubMed/MEDLINE, SciELO, LILACS, Cochrane, Google Scholar, ResearchGate and medRxiv. There were no restrictions concerning type of study. The review included 48 original research articles, 11 review articles, a meta-analysis, 2 pre-published articles, 15 systematic reviews, and 10 editorials or comments. DEVELOPMENT: Medical thinking on congenital or intrapartum maternal-fetal/neonatal transmission of SARS-CoV-2 has evolved from preliminary evidence that was divided as to whether these forms of vertical transmission were even possible to current evidence support ing both forms of transmission and hypothesizing as to the mechanisms that guide them. The presence of the SARS-CoV-2 virus in maternal, placental, fetal or neonatal tissues has been demonstrated by RT-PCR, specific immunoglobulin detection tests, immunostaining and in-situ hybridization. It is estimated that infections acquired either congenitally or intrapartum occur in 1.8%-8.0% of newborns born to women who test positive for COVID-19 at the end of their pregnancies. This review found 53 neonates who were diagnosed with COVID-19 in the first 48 hours of life by either RT-PCR or specific IgM tests. According to criteria outlined in this review, the timing of infection corresponded to congenital or intrapartum transmission in 39.6% (21/53) of COVID-19-positive newborns, to postpartum transmission in 15.1% (8/53) and remains unspecified in 45.3% (24/53). CONCLUSIONS: Congenital and intrapartum SARS-CoV-2 infection in the fetus/newborn is possible, but rare. International collaborative studies using common epidemiological surveillance instruments would allow for a more precise specification of the frequency of congenital and intrapartum SARS-CoV-2 infection at the population level.

Learning from the first wave: Lessons about managing patient flow and resource utilization on medical wards at providence health during the COVID-19 pandemic.

We report the successful implementation of a modified Traffic Control Bundling (TCB) protocol called "Red, Yellow and Green" on the inpatient medical units at St. Paul's Hospital in Vancouver, Canada during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. The modified TCB protocol demonstrates an important example on how hospitals can rapidly reorganize operational and clinical processes to reallocate existing capacity to minimize exposure, improve traffic flow and reduce nosocomial transmissions of COVID-19 to health care workers (HCWs) and other patients. Preliminary evidence demonstrates the benefits on how an existing facility can be redesigned for adjustable ward capacity to provide disease containment under a context of uncertainty of disease transmission and varying patient load. Important lessons in preparation for the evolution of the pandemic fall into categories of risk management, capacity and demand management.

Novas variantes do coronavírus

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

Tire suas dúvidas: festas em locais abertos oferecem risco de contaminação?

Saiba mais em www.saopaulo.sp.gov.br/coronavirus

Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial.

OBJECTIVE: Recommendations for widespread use of face mask, including suggested type, should reflect the current published evidence and concurrently be studied. This review evaluates the preclinical and clinical evidence on use of cloth and surgical face masks in SARS-CoV-2 transmission and proposes a trial to gather further evidence. METHODS: PubMed, EMbase, and the Cochrane Library were searched. Studies of SARS-CoV-2 and face masks and randomized controlled trials (RCTs) of n ≥ 50 for other respiratory illnesses were included. RESULTS: Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. CONCLUSION: There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance.