Interferon therapy in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis of clinical studies.

Concern regarding coronavirus (CoV) outbreaks has stayed relevant to global health in the last decades. Emerging COVID-19 infection, caused by the novel SARS-CoV2, is now a pandemic, bringing a substantial burden to human health. Interferon (IFN), combined with other antivirals and various treatments, has been used to treat and prevent MERS-CoV, SARS-CoV, and SARS-CoV2 infections. We aimed to assess the clinical efficacy of IFN-based treatments and combinational therapy with antivirals, corticosteroids, traditional medicine, and other treatments. Major healthcare databases and grey literature were investigated. A three-stage screening was utilized, and included studies were checked against the protocol eligibility criteria. Risk of bias assessment and data extraction were performed, followed by narrative data synthesis. Fifty-five distinct studies of SARS-CoV2, MERS-CoV, and SARS-CoV were spotted. Our narrative synthesis showed a possible benefit in the use of IFN. A good quality cohort showed lower CRP levels in Arbidol (ARB) + IFN group vs. IFN only group. Another study reported a significantly shorter chest X-ray (CXR) resolution in IFN-Alfacon-1 + corticosteroid group compared with the corticosteroid only group in SARS-CoV patients. In a COVID-19 trial, total adverse drug events (ADEs) were much lower in the Favipiravir (FPV) + IFN-α group compared with the LPV/RTV arm (P = 0.001). Also, nausea in patients receiving FPV + IFN-α regimen was significantly lower (P = 0.03). Quantitative analysis of mortality did not show a conclusive effect for IFN/RBV treatment in six moderately heterogeneous MERS-CoV studies (log OR = -0.05, 95% CI: (-0.71,0.62), I2 = 44.71%). A meta-analysis of three COVID-19 studies did not show a conclusive nor meaningful relation between receiving IFN and COVID-19 severity (log OR = -0.44, 95% CI: (-1.13,0.25), I2 = 31.42%). A lack of high-quality cohorts and controlled trials was observed. Evidence suggests the potential efficacy of several combination IFN therapies such as lower ADEs, quicker resolution of CXR, or a decrease in inflammatory cytokines; Still, these options must possibly be further explored before being recommended in public guidelines. For all major CoVs, our results may indicate a lack of a definitive effect of IFN treatment on mortality. We recommend such therapeutics be administered with extreme caution until further investigation uncovers high-quality evidence in favor of IFN or combination therapy with IFN.

Radiografía de tórax pediátrica en la era COVID / Pediatric chest X-rays during the COVID-19 pandemic

INTRODUCCIÓN: A mediados de diciembre de 2019 se describió en China una enfermedad infecciosa causada por un nuevo tipo de coronavirus que provocaba infección respiratoria aguda y pronto se extendió por el país y por el resto del mundo. A pesar de que la radiografía de tórax es la prueba de elección inicial ante infecciones respiratorias bajas con o sin disnea, hay pocos artículos que describan los hallazgos radiológicos del niño con COVID-19. OBJETIVO: Describir las características clínicas, analíticas y los hallazgos en la radiografía de tórax de la población pediátrica atendida con clínica de infección respiratoria en nuestro hospital durante el mes de marzo. Analizar la frecuencia de COVID-19 frente a otras infecciones respiratorias y sus manifestaciones radiológicas. MATERIAL Y MÉTODOS: Estudio observacional transversal desde el 1 de marzo al 31 de marzo del 2020 de todos los niños con clínica de infección respiratoria (fiebre, rinorrea, tos y/o disnea) que han precisado radiografía de tórax en nuestro hospital. RESULTADOS: 231 niños precisaron radiografía de tórax por clínica de infección respiratoria, 90 (38,9%) niñas y 141 (61%) niños; rango de edad 1 mes-16 años, con una mediana de 4 años. La mayoría de los niños presentaron síntomas leves (88,4%). Un 29,9% de los niños presentaba ambiente epidémico familiar positivo con clínica respiratoria similar a la que presentaba el paciente. Se realizó test PCR SARS-CoV-2 a 47 de los niños que acudieron a la urgencia (20,3%), que fue positivo en 3 (6,3% de los testados). Se realizaron determinaciones microbiológicas al 36,8% (85/231), demostraron otros agentes infecciosos diferentes al SARS-CoV-2 en el 35,3% de los pacientes (30/85). Únicamente uno de los pacientes PCR positivo para SARS-CoV-2 presentó infección de orina por Escherichia coli y hemocultivo positivo para Streptococcus viridans. El 73,2% de los pacientes presentó algún tipo de alteración en la radiografía de tórax. Los engrosamientos peribronquiales fueron el hallazgo más común en el 57%. El 38,5% presentó consolidación parenquimatosa, que en un 29,2% fue bilateral y en un 3,3% asoció derrame pleural. Se demostró aumento de la trama intersticial en el 7,3%. El 7,3% se manifestó con opacidades en vidrio deslustrado. CONCLUSIÓN: Durante el mes de marzo coexistieron infecciones respiratorias sintomáticas COVID-19 y no COVID-19. El patrón radiológico de las infecciones respiratorias, incluida la COVID-19, no es específico y la radiografía en ningún caso fue suficiente para establecer el diagnóstico. Los niños con clínica respiratoria compatible con COVID-19, con o sin PCR confirmatoria, presentaron síntomas leves y en su mayoría no requirieron ingreso ni ventilación invasiva. En un entorno de transmisión comunitaria, la ausencia de antecedente epidemiológico conocido no debería ser una contraindicación para realizar estudio de PCR para SARS-CoV-2

BACKGROUND: An infectious disease caused by a new type of coronavirus that can manifest as an acute respiratory infection was discovered in China in mid-December 2019 and soon spread throughout the country and to the rest of the world. Although chest X-rays are the initial imaging technique of choice for low respiratory infections with or without dyspnea, few articles have reported the radiologic findings in children with COVID-19. OBJECTIVE: To describe the clinical, laboratory, and chest X-ray findings in pediatric patients with signs and symptoms of respiratory infection attended at our hospital in March 2020. To analyze the frequency of COVID-19 compared to other respiratory infections, and to describe the radiologic manifestations of COVID-19 in pediatric patients. MATERIAL AND METHODS: This cross-sectional observational study included all children with clinical manifestations of respiratory infection (fever, rhinorrhea, cough, and/or dyspnea) that required chest X-rays in our hospital between March 1 and March 31. RESULTS: A total of 231 pediatric patients (90 (39%) girls and 141 (61%) boys; mean age, 4 y, range 1 month - 16 years) underwent chest X-rays for suspected respiratory infections. Most (88.4%) had mild symptoms; 29.9% had a family member positive for COVID-19 with symptoms similar to those of the patient. Nasal and/or throat swabs were analyzed for SARS-CoV-2 with PCR in the 47 (20.3%) children who presented at the emergency department; 3 (6.3%) of these were positive. Microbiological analyses were done in 85 (36.8%) of all patients, finding infections due to pathogens other than SARS-CoV-2 in 30 (35.3%). One of the patients with a PCR positive for SARS-CoV-2 had urine infection due to E. coli and blood culture positive for S. viridans. Abnormalities were observed on X-rays in 73.2% of the patients. Peribronchial thickening was the most common abnormal finding, observed in 57% of patients. Parenchymal consolidations were observed in 38.5%, being bilateral in 29.2% and associated with pleural effusion in 3.3%. The interstitial lines were thickened in 7.3%, and 7.3% had ground-glass opacities. CONCLUSION: During March 2020, COVID-19 and other symptomatic respiratory infections were observed. The radiologic pattern of these infections is nonspecific, and chest X-rays alone are insufficient for the diagnosis. Children with clinical manifestations compatible with COVID-19 (with or without PCR confirmation of infection by SARS-CoV-2) had mild symptoms and most did not require admission or invasive mechanical ventilation. In a context of community transmission, the absence of a known epidemiological antecedent should not be a contraindication for PCR to detect SARS-CoV-2

Diagnóstico de neumonía COVID-19 en pacientes asintomáticos tras la realización de un PET/TC oncológico / Diagnosis of COVID-19 pneumonia in asymptomatic patients after an oncological PET/CT

INTRODUCCIÓN: El 30 de enero de 2020 la organización mundial de la salud (OMS) declaró una emergencia internacional por la pandemia causada por un nuevo coronavirus. Existen algunas indicaciones oncológicas que tienen especial prioridad y se siguen realizando estudios a pesar de la situación actual. En estos estudios hemos encontrado hallazgos sospechosos de neumonía COVID-19 en pacientes asintomáticos. El objetivo de este trabajo es valorar la incidencia de estos hallazgos, describir sus características y valorar la evolución de los pacientes sospechosos. MATERIAL Y MÉTODOS: Se han revisado los estudios PET oncológicos realizados entre el 18 de marzo y el 8 de abril de 2020. Se han identificado los pacientes que presentaban hallazgos sugerentes de corresponder con un proceso infeccioso pulmonar de forma incidental en pacientes asintomáticos. Se han revisado las historias clínicas de estos pacientes para confirmar o descartar la infección por SARS-CoV-2. RESULTADOS: Durante el periodo especificado se realizaron un total de 129 estudios PET/TC con indicación oncológica. De ellos, en 11 (8,5%) se encontraron hallazgos sospechosos de proceso infeccioso pulmonar. Se trataba de 8 varones y 3 mujeres con edades comprendidas entre los 30 y los 79 años (media: 62,2). CONCLUSIONES: Los pacientes con COVID-19 pueden presentar escasos síntomas de la enfermedad, y en los estudios PET/TC se pueden detectar tanto pacientes presintomáticos como pacientes casi asintomáticos por lo que los médicos nucleares deben prestar especial atención en la valoración pulmonar de los estudios PET/TC

INTRODUCTION: On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients. MATERIAL AND METHODS: Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV-2 infection. RESULTS: During the specified period, a total of 129 PET/CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2). CONCLUSIONS: Patients with COVID-19 can present few symptoms of the disease, and in PET/CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET/CT studies

No es COVID-19 todo lo que reluce / Not all that glitters is COVID-19

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Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review.

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVID-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review. Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients' manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0. Results A total of 24 studies were included, composing of 10 studies of COVID-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to "mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly" was similar among the 3 groups (χ2=7.966, P>0.05). There were no significant differences on the lesion distribution (χ2=13.053, P>0.05) and predominate involvement of the subpleural area of bilateral lower lobes (χ 2=4.809, P>0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (χ 2=23.509, P<0.05). The proportions of crazy-paving pattern (χ 2=23.037, P<0.001), organizing pneumonia pattern (P<0.05) and pleural effusions (P<0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SARS than COVID-19 and MERS (χ 2=6.275, P<0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (χ 2=22.412, P<0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group. Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SARS only. MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Nosocomial COVID-19 Infection and Severe COVID-19 Pneumonia in Patients Hospitalized for Alcoholic Liver Disease: A Case Report.

BACKGROUND COVID-19 is an infectious disease caused by SARS-CoV-2. It has spread rapidly through the world, endangering human life. The main target of COVID-19 is the lungs; however, it can involve other organs, including the liver. Patients with severe COVID-19 have an increased incidence of abnormal liver function, and patients with liver disorders are considered to be at a higher risk of severe COVID-19 infection. The mechanism of liver injury reported in 14% to 53% of COVID-19 patients is poorly recognized and several possibilities need to be considered (cytokine storm, direct viral action, hypoxia). The incidence of underlying liver comorbidities in patients with a COVID-19 infection ranges from 1% to 11%. CASE REPORT This is a report of 2 nosocomial COVID-19 infections and severe COVID-19 pneumonia in 2 patients who were hospitalized during treatment for alcoholic liver disease (ALD). Case 1 and case 2 were a 31-year-old woman and a 40-year-old woman, respectively, with decompensated ALD and symptoms of the COVID-19 infection. Both patients were transferred from another hospital to our hospital after confirmation of COVID-19 during their hospitalization. The course of the infection progressed rapidly in both patients with the development of multiple-organ failure and death over a short period. CONCLUSIONS There are no clear recommendations on the management of ALD in the COVID-19 pandemic. Alcoholic hepatitis may be a risk factor for severe COVID-19 and a poor outcome. A high percentage of nosocomial COVID-19 infections are observed; therefore, special precautions should be taken to minimize the risk of COVID-19 exposure.

Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia.

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.

Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle?

The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.

Clinical and imaging findings of discharged patients with SARS-CoV-2 positive anal swab samples: a descriptive study.

BACKGROUND: To explore the clinical features and CT findings of clinically cured coronavirus disease 2019 (COVID-19) patients with viral RNA positive anal swab results after discharge. METHODS: Forty-two patients with COVID-19 who were admitted to Yongzhou Central Hospital, Hunan, China, between January 20, 2020, and March 2, 2020, were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using anal swab viral RT-PCR. In this report, we present the clinical characteristics and chest CT features of six patients with positive anal swab results and compare the clinical, laboratory, and CT findings between the positive and negative groups. RESULTS: The anal swab positivity rate for SARS-CoV-2 RNA in discharged patients was 14.3% (6/42). All six patients were male. In the positive group, 40% of the patients (2/5) had a positive stool occult blood test (OBT), but none had diarrhea. The median duration of fever and major symptoms (except fever) in the positive patients was shorter than that of the negative patients (1 day vs. 6 days, 4.5 days vs. 10.5 days, respectively). The incidence of asymptomatic cases in the positive group (33.3%) was also higher than that of the negative group (5.6%). There were no significant differences in the CT manifestation or evolution of the pulmonary lesions between the two groups. CONCLUSION: In our case series, patients with viral RNA positive anal swabs did not exhibit gastrointestinal symptoms, and their main symptoms disappeared early. They had similar CT features to the negative patients, which may be easier to be ignored. A positive OBT may indicate gastrointestinal damage caused by SARS-CoV-2 infection.

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis.

AIM: To determine the overall rate of chest imaging findings in asymptomatic cases, describe the most common patterns found, and determine the rate of later symptom development in these initially asymptomatic cases. MATERIALS AND METHODS: The PubMed and EMBASE databases were searched until 1 May 2020, for studies examining the proportion of positive chest imaging findings in asymptomatic cases diagnosed with COVID-19 and a random-effects meta-analysis of proportions was performed. Heterogeneity was assessed using the I2 statistic. RESULTS: Among 858 non-duplicate studies, seven studies with a total of 231 asymptomatic cases met the inclusion criteria. In the primary analysis, the pooled estimate of the overall rate of positive chest computed tomography (CT) findings among asymptomatic cases was 63% (95% confidence interval [CI]: 44-78%). Among 155/231 cases that were followed up for later symptom development, 90/155 remained asymptomatic and 65/155 developed symptoms during the study period (that ranged between seven and 30 days of follow-up). The pooled estimate of the rate of positive chest CT findings was 62% (95% CI: 38-81%) in cases that remained asymptomatic, while it was 90% (95% CI: 49-99%) in cases that developed symptoms. Among CT findings, the pooled estimate of the overall rate of ground-glass opacities (GGO) at CT alone was 71% (95% CI: 50-86%). Among other CT findings reported, 22/231 patients had GGO with consolidation, 7/231 patients had stripe shadows with or without GGO, and 8/231 patients had GGO with interlobular septal thickening. Among initially asymptomatic cases with positive CT findings, the pooled estimate of the overall rate of later symptom development was 26% (95% CI: 14-43%). CONCLUSION: In COVID-19, asymptomatic cases can have positive chest CT findings, and COVID-19 should be considered among cases with CT abnormalities even when there are no other symptoms. There is a need for close clinical monitoring of asymptomatic cases with radiographic findings as a significant percentage will develop symptoms.

Lung ultrasonography in patients with COVID-19: comparison with CT.

AIM: To determine whether findings from lung ultrasound and chest high-resolution computed tomography (HRCT) correlate when evaluating COVID-19 pulmonary involvement. MATERIALS AND METHODS: The present prospective single-centre study included consecutive symptomatic patients with reverse transcription polymerase chain reaction (RT-PCR)-proven COVID-19 who were not in the intensive care unit. All patients were assessed using HRCT and ultrasound of the lungs by distinct operators blinded to each other's findings. The number of areas (0-12) with B-lines and/or consolidations was evaluated using ultrasound and compared to the percentage and classification (absent or limited, <10%; moderate, 10-25%; extensive, 25-50%; severe, 50-75%; critical, >75%) of lung involvement on chest HRCT. RESULTS: Data were analysed for 21 patients with COVID-19 (median [range] age 65 [37-90] years, 76% male) and excellent correlation was found between the ultrasound score for B-lines and the classification (p<0.01) and percentage of lung involvement on chest HRCT (r=0.935, p<0.001). In addition, the ultrasound score correlated positively with supplemental oxygen therapy (r=0.45, p=0.041) and negatively with minimal oxygen saturation at ambient air (r=-0.652, p<0.01). CONCLUSION: The present study suggests that among COVID-19 patients, lung ultrasound and HRCT findings agree in quantifying lung involvement and oxygen parameters. In the context of the COVID-19 pandemic, lung ultrasound could be a relevant alternative to chest HRCT.

¿Estamos preparados? / Are we ready?

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La radiología en tiempos de distopías y cisnes negros: reflexiones desde el confinamiento COVID-19 / Radiology in times of dystopia and black swans: reflections during the COVID-19 lockdown

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Reinventar el proceso radiológico. Un verdadero reto / Reinventing the radiological process: a real challenge

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Atención primaria y residencias de ancianos: a propósito de la COVID-19 / Primary care, residential homes for the elderly, and COVID-19

Las residencias de ancianos han sido especialmente golpeadas durante la crisis por la actual pandemia por COVID-19. En el momento de redactar este artículo son más de 17.500 los ancianos que fallecieron por coronavirus y que vivían en residencias, más de un 66% de las defunciones. Las tasas de contagio y letalidad en la población institucionalizada son altas por la avanzada edad y deficitario sistema inmune, la presencia de comorbilidades, porque se trata de personas frágiles, porque conviven con otros residentes y cuidadores en una institución cerrada y la transmisibilidad es fácil en un contexto de alta contagiosidad y virulencia del virus. Las personas de edad avanzada presentan con mayor frecuencia las formas más graves de la enfermedad. Las presentaciones atípicas son más frecuentes en ancianos y pueden retrasar el diagnóstico. La prueba de reacción en cadena de la polimerasa (PCR) en los primeros 7 días para la detección de RNA viral del SARS-CoV-2 se considera el gold standard. Los criterios de derivación a un centro hospitalario desde los centros residenciales deberían tener en cuenta una valoración de la comorbilidad, la gravedad, la presencia de deterioro cognitivo grave y la dependencia o la necesidad de soporte ventilatorio en pacientes graves. Los centros sociosanitarios deben disponer de planes de contingencia para ofrecer una respuesta ante la aparición de casos de COVID-19. El aislamiento durante las pandemias puede tener importantes consecuencias físicas y psicosociales en los residentes. Se hace necesario reflexionar y reivindicar un nuevo modelo residencial desde un enfoque de atención centrada en la persona que procure la integración de los servicios sanitarios y sociales

Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services

The Potential for Remotely Mentored Patient-Performed Home Self-Monitoring for New Onset Alveolar-Interstitial Lung Disease.

Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an acute respiratory illness. Although most infected persons are asymptomatic or have only mild symptoms, some patients progress to devastating disease; such progression is difficult to predict or identify in a timely manner. COVID-19 patients who do not require hospitalization can self-isolate at home. Calls from one disease epicenter identify the need for homebased isolation with telemedicine surveillance to monitor for impending deterioration. Methodology: Although the dominant approach for these asymptomatic/paucisymptomatic patients is to monitor oxygen saturation, we suggest additionally considering the potential merits and utility of home-based imaging. Chest computed tomography is clearly impractical, but ultrasound has shown comparable sensitivity for lung involvement, with major advantages of short and simple procedures, low cost, and excellent repeatability. Thoracic ultrasound may thus allow remotely identifying the development of pneumonitis at an early stage of illness and potentially averting the risk of insidious deterioration to severe pneumonia and critical illness while in home isolation. Conclusions: Lung sonography can be easily performed by motivated nonmedical caregivers when directed and supervised in real time by experts. Remote mentors could thus efficiently monitor, counsel, and triage multiple home-based patients from their "control center." Authors believe that this approach deserves further attention and study to reduce delays and failures in timely hospitalization of home-isolated patients.

Should point-of-care ultrasound become part of healthcare worker testing for COVID?

The NHS in England has rapidly expanded staff testing for COVID-19 in order to allow healthcare workers who would otherwise be isolating with symptoms suspicious of COVID-19 to be cleared to work. However, the high false negative rate associated with current RT-PCR tests could put other staff, family members and patients at risk. We believe combining swab testing with real-time lung ultrasound (LUS) would improve the ability to rule-in COVID-19 infection in those requiring screening.