RESUMO
BACKGROUND: Programs offering financial support have been established to mitigate the economic fallout and vulnerabilities arising from the COVID-19 pandemic. Moreover, financial incentives were introduced to promote compliance with social isolation measures, thereby preventing SARS-CoV-2 infections and transmission. However, few low- and middle-income countries have implemented financial aid to alleviate the socio-economic impact of the COVID-19 pandemic. We estimated the association between the Brazilian Emergency Aid (EA) Program and SARS-CoV-2 testing demand, SARS-CoV-2 prevalence, and social isolation levels. METHODS: In this quasi-experimental study, we assessed microdata information from 380,000 individuals surveyed in the COVID-19 National Household Sample Survey (COVID-19 NHSS) between July 1, 2020, and Nov 30, 2020. Individuals meeting the EA eligibility criteria, those who have taken the SARS-CoV-2 test, those diagnosed with COVID-19, and/or those complying with social isolation measures were included. Beneficiaries and non-beneficiaries were matched (1:1) using propensity score matching, combined with the entropy balance technique and inverse probability treatment weighting, considering all relevant socioeconomic and health covariates. We performed logistic regression to compute the monthly average impact of EA benefits on the outcomes above. RESULTS: We included 171,183 performed tests, 19,218 COVID-19 cases, and individuals' self-response in complying with mild (N = 660,297), moderate (N = 597,159), strict social isolation (N = 149,125), and those who did not constrain social gatherings (N = 1,406,581). EA recipients showed greater testing demand (November; odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.001-1.026); however, this did not significantly reduce SARS-CoV-2 prevalence. Beneficiaries adhered better to mild isolation from July-September (September; OR: 1.017, 95% CI: 1.007-1.028), with no significant improvement from October-November. EA beneficiaries did not adhere to moderate (July, OR: 0.95, 95% CI: 0.94-0.97; November, OR: 0.83, 95% CI: 0.80-0.86) or strict (July, OR: 0.79, 95% CI: 0.75-0.84; November, OR: 0.77, 95% CI: 0.73-0.81) isolation compared to non-beneficiaries. CONCLUSIONS: Despite the severe COVID-19 situation in Brazil owing to the lack of effective public health policies and government resistance to scientific guidance, being an EA beneficiary was associated with increased testing demand and better adherence to mild social isolation measures.
Assuntos
COVID-19 , SARS-CoV-2 , Isolamento Social , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Brasil/epidemiologia , Isolamento Social/psicologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Prevalência , Teste para COVID-19/estatística & dados numéricos , Adulto Jovem , Adolescente , Idoso , Pandemias , Assistência Pública/estatística & dados numéricosRESUMO
BACKGROUND: The COVID-19 pandemic exposed several health disparities experienced by underserved and Latino/a communities, including inequitable access to COVID-19 testing. OBJECTIVE AND GOALS: To describe the utilization of a community-driven and culturally-tailored testing model on COVID-19 testing in an underserved Latino/a community in San Diego. METHODS: The Community-driven Optimization of COVID-19 testing to Reach and Engage Underserved Areas for Testing Equity (CO-CREATE) project implemented a community co-designed COVID-19 testing program in partnership with a Federally Qualified Health Center in a US/Mexico border community. RESULTS: Between May 2021 and March 2023, 24, 422 COVID-19 PCR tests were administered to 13,253 individuals, among whom 93% percent identified as Latino/a, 57% spoke Spanish in the home, and 38% resided in our target community adjacent to the US/Mexico border, San Ysidro. Based on a subset of available county testing data, CO-CREATE accounted for nearly 12% of all COVID-19 tests reported for San Ysidro residents. Over the course of the project, we estimated that nearly 17% of all San Ysidro residents were tested for COVID-19 through the CO-CREATE project. CONCLUSION: These findings highlight the success and reach of this culturally responsive and community co-designed COVID-19 testing program, within a Latino/a border community. Future public health interventions should focus on identifying testing barriers and design appropriate strategies to ensure equitable access to resources and testing uptake for all community members.
Assuntos
Teste para COVID-19 , COVID-19 , Hispânico ou Latino , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , California , COVID-19/epidemiologia , COVID-19/diagnóstico , Teste para COVID-19/estatística & dados numéricos , Área Carente de Assistência Médica , MéxicoRESUMO
BACKGROUND: During the coronavirus disease 19 (COVID-19) pandemic, diagnostic testing of the general population proved challenging due to limitations of the gold-standard diagnostic procedure using reverse transcription real-time polymerase chain reaction (RT-qPCR) for large-scale testing on the centralised model, especially in low-resource areas. OBJECTIVES: To address this, a point-of-care (PoC) diagnostic protocol for COVID-19 was developed, providing fast, reliable, and affordable testing, particularly for low-mid develop areas. METHODS: The PoC diagnostic process combines a simple paper-based RNA extraction method housed within a 3D-printed plastic device with a colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay. Nasopharyngeal/oropharyngeal swabs (NOS) and saliva samples were tested between 2020 and 2021, with the assistance of Santa Catarina's State Health Secretary, Brazil. FINDINGS: The developed diagnostic protocol showed a limit of detection of 9,900 copies and an overall diagnostic specificity of 98% for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1,348 clinical analysed samples. The diagnostic sensitivity was 95% for NOS samples, 85% for early morning saliva, and 69% for indiscriminate saliva. MAIN CONCLUSIONS: In conclusion, the developed device successfully extracted SARS-CoV-2 viral RNA from swabs and saliva clinical samples. When combined with colorimetric RT-LAMP, it provides results within 45 min using minimal resources, thus delivering a diagnostic kit protocol that is applicable in large-scale sampling.
Assuntos
COVID-19 , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Testes Imediatos , SARS-CoV-2 , Saliva , Sensibilidade e Especificidade , Humanos , COVID-19/diagnóstico , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Saliva/virologia , RNA Viral/análise , RNA Viral/isolamento & purificação , Teste de Ácido Nucleico para COVID-19/métodos , Pandemias , Brasil , Nasofaringe/virologia , Reprodutibilidade dos Testes , Teste para COVID-19/métodosRESUMO
Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.
Assuntos
COVID-19 , Análise Custo-Benefício , Modelos Teóricos , SARS-CoV-2 , Autoteste , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/diagnóstico , COVID-19/transmissão , COVID-19/economia , SARS-CoV-2/isolamento & purificação , Países em Desenvolvimento , Brasil/epidemiologia , Zâmbia/epidemiologia , Teste para COVID-19/economia , Teste para COVID-19/métodos , Eventos de MassaRESUMO
Combination COVID-19/influenza rapid tests provide a way to quickly and accurately differentiate between the two infections. The goal of this economic evaluation was to assess the cost and health benefits of a combination COVID-19/influenza Rapid Diagnostic Test (RDT) vs. current standard-of-care in the Brazilian private healthcare setting. A dual decision tree model was developed to estimate the impact of rapid differentiation of COVID-19 and influenza in a hypothetical cohort of 1,000 adults with influenza-like illness in an ambulatory healthcare setting. The model compared the use of a combination COVID-19/influenza RDT to Brazil standard diagnostic practice of a COVID-19 RDT and presumptive influenza diagnosis. Different levels of influenza prevalence were modeled with co-infection estimated as a function of the COVID-19 prevalence. Outcomes included accuracy of diagnosis, antiviral prescriptions and healthcare resource use (hospital bed days and ICU occupancy). Depending on influenza prevalence, considering 1,000 patients with influenza-like illness, a combination RDT compared to standard practice was estimated to result in between 88 and 149 fewer missed diagnoses of influenza (including co-infection), 161 to 185 fewer cases of over-diagnosis of influenza; a 24 to 34% reduction in hospital bed days and a 16 to 26% reduction in ICU days. In the base case scenario (20% influenza, 5% COVID-19), the combination RDT was estimated to result in cohort cost savings of $99. Based upon a de novo economic model, this analysis indicates that use of a combination RDT could positively impact influenza antiviral prescriptions and lower healthcare resource use.
Assuntos
COVID-19 , Influenza Humana , Humanos , COVID-19/diagnóstico , Brasil/epidemiologia , Influenza Humana/diagnóstico , Influenza Humana/economia , Análise Custo-Benefício , Adulto , SARS-CoV-2 , Teste para COVID-19/economia , Teste para COVID-19/métodos , Coinfecção , Testes de Diagnóstico RápidoRESUMO
BACKGROUND: The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited. OBJECTIVE: To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia. METHODS: Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods. RESULTS: The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies. CONCLUSION: This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.
Main findings: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.Added knowledge: By providing a detailed analysis of testing disparities and quarantine policies' effectiveness within a specific Latin American context, our research fills a critical gap in understanding their impacts on health system responses and disease control.Global health impact for policy and action: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.
Assuntos
COVID-19 , Análise de Séries Temporais Interrompida , Quarentena , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Bolívia/epidemiologia , Política de Saúde , Teste para COVID-19/estatística & dados numéricos , Pandemias/prevenção & controleRESUMO
BACKGROUND: The COVID-19 pandemic underscored the need for rapid and accurate diagnostic tools. In August 2020, the Abbott BinaxNOW COVID-19 Antigen Card test became available as a timely and affordable alternative for SARS-CoV-2 molecular testing, but its performance may vary due to factors including timing and symptomatology. This study evaluates BinaxNOW diagnostic performance in diverse epidemiological contexts. METHODS: Using RT-PCR as reference, we assessed performance of the BinaxNOW COVID-19 test for SARS-CoV-2 detection in anterior nasal swabs from participants of two studies in Puerto Rico from December 2020 to May 2023. Test performance was assessed by days post symptom onset, collection strategy, vaccination status, symptomatology, repeated testing, and RT-PCR cycle threshold (Ct) values. RESULTS: BinaxNOW demonstrated an overall sensitivity of 84.1% and specificity of 98.8%. Sensitivity peaked within 1-6 days after symptom onset (93.2%) and was higher for symptomatic (86.3%) than asymptomatic (67.3%) participants. Sensitivity declined over the course of infection, dropping from 96.3% in the initial test to 48.4% in testing performed 7-14 days later. BinaxNOW showed 99.5% sensitivity in participants with low Ct values (≤ 25) but lower sensitivity (18.2%) for participants with higher Cts (36-40). CONCLUSIONS: BinaxNOW demonstrated high sensitivity and specificity, particularly in early-stage infections and symptomatic participants. In situations where test sensitivity is crucial for clinical decision-making, nucleic acid amplification tests are preferred. These findings highlight the importance of considering clinical and epidemiological context when interpreting test results and emphasize the need for ongoing research to adapt testing strategies to emerging SARS-CoV-2 variants.
Assuntos
COVID-19 , SARS-CoV-2 , Sensibilidade e Especificidade , Humanos , COVID-19/diagnóstico , Porto Rico/epidemiologia , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/genética , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Antígenos Virais/análise , Adulto Jovem , Adolescente , Teste Sorológico para COVID-19/métodos , Idoso , Teste para COVID-19/métodosRESUMO
BACKGROUND: In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years. METHODS: We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection. RESULTS: Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection. CONCLUSIONS: This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated.
Assuntos
COVID-19 , Programas de Rastreamento , Humanos , Haiti/epidemiologia , COVID-19/epidemiologia , COVID-19/mortalidade , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Incidência , Programas de Rastreamento/estatística & dados numéricos , Adulto Jovem , SARS-CoV-2 , Adolescente , Idoso , Fatores Socioeconômicos , Teste para COVID-19/estatística & dados numéricosRESUMO
OBJECTIVE: To evaluate the feasibility and accuracy of an unprecedented COVID-19 antigen testing program in schools, which required a healthcare provider order, laboratory director, a Clinical Laboratory Improvement Amendments certificate of waiver, as well as training of school personnel. STUDY DESIGN: Descriptive report of a point-of-care, school-based antigen testing program in California from August 1st, 2021 through May 30, 2022, in which participants grades K-12 self-swabbed and school personnel performed testing. Participants included 944 009 students, personnel, and community members from 4022 California kindergarten through high schools. Outcomes measured include sensitivity and specificity (with polymerase chain reaction [PCR] as comparator) of the Abbott BinaxNOW antigen test, number of tests performed, and active infections identified. RESULTS: Of 102 022 paired PCR/antigen tests, the overall sensitivity and specificity for the antigen test was 81.2% (95% CI: 80.5%-81.8%) and 99.6% (95% CI: 99.5%-99.6%), respectively, using cycle threshold values <30. During January through March 2022, the highest prevalence period, the positive predictive value of antigen testing was 94.7% and the negative predictive value was 94.2%. Overall, 4022 school sites were enrolled and 3 987 840 million antigen tests were performed on 944 009 individuals. A total of 162 927 positive antigen tests were reported in 135 163 individuals (14.3% of persons tested). CONCLUSIONS: Rapidly implementing a school-based testing program in thousands of schools is feasible. Self-swabbing and testing by school personnel can yield accurate results. On-site COVID-19 testing is no longer necessary in schools, but this model provides a framework for future infectious disease threats.
Assuntos
COVID-19 , Testes Imediatos , Sensibilidade e Especificidade , Humanos , COVID-19/diagnóstico , COVID-19/epidemiologia , California , Criança , Adolescente , Instituições Acadêmicas , Feminino , Masculino , Teste para COVID-19/métodos , Teste Sorológico para COVID-19/métodos , Serviços de Saúde Escolar , SARS-CoV-2 , Estudos de ViabilidadeRESUMO
As the SARS-CoV-2 virus spread throughout the world, millions of positive cases of COVID-19 were registered and, even though there are millions of people already vaccinated against SARS-CoV-2, a large part of the global population remains vulnerable to contracting the virus. Massive nasopharyngeal sample collection in Puerto Rico at the beginning of the pandemic was limited by the scarcity of trained personnel and testing sites. To increase SARS-CoV-2 molecular testing availability, we evaluated the diagnostic accuracy of self-collected nasal, saliva, and urine samples using the TaqPath reverse transcription polymerase chain reaction (RT-PCR) COVID-19 kit to detect SARS-CoV-2. We also created a colorimetric loop-mediated isothermal amplification (LAMP) laboratory developed test (LDT) to detect SARS-CoV-2, as another strategy to increase the availability of molecular testing in community-based laboratories. Automated RNA extraction was performed in the KingFisher Flex instrument, followed by PCR quantification of SARS-CoV-2 on the 7500 Fast Dx RT-PCR using the TaqPath RT-PCR COVID-19 molecular test. Data was interpreted by the COVID-19 Interpretive Software from Applied Biosystems and statistically analyzed with Cohen's kappa coefficient (k). Cohen's kappa coefficient (k) for paired nasal and saliva samples showed moderate agreement (0.52). Saliva samples exhibited a higher viral load. We also observed 90% concordance between LifeGene-Biomarks' SARS-CoV-2 Rapid Colorimetric LAMP LDT and the TaqPath RT-PCR COVID-19 test. Our results suggest that self-collected saliva is superior to nasal and urine samples for COVID-19 testing. The results also suggest that the colorimetric LAMP LDT is a rapid alternative to RT-PCR tests for the detection of SARS-CoV-2. This test can be easily implemented in clinics, hospitals, the workplace, and at home; optimizing the surveillance and collection process, which helps mitigate global public health and socioeconomic upheaval caused by airborne pandemics.
Assuntos
COVID-19 , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , SARS-CoV-2 , Saliva , Manejo de Espécimes , Humanos , Saliva/virologia , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , COVID-19/diagnóstico , COVID-19/virologia , COVID-19/urina , Técnicas de Amplificação de Ácido Nucleico/métodos , Manejo de Espécimes/métodos , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , RNA Viral/análise , RNA Viral/urina , RNA Viral/genética , RNA Viral/isolamento & purificação , Teste de Ácido Nucleico para COVID-19/métodos , Sensibilidade e Especificidade , Porto Rico/epidemiologia , Teste para COVID-19/métodosRESUMO
Background and Objectives: it is extremely important and necessary to assess epidemiological events through the analysis of measures adopted at the time of crises, especially those with a health impact as a way of improving the system for future events, with testing being a gold standard to be assessed during an epidemic. This study aimed to analyze tests for COVID-19 diagnosis, with a view to detecting possible false negative results, in Parnaíba, Piauí, from March to December 2020. Methods: a statistical analysis of the data reported and made available by the Municipal Health Department using the IBM SPSS Statistics® 21.0 software, in which the variables type of test, date of symptom onset and date of material collection were crossed to obtain the results. Results: a total of 9,473 tests were negative, of which 11.1% were carried out using the RT-PCR methodology, 6.5% using rapid antigen tests, and 82.3% using a rapid antibody test. The analysis revealed that only 0.47% RT-PCR tests and 1.7% rapid antigen tests had been carried out within the ideal testing interval. On the other hand, the rapid antibody test had 0.14% performed outside the range. Conclusion: the most successful diagnostic test was the rapid antibody test, but it is the least specific and not suitable for determining health crisis management policies, especially for isolation measures for infected people, which suggests improvements in testing systems and development of tests with longer and more accurate testing intervals.(AU)
Justificativa e Objetivos: é de suma importância e necessidade a avaliação dos eventos epidemiológicos por meio da análise das medidas adotadas no momento das crises, em especial aqueles de impacto sanitário como forma de melhor o sistema para eventos futuros, sendo a testagem um padrão-ouro a ser avaliado durante uma epidemia. O objetivo deste estudo foi analisar os testes para o diagnóstico de COVID-19, na perspectiva de detectar possíveis resultados falsos negativos, em Parnaíba, Piauí, de março a dezembro de 2020. Métodos: análise estatística dos dados notificados e disponibilizados pela Secretaria Municipal de Saúde a partir do software IBM SPSS® Statistics 21.0, em que as variáveis tipo de teste, data do início dos sintomas e data da coleta do material foram cruzadas para obtenção dos resultados. Resultados: 9.473 testes resultaram negativo, em que 11,1% foram realizados pela metodologia RT-PCR, 6,5%, pelos testes rápidos de antígeno, e 82,3%, por teste rápido de anticorpo. A análise revelou que apenas 0,47% testes por RT-PCR e 1,7% testes rápidos de antígeno haviam sido realizados dentro do intervalo ideal de testagem. Por outro lado, o teste rápido de anticorpo teve 0,14% realizados fora do intervalo. Conclusão: o teste com maior sucesso de diagnóstico foi o teste rápido de anticorpo, porém é o menos específico e não adequado para determinação de políticas de gerenciamento de crise sanitária, em especial para medidas de isolamento de infectados, o que sugere melhorias em sistemas de testagem e desenvolvimento de testes com intervalos de testagem maior e precisos.(AU)
Justificación y Objetivo: es sumamente importante y necesario evaluar los eventos epidemiológicos a través del análisis de las medidas adoptadas en el momento de las crisis, especialmente aquellas con impacto en la salud, como una forma de mejorar el sistema para eventos futuros, siendo las pruebas un estándar de oro a ser evaluado durante una epidemia. El objetivo de este estudio fue analizar pruebas para el diagnóstico de COVID-19, con miras a detectar posibles resultados falsos negativos, en Parnaíba, Piauí, de marzo a diciembre de 2020. Métodos: análisis estadístico de los datos reportados y puestos a disposición por la Secretaría de Salud Municipal mediante el software IBM SPSS® Statistics 21.0, en el cual se cruzaron las variables tipo de prueba, fecha de inicio de síntomas y fecha de recolección del material para obtener los resultados. Resultados: un total de 9.473 pruebas resultaron negativas, de las cuales el 11,1% se realizaron mediante la metodología RT-PCR, el 6,5% mediante pruebas rápidas de antígenos y el 82,3% mediante prueba rápida de anticuerpos. El análisis reveló que sólo el 0,47% de las pruebas RT-PCR y el 1,7% de las pruebas rápidas de antígenos se habían realizado dentro del intervalo de prueba ideal. Por otro lado, la prueba rápida de anticuerpos tuvo un 0,14% realizado fuera del rango. Conclusión: la prueba diagnóstica más exitosa fue la prueba rápida de anticuerpos, pero es la menos específica y no adecuada para determinar políticas de gestión de crisis sanitarias, especialmente para medidas de aislamiento de personas infectadas, lo que sugiere mejoras en los sistemas de pruebas y desarrollo de pruebas con tiempos más largos y precisos. intervalos de prueba.(AU)
Assuntos
Humanos , Técnicas de Laboratório Clínico , Teste para COVID-19 , COVID-19 , Resultados NegativosRESUMO
Objectives: The COVID-19 pandemic caused a global shortage of nasopharyngeal (NP) swabs, required for RT-PCR testing. Canadian manufacturers were contacted to share NP swab innovations. The primary objective was to determine whether novel NP test swabs were comparable to commercially available swabs regarding user characteristics, ability to collect a specimen, and diagnostic performance using RT-PCR testing. Methods: Participants were randomized by swab (test/control) and nostril (left/right). A calculated positive percent agreement ≥90% was considered successful. Mean Ct values of viral genes and housekeeping gene (RNase P) were considered similar if a Ct difference ≤ 2 between control and test group was obtained. There also was a qualitative assessment of swabs usability. Results: 647 participants were enrolled from Huaycan Hospital in Lima, Peru, distributed over 8 NP swabs brands. Seven brands agreed to share their results. There were no statistically significant differences between the test swabs of these 7 brands and control swabs. Conclusion: All the seven brands are comparable to the commercially available flocked swabs used for SARS-CoV-2 regarding test results agreement, ability to collect a specimen, and user characteristics.
Assuntos
COVID-19 , Nasofaringe , SARS-CoV-2 , Manejo de Espécimes , Humanos , COVID-19/diagnóstico , Manejo de Espécimes/métodos , Nasofaringe/virologia , Canadá , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/genética , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Peru/epidemiologia , Pandemias , Teste de Ácido Nucleico para COVID-19/métodos , Adulto Jovem , Adolescente , Teste para COVID-19/métodos , IdosoRESUMO
PURPOSE: In this work, we aimed to describe the strategy of the weekly SARS-CoV-2 RT-PCR surveillance program that was implemented in our bone marrow transplantation (BMT) unit. METHODS: Our unit performed SARS-CoV-2 RT-PCR before admission and then weekly during hospitalization even if the patient was asymptomatic. From May 2021 to May 2022, we collected data from all patients that were admitted in the BMT unit to perform transplantation. The total of SARS-CoV-2 RT-PCR performed and the positive rate were described. RESULTS: During the study period, 65 patients were admitted for HSCT. A total of 414 SARS-CoV-2 RT-PCR were performed. Two cases were detected (positivity rate, 0.48%). After the positive test, both patients were isolated outside the BMT unit. CONCLUSION: We postulate that diagnosing these patients and isolating them outside the transplantation unit may have prevented secondary symptomatic cases.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Transplante de Medula Óssea , Brasil/epidemiologia , Teste para COVID-19 , Técnicas de Laboratório Clínico , Hospitais de EnsinoRESUMO
OBJECTIVES: The COVID-19 pandemic has had a significant global impact since its declaration in March 2020. The COVID-19 pandemic has disproportionately impacted cancer patients, particularly those with breast cancer. This study aims to analyze the effects of the pandemic on women diagnosed with breast cancer recurrence. METHODS: A cohort study was conducted at a tertiary public hospital in São Paulo State, Brazil. Data were collected from electronic records. Patients diagnosed with breast cancer and experiencing recurrence between January 2011 and March 2022 were included. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. RESULTS: The study included 187 patients, 45 in the pandemic group (recurrence after March 23, 2020) and 142 in the pre-pandemic group. Distant recurrences were more frequent in both groups (pre-pandemic: 62.7 %, pandemic: 75.5 %). Compared to the pre-pandemic group (1.8 years), the pandemic group experienced a longer mean time to recurrence detection (2.9 years) and significantly decreased median survival (9 months vs. 22 months). The Cox regression analysis confirmed an increased risk of death for women diagnosed with breast cancer recurrence during the pandemic period (HR = 1.92, 95 % CI 1.19â3.12). CONCLUSION: The present study is among the first to investigate the pandemic's specific effects on breast cancer recurrence, revealing concerning delays in detection and a decrease in survival rates. Prompt diagnosis, timely treatment initiation, and comprehensive support are crucial during public health crises. These findings urge healthcare systems to prioritize tailored care for breast cancer patients during pandemics.
Assuntos
Neoplasias da Mama , COVID-19 , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Pandemias , Estudos de Coortes , Diagnóstico Tardio , Brasil/epidemiologia , Teste para COVID-19RESUMO
Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 - 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 - 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.
Assuntos
COVID-19 , Transplante de Células-Tronco Hematopoéticas , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Pandemias , Brasil/epidemiologia , Teste para COVID-19 , Fatores de Risco , COVID-19/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversosRESUMO
We report on the first case of congenital Zika syndrome to be identified during the COVID-19 pandemic in Puerto Rico. The Zika virus (ZIKV) infection was first seen in Puerto Rico in December 2015. It is a flavivirus with vertical transmission, spreading from infected mothers to their fetuses and having a broad spectrum of clinical manifestations, of which microcephaly is the most worrisome. In Puerto Rico, routine ZIKV screening during pregnancy was implemented in October 2016. However, this practice has become less frequent over time. Nevertheless, the transmission of ZIKV continues, so it is important to ensure routine ZIKV screening in endemic regions, such as Puerto Rico.
Assuntos
COVID-19 , Infecção por Zika virus , Zika virus , Gravidez , Lactente , Feminino , Humanos , Recém-Nascido , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle , Pandemias , COVID-19/epidemiologia , Recém-Nascido Prematuro , Teste para COVID-19RESUMO
BACKGROUND: The number and specificities of telehealth service units that expanded their services and diversified with the COVID-19 pandemic in Brazil need to be discovered. The objective of this manuscript is to present a methodology for the diagnostic evaluation of 19 telehealth units from different regions of the country for federal governmental decision-making. METHODS: A cross-sectional quantitative and qualitative study was carried out in the form of a census based on administrative records with an online survey and in-depth interviews with local telehealth managers. RESULTS: Despite the discontinuity of regular funding, the results point to a diversity of initiatives and advances. Citizenship, sustainability, security, and budget management are recurring themes in the maturity analysis of telehealth services after the advent of the pandemic. CONCLUSION: It is necessary for Brazil to build a resilient model of the maturity of telehealth services that contemplates the different regional scenarios.
Assuntos
COVID-19 , Telemedicina , Humanos , Brasil/epidemiologia , Pandemias , Estudos Transversais , COVID-19/epidemiologia , Teste para COVID-19RESUMO
The COVID-19 pandemic has had a significant impact on the health and economy of the global population. Even after recovery from the disease, post-COVID-19 symptoms, such as pulmonary fibrosis, continue to be a concern. This narrative review aims to address pulmonary fibrosis (PF) from various perspectives, including the fibrotic mechanisms involved in idiopathic and COVID-19-induced pulmonary fibrosis. On the other hand, we also discuss the current therapeutic drugs in use, as well as those undergoing clinical or preclinical evaluation. Additionally, this article will address various biomarkers with usefulness for PF prediction, diagnosis, treatment, prognosis, and severity assessment in order to provide better treatment strategies for patients with this disease.
Assuntos
COVID-19 , Fibrose Pulmonar Idiopática , Humanos , Pandemias , COVID-19/complicações , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/etiologia , Fibrose , Biomarcadores , Teste para COVID-19RESUMO
Mass spectrometry (MS) is a powerful analytical technique that plays a central role in modern protein analysis and the study of proteostasis. In the field of advanced molecular technologies, MS-based proteomics has become a cornerstone that is making a significant impact in the post-genomic era and as precision medicine moves from the research laboratory to clinical practice. The global dissemination of COVID-19 has spurred collective efforts to develop effective diagnostics, vaccines, and therapeutic interventions. This chapter highlights how MS seamlessly integrates with established methods such as RT-PCR and ELISA to improve viral identification and disease progression assessment. In particular, matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) takes the center stage, unraveling intricate details of SARS-CoV-2 proteins, revealing modifications such as glycosylation, and providing insights critical to formulating therapies and assessing prognosis. However, high-throughput analysis of MALDI data presents challenges in manual interpretation, which has driven the development of programmatic pipelines and specialized packages such as MALDIquant. As we move forward, it becomes clear that integrating proteomic data with various omic findings is an effective strategy to gain a comprehensive understanding of the intricate biology of COVID-19 and ultimately develop targeted therapeutic paradigms.