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4.
J Otolaryngol Head Neck Surg ; 49(1): 71, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023663

RESUMO

Within Neurotology, special draping systems have been devised for mastoid surgery recognizing that drilling of middle ear mucosa is an aerosol generating medical procedure (AGMP) which can place surgical teams at risk of COVID-19 infection. We provide a thorough description of a barrier system utilized in our practice, along with work completed by our group to better quantify its effectiveness. Utilization of a barrier system can provide near complete bone dust and droplet containment within the surgical field and prevent contamination of other healthcare workers. As this is an early system, further adaptations and national collaborations are required to ultimately arrive at a system that seamlessly integrates into the surgical suite. While these barrier systems are new, they are timely as we face a pandemic, and can play a crucial role in safely resuming surgery.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/epidemiologia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia , Comorbidade , Otopatias/cirurgia , Humanos , Pandemias , Equipamento de Proteção Individual
5.
Can Respir J ; 2020: 2045341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33005276

RESUMO

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Assuntos
Doenças Assintomáticas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral , Medição de Risco/métodos , Adulto , Fatores Etários , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Erros de Diagnóstico/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Fatores Sexuais
8.
BMC Med ; 18(1): 316, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33012285

RESUMO

BACKGROUND: Many low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study, we collect contact data from residents of informal settlements around Nairobi, Kenya, to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). METHODS: We conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, 4 weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7 pm and 5 am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. RESULTS: We estimate that control measures reduced physical contacts by 62% and non-physical contacts by either 63% or 67%, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. Eighty-six percent of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. CONCLUSION: COVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the comparatively low epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Relações Interpessoais , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Quênia/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pobreza/estatística & dados numéricos , Isolamento Social , Fatores Socioeconômicos , Inquéritos e Questionários
13.
Acta Biomed ; 91(3): ahead of print, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32921744

RESUMO

During the COVID-19 pandemic, surgical elective procedures were stopped in our plastic surgery unit. Limitations for consultations and for follow-up of previous surgical procedures were imposed in order to minimize the risk of contagion in waiting rooms and outpatient clinics. We have identified telemedicine as an alternative way to follow patients during the lockdown. Nevertheless, we have experienced different difficulties. We have not had the possibility to use a secure teleconferencing software. In our unit we had not technological devices. Surgeons in our department were not able to use remote video technology for patient management. Guidelines for an appropriate selection of patients which could be served via telemedicine had to be created. Telemedicine must be regulated by healthcare organizations for legal, ethical, medico-legal and risk management aspects. Even if we have experienced an important need to use telematic solutions during the COVID-19 lockdown, liability and risk management issues has greatly limited this possibility in our unit. The need of telemedicine in the time of COVID-19 pandemic has encouraged us to implement future virtual encounters in order to reduce unnecessary in-person visits by taking into consideration all legal, ethical and medico-legal aspects.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Gestão de Riscos/métodos , Cirurgia Plástica/organização & administração , Telemedicina/métodos , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão
15.
Prev Chronic Dis ; 17: E109, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32945766

RESUMO

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York City closed all nonessential businesses and restricted the out-of-home activities of residents as of March 22, 2020. This order affected different neighborhoods differently, as stores and workplaces are not randomly distributed across the city, and different populations may have responded differently to the out-of-home restrictions. This study examines how the business closures and activity restrictions affected COVID-19 testing results. An evaluation of whether such actions slowed the spread of the pandemic is a crucial step in designing effective public health policies. METHODS: Daily data on the fraction of COVID-19 tests yielding a positive result at the zip code level were analyzed in relation to the number of visits to local businesses (based on smartphone location) and the number of smartphones that stayed fixed at their home location. The regression model also included vectors of fixed effects for the day of the week, the calendar date, and the zip code of residence. RESULTS: A large number of visits to local businesses increased the positivity rate of COVID-19 tests, while a large number of smartphones that stayed at home decreased it. A doubling in the relative number of visits increases the positivity rate by about 12.4 percentage points (95% CI, 5.3 to 19.6). A doubling in the relative number of stay-at-home devices lowered it by 2.0 percentage points (95% CI, -2.9 to -1.2). The business closures and out-of-home activity restrictions decreased the positivity rate, accounting for approximately 25% of the decline observed in April and May 2020. CONCLUSION: Policy measures decreased the likelihood of positive results in COVID-19 tests. These specific policy tools may be successfully used when comparable health crises arise in the future.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Comércio/legislação & jurisprudência , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa , Pandemias , Pneumonia Viral , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Controle de Doenças Transmissíveis/instrumentação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Formulação de Políticas , Gestão da Saúde da População , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Medição de Risco/métodos , Smartphone/estatística & dados numéricos , Distância Social
16.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 55-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965357

RESUMO

In the context of the COVID-19 pandemic, endoscopy services must adopt preventive measures to maintain proper functioning due to a high risk of disease contagion. Triage protocols before and after the procedure, personal protective equipment, and environmental contamination control are some of the endoscopy society's recommendations. However, the risk of infection may remain high due to poor control over the source of contamination.Using a combination of standardized supplies and accessories in a hospital, a ventilation mask adapted to be used in endoscopic procedures is proposed to reduce COVID-19 contamination.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
18.
Tex Med ; 116(8): 20-25, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866271

RESUMO

Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist's practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving - and trying their best to prepare for future threats - others weren't so lucky. On-the-ground experiences align with the Texas Medical Association's Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other - challenging or torpedoing the viability of various practice types.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Prática Profissional , Telemedicina , Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Tomada de Decisões Gerenciais , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Inovação Organizacional , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/tendências , Prática Profissional/economia , Prática Profissional/tendências , Texas/epidemiologia
19.
Tex Med ; 116(8): 30-31, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866272

RESUMO

IN TEXAS, COVID-19 outbreaks have been especially pronounced in three types of facilities: nursing homes, jails or prisons, and meatpacking plants. The Amarillo area has plenty of all three. But it was the meatpacking plants that drew national attention to Amarillo's COVID-19 problems. The city, which straddles Potter and Randall counties, has numerous plants that employ 12,000 to 15,000 people. In early April, Amarillo's two hospitals began filling up with COVID-19 patients who worked at a plant in neighboring Moore County. Two weeks later, workers from a plant in Potter County flooded in.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Embalagem de Alimentos , Controle de Infecções , Produtos da Carne/virologia , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Embalagem de Alimentos/métodos , Embalagem de Alimentos/normas , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Indústria de Embalagem de Carne/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Texas/epidemiologia
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