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Ann Emerg Med ; 76(4): 413-426, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012377


STUDY OBJECTIVE: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of coronavirus disease 2019 (COVID-19)-affected populations, especially in low- and middle-income countries with less rapid and reliable vital statistics registration systems. Although official COVID-19 statistics in Mexico report almost exclusively inhospital mortality events, excess out-of-hospital mortality has been identified in other countries, including 1 EMS study in Italy that showed a 58% increase. Additionally, EMS and hospital reports from several countries have suggested that silent hypoxemia-low Spo2 in the absence of dyspnea-is associated with COVID-19. It is unclear, however, how these phenomena can be generalized to low- and middle-income countries. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many low- and middle-income country settings. METHODS: In this observational study, we calculated numbers of weekly out-of-hospital deaths and respiratory cases handled by EMS in Tijuana, and estimated the difference between peak epidemic rates and expected trends based on data from 2014 to 2019. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status, and examined for changing demographic or clinical features, including mean Spo2. RESULTS: An estimated 194.7 excess out-of-hospital deaths (95% confidence interval 135.5 to 253.9 deaths) occurred during the peak window (April 14 to May 11), representing an increase of 145% (95% CI 70% to 338%) compared with expected levels. During the same window, only 5 COVID-19-related out-of-hospital deaths were reported in official statistics. This corresponded with an increase in respiratory cases of 236.5% (95% CI 100.7% to 940.0%) and a decrease in mean Spo2 to 77.7% from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-socioeconomic-status areas, although respiratory cases were more concentrated in high-socioeconomic-status areas. CONCLUSION: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in low- and middle-income countries. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly 3-fold greater than increases reported in EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine whether excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of health care. We also found evidence of worsening rates of hypoxemia among respiratory patients treated by EMS, suggesting a possible increase in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed social disparities in out-of-hospital death that warrant monitoring and amelioration.

Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Hipóxia/virologia , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Vigilância em Saúde Pública , Classe Social , Adulto Jovem
Infect Dis Poverty ; 9(1): 139, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028400


BACKGROUND: Health workers (HWs) are at increased risk for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and a possible source of nosocomial transmission clusters. Despite the increased risk, the best surveillance strategy and management of exposed HWs are not yet well known. The aim of this review was to summarize and critically analyze the existing evidence related to this topic in order to support public health strategies aimed at protecting HWs in the hospital setting. MAIN TEXT: A comprehensive computerized literature research from 1 January 2020 up to 22 May 2020 was made to identify studies analyzing the burden of infection, risk assessment, surveillance and management of HWs exposed to SARS-CoV-2. Among 1623 citation identified using MEDLINE, Embase, Google Scholar and manual search, we included 43 studies, 14 webpages and 5 ongoing trials. Health workers have a high risk of acquiring infection while caring for coronavirus disease 2019 (COVID-19) patients. In particular, some types exposures and their duration, as well as the inadequate or non-use of personal protective equipment (PPE) are associated with increased infection risk. Strict infection prevention and control procedures (IPC), adequate training programs on the appropriate use of PPE and close monitoring of HWs with symptom surveillance and testing are essential to significantly reduce the risk. At the moment there is not enough evidence to provide precise indications regarding pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). CONCLUSIONS: During the spread of COVID-19 outbreak, numerous published papers investigated the epidemiology, risk assessment and prevention and control of SARS-CoV-2. However, more high-quality studies are needed to provide valid recommendations for better management and for the clinical and microbiological surveillance of healthcare personnel.

Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Gerenciamento Clínico , Monitoramento Epidemiológico , Hospitais , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Profilaxia Pós-Exposição , Vigilância em Saúde Pública , Medição de Risco/métodos , Fatores de Risco
J. Health NPEPS ; 5(2)set. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1119828


Objetivo: analisar os dados epidemiológicos da COVID-19 em Uberlândia e confrontá-los com as determinações municipais de abertura e fechamento comercial em diferentes momentos da pandemia. Método: trata-se de estudo epidemiológico, observacional e descritivo, utilizando dados secundários, referente aos casos notificados da COVID-19 em Uberlândia. Resultados: foram realizados 59.994 testes, sendo 14.389 positivos (23,98%) e 45.605 negativos (76,02%). Registraram-se 265 óbitos e taxa de letalidade de 1,89%. Casos confirmados apresentaram tendência de crescimento após abertura comercial, tendência de estabilização após fechamento comercial, e tendência de queda após a última reabertura comercial, acompanhada de acúmulo de testes suspeitos e queda da testagem populacional. Entre os internados diários, houve predomínio de homens (59%), maiores de 60 anos (55%) e alocados em leitos de enfermaria (55%). Conclusão: percebeu-se expressiva influência do grau de abertura comercial nos indicadores da doença, com incremento da frequência de testes positivos e óbitos, e manutenção das internações.(AU)

Objective: to analyze COVID-19's epidemiological data in Uberlândia and compare them with the municipal determinations of opening and closing of commercial's acitivities at different times of the pandemic. Method: this is an epidemiological, observational and descriptive study, using secondary data, referring to notified cases of COVID-19 in Uberlândia. Results: 59,994 tests were performed, of which 14,389 were positive (23.98%) and 45,605 negative (76.02%). There were 265 deaths and a fatality rate of 1.89%. Confirmed cases showed a growth tendency after commercial opening, a stabilization tendecy after commercial closing, and a downward tendecy after the last commercial reopening, accompanied by an accumulation of suspicious tests and a drop in population testing. Among daily inpatients, there was a predominance of men (59%), older than 60 years old (55%) and allocated to infirmary beds (55%). Conclusion: there was a significant influence of the degree of commercial opening in the indicators of the disease, with an increase in the frequency of positive tests and deaths, and maintenance of hospitalizations.(AU)

Objetivo: analizar los datos epidemiológicos de COVID-19 en Uberlândia y confrontarlos con las determinaciones municipales de apertura y cierre comercial en diferentes momentos de la pandemia. Método: se trata de un estudio epidemiológico, observacional y descriptivo, utilizando datos secundarios, referidos a los casos notificados de COVID-19 en Uberlândia. Resultados: se realizaron 59.994 pruebas, de las cuales 14.389 fueron positivas (23,98%) y 45,605 negativas (76,02%). Hubo 265 muertes y una tasa de mortalidad del 1,89%. Los casos confirmados mostraron una tendencia de crecimiento después de la apertura comercial, una tendencia de estabilización después del cierre comercial y una tendencia a la baja después de la última reapertura comercial, acompañada de una acumulación de pruebas sospechosas y una caída en las pruebas de población. Entre los internados diarios, hubo predominio de hombres (59%), mayores de 60 años (55%) y asignados a camas de enfermería (55%). Conclusión: hubo una influencia significativa del grado de apertura comercial en los indicadores de la enfermedad, con un aumento en la frecuencia de pruebas positivas y muertes, y mantenimiento de hospitalizaciones.(AU)

Humanos , Infecções por Coronavirus/epidemiologia , Pandemias , Vigilância em Saúde Pública , Monitoramento Epidemiológico , Brasil/epidemiologia , Estudos Epidemiológicos , Epidemiologia Descritiva
Cien Saude Colet ; 25(9): 3567-3571, 2020 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32876259


On February 3, 2020, the Brazilian Ministry of Health declared a state of emergency in public health of national relevance due to the pandemic caused by the new coronavirus SARS-CoV-2. As a result, IBGE postponed the 2020 Demographic Census and started to formulate a COVID-19 PNAD. The survey included a total sample of 349 thousand people in about 200 thousand households. Of the total Brazilian resident population, the IBGE estimated in May/2020 that 24.0 million (11.4%) had at least one of the flu-like syndrome symptoms. Of this contingent, 20.2 million (84.3% of all symptomatic patients) did not seek health care. The innovations brought to health surveillance and the IBGE's pioneering spirit show that it is possible, in a continental country that has been experiencing several local epidemics at different times in its territory, that other countries also develop similar household surveys, with weekly data collection (referred to epidemiological weeks) by telephone in an innovative and timely manner. The COVID-19 PNAD also brought new technology to the Institute, reviving its role as an external evaluator of the Unified Health System (SUS).

Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Saúde Pública , Inquéritos e Questionários , Betacoronavirus/isolamento & purificação , Tecnologia Biomédica , Brasil , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Assistência à Saúde/organização & administração , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/terapia , Pneumonia Viral/virologia
J Med Internet Res ; 22(9): e20924, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32915762


BACKGROUND: SARS-CoV-2, the novel coronavirus that causes COVID-19, is a global pandemic with higher mortality and morbidity than any other virus in the last 100 years. Without public health surveillance, policy makers cannot know where and how the disease is accelerating, decelerating, and shifting. Unfortunately, existing models of COVID-19 contagion rely on parameters such as the basic reproduction number and use static statistical methods that do not capture all the relevant dynamics needed for surveillance. Existing surveillance methods use data that are subject to significant measurement error and other contaminants. OBJECTIVE: The aim of this study is to provide a proof of concept of the creation of surveillance metrics that correct for measurement error and data contamination to determine when it is safe to ease pandemic restrictions. We applied state-of-the-art statistical modeling to existing internet data to derive the best available estimates of the state-level dynamics of COVID-19 infection in the United States. METHODS: Dynamic panel data (DPD) models were estimated with the Arellano-Bond estimator using the generalized method of moments. This statistical technique enables control of various deficiencies in a data set. The validity of the model and statistical technique was tested. RESULTS: A Wald chi-square test of the explanatory power of the statistical approach indicated that it is valid (χ210=1489.84, P<.001), and a Sargan chi-square test indicated that the model identification is valid (χ2946=935.52, P=.59). The 7-day persistence rate for the week of June 27 to July 3 was 0.5188 (P<.001), meaning that every 10,000 new cases in the prior week were associated with 5188 cases 7 days later. For the week of July 4 to 10, the 7-day persistence rate increased by 0.2691 (P=.003), indicating that every 10,000 new cases in the prior week were associated with 7879 new cases 7 days later. Applied to the reported number of cases, these results indicate an increase of almost 100 additional new cases per day per state for the week of July 4-10. This signifies an increase in the reproduction parameter in the contagion models and corroborates the hypothesis that economic reopening without applying best public health practices is associated with a resurgence of the pandemic. CONCLUSIONS: DPD models successfully correct for measurement error and data contamination and are useful to derive surveillance metrics. The opening of America involves two certainties: the country will be COVID-19-free only when there is an effective vaccine, and the "social" end of the pandemic will occur before the "medical" end. Therefore, improved surveillance metrics are needed to inform leaders of how to open sections of the United States more safely. DPD models can inform this reopening in combination with the extraction of COVID-19 data from existing websites.

Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Política de Saúde , Modelos Biológicos , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Vigilância em Saúde Pública/métodos , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia
PLoS Comput Biol ; 16(9): e1007836, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32960900


Early warning signals (EWS) identify systems approaching a critical transition, where the system undergoes a sudden change in state. For example, monitoring changes in variance or autocorrelation offers a computationally inexpensive method which can be used in real-time to assess when an infectious disease transitions to elimination. EWS have a promising potential to not only be used to monitor infectious diseases, but also to inform control policies to aid disease elimination. Previously, potential EWS have been identified for prevalence data, however the prevalence of a disease is often not known directly. In this work we identify EWS for incidence data, the standard data type collected by the Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO). We show, through several examples, that EWS calculated on simulated incidence time series data exhibit vastly different behaviours to those previously studied on prevalence data. In particular, the variance displays a decreasing trend on the approach to disease elimination, contrary to that expected from critical slowing down theory; this could lead to unreliable indicators of elimination when calculated on real-world data. We derive analytical predictions which can be generalised for many epidemiological systems, and we support our theory with simulated studies of disease incidence. Additionally, we explore EWS calculated on the rate of incidence over time, a property which can be extracted directly from incidence data. We find that although incidence might not exhibit typical critical slowing down properties before a critical transition, the rate of incidence does, presenting a promising new data type for the application of statistical indicators.

Doenças Transmissíveis/epidemiologia , Biologia Computacional/métodos , Modelos Estatísticos , Vigilância em Saúde Pública/métodos , Controle de Doenças Transmissíveis , Humanos , Incidência , Prevalência
Medicine (Baltimore) ; 99(37): e22067, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925742


INTRODUCTION: Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined. METHODOLOGY AND ANALYSIS: The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.

Utilização de Instalações e Serviços , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Vigilância em Saúde Pública , Qualidade de Vida , Saúde da População Rural , Estudos Transversais , Ecossistema , Programas Governamentais , Acesso aos Serviços de Saúde , Humanos , Malásia/epidemiologia
Rev Soc Bras Med Trop ; 53: e20200528, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935787


INTRODUCTION: The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. METHODS: The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. RESULTS: Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. CONCLUSIONS: The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics.

Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Algoritmos , Brasil/epidemiologia , Humanos , Pandemias
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32938607


To mitigate the spread of COVID-19, governments throughout the world have introduced emergency measures that constrain individual freedoms, social and economic rights and global solidarity. These regulatory measures have closed schools, workplaces and transit systems, cancelled public gatherings, introduced mandatory home confinement and deployed large-scale electronic surveillance. In doing so, human rights obligations are rarely addressed, despite how significantly they are impacted by the pandemic response. The norms and principles of human rights should guide government responses to COVID-19, with these rights strengthening the public health response to COVID-19.

Infecções por Coronavirus , Direitos Humanos , Pandemias , Pneumonia Viral , Direito à Saúde , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Privacidade , Vigilância em Saúde Pública
Brasília, D.F.; OPAS; 2020-09-22.
em Português | PAHO-IRIS | ID: phr2-52718


O Manual de Vigilância de Pneumonia Bacteriana e Meningite em Menores de 5 anos: Guia Prático tornou-se referência de destaque para os profissionais de saúde da Região das Américas que lidam com atividades de vigilância epidemiológica. Abrange doenças, principais agentes etiológicos, vacinas disponíveis, procedimentos laboratoriais e de vigilância para captura e monitoramento de casos, bem como análise de dados para a produção de informações relevantes. Esta segunda edição introduz novos conceitos e procedimentos de atualização para refletir a introdução de testes de biologia molecular em diagnósticos laboratoriais e a disponibilidade de novas vacinas.

Saúde da Criança , Meningites Bacterianas , Pneumonia Bacteriana , Imunização , Vacinação , Vigilância Imunológica , Vigilância em Saúde Pública
Brasília, D.F.; OPAS; 2020-09-08. (OPAS-W/BRA/COVID-19/20-108).
Não convencional em Português | PAHO-IRIS | ID: phr2-52644


O que há de novo nesta versão: • Revisão da definição de casos suspeitos e prováveis para integrar maior conhecimento sobre o espectro clínico dos sinais e sintomas da COVID-19 e considerar as situações em que o teste não está disponível para todos. • Abordagens atualizadas para vigilância, incluindo vigilância ambiental e sorológica para SARS-CoV-2. • Revisão das variáveis incluídas na vigilância semanal para que se adequem à nova definição de caso e objetivos de vigilância (ou seja, inclusão de casos prováveis, casos de profissionais de saúde e grupos de idade atualizados para notificação de casos e mortes). • Informações sobre a importância da coleta de metadados para a análise e interpretação dos dados de vigilância. • Recomendações para encerrar a notificação baseada em casos para vigilância global e substituí-la por notificação agregada. Objetivo deste documento: Este documento fornece orientação aos Estados Membros sobre a implementação da vigilância para COVID-19 e as exigências de notificação à OMS.

Infecções por Coronavirus , Betacoronavirus , Pandemias , Vigilância em Saúde Pública
Av. enferm ; 38(2): 149-158, May-Aug. 2020. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1114685


Resumo Objetivo: conhecer a configuração epidemiológica dos atendimentos oncológicos em uma macrorregião de saúde brasileira, localizada no estado de Minas Gerais, entre 2008 e 2017. Materiais e métodos: estudo quantitativo, exploratório, transversal e descritivo, realizado com dados secundários de cinco municípios localizados no estado de Minas Gerais. Resultados: houve 54.206 atendimentos a indivíduos com câncer, com predominância do sexo masculino (53,38 %), faixa etária de 60 a 79 anos (49,95 %), cor branca (79,08 %), ensino fundamental incompleto (48,36 %) e estado conjugal casado (57,34 %). As neoplasias de pele representam a mais frequente localização primária (22,35 %). O estadiamento I do tumor foi o mais observado (20,98 %). As razões mais predominantes para não tratar, depois da opção "não se aplica", foram doença avançada, falta de condições clínicas ou outras (6,97 %), ao passo que se verificou predomínio de doença estável (31,59 %) no final do primeiro tratamento recebido. Conclusão: os resultados apresentados oferecem subsídios para identificar as prioridades da atenção oncológica e traçam a configuração dos atendimentos a pacientes com câncer, o que direciona o planejamento de intervenções para proporcionar um atendimento de qualidade.

Resumen Objetivo: conocer la configuración epidemiológica de la atención del cáncer en una macrorregión de salud, ubicada en el estado de Minas Gerais, Brasil, entre 2008 y 2017. Materiales y métodos: estudio cuantitativo, exploratorio, transversal y descriptivo, realizado con datos secundarios de cinco municipios ubicados en el estado de Minas Gerais. Resultados: se atendieron a 54.206 pacientes con cáncer, predominantemente hombres (53,38 %), en un rango etario de 60 a 79 años (49,95 %), blancos (79,08 %), con educación básica primaria incompleta (48,36 %) y casados (57,34 %). Las neoplasias de piel representan la localización primaria más frecuente (22,35 %). La etapa I del tumor fue la más observada (20,98 %). Las razones más frecuentes para no tratar, después de la opción "no se aplica", fueron enfermedad avanzada, falta de condiciones clínicas u otras (6,97 %), mientras que se verificó el predominio de la enfermedad estable (31,59 %) al final del primer tratamiento recibido. Conclusión: los resultados presentados brindan apoyo para identificar las prioridades de la atención oncológica y establecen la configuración de la atención para pacientes con cáncer, lo que dirige la planificación de las intervenciones para proporcionar atención de calidad.

Abstract Objective: to know the epidemiological configuration of cancer care in a health macro-region in the Brazilian state of Minas Gerais between 2008 and 2017. Materials and methods: quantitative, exploratory, cross-sectional and descriptive study, conducted with secondary data from five municipalities of the state of Minas Gerais. Results: there were 54,206 visits to cancer patients, predominantly male (53.38%), aged 60 to 79 years (49.95%), white (79.08%), with incomplete elementary school education (48.36 %), and married (57.34 %). Skin neoplasms represent the most frequent primary location (22.35%). Stage I of the tumor was the most observed (20.98 %). The most prevalent reasons for not treating after the "not applicable" option were advanced disease and lack of clinical conditions or other conditions (6.97 %), whereas stable disease (31.59%) prevailed at the end of the first treatment received. Conclusion: the results provide support to identify the priorities of cancer care and outline the configuration for cancer treatment in patients, which directs the planning of interventions to provide high quality care.

Humanos , Epidemiologia , Vigilância em Saúde Pública , Sistemas de Informação em Saúde , Neoplasias
JMIR Public Health Surveill ; 6(3): e19399, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32788148


BACKGROUND: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases of coronavirus disease (COVID-19) in the United States has exponentially increased. Identifying and monitoring individuals with COVID-19 and individuals who have been exposed to the disease is critical to prevent transmission. Traditional contact tracing mechanisms are not structured on the scale needed to address this pandemic. As businesses reopen, institutions and agencies not traditionally engaged in disease prevention are being tasked with ensuring public safety. Systems to support organizations facing these new challenges are critically needed. Most currently available symptom trackers use a direct-to-consumer approach and use personal identifiers, which raises privacy concerns. OBJECTIVE: Our aim was to develop a monitoring and reporting system for COVID-19 to support institutions conducting monitoring activities without compromising privacy. METHODS: Our multidisciplinary team designed a symptom tracking system after consultation with experts. The system was designed in the Georgetown University AvesTerra knowledge management environment, which supports data integration and synthesis to identify actionable events and maintain privacy. We conducted a beta test for functionality among consenting Georgetown University medical students. RESULTS: The symptom tracker system was designed based on guiding principles developed during peer consultations. Institutions are provided access to the system through an efficient onboarding process that uses clickwrap technology to document agreement to limited terms of use to rapidly enable free access. Institutions provide their constituents with a unique identifier to enter data through a web-based user interface to collect vetted symptoms as well as clinical and epidemiologic data. The website also provides individuals with educational information through links to the COVID-19 prevention recommendations from the US Centers for Disease Control and Prevention. Safety features include instructions for people with new or worsening symptoms to seek care. No personal identifiers are collected in the system. The reporter mechanism safeguards data access so that institutions can only access their own data, and it provides institutions with on-demand access to the data entered by their constituents, organized in summary reports that highlight actionable data. Development of the system began on March 15, 2020, and it was launched on March 20, 2020. In the beta test, 48 Georgetown University School of Medicine students or their social contacts entered data into the system from March 31 to April 5, 2020. One of the 48 users (2%) reported active COVID-19 infection and had no symptoms by the end of the monitoring period. No other participants reported symptoms. Only data with the unique entity identifier for our beta test were generated in our summary reports. CONCLUSIONS: This system harnesses insights into privacy and data sharing to avoid regulatory and legal hurdles to rapid adaption by entities tasked with maintaining public safety. Our pilot study demonstrated feasibility and ease of use. Refinements based on feedback from early adapters included release of a Spanish language version. These systems provide technological advances to complement the traditional contact tracing and digital tracing applications being implemented to limit SARS-CoV-2 transmission during reopening.

Comércio/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vigilância em Saúde Pública/métodos , Segurança , Busca de Comunicante/economia , Infecções por Coronavirus/epidemiologia , Estudos de Viabilidade , Humanos , Projetos Piloto , Pneumonia Viral/epidemiologia , Privacidade , Avaliação de Sintomas , Estados Unidos/epidemiologia
PLoS Comput Biol ; 16(8): e1008117, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32804932


Understanding the behavior of emerging disease outbreaks in, or ahead of, real-time could help healthcare officials better design interventions to mitigate impacts on affected populations. Most healthcare-based disease surveillance systems, however, have significant inherent reporting delays due to data collection, aggregation, and distribution processes. Recent work has shown that machine learning methods leveraging a combination of traditionally collected epidemiological information and novel Internet-based data sources, such as disease-related Internet search activity, can produce meaningful "nowcasts" of disease incidence ahead of healthcare-based estimates, with most successful case studies focusing on endemic and seasonal diseases such as influenza and dengue. Here, we apply similar computational methods to emerging outbreaks in geographic regions where no historical presence of the disease of interest has been observed. By combining limited available historical epidemiological data available with disease-related Internet search activity, we retrospectively estimate disease activity in five recent outbreaks weeks ahead of traditional surveillance methods. We find that the proposed computational methods frequently provide useful real-time incidence estimates that can help fill temporal data gaps resulting from surveillance reporting delays. However, the proposed methods are limited by issues of sample bias and skew in search query volumes, perhaps as a result of media coverage.

Surtos de Doenças/estatística & dados numéricos , Internet , Vigilância em Saúde Pública/métodos , Ferramenta de Busca/estatística & dados numéricos , Biologia Computacional , Coleta de Dados/métodos , Métodos Epidemiológicos , Humanos , Aprendizado de Máquina
Proc Natl Acad Sci U S A ; 117(36): 22597-22602, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32826332


By March 2020, COVID-19 led to thousands of deaths and disrupted economic activity worldwide. As a result of narrow case definitions and limited capacity for testing, the number of unobserved severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during its initial invasion of the United States remains unknown. We developed an approach for estimating the number of unobserved infections based on data that are commonly available shortly after the emergence of a new infectious disease. The logic of our approach is, in essence, that there are bounds on the amount of exponential growth of new infections that can occur during the first few weeks after imported cases start appearing. Applying that logic to data on imported cases and local deaths in the United States through 12 March, we estimated that 108,689 (95% posterior predictive interval [95% PPI]: 1,023 to 14,182,310) infections occurred in the United States by this date. By comparing the model's predictions of symptomatic infections with local cases reported over time, we obtained daily estimates of the proportion of symptomatic infections detected by surveillance. This revealed that detection of symptomatic infections decreased throughout February as exponential growth of infections outpaced increases in testing. Between 24 February and 12 March, we estimated an increase in detection of symptomatic infections, which was strongly correlated (median: 0.98; 95% PPI: 0.66 to 0.98) with increases in testing. These results suggest that testing was a major limiting factor in assessing the extent of SARS-CoV-2 transmission during its initial invasion of the United States.

Doenças Transmissíveis Emergentes/transmissão , Infecções por Coronavirus/transmissão , Modelos Teóricos , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Infecções Comunitárias Adquiridas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública , Estados Unidos/epidemiologia