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1.
Ethn Health ; 26(1): 36-48, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428455

RESUMO

OBJECTIVES: Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization. DESIGN: An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020). RESULTS: A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45-0.74), Blacks (r = 0.51, 95% CI 0.32-0.66), or Asians (r = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites (r = -0.63, 95% CI -0.75, -0.45). CONCLUSIONS: We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.


Assuntos
/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hospitalização/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Adulto , /epidemiologia , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Washington/epidemiologia
3.
Sci Total Environ ; 752: 141650, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898797

RESUMO

BACKGROUND: Vibrio parahaemolyticus is a major cause of seafood-borne illness. It is naturally prevalent in brackish waters and accumulates in shellfish. Vibriosis cases are rising globally, likely due to rising temperatures. OBJECTIVES: To identify associations between vibriosis in Washington State and pre-harvest environmental and V. parahaemolyticus genetic measurements sampled from shellfish. METHODS: Successful vibriosis traceback investigations were spatiotemporally matched to routine intertidal oyster (Crassostrea gigas) sampling events, which included measurements of temperature, salinity, and V. parahaemolyticus genetic targets (thermolabile hemolysin: tlh; thermostable direct hemolysin: tdh; thermostable direct-related hemolysin: trh). Unmatched sampling events were treated as controls. Associations were evaluated using logistic regression models. RESULTS: Systematic differences were observed across Washington harvesting zones. These included positive associations between the odds of vibriosis and all three genetic targets in South Puget Sound, with a large odds ratio (OR) = 13.0 (95% CI: 1.5, 115.0) for a 1-log10 increase in tdh when total bacterium abundance was low (tlh < 1 log10 MPN/g). A positive association also occurred for a 1 °C increase in tissue temperature OR = 1.20 (95% CI: 1.10, 1.30) while a negative association occurred for a similar increase in water temperature OR = 0.70 (95% CI: 0.59, 0.81). In contrast, the coastal bays displayed positive associations for water temperature OR = 2.16 (95% CI, 1.15, 4.05), and for a 1-log10 increase in the tdh:trh ratio OR = 5.85 (95% CI, 1.06, 32.26). DISCUSSION: The zonal variation in associations indicates unique pathogenic strain prominence, suggesting tdh+/trh+ strains in South Puget Sound, such as the O4:K12 serotype, and tdh+/trh- strains in the coastal bays. The temperature discrepancy between water and oyster tissue suggests that South Puget Sound pathogenic strains flourish with exposure to relatively warm air during low tide. These findings identify new ecological risk factors for vibriosis in Washington State that can be used in future prevention efforts.


Assuntos
Vibrioses , Vibrio parahaemolyticus , Animais , Proteínas de Bactérias , Proteínas Hemolisinas , Frutos do Mar , Vibrioses/epidemiologia , Washington/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33353095

RESUMO

Individual-level Coronavirus Disease 2019 (COVID-19) case data suggest that certain populations may be more impacted by the pandemic. However, few studies have considered the communities from which positive cases are prevalent, and the variations in testing rates between communities. In this study, we assessed community factors that were associated with COVID-19 testing and test positivity at the census tract level for the Seattle, King County, Washington region at the summer peak of infection in July 2020. Multivariate Poisson regression was used to estimate confirmed case counts, adjusted for testing numbers, which were associated with socioeconomic status (SES) indicators such as poverty, educational attainment, transportation cost, as well as with communities with high proportions of people of color. Multivariate models were also used to examine factors associated with testing rates, and found disparities in testing for communities of color and communities with transportation cost barriers. These results demonstrate the ability to identify tract-level indicators of COVID-19 risk and specific communities that are most vulnerable to COVID-19 infection, as well as highlight the ongoing need to ensure access to disease control resources, including information and education, testing, and future vaccination programs in low-SES and highly diverse communities.


Assuntos
/diagnóstico , Fatores Socioeconômicos , Grupos Étnicos , Disparidades em Assistência à Saúde , Humanos , Pandemias , Pobreza , Transportes , Washington/epidemiologia
5.
Health Educ Behav ; 47(6): 845-849, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33148042

RESUMO

The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19-related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.


Assuntos
Infecções por Coronavirus/etnologia , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/etnologia , Betacoronavirus , Barreiras de Comunicação , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Habitação/normas , Humanos , Pandemias , Tradução , Estados Unidos/epidemiologia , Washington/epidemiologia , Trabalho/estatística & dados numéricos
6.
BMJ Open ; 10(10): e041772, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082198

RESUMO

OBJECTIVES: Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands. DESIGN: Rapid clinical ethnography of patient-provider encounters during an initial pandemic 'surge' conducted by a team of clinician-researchers using a structured protocol for qualitative data collection and analysis. SETTING: Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020. PARTICIPANTS: Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients. RESULTS: We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale. CONCLUSIONS: Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pesquisa Qualitativa , Centros de Traumatologia/estatística & dados numéricos , Humanos , Washington/epidemiologia
8.
Emerg Med J ; 37(11): 707-713, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32958477

RESUMO

Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use is not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure and PPE use. We conducted a retrospective cohort investigation of laboratory-confirmed patients with COVID-19 in King County, Washington, USA, who received 9-1-1 EMS responses from 14 February 2020 to 26 March 2020. We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE. There were 274 EMS encounters for 220 unique COVID-19 patients involving 700 unique EMS providers with 988 EMS person-encounters. Use of 'full' PPE including mask (surgical or N95), eye protection, gown and gloves (MEGG) was 67%. There were 151 person-exposures among 129 individuals, who required 981 quarantine days. Of the 700 EMS providers, 3 (0.4%) tested positive within 14 days of encounter, though these positive tests were not attributed to occupational exposure from inadequate PPE. Programmatic changes were associated with a temporal reduction in exposures. When stratified at the study encounters midpoint, 94% (142/151) of exposures occurred during the first 137 EMS encounters compared with 6% (9/151) during the second 137 EMS encounters (p<0.01). By the investigation's final week, EMS deployed MEGG PPE in 34% (3579/10 468) of all EMS person-encounters. Less than 0.5% of EMS providers experienced COVID-19 illness within 14 days of occupational encounter. Programmatic strategies were associated with a reduction in exposures, while achieving a measured use of PPE.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Serviços Médicos de Emergência/organização & administração , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/estatística & dados numéricos , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento , Pandemias , Quarentena , Estudos Retrospectivos , Medição de Risco , Washington/epidemiologia
9.
Science ; 370(6516): 564-570, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32912998

RESUMO

Accurate understanding of the global spread of emerging viruses is critical for public health responses and for anticipating and preventing future outbreaks. Here we elucidate when, where, and how the earliest sustained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission networks became established in Europe and North America. Our results suggest that rapid early interventions successfully prevented early introductions of the virus from taking hold in Germany and the United States. Other, later introductions of the virus from China to both Italy and Washington state, United States, founded the earliest sustained European and North America transmission networks. Our analyses demonstrate the effectiveness of public health measures in preventing onward transmission and show that intensive testing and contact tracing could have prevented SARS-CoV-2 outbreaks from becoming established in these regions.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Filogenia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Viagem Aérea , China/epidemiologia , Simulação por Computador , Busca de Comunicante , Infecções por Coronavirus/prevenção & controle , Evolução Molecular , Genoma Viral , Alemanha/epidemiologia , Humanos , Itália/epidemiologia , Programas de Rastreamento , Mutação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Washington/epidemiologia
10.
Science ; 370(6516): 571-575, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32913002

RESUMO

After its emergence in Wuhan, China, in late November or early December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus rapidly spread globally. Genome sequencing of SARS-CoV-2 allows the reconstruction of its transmission history, although this is contingent on sampling. We analyzed 453 SARS-CoV-2 genomes collected between 20 February and 15 March 2020 from infected patients in Washington state in the United States. We find that most SARS-CoV-2 infections sampled during this time derive from a single introduction in late January or early February 2020, which subsequently spread locally before active community surveillance was implemented.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Genoma Viral , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Teorema de Bayes , Humanos , Funções Verossimilhança , Pandemias , Filogenia , Washington/epidemiologia
12.
PLoS One ; 15(8): e0237695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790745

RESUMO

BACKGROUND: Physical distancing and other COVID-19 pandemic mitigation strategies may have unintended consequences on a number of health behaviors and health outcomes. The purpose of this study was to investigate the association between perceived change in physical activity or exercise and mental health outcomes over the short-term in response to COVID-19 mitigation strategies in a sample of adult twins. METHODS: This was a cross-sectional study of 3,971 identical and same-sex fraternal adult twins (909 pairs, 77% identical) from the community-based Washington State Twin Registry. Participants in this study completed an online survey examining the impact of COVID-19 mitigation on a number of health-related behaviors and outcomes, administered between March 26 and April 5, 2020. In the present study, the exposure was perceived change in physical activity or exercise. The outcomes were levels of perceived anxiety and stress. RESULTS: More twin pairs reported a decrease in physical activity levels (42%) than those reporting no change (31%) or increased physical activity levels (27%). A perceived decrease in physical activity or exercise was associated with higher stress and anxiety levels. However, the physical activity-stress relationship was confounded by genetic and shared environmental factors. On the other hand, the physical activity-anxiety relationship held after controlling for genetic and shared environmental factors, although it was no longer significant after further controlling for age and sex, with older twins more likely to report lower levels of anxiety and females more likely to report higher levels of anxiety. CONCLUSIONS: Strategies to mitigate the COVID-19 pandemic may be impacting physical activity and mental health, with those experiencing a decrease in physical activity also having higher levels of stress and anxiety. These relationships are confounded by genetic and shared environmental factors, in the case of stress, and age and sex, in the case of anxiety.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Exercício Físico , Saúde Mental/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena , Gêmeos , Adulto , Fatores Etários , Idoso , Ansiedade , Infecções por Coronavirus/virologia , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Fatores Sexuais , Inquéritos e Questionários , Washington/epidemiologia
14.
Exp Parasitol ; 217: 107956, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32659234

RESUMO

The species name Cryptosporidium bollandi n. sp. is proposed for Cryptosporidium piscine genotype 2 based on morphological, biological and molecular characterisation. Phylogenetic analyses of 18S rRNA (18S) sequences revealed that C. bollandi n. sp. was most closely related to piscine genotype 4 (5.1% genetic distance) and exhibited genetic distances of 10.0%, 12.2% and 25.2% from Cryptosporidium molnari, Cryptosporidium huwi and Cryptosporidium scophthtalmi, respectively. At the actin locus, C. bollandi n. sp. was again most closely related to piscine genotype 4 (6.8% genetic distance) and exhibited 15.5% (C. molnari), 18.4% (C. huwi), 22.9% (C. scophthalmi) and up to 27.5% genetic distance from other Cryptosporidium spp. (Cryptosporidium felis). Phylogenetic analysis of concatenated 18S and actin sequences showed that C. bollandi n. sp. exhibited 12.9% (C. molnari) to 21.1% (C. canis) genetic distance from all other Cryptosporidium spp. Genetic data as well as previous histological analysis clearly supports the validity of C. bollandi n. sp. as a separate species.


Assuntos
Ciclídeos/parasitologia , Criptosporidiose/parasitologia , Cryptosporidium/fisiologia , Doenças dos Peixes/parasitologia , Actinas/química , Actinas/genética , Animais , Sequência de Bases , Evolução Biológica , Criptosporidiose/epidemiologia , Cryptosporidium/classificação , Cryptosporidium/genética , Cryptosporidium/ultraestrutura , DNA de Protozoário/química , DNA de Protozoário/isolamento & purificação , Doenças dos Peixes/epidemiologia , Pesqueiros , Genótipo , Funções Verossimilhança , Microscopia Eletrônica de Transmissão/veterinária , Filogenia , Reação em Cadeia da Polimerase/veterinária , Prevalência , RNA Ribossômico 18S/química , Washington/epidemiologia , Austrália Ocidental/epidemiologia
15.
JAMA Netw Open ; 3(7): e2014549, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32639570

RESUMO

Importance: The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS). Objective: To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS. Design, Setting, and Participants: This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020. Exposures: COVID-19 was diagnosed by reverse transcription-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter. Main Outcomes and Measures: Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care. Results: Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients). Conclusions and Relevance: The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.


Assuntos
Infecções por Coronavirus/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Serviços Médicos de Emergência , Febre/epidemiologia , Hipóxia/epidemiologia , Múltiplas Afecções Crônicas/epidemiologia , Pneumonia Viral/epidemiologia , Taquipneia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Técnicas de Laboratório Clínico , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Terapia Respiratória , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Washington/epidemiologia
16.
J Child Adolesc Psychopharmacol ; 30(7): 404-413, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32639849

RESUMO

Objective: Telemental health (TMH) is not well described for mental health service delivery during crises. Most child and adolescent psychiatry training programs have not integrated TMH into their curricula and are ill equipped to respond during crises to their patients' needs. In this study, we present the implementation of a home-based TMH (HB-TMH) service during the COVID-19 pandemic. Methods: We describe the technological, administrative, training, and clinical implementation components involved in transitioning a comprehensive outpatient child and adolescent psychiatry program to a HB-TMH virtual clinic. Results: The transition was accomplished in 6 weeks. Most in-clinic services were rapidly moved off campus to the home. Owing to challenges encountered with each implementation component, phone sessions bridged the transition from in-clinic to reliable virtual appointments. Within 3 weeks (March 20, 2020) of planning for HB-TMH, 67% of all appointments were conducted at home, and within 4 weeks (March 27, 2020), 90% were conducted at home. By week 6 (April 3, 2020), reliable HB-TMH appointments were implemented. Conclusions: The COVID-19 pandemic crisis created the opportunity to innovate a solution to disrupted care for our established patients and to create a resource for youth who developed problems during the crisis. Our department was experienced in providing TMH services that facilitated the transition to HB-TMH, yet still had to overcome known and unanticipated challenges. Our experience provides a roadmap for establishing a HB-TMH service with focus on rapid implementation. It also demonstrates a role for TMH during (rather than after) future crises when usual community resources are not available.


Assuntos
Infecções por Coronavirus , Serviços de Assistência Domiciliar , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Telemedicina , Adolescente , Betacoronavirus , Criança , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/tendências , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Telemedicina/organização & administração , Washington/epidemiologia
18.
Lancet ; 396(10247): 320-332, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32682491

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS: In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS: The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION: The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING: None.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/patologia , Células Epiteliais Alveolares/ultraestrutura , Células Epiteliais Alveolares/virologia , Autopsia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Trato Gastrointestinal/patologia , Trato Gastrointestinal/ultraestrutura , Trato Gastrointestinal/virologia , Coração/virologia , Humanos , Rim/patologia , Rim/ultraestrutura , Rim/virologia , Fígado/patologia , Fígado/ultraestrutura , Fígado/virologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Miocárdio/ultraestrutura , Pandemias , Pneumonia Viral/epidemiologia , Alvéolos Pulmonares/patologia , Alvéolos Pulmonares/ultraestrutura , Mucosa Respiratória/patologia , Mucosa Respiratória/ultraestrutura , Mucosa Respiratória/virologia , Baço/patologia , Baço/ultraestrutura , Baço/virologia , Trombose/patologia , Traqueia/patologia , Traqueia/ultraestrutura , Traqueia/virologia , Washington/epidemiologia
20.
J Am Coll Surg ; 231(3): 316-324.e1, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32561446

RESUMO

BACKGROUND: Washington State experienced the first major outbreak of COVID-19 in the US and despite a significant number of cases, has seen a relatively low death rate per million population compared with other states with major outbreaks, and has seen a substantial decrease in the projections for healthcare use, that is, "flattening the curve." This consensus report seeks to identify the key factors contributing to the effective health system disaster response in western WA. METHODS: A multidisciplinary, expert panel including individuals and organizations who were integral to managing the public health and emergency healthcare system response were engaged in a consensus process to identify the key themes and lessons learned and develop recommendations for ongoing management of the COVID-19 pandemic. RESULTS: Six key themes were identified, including early communication and coordination among stakeholders; regional coordination of the healthcare system response; rapid development and access to viral testing; proactive management of long-term care and skilled nursing facilities; proactive management of vulnerable populations; and effective physical distancing in the community. CONCLUSIONS: Based on the lessons learned in each of the areas identified by the panel, 11 recommendations are provided to support the healthcare system disaster response in managing future outbreaks.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Comunicação , Infecções por Coronavirus/diagnóstico , Serviços Médicos de Emergência/organização & administração , Humanos , Assistência de Longa Duração/organização & administração , Pneumonia Viral/diagnóstico , Participação dos Interessados , Washington/epidemiologia
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