Member publications
Welcome to the publications tracker of the Coalition for Equitable ResearCh in Low-resource sEttings (CERCLE)!
Since March 2021, CERCLE initiated a comprehensive catalogue of COVID-19-related publications co-authored by CERCLE members, either in the course of their own work or as part of a coalition group (i.e., working group, Steering Committee or other ad hoc group). As we broaden our scope, this compilation will consistently evolve to incorporate publications pertinent to infectious diseases of epidemic and pandemic potential, as well as those addressing antimicrobial resistance (AMR).To find articles from CERCLE members linked to, or informed by coalition efforts, filter by Coalition Publications in the Research Area column of the table below.
If you or your institution is a coalition member and you would like us to share your recent peer-reviewed publication on COVID-19, let us know at info@cerclecoalition.org.
Members Publications
| Publication title | Authors (coalition members are displayed in bold caracters) | Journal | Publication Date | DOI Link | Abstract | Research area | URL |
|---|---|---|---|---|---|---|---|
| COVID-19: intensive care units, mechanical ventilators, and latent mortality profiles associated with case-fatality in Brazil | Rafael da Silveira Moreira | Cadernos de saude publica | May 18, 2020 | https://doi.org/10.1590/0102-311X00080020 | In response to the accelerated increase in the number of COVID-19 cases, countries must increase their supply of beds in intensive care units (ICUs). Respiratory diseases, neoplasms, cardiopathies and hypertension, and diabetes are associated with higher COVID-19 case-fatality. The study aimed to identify the regions of Brazil with higher specific mortality rates from these comorbidities and the regions with the greatest shortage of ICU beds and mechanical ventilators. A cross-sectional ecological study was performed in which the units of analysis were the country’s Health Regions. Data were obtained from Brazilian Health Informatics Department - DATASUS (National Registry of Healthcare Establishments - 2019, Mortality Information Systems - 2017, and Population Projections - 2017). We calculated the disease group-specific mortality rates for hypertension, neoplasms, diabetes, cardiac diseases, respiratory diseases and the rates of total ICU beds, private ICU beds, ICU beds in the Brazilian Unified National Health System (SUS), and ventilators in the SUS, per 100,000 inhabitants. The mortality profile was determined by latent profiles analysis, and the cluster analysis of ICU beds and ventilators used the spatial scan method. Kernel maps were constructed for the data’s visualization. Level of significance was set at 5%. Four latent mortality profiles were observed. The Health Regions with the highest mean mortality rates were located in regions with shortages of ICU beds and ventilators, especially in parts of the Northeast, Southeast, and South of Brazil. The spatial localization of regions with both the highest mortality and shortages of ICU beds/ventilators requires attention by policymakers and public planners to deal efficiently and fairly with the COVID-19 epidemic in Brazil. | Clinical Epidemiology | https://www.scielo.br/j/csp/a/NPz56K7Zys3fFDZdWHdcYWn/?lang=en |
| Serology testing in the COVID-19 pandemic response | Prof Rosanna W Peeling, PhD Catherine J Wedderburn, MBChB Prof Patricia J Garcia, MD Debrah Boeras, PhD Noah Fongwen, MD John Nkengasong, PhD Amadou Sall, PhD Prof Amilcar Tanuri, MD Prof David L Heymann, MD | The Lancet Infectious Diseases | July 17, 2020 | https://doi.org/10.1016/S1473-3099(20)30517-X | The collapse of global cooperation and a failure of international solidarity have led to many low-income and middle-income countries being denied access to molecular diagnostics in the COVID-19 pandemic response. Yet the scarcity of knowledge on the dynamics of the immune response to infection has led to hesitation on recommending the use of rapid immunodiagnostic tests, even though rapid serology tests are commercially available and scalable. On the basis of our knowledge and understanding of viral infectivity and host response, we urge countries without the capacity to do molecular testing at scale to research the use of serology tests to triage symptomatic patients in community settings, to test contacts of confirmed cases, and in situational analysis and surveillance. The WHO R&D Blue Print expert group identified eight priorities for research and development, of which the highest is to mobilise research on rapid point-of-care diagnostics for use at the community level. This research should inform control programmes of the required performance and utility of rapid serology tests, which, when applied specifically for appropriate public health measures to then be put in place, can make a huge difference. | "Virology, Immunology and Diagnostics" | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30517-X/fulltext |
| Sustainable Health Equity—Can It Be Secured in a Post-COVID World? | Ged Williams, Adriano Friganovic | The World of Critical Care Nursing | September 1, 2020 | bmjgh-2021-007466 | including hemoptysis as first presentation followed by high-grade fever, sore throat, and fatigue. SARS-CoV-2 was confirmed | other | https://www.scilit.net/article/0d9725d361acd69b48ee3d6b4126fd44 |
| CSF Biomarkers in Patients With COVID-19 and Neurologic Symptoms | Arvid Edén, Nelly Kanberg, Johanna Gostner, Dietmar Fuchs, Lars Hagberg, Lars-Magnus Andersson, Magnus Lindh, Richard W. Price, Henrik Zetterberg, Magnus Gisslén | Connect: | October 1, 2020 | View article | by RT-PCR and also diagnosed dengue later on.COVID-19 and dengue fever could be a harmful combination | "Virology, Immunology and Diagnostics",other | https://n.neurology.org/content/96/2/e294.abstract |
| Predicting susceptibility for SARS‐CoV‐2 infection in domestic and wildlife animals using ACE2 protein sequence homology | Ashutosh Kumar, Sada N. Pandey, Vikas Pareek, Ravi K. Narayan, Muneeb A. Faiq, Chiman Kumari | Zoo Biology | October 9, 2020 | https://doi.org/10.1002/zoo.21576 | The article is presenting a bioinformatics based method predicting susceptibility for SARS‐CoV‐2 infection in domestic and wildlife animals. Recently, there were reports of cats and ferrets, dogs, minks, golden hamster, rhesus monkeys, tigers, and lions testing for SARS‐CoV‐2 RNA which indicated for the possible interspecies viral transmission. Our method successfully predicted the susceptibility of these animals for contracting SARS‐CoV‐2 infection. This method can be used as a screening tool for guiding viral RNA testing for domestic and wildlife animals at risk of getting COVID‐19. We provide a list of the animals at risk of developing COVID‐19 based on the susceptibility score. | Modelling,Transmission,other | https://onlinelibrary.wiley.com/doi/10.1002/zoo.21576 |
| Biomarker Research and Development for Coronavirus Disease 2019 (COVID-19): European Medical Research Infrastructures Call for Global Coordination | Emanuela Oldoni, Alain van Gool, Laura García Bermejo, Andreas Scherer, Michaela Th Mayrhofer, Francesco Florindi, Jacques Demotes, Christine Kubiak, Anne-Charlotte Fauvel, Florence Bietrix, Anton Ussi, and Antonio L Andreu | Clinical Infectious Diseases | October 22, 2020 | https://doi.org/10.1093/cid/ciaa1250 | An effective response to the coronavirus disease 2019 (COVID-19) pandemic requires a better understanding of the biology of the infection and the identification of validated biomarker profiles that would increase the availability, accuracy, and speed of COVID-19 testing. Here, we describe the strategic objectives and action lines of the European Alliance of Medical Research Infrastructures (AMRI), established to improve the research process and tackle challenges related to diagnostic tests and biomarker development. Recommendations include: the creation of a European taskforce for validation of novel diagnostic products, the definition and promotion of criteria for COVID-19 samples biobanking, the identification and validation of biomarkers as clinical endpoints for clinical trials, and the definition of immune biomarker signatures at different stages of the disease. An effective management of the COVID-19 pandemic is possible only if there is a high level of knowledge and coordination between the public and private sectors within a robust quality framework. | other | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665366/ |
| A Comprehensive Review of Neurologic Manifestations of COVID-19 and Management of Pre-existing Neurologic Disorders in Children | Kim Y, Walser SA, Asghar SJ, Jain R, Mainali G, Kumar A | Journal of Child Neurology | October 28, 2020 | https://doi.org/10.1177%2F0883073820968995 | Since the first reports of SARS-CoV-2 infection from China, multiple studies have been published regarding the epidemiologic aspects of COVID-19 including clinical manifestations and outcomes. The majority of these studies have focused on respiratory complications. However, recent findings have highlighted the systemic effects of the virus, including its potential impact on the nervous system. Similar to SARS-CoV-1, cellular entry of SARS-CoV-2 depends on the expression of ACE2, a receptor that is abundantly expressed in the nervous system. Neurologic manifestations in adults include cerebrovascular insults, encephalitis or encephalopathy, and neuromuscular disorders. However, the presence of these neurologic findings in the pediatric population is unclear. In this review, the potential neurotropism of SARS-CoV-2, known neurologic manifestations of COVID-19 in children, and management of preexisting pediatric neurologic conditions during the COVID-19 pandemic are discussed. | Clinical Management,"Maternal, Newborn and Child Health",other | https://journals.sagepub.com/doi/full/10.1177/0883073820968995 |
| Who should be prioritised for COVID-19 vaccination? | Fiona M Russell & Brian Greenwood | HUMAN VACCINES & IMMUNOTHERAPEUTICS | November 3, 2020 | https://doi.org/10.1080/21645515.2020.1827882 | The development of COVID-19 vaccines is occurring at a rapid pace, with the potential for a vaccine to be available within 6 months. So who should be prioritized for vaccination when in the first instance, there will be insufficient supply to meet demand? There is no doubt that health-care workers in all settings should be vaccinated first, but who comes next will be a complex decision based on local epidemiology, societal values, and the ability of the vaccines to prevent both severe disease and to reduce transmission thereby eliciting herd protection. The decision on who to vaccinate should be equitable, highly contextualized, and based on the property of each vaccine. In some settings, the elderly may be prioritized, in others, it may be the population most likely to get infected and responsible for community spread. To support decision-making on who to be prioritized for vaccination requires urgent additional research on the epidemiology of COVID-19; preexisting immunity and who is responsible for transmission in a variety of settings; the safety, immunogenicity, and efficacy of COVID-19 vaccines in children and pregnant women; and determining whether COVID-19 vaccines prevent asymptomatic infection and transmission. | Vaccines,Ethics,Public Health | https://www.tandfonline.com/doi/pdf/10.1080/21645515.2020.1827882 |
| Solutions to COVID-19 data sharing | Greg Fegan, Phaik Yeong Cheah, and the Data Sharing Working Group | The Lancet Digital Health | December 1, 2020 | https://doi.org/10.1016/ | none | Data Sharing,Coalition publications | https://covid19crc.org/wp-content/uploads/2020/12/COVID-19crc-DataSharing-WG-TheLancetDigitalHealth-Comment.pdf |
| A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness | Sabeena Ahmed, Mohammad Mahbubul Karim, Allen G. Ross, Mohammad Sharif Hossain, John D. Clemens, Mariya Kibtiya Sumiya, Ching Swe Phru, Mustafizur Rahman, Khalequ Zaman, Jyoti Somani, Rubina Yasmin, Mohammad Abul Hasnat, Ahmedul Kabir, Asma Binte Aziz, Wasif Ali Khan | International Journal of Infectious Diseases | December 2, 2020 | https://doi.org/10.1016/j.ijid.2020.11.191 | Ivermectin, a US Food and Drug Administration-approved anti-parasitic agent, was found to inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in vitro. A randomized, double-blind, placebo-controlled trial was conducted to determine the rapidity of viral clearance and safety of ivermectin among adult SARS-CoV-2 patients. The trial included 72 hospitalized patients in Dhaka, Bangladesh, who were assigned to one of three groups: oral ivermectin alone (12 mg once daily for 5 days), oral ivermectin in combination with doxycycline (12 mg ivermectin single dose and 200 mg doxycycline on day 1, followed by 100 mg every 12 h for the next 4 days), and a placebo control group. Clinical symptoms of fever, cough, and sore throat were comparable among the three groups. Virological clearance was earlier in the 5-day ivermectin treatment arm when compared to the placebo group (9.7 days vs 12.7 days; p = 0.02), but this was not the case for the ivermectin + doxycycline arm (11.5 days; p = 0.27). There were no severe adverse drug events recorded in the study. A 5-day course of ivermectin was found to be safe and effective in treating adult patients with mild COVID-19. Larger trials will be needed to confirm these preliminary findings. | Clinical Pharmacology and Drug Candidates,Clinical Management | https://www.sciencedirect.com/science/article/pii/S1201971220325066#! |
| Cutaneous adverse effects due to personal protective measures during COVID-19 pandemic: a study of 101 patients | Sabha Mushtaq MD, DNB, Erdinc Terzi MD, Sebastiano Recalcati MD, Julio C. Salas-Alanis MD, Sanober Amin MD, PhD, Nafis Faizi MD, MPH | International Journal of Dermatology | December 15, 2020 | https://doi.org/10.1111/ijd.15354 | Background Coronavirus Disease 2019 (COVID-19) is a viral illness caused by the novel coronavirus SARS-CoV-2 which spreads via droplets from an infected person. There has been an unprecedented rise in the use of personal protective equipment and practice of personal hygiene measures against COVID-19. The extended use of protective measures (PM) can lead to ill effects on the skin. Our aim was to investigate PM-induced dermatoses amongst healthcare workers and the general population during the COVID-19 pandemic. Methods A cross-sectional study was conducted over a period of 2 months. The study subjects were patients who presented to dermatology outpatient clinics or sought teleconsultation for skin problems related to the use of PMs against COVID-19. A detailed history was obtained and cutaneous examination was documented for all the patients in a pre-set proforma. Diagnoses of the adverse skin effects were formulated based upon history and clinical examination. Results A total of 101 cases with cutaneous adverse effects due to the use of PMs against COVID-19 were included in the study. The general population and healthcare workers were affected similarly, comprising of 54.5% and 45.5%, respectively. The mean age of the study participants was 36.71 ± 15.72 years. The most common culprit material was soap and water (56.4%). Contact dermatitis was found to be the most common adverse effect in the majority of our patients (72.3%). The most common symptom reported was pruritus (45.5%). The wearing of personal protective equipment for a longer duration was significantly associated with multiple symptoms (P = 0.026). Conclusion The enhanced use of different PMs against COVID-19 can result in a variety of adverse skin effects. In our study, the use of soap and water was the most common culprit PM, and contact dermatitis was the most common adverse effect noted. | other | https://onlinelibrary.wiley.com/doi/full/10.1111/ijd.15354 |
| Differential serological and neutralizing antibody dynamics after an infection by a single SARS-CoV-2 strain | Emmanuelle Billon-Denis, Audrey Ferrier-Rembert, Annabelle Garnier, Laurence Cheutin, Clarisse Vigne, Emilie Tessier, Jessica Denis, Cyril Badaut, Clémence Rougeaux, Anne Depeille Wuille, Hawa Timera, Laet itia Boutin, Isabelle Drouet, Noémie Verguet, Flora Nolent, Olivier Gorgé, Olivier Ferraris & Jean-Nicolas Tournier | Infection | January 2, 2021 | https://doi.org/10.1007/s15010-020-01556-8 | Background We report here the case of two coworkers infected by the same SARS-CoV-2 strain, presenting two different immunological outcomes. Case One patient presented a strong IgG anti-receptor-binding domain immune response correlated with a low and rapidly decreasing titer of neutralizing antibodies. The other patient had a similar strong IgG anti-receptor-binding domain immune response but high neutralizing antibody titers. Discussion and conclusion Thus, host individual factors may be the main drivers of the immune response varying with age and clinical severity. | "Virology, Immunology and Diagnostics" | https://link.springer.com/article/10.1007/s15010-020-01556-8 |
| Medicines dispensing practice during the era of COVID-19 pandemic: a commentary | Gemmechu Hasen, Rashed Edris, Gadisa Chala, Yesuneh Tefera, Hawi Hussen, Tamirat Tekassa & Sultan Suleman | Journal of Pharmaceutical Policy and Practice | January 4, 2021 | https://doi.org/10.1186/s40545-020-00285-5 | The coronavirus disease 19 (COVID-19) pandemic is putting a huge strain on healthcare systems and is a turning point for the beginning of a global health crisis of an unprecedented condition. As such, the provision of quality pharmacy services particularly, dispensing practice with pre-existing challenges in resource-limited settings is a grave concern in the era of the COVID-19 pandemic. Thus, in this commentary we described the pattern of dispensing practice in the midst of the COVID-19 pandemic by evaluating the current condition of drug dispensing practice in drug retail outlets of Jimma Town. | other | https://link.springer.com/article/10.1186/s40545-020-00285-5 |
| Recommendations for the Management of COVID-19 in Low- and Middle-Income Countries | Arjen M. Dondorp, Alfred C. Papali, and Marcus J. Schultz for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU) | The American Journal of Tropical Medicine and Hygiene | January 6, 2021 | https://doi.org/10.4269/ajtmh.20-1597 | none | Clinical Management | https://www.ajtmh.org/view/journals/tpmd/aop/article-10.4269-ajtmh.20-1597/article-10.4269-ajtmh.20-1597.xml?tab_body=fulltext |
| Stigma: the social virus spreading faster than COVID-19 | Kim Robin van Daalen, Mark Cobain, Oscar H Franco, Rajiv Chowdhury | Journal of Epidemiology and Community Health | January 7, 2021 | http://dx.doi.org/10.1136/jech-2020-214436 | none | other,Public Health,Social Science | https://jech.bmj.com/content/jech/75/4/313.full.pdf |
| Pragmatic Recommendations for the Management of Acute Respiratory Failure and Mechanical Ventilation in Patients with COVID-19 in Low- and Middle-Income Countries | Ary Serpa Neto, William Checkley, Chaisith Sivakorn, Madiha Hashmi, Alfred Papali, Marcus J. Schultz, and for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU) | The American Journal of Tropical Medicine and Hygiene | January 13, 2021 | https://dx.doi.org/10.4269%2Fajtmh.20-0796 | Management of patients with severe or critical COVID-19 is mainly modeled after care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, and these recommendations are based on evidence that often originates from investigations in resource-rich intensive care units located in high-income countries. Often, it is impractical to apply these recommendations to resource-restricted settings, particularly in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for acute respiratory failure and mechanical ventilation management in patients with severe/critical COVID-19 in LMICs. We suggest starting supplementary oxygen when SpO2 is persistently lower than 94%. We recommend supplemental oxygen to keep SpO2 at 88–95% and suggest higher targets in settings where continuous pulse oximetry is not available but intermittent pulse oximetry is. We suggest a trial of awake prone positioning in patients who remain hypoxemic; however, this requires close monitoring, and clear failure and escalation criteria. In places with an adequate number and trained staff, the strategy seems safe. We recommend to intubate based on signs of respiratory distress more than on refractory hypoxemia alone, and we recommend close monitoring for respiratory worsening and early intubation if worsening occurs. We recommend low–tidal volume ventilation combined with FiO2 and positive end-expiratory pressure (PEEP) management based on a high FiO2/low PEEP table. We recommend against using routine recruitment maneuvers, unless as a rescue therapy in refractory hypoxemia, and we recommend using prone positioning for 12–16 hours in case of refractory hypoxemia (PaO2/FiO2 < 150 mmHg, FiO2 ≥ 0.6 and PEEP ≥ 10 cmH2O) in intubated patients as standard in ARDS patients. We also recommend against sharing one ventilator for multiple patients. We recommend daily assessments for readiness for weaning by a low-level pressure support and recommend against using a T-piece trial because of aerosolization risk. | Clinical Management | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957237/ |
| COVID-19 outbreak in Brazil: adherence to national preventive measures and impact on people’s lives, an online survey | Edlaine Faria de Moura Villela, Rossana Verónica Mendoza López, Ana Paula Sayuri Sato, Fábio Morato de Oliveira, Eliseu Alves Waldman, Rafael Van den Bergh, Joseph Nelson Siewe Fodjo & Robert Colebunders | BMC Public Health | January 18, 2021 | https://doi.org/10.1186/s12889-021-10222-z | Background The first case of COVID-19 infection was diagnosed in Brazil 26th February 2020. By March 16th, physical distancing and confinement measures were implemented by the Brazilian government. Little is known about how these measures were followed up by the Brazilian people and their impact on daily routine. Methods In early April 2020, using an online platform, we organized an online survey among adults living in Brazil about their COVID-19 preventive behavior and impact on their daily routine. Results Data from 23,896 respondents were analyzed (mean age: 47.4 years). Due to COVID-19 restrictions, half (51.1%) of the professionals reported working from home. Regular handwashing was practiced by 98.7% of participants; 92.6% reported adhering to the 1.5-2 m physical distancing rule, but only 45.5% wore a face mask when going outside. While 29.3% of respondents found it relatively easy to stay at home, indoor confinement was extremely difficult for 7.9% of participants. Moreover, 11% of participants were extremely worried about their health during the COVID-19 epidemic. Younger people, male, persons living in a rural area/village or popular neighbourhoods, students and workers reported less preventive behaviour. Conclusion Restrictive measures markedly affected the daily and professional routines of Brazilians. Participants showed a satisfactory level of adherence to national COVID-19 prevention guidelines. Qualitative and follow-up studies are needed to monitor the impact of COVID-19 in the Brazilian society. | Social Science,Public Health,Transmission,other | https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10222-z |
| Looking beyond COVID-19 vaccine phase 3 trials | Jerome H. Kim, Florian Marks & John D. Clemens | Nature Medicine | January 19, 2021 | https://doi.org/10.1038/s41591-021-01230-y | After the recent announcement of COVID-19 vaccine efficacy in clinical trials by several manufacturers for protection against severe disease, a comprehensive post-efficacy strategy for the next steps to ensure vaccination of the global population is now required. These considerations should include how to manufacture billions of doses of high-quality vaccines, support for vaccine purchase, coordination of supply, the equitable distribution of vaccines and the logistics of global vaccine delivery, all of which are a prelude to a massive vaccination campaign targeting people of all ages. Furthermore, additional scientific questions about the vaccines remain that should be answered to improve vaccine efficacy, including questions regarding the optimization of vaccination regimens, booster doses, the correlates of protection, vaccine effectiveness, safety and enhanced surveillance. The timely and coordinated execution of these post-efficacy tasks will bring the pandemic to an effective, and efficient, close. | Vaccines,Regulatory,Study Design and Analytics | https://www.nature.com/articles/s41591-021-01230-y#Sec1 |
| The state of health research governance in Africa: what do we know and how can we improve? | Juliet Nabyonga-Orem, James Avoka Asamani & Micheal Makanga | BMC Health Research Policy and Systems | January 22, 2021 | https://doi.org/10.1186/s12961-020-00676-9 | Background The developments in global health, digital technology, and persistent health systems challenges, coupled with global commitments like attainment of universal health coverage, have elevated the role of health research in low- and middle-income countries. However, there is a need to strengthen health research governance and create a conducive environment that can promote ethics and research integrity and increase public trust in research. Objective To assess whether the necessary structures are in place to ensure health research governance. Methods Employing a cross-sectional survey, we collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region. Data were analysed using basic descriptive and comparative analysis. Results Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north–south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research. Conclusion Governance structures must be adaptive to embrace new developments in science. Further, strong coordination is key to ensuring comprehensiveness and complementarity in both research development and generation of evidence. The majority of committees perform a dual role of ethics and scientific review, and these need to ensure representation of relevant expertise. Opportunities that accrue from collaborative research need to be seized through strong MoH leadership and clear partnership frameworks that guide negotiations. | other,Research governance,Social Science | https://rdcu.be/ckKs7 |
| COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting | Eliana Nogueira Castro de Barros, Adriana P. do Valle, Patricia Emilia Braga, Juliana Y. K. Viscondi, Antonio R. B. da Fonseca, Tazio Vanni, Anderson da Silva, Maria Regina Cardoso, Paulo José F. Villas-Boas, Alexander Roberto Precioso | Revista do Instituto de Medicina Tropical de São Paulo | January 29, 2021 | https://doi.org/10.1590/S1678-9946202163010 | This cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% – 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions. | "Virology, Immunology and Diagnostics" | https://www.scielo.br/j/rimtsp/a/NkywY6DyGQTccx5BqvNfK9v/?format=html&lang=en |
| Healthy ageing in the time of COVID-19: A wake-up call for action | Marilyne Menassa, Esther M.C. Vriend, Oscar H. Franco | Maturitas | January 30, 2021 | https://doi.org/10.1016/j.maturitas.2021.01.007 | none | other,Public Health | https://www.maturitas.org/article/S0378-5122(21)00014-1/fulltext#articleInformation |
| Transparency in research and publications on COVID-19 | Alex Sandro Rolland Souza, Afra Suassuna Fernandes, Lygia Carmem de Moraes Vanderlei, Aurélio Antônio Ribeiro da Costa, Ana Laura Carneiro Gomes Ferreira, Luciana Santos Dubeux, Cynthia Braga, José Eulálio Cabral Filho | Revista Brasileira de Saúde Materno Infantil | February 1, 2021 | https://doi.org/10.1590/1806-9304202100S100001 | none | Research governance,other | https://www.scielo.br/j/rbsmi/a/YGf53sCqXnPJMkGp5vg4TCs/?lang=en&stop=previous&format=html |
| Development and deployment of COVID-19 vaccines for those most vulnerable | Wayne C. Koff, Theodore Schenkelberg, Tere Williams, Ralph S. Baric, Adrian McDermott, Cheryl M. Cameron, Mark J. Cameron, Matthew B. Friemann, Gabriele Neumann, Yoshihiro Kawaoka, Alyson A. Kelvin, Ted M. Ross, Stacey Schultz-Cherry, Timothy D. Mastro, Frances H. Priddy, Kristine A. Moore, Julia T. Ostrowsky, Michael T. Osterholm, Jaap Goudsmit | Science Transnational Medicine | February 3, 2021 | http://dx.doi.org/10.1126/scitranslmed.abd1525 | Development of safe and effective COVID-19 vaccines is a global priority and the best hope for ending the COVID-19 pandemic. Remarkably, in less than 1 year, vaccines have been developed and shown to be efficacious and are already being deployed worldwide. Yet, many challenges remain. Immune senescence and comorbidities in aging populations and immune dysregulation in populations living in low-resource settings may impede vaccine effectiveness. Distribution of vaccines among these populations where vaccine access is historically low remains challenging. In this Review, we address these challenges and provide strategies for ensuring that vaccines are developed and deployed for those most vulnerable. | Vaccines | https://stm.sciencemag.org/content/13/579/eabd1525 |
| Mobile apps for detecting falsified and substandard drugs: A systematic review | Agustín Ciapponi, Manuel Donato, A. Metin Gülmezoglu, Tomás Alconada, Ariel Bardach | PLoS ONE | February 4, 2021 | https://doi.org/10.1371/journal.pone.0246061 | The use of substandard and counterfeit medicines (SCM) leads to significant health and economic consequences, like treatment failure, rise of antimicrobial resistance, extra expenditures of individuals or households and serious adverse drug reactions including death. Our objective was to systematically search, identify and compare relevant available mobile applications (apps) for smartphones and tablets, which use could potentially affect clinical and public health outcomes. We carried out a systematic review of the literature in January 2020, including major medical databases, and app stores. We used the validated Mobile App Rating Scale (MARS) to assess the quality of apps, (1 worst score, 3 acceptable score, and 5 best score). We planned to evaluate the accuracy of the mobile apps to detect SCM. We retrieved 335 references through medical databases and 42 from Apple, Google stores and Google Scholar. We finally included two studies of the medical database, 25 apps (eight from the App Store, eight from Google Play, eight from both stores, and one from Google Scholar), and 16 websites. We only found one report on the accuracy of a mobile apps detecting SCMs. Most apps use the imprint, color or shape for pill identification, and only a few offer pill detection through photographs or bar code. The MARS mean score for the apps was 3.17 (acceptable), with a maximum of 4.9 and a minimum of 1.1. The ‘functionality’ dimension resulted in the highest mean score (3.4), while the ‘engagement’ and ‘information’ dimensions showed the lowest one (3.0). In conclusion, we found a remarkable evidence gap about the accuracy of mobile apps in detecting SCMs. However, mobile apps could potentially be useful to screen for SCM by assessing the physical characteristics of pills, although this should still be assessed in properly designed research studies. | Supply and Market Dynamics; Medicine Quality | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246061 |
| A live measles-vectored COVID-19 vaccine induces strong immunity and protection from SARS-CoV-2 challenge in mice and hamsters | Phanramphoei N. Frantz, Aleksandr Barinov, Claude Ruffié, Chantal Combredet, Valérie Najburg, Guilherme Dias de Melo, Florence Larrous, Lauriane Kergoat, Samaporn Teeravechyan, Anan Jongkaewwattana, Emmanuelle Billon-Denis, Jean-Nicolas Tournier, Matthieu Prot, Laurine Levillayer, Laurine Conquet, Xavier Montagutelli, Magali Tichit, David Hardy, Priyanka Fernandes, Hélène Strick-Marchand, James Di Santo, Etienne Simon-Lorière, Hervé Bourhy & Frédéric Tangy | Nature Communications | February 5, 2021 | https://doi.org/10.1038/s41467-021-26506-2 | Several COVID-19 vaccines have now been deployed to tackle the SARS-CoV-2 pandemic, most of them based on messenger RNA or adenovirus vectors.The duration of protection afforded by these vaccines is unknown, as well as their capacity to protect from emerging new variants. To provide sufficient coverage for the world population, additional strategies need to be tested. The live pediatric measles vaccine (MV) is an attractive approach, given its extensive safety and efficacy history, along with its established large-scale manufacturing capacity. We develop an MV-based SARS-CoV-2 vaccine expressing the prefusion-stabilized, membrane-anchored full-length S antigen, which proves to be efficient at eliciting strong Th1-dominant T-cell responses and high neutralizing antibody titers. In both mouse and golden Syrian hamster models, these responses protect the animals from intranasal infectious challenge. Additionally, the elicited antibodies efficiently neutralize in vitro the three currently circulating variants of SARS-CoV-2. | https://www.nature.com/articles/s41467-021-26506-2 | |
| Latent class analysis of COVID-19 symptoms in Brazil: results of the PNAD-COVID19 survey | Rafael da Silveira Moreira | Cadernos de Saúde Pública | February 5, 2021 | https://doi.org/10.1590/0102-311X00238420 | The lack of mass testing for COVID-19 diagnosis creates the need to determine the magnitude of the disease based on its clinical symptoms. The study aimed to analyze the profile of COVID-19 symptoms and related aspects in Brazil. The author analyzed the sample of participants from the Brazilian National Household Sample Survey (PNAD-COVID19) conducted in May 2020. Latent class analysis (LCA) was performed with sociodemographic covariables and 11 symptoms reported by 346,181 individuals. Rao-Scott test and standardized residual analysis were used to measure the association with the pattern of health services use. Spatial scan analysis was performed to identify areas at risk of COVID-19 cases. LCA showed six classes of symptoms based on the pattern of answers by participants: (1) all the symptoms; (2) high prevalence of symptoms; (3) predominance of fever; (4) predominance of cough/sore throat; (5) mild symptoms with predominance of headache; and (6) absence of symptoms. Female sex, brown skin color, the North and Northeast regions of Brazil, and all three older age brackets showed stronger association with the class with all the symptoms (class 1). Most use of health services was also by this group of individuals, but with different profiles of use. Spatial analysis showed juxtaposition of this class with areas at greater risk of COVID-19. These finding underline the importance of investigating symptoms for the epidemiological identification of possible cases in a scenario with low population testing rates. | Clinical Epidemiology | https://www.scielo.br/j/csp/a/WSxLPSVrxdqDQ4FGkqTrS7C/?lang=en |
| Obesity and COVID‐19 in Latin America: A tragedy of two pandemics—Official document of the Latin American Federation of Obesity Societies | Bruno Halpern, Maria Laura da Costa Louzada, Pablo Aschner, Fernando Gerchman, Imperia Brajkovich, José Rocha Faria‐Neto, Felix Escaño Polanco, Julio Montero, Silvia María Marín Juliá, Paulo Andrade Lotufo, Oscar H. Franco | Obesity reviews | February 8, 2021 | https://doi.org/10.1111/obr.13165 | In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies. | Public Health,other | https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13165 |
| Higher vs lower doses of dexamethasone in patients with COVID‐19 and severe hypoxia (COVID STEROID 2) trial: Protocol and statistical analysis plan | Marie Warrer Munch, Anders Granholm, Sheila Nainan Myatra, Bharath Kumar Tirupakuzhi Vijayaraghavan, Maria Cronhjort, Rebecka Rubenson Wahlin, Stephan M. Jakob, Luca Cioccari, Maj‐Brit Nørregaard Kjær, Gitte Kingo Vesterlund, Tine Sylvest Meyhoff, Marie Helleberg, Morten Hylander Møller, Thomas Benfield, Balasubramanian Venkatesh, Naomi Hammond, Sharon Micallef, Abhinav Bassi, Oommen John, Vivekanand Jha, Klaus Tjelle Kristiansen, Charlotte Suppli Ulrik, Vibeke Lind Jørgensen, Margit Smitt, Morten H. Bestle, Anne Sofie Andreasen, Lone Musaeus Poulsen, Bodil Steen Rasmussen, Anne Craveiro Brøchner, Thomas Strøm, Anders Møller, Mohd Saif Khan, Ajay Padmanaban, Jigeeshu Vasishtha Divatia, Sanjith Saseedharan, Kapil Borawake, Farhad Kapadia, Subhal Dixit, Rajesh Chawla, Urvi Shukla, Pravin Amin, Michelle S. Chew, Christian Gluud, Theis Lange, Anders Perner | The Acta Anaesthesiologica Scandinavica | February 14, 2021 | https://dx.doi.org/10.1111%2Faas.13795 | Background The coronavirus disease 2019 (COVID‐19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low‐dose corticosteroids have proven clinical benefit in patients with severe COVID‐19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical benefits in COVID‐19. At present, the balance between benefits and harms of higher vs. lower doses of corticosteroids for patients with COVID‐19 is unclear. Methods The COVID STEROID 2 trial is an investigator‐initiated, international, parallel‐grouped, blinded, centrally randomised and stratified clinical trial assessing higher (12 mg) vs. lower (6 mg) doses of dexamethasone for adults with COVID‐19 and severe hypoxia. We plan to enrol 1,000 patients in Denmark, Sweden, Switzerland and India. The primary outcome is days alive without life support (invasive mechanical ventilation, circulatory support or renal replacement therapy) at day 28. Secondary outcomes include serious adverse reactions at day 28; all‐cause mortality at day 28, 90 and 180; days alive without life support at day 90; days alive and out of hospital at day 90; and health‐related quality of life at day 180. The primary outcome will be analysed using the Kryger Jensen and Lange test adjusted for stratification variables and reported as adjusted mean differences and median differences. The full statistical analysis plan is outlined in this protocol. Discussion The COVID STEROID 2 trial will provide evidence on the optimal dosing of systemic corticosteroids for COVID‐19 patients with severe hypoxia with important implications for patients, their relatives and society. | Clinical Pharmacology and Drug Candidates,Clinical Management | https://onlinelibrary.wiley.com/doi/10.1111/aas.13795 |
| Innate cell profiles during the acute and convalescent phase of SARS-CoV-2 infection in children | Melanie R. Neeland, Samantha Bannister, Vanessa Clifford, Kate Dohle, Kim Mulholland, Philip Sutton, Nigel Curtis, Andrew C. Steer, David P. Burgner, Nigel W. Crawford, Shidan Tosif & Richard Saffery | Nature Communications | February 17, 2021 | https://doi.org/10.1038/s41467-021-21414-x | Children have mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed disease (COVID-19) compared to adults and the immunological mechanisms underlying this difference remain unclear. Here, we report acute and convalescent innate immune responses in 48 children and 70 adults infected with, or exposed to, SARS-CoV-2. We find clinically mild SARS-CoV-2 infection in children is characterised by reduced circulating subsets of monocytes (classical, intermediate, non-classical), dendritic cells and natural killer cells during the acute phase. In contrast, SARS-CoV-2-infected adults show reduced proportions of non-classical monocytes only. We also observe increased proportions of CD63+ activated neutrophils during the acute phase to SARS-CoV-2 in infected children. Children and adults exposed to SARS-CoV-2 but negative on PCR testing display increased proportions of low-density neutrophils that we observe up to 7 weeks post exposure. This study characterises the innate immune response during SARS-CoV-2 infection and household exposure in children. | "Maternal, Newborn and Child Health","Virology, Immunology and Diagnostics" | https://www.nature.com/articles/s41467-021-21414-x?fbclid=IwAR1V-WOKoCnZL5KAfxIAtxLiBM8qoBcVzTtN2mD7303kTbZdg59YXkn1DyM |
| Clinical Characteristics and Mortality Profile of COVID-19 Patients Aged less than 20 years Old in Pernambuco – Brazil | Gabrielle R. Sena, Tiago P. F. Lima, Suely A. Vidal, Maria do Carmo M. B. Duarte, Patrícia G. M. Bezerra, Eduardo J. Fonseca Lima, Cynthia Braga, Lívia B. de Andrade, Mecneide M. Lins, Leuridan C. Torres, Jurema T. O. Lima, and Maria Julia G. Mello | The American journal of tropical medicine and hygiene | February 18, 2021 | https://dx.doi.org/10.4269%2Fajtmh.20-1368 | COVID-19 in children and adolescents has low frequency, severity, and fatality rate all over the world. A cross-sectional study was conducted to assess the epidemiological and clinical aspects of COVID-19 in patients younger than 20 years in Pernambuco (Brazil), with cases confirmed by reverse-transcriptase–PCR SARS-CoV-2 between 13 February and June 19, 2020, reported on information systems. Data regarding age (< 30 days, 1–11 months, 1–4 years, 5–9 years, 10–14 years, and 15–19 years), gender, color/race, symptoms, pregnancy or puerperium, comorbidities, hospitalization, and death were investigated. Fatality rate and mortality coefficient were calculated, and a multiple logistic regression analysis was performed to determine if gender, age, and comorbidities were factors associated with death. Of 682 pediatric cases, 52.8% were female, with a mean age of 9 ± 7.2 years. The most frequent symptoms were fever (64.4%), cough (52.4%), and respiratory distress (32.4%). Hospitalization was reported in 46.2% of cases, mainly among neonates (80.3%) and infants (73.8%). Thirty-eight deaths were notified, and a fatality rate of 5.6% (95% CI: 3.9–7.3) was found, with higher fatality rates among neonates 11.5% (7 of 61) and 9.5% (8 of 84) infants. The mortality coefficient was 10.9 per 100,000 inhabitants < 1 year of age, whereas comorbidities (Odds ratio [OR] = 14.13, 95% CI: 6.35–31.44), age < 30 days (OR = 5.17, 95% CI: 1.81–14.77), and age 1–11 months (OR = 3.28, 95% CI: 1.21–8.91) were independent factors associated with death. The results demonstrate the vulnerability of neonates and infants with severe conditions, need hospitalization, and high fatality rate, indicating the necessity to adapt public health policies for these age-groups. | Clinical Epidemiology,other | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045659/ |
| The use of dried blood spots for the serological evaluation of SARS-CoV-2 antibodies | Zheng Quan Toh, Rachel A Higgins, Jeremy Anderson, Nadia Mazarakis, Lien Anh Ha Do, Karin Rautenbacher, Pedro Ramos, Kate Dohle, Shidan Tosif, Nigel Crawford, Kim Mulholland, and Paul V Licciardi | Journal of Public Health | February 22, 2021 | https://dx.doi.org/10.1093%2Fpubmed%2Ffdab011 | Background To determine if dried blood spot specimens (DBS) can reliably detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, we compared the SARS-CoV-2 IgG antibody response in paired serum and eluates from DBS specimens. Methods A total of 95 paired DBS and serum samples were collected from 74 participants (aged 1–63 years) as part of a household cohort study in Melbourne, Australia. SARS-CoV-2 IgG antibodies specific for the receptor-binding domain (RBD) and S1 proteins between serum and eluates from DBS specimens were compared using an FDA-approved ELISA method. Results Among the 74 participants, 42% (31/74) were children and the rest were adults. A total of 16 children and 13 adults were SARS-CoV-2 positive by polymerase chain reaction. The IgG seropositivity rate was similar between serum and DBS specimens (18.9% (18/95) versus 16.8% (16/95)), respectively. Similar RBD and S1-specific IgG levels were detected between serum and DBS specimens. Serum IgG levels strongly correlated with DBS IgG levels (r = 0.99, P < 0.0001) for both SARS-CoV-2 proteins. Furthermore, antibodies remained stable in DBS specimens for >3 months. Conclusions DBS specimens can be reliably used as an alternative to serum samples for SARS-CoV-2 antibody measurement. The use of DBS specimens would facilitate serosurveillance efforts particularly in hard-to-reach populations and inform public health responses including COVID-19 vaccination strategies. | Public Health,"Virology, Immunology and Diagnostics" | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928805/ |
| COVID-19, children and schools: overlooked and at risk | Kathleen E Ryan, Sharon Goldfield, Margie H Danchin, Fiona Russell | The Medical Journal of Australia | February 28, 2021 | https://doi.org/10.5694/mja2.50936 | none | Public Health,"Maternal, Newborn and Child Health" | https://onlinelibrary.wiley.com/doi/10.5694/mja2.50936 |
| Human Papillomavirus Vaccination After COVID-19 | Zheng Quan Toh, Fiona M. Russell, Suzanne M. Garland, Edward K. Mulholland, George Patton, Paul V. Licciardi | JNCI Cancer Spectrum | March 2, 2021 | https://doi.org/10.1093/jncics/pkab011 | The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a singledose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer. | Vaccines,other,Public Health | https://watermark.silverchair.com/pkab011.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAqUwggKhBgkqhkiG9w0BBwagggKSMIICjgIBADCCAocGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMprOCYtPoWvogZc3WAgEQgIICWIAk_bJDylZ10qP3ORBjw7YI6XzFvJuEgwKNVMZksCWzhYDTZs1wH6v97mqk-IXQ9DLFsMpoxI6diK01Fkpuv_6ED-zAho3s3uRPi6SPV1uKeXgsC5C34o0iVQLKYR5O1JYgD4jngfXjY2sXkQziSKsxk8LW2EP86wU0abPeqBv7t6B-c0CUzqOjKE2EMcyHSaREEj7ZHe0lMsqsrNM9J5H9AX8kP-oMp8SRAgvew8VEEeg8fqm-P3SljiVhZm9sxO_ezkenYFwVlSMuHyfxsWTsJgZoTbh-kqhzCNMctPL2odePnOxIgyp7EBLjl3VmTbEOfT7j2wv6UbGSoQ2o6LlEwOoGQS2WNajxQc1_i5uoHkxOZ4acOF8UI7ijyHA4aZfTb2xG1sjDG8SImKGrkyYv6bB-p77Wg2CnBW8gxzwFtx0trw2qu37kDxpZe0-QEHcrSDLpYwaJ1XTEG9RJdNeCYHJllOzJ8iWRVlrPY3IOzPgv9EQ651TwhG70QcnHw4-CIta9cuHtjCIbBjnj9Er_21WhJeRanAPnOAdvhxoFqfr41XIcowUySrw4ozdkzAyXe56TsPwbjFCLJDzgTtG1zHDpK7mtoDoA1dqZwC7CvF671BeziRWEZ95oZrAgjs5KbRtGgwgdcV3cC8rpW35_M0hfcCSbgMECt1ZHxB7iRU7Pv-mtXgyQbmOHJcyXZ3O4_qVvpGPbiXU7wJNW11HpQAi1nP8O4BC-lsUbuGaXayOXJLAEr2ciBFQuxBk56atpwILpl0qTulbhfqtO6mAqh36hISDyFQ |
| Mapping time use in clinical trials for vaccines against emerging infectious diseases | Henshaw Mandi, Solomon Abebe Yimer and Gunnstein Norheim | Clinical Trials | March 2, 2021 | https://doi.org/10.1177/1740774520977283 | Background: Vaccines are potent tools to prevent outbreaks of emerging infectious diseases from becoming epidemics and need to be developed at an accelerated pace to have any impact on the course of an ongoing epidemic. The aim of this study was to describe time use in the execution of vaccine trials, to identify steps that could be accelerated to improve preparedness and planning for future emerging infectious diseases vaccine trials. Methods: We used a mixed-methods approach to map time use and process steps that could be accelerated during vaccine trials. Trials for vaccines against infectious diseases registered in three global trial databases reported in the period 2011–2017 were eligible to join the survey. We invited sponsors to contribute data through a predefined structured questionnaire for clinical trial process metrics. Data were stratified by trial phase, disease type (i.e. emerging infectious diseases or not emerging infectious diseases), sponsor type, and continent. Qualitative interviews were conducted with purposively selected sponsors, and thematic analysis of the interview transcripts was performed. Results: Based on data from 155 vaccine trials including 29,071 subjects, 52% were phase I, 23% phase II, and 25% phase III. We found that the regulatory approval, subject enrollment, study execution, and study close-out accounted for most of the cycle time of the vaccine trial process. Cycle times for the regulatory and ethical approvals, contract agreement, site initiation, and study execution were shorter in trials conducted during outbreaks. Qualitative interviews indicated that early engagement of the regulatory and independent ethical committee authorities in planning the vaccine trials was critical for saving time in trial approval. Furthermore, adapting the trial implementation to the reality of the study sites and active involvement of the local investigators during the planning of the trial and protocol writing were stated to be of paramount importance to successful completion of trials at an accelerated pace. Conclusion: The regulatory approval, subject recruitment, study execution, and close-out cycle times accounted for most of the vaccine trial time use and are activities that could be accelerated during a vaccine trial planning and implementation. We encourage tracking of key cycle time metrics and facilitating sharing of knowledge across industry and academia, as this may serve to reduce the time from index case detection to access of a vaccine during emerging infectious diseases epidemics. | Study Design and Analytics,Vaccines | https://media.tghn.org/medialibrary/2021/03/Mandi_et_al._2021._Mapping_time_use_in_clinical_trials_for_vaccines_against_emerging_infectious_diseases.pdf |
| Problematic Covid-19 vaccine trials in times of vaccine nationalism | Raffaella Ravinetto | Indian Journal of Medical Ethics | March 3, 2021 | https://doi.org/10.20529/ijme.2021.014 | Thanks to an impressive R&D effort, three vaccines for COVID19 have been conditionally approved by stringent regulators as of February 2021, and sixteen have entered the WHO evaluation process. However, they all need to keep on being evaluated in clinical trials.The WHO Ad Hoc Expert Group on the Next Steps for Covid19 Vaccine suggested that countries with limited or no access to an effective vaccine could ethically permit placebocontrolled trials, even if effective vaccines were already being marketed elsewhere. Here, I argue that inclusion in a placebocontrolled trial is ethically sound for those who would be in any case ineligible for vaccination outside the trial, and as long as the access to the vaccine outside the trial depends on a transparent and just allocation framework. Conversely, carrying out placebocontrolled studies in countries where vaccines are not (or are insufficiently) available because of unequal global allocation, would be unethical, as an ethical strategy cannot be built on an unethical premise. | Supply and Market Dynamics; Medicine Quality,Vaccines,Ethics,Research governance,other | https://pure.itg.be/ws/portalfiles/portal/12948972/2021_IJME_Problematic_Covid_19_vaccine_trials_3_3_2021.pdf |
| International citizen project to assess early stage adherence to public health measures for COVID-19 in South Africa | Mohammed Majam, Alex Fischer, Jane Phiri, Francois Venter, Samanta T. Lalla-Edward | PLoS ONE | March 4, 2021 | https://doi.org/10.1371/journal.pone.0248055 | Introduction With over 500 000 infections and nearly 12 000 deaths, South Africa (SA) is the African epicenter of the current Coronavirus (COVID-19) pandemic. SA has implemented a 5-stage Risk-Adjusted Strategy which includes a phased national lockdown, requiring social distancing, frequent hand washing and wearing face masks. Strict adherence to this strategy is crucial to reducing COVID-19 transmission, flattening the curve, and preventing resurgence. As part of the 22-country International Citizens Project COVID-19 (ICPcovid), this study aimed to describe the SA adherence to the Risk-Adjusted Strategy and identify determinants of adherence. Method During 24 April-15 May 2020, people were electronically invited, through social media platforms and a text blast, to complete an online survey, accessible via www.icpcovid.com. The survey investigated COVID-19 testing and preventative adherence measures, then used logistic regression analysis to identify predictors of adherence. Results There were 951 participants, with 731(76.9%) 25 to 54 years. Most (672;70.7%) were female, and 705(74.1%) had a university degree. Since the epidemic started, 529(55.6%) and 436(45.9%) participants stated they were eating healthier and taking more vitamins, respectively. Only 82(8.6%) had been COVID-19 tested, and 1(1.2%) tested positive. In public, 905(95.2%) socially distanced, however 99(10.4%) participants had recently attended meetings with over ten people. Regular hand washing was practiced by 907(95.4%) participants, 774(81.4%) wore face masks and 854(89.8%) stayed home when they experienced flu-like symptoms. The odds of adhering to the guidelines were lower among men versus women (AOR 0.72, 95% confidence interval [CI] = 0.528, 0.971) and those who had flu-like symptoms (AOR 0.42, 95% CI = 0.277, 0.628). In contrast, increased odds were reported for those who reported increased vitamin intake (AOR 1.37, 95% CI = 1.044,1.798), and were either cohabiting or married (AOR 1.39, 95% CI = 1.042,1.847). Conclusion Despite high reported adherence, face mask use and symptomatic individuals not self-isolating, were areas for improvement. However, these factors cannot solely account for SA’s increasing COVID-19 cases. Larger general population studies are needed to identify other adherence predictors for a strengthened SA COVID-19 response. While the government must continue to educate the entire population on preventative measures, provide personal protective equipment and stress the importance of adherence, there also needs to be implementation of prioritised prevention strategies for men and single individuals to address their demonstrated lower adherence. | Social Science,Public Health | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248055 |
| Violence and discrimination among Ugandan residents during the COVID-19 lockdown | Elizabeth Katana, Bob Omoda Amodan, Lilian Bulage, Alex R. Ario, Joseph Nelson Siewe Fodjo, Robert Colebunders & Rhoda K. Wanyenze | BMC Public Health | March 8, 2021 | https://doi.org/10.1186/s12889-021-10532-2 | Background In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda’s communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. Methods In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants’ characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. Results Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10–2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03–2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14–4.50). Conclusion A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males. | Public Health,other,Social Science | https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10532-2#Abs1 |
| Addressing challenges to rolling out COVID-19 vaccines in African countries | Jean B Nachega, Nadia A Sam-Agudu, Refiloe Masekela, Marieke M van der Zalm, Sabin Nsanzimana, Jeanine Condo, Francine Ntoumi, Helena Rabie, Mariana Kruger, Charles S Wiysonge, John D Ditekemena, Raphael B Chirimwami, Mukanire Ntakwinja, Denis M Mukwege, Emilia Noormahomed, Masudah Paleker, Hassan Mahomed, Jean-Jacques Muyembe Tamfum, Alimuddin Zumla, Fatima Suleman | The Lancet Global Health | March 10, 2021 | https://doi.org/10.1016/S2214-109X(21)00097-8 | none | Vaccines | https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00097-8/fulltext?dgcid=hubspot_email_newsletter_lancetcovid21&utm_campaign=lancetcovid21&utm_medium=email&_hsmi=115531331&_hsenc=p2ANqtz-_UuwP-8oY0ht2k_iBUktpa1nGsulf4JIVRokDd20IwwJ4PJAY5jtdR607j_JSBS7JvyCjRS8TgE1rICnR-PW04tIyCUA&utm_content=115509120&utm_source=hs_email |
| Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers. | Workers Willemke Stilma, Eva Akerman, Antonio Artigas, Andrew Bentley, Lieuwe D. Bos, Thomas J. C. Bosman, Hendrik de Bruin, Tobias Brummaier, Laura A. Buiteman-Kruizinga, Francesco Carc `o, Gregg Chesney, Cindy Chu, Paul Dark, Arjen M. Dondorp, Harm J. H. Gijsbers, Mary Ellen Gilder, Domenico L. Grieco, Rebecca Inglis, John G. Laffey,23,24 Giovanni Landoni,Weihua Lu, Lisa M. N. Maduro, Rose McGready, Bairbre McNicholas, Diego de Mendoza, Luis Morales-Quinteros, Francois Nosten, Alfred Papali, Gianluca Paternoster, Frederique Paulus, Luigi Pisani, Eloi Prud’homme, Jean-Damien Ricard, Oriol Roca, Chiara Sartini, Vittorio Scaravilli, Marcus J. Schultz,Chaisith Sivakorn, Peter E. Spronk, Jaques Sztajnbok, Youssef Trigui, Kathleen M. Vollman, and Margaretha C. E. van der Woude | The American Journal of Tropical Medicine and Hygiene | March 11, 2021 | https://doi.org/10.4269/ajtmh.20-1445 | Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs. | Clinical Management | https://europepmc.org/article/med/33705348 |
| Coding-Complete Genome Sequence and Phylogenetic Relatedness of a SARS-CoV-2 Strain Detected in March 2020 in Cameroon | Richard Njouom, Serge Alain Sadeuh-Mbaa, Jules Tchatchuenga, Moussa Moïse Diagneb, Ndongo Diab, Paul Alain Ngoupo Tagnouokama, Yap Boum, Achta Hamadoua, Linda Essod, Ousmane Fayeb, Mathurin Cyrille Tejiokema, Marie Claire Okomoe, Alain Etoundid, Elisabeth Carniela, and Sara Eyangoha, | Microbiology Resource Announcements | March 11, 2021 | https://doi.org/10.1128/MRA.00093-21. | We describe the coding-complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain obtained in Cameroon from a 58-year-old French patient who arrived from France on 24 February 2020. Phylogenetic analysis showed that this virus, named hCoV-19/Cameroon/1958-CMR-YAO/2020, belongs to lineage B.1.5 and is closely related to an isolate from France. | "Virology, Immunology and Diagnostics",other | https://journals.asm.org/doi/epub/10.1128/MRA.00093-21 |
| Aerosols and SARS-CoV-2: Statement of the “Expert Group Aerosols” on the development, infectivity, spread and reduction of airborne, virus-containing particles in the air | Stefan Brockmann, Achim Dittler, Gunnar Grün, Michael Haibel, Thomas Iftner, Hans-Georg Kräusslich, Boris Mizaikoff, Jennifer Niessner, B Richter, Claudia Spahn, Konstantinos Stergiaropoulos, and Heike von Baum | Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) | March 12, 2021 | https://dx.doi.org/10.1055%2Fa-1363-0972 | Aerosols are currently seen as one of the main transmission routes for SARS-CoV-2, but a comprehensive understanding of the processes and appropriate action/adaptation of protection concepts requires the exchange of information across interdisciplinary boundaries. Against this background, the Baden-Württemberg state government launched in October 2020 a multidisciplinary “Expert Group Aerosols” comprising engineers, natural scientists and medical professionals. In its statement, the group has compiled the current state of knowledge in all relevant disciplines in the context of airborne SARS-CoV-2 infection. In addition to the well-known hygiene and social distancing rules, the importance of the correct use of effective masks is emphasized. Furthermore, the necessity for dynamic and correct ventilation is pointed out and illustrated with ventilation intervals and periods for different scenarios as examples. The effectiveness of stationary or mobile cabin air filters as an important component in the protection concept is discussed. The first opinion of the expert group makes it clear that the existing hygiene and social distancing rules offer the best possible protection against SARS-CoV-2 infection only when correctly applied in combination. | "Virology, Immunology and Diagnostics",Transmission | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043587/ |
| Promoting diagnostics as a global good | Catharina Boehme, Emma Hannay & Madhukar Pai | Nature Medicine | March 15, 2021 | https://doi.org/10.1038/s41591-020-01215-3 | none | "Virology, Immunology and Diagnostics" | https://rdcu.be/ckKE7 |
| The COVID-19 pandemic is deepening the health crisis in South Kivu, Democratic Republic of Congo | René Écochard, Patient Wimba, Justin Bengehya, Philippe Bianga Katchunga, Séraphine Lugwarha, Moise Oyimangirwe, Jacques-Aimé Bazeboso, Léon Tshilolo, Benjamin Longo-Mbenza, Muriel Rabilloud, Jean Iwaz, Jean-François Étard, Philippe Vanhems | International Journal of Infectious Diseases | March 17, 2021 | https://doi.org/10.1016/j.ijid.2021.03.043 | Objective The outbreak of coronavirus disease 2019 (COVID-19) in South Kivu, Democratic Republic of Congo raised concerns regarding additional morbidity and mortality. Updating these indicators before a second wave is essential in order to prepare for additional help. Methods From mid-May to mid-December 2020, weekly surveys were undertaken in sampled streets from 10 health areas to quantify the use of barrier measures, and interview pedestrians about sickness and deaths in their households. Crude death rates (CDRs) were estimated. Results Minimal use or no use of face masks was observed in at least half of the streets. From May to December 2020, the number of suspected cases of COVID-19 increased six-fold (P < 0.05). Of deaths within 30 days preceding the interviews, 20% were considered to be related to COVID-19. The monthly CDRs at the beginning and end of the study were approximately 5 and 25 per 1000 population, respectively (P < 0.05); that is, annual CDRs of 60 and 260 per 1000 population, respectively. Thus, during the first wave, the estimated mortality rate increased by 50% compared with previous years, and increased at least four-fold by the end of 2020. Conclusion Despite possible overestimations, the excess mortality in South Kivu is extremely concerning. This crisis calls for a rapid response and increased humanitarian assistance. | Clinical Epidemiology,Data Management | https://www.ijidonline.com/article/S1201-9712(21)00261-7/fulltext |
| Nasopharyngeal Microbial Communities of Patients Infected With SARS-CoV-2 That Developed COVID-19 | Maria Paz Ventero, Rafael R. C. Cuadrat, Inmaculada Vidal, Bruno G. N. Andrade, Carmen Molina-Pardines, Jose M. Haro-Moreno, Felipe H. Coutinho, Esperanza Merino, Luciana C. A. Regitano, Cynthia B. Silveira, Haithem Afli, Mario López-Pérez and Juan Carlos Rodríguez | Frontiers in Microbiology | March 17, 2021 | https://doi.org/10.3389/fmicb.2021.637430 | none | "Virology, Immunology and Diagnostics",other | https://www.frontiersin.org/articles/10.3389/fmicb.2021.637430/full#h1 |
| Guidelines should not pool evidence from uncomplicated and severe COVID-19 | Nicholas J White, Nathalie Strub-Wourgaft, Abul Faiz, Philippe J Guerin | The Lancet | March 22, 2021 | https://doi.org/10.1016/S0140-6736(21)00469-4 | none | other,Coalition publications | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00469-4/fulltext |
| Guidelines should not pool evidence from uncomplicated and severe COVID-19 | Nicholas J White, Nathalie Strub-Wourgaft, Abul Faiz, Philippe J Guerin | The Lancet | March 23, 2021 | https://doi.org/10.1016/S0140-6736(21)00469-4 | none | other,Study Design and Analytics | https://www.sciencedirect.com/science/article/pii/S0140673621004694# |
| The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study | Stephanie J Salyer, Justin Maeda, Senga Sembuche, Yenew Kebede, Akhona Tshangela, Mohamed Moussif, Chikwe Ihekweazu, Natalie Mayet, Ebba Abate, Ahmed Ogwell Ouma, John Nkengasong. | The Lancet | March 24, 2021 | https://doi.org/10.1016/S0140-6736(21)00632-2 | none | Clinical Epidemiology | https://www.sciencedirect.com/science/article/pii/S0140673621006322 |
| N-Acetylcysteine and Hydrogen Sulfide in Coronavirus Disease 2019 | Arno R. Bourgonje, Annette K. Offringa, Larissa E. van Eijk, Amaal E. Abdulle, Jan-Luuk Hillebrands, Peter H.J. van der Voort, Harry van Goor, and Ed J. van Hezik | Antioxidants & Redox Signaling | March 25, 2021 | https://doi.org/10.1089/ars.2020.8247 | Abstract Significance: Hydrogen sulfide (H2S) is one of the three main gasotransmitters that are endogenously produced in humans and are protective against oxidative stress. Recent findings from studies focusing on coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shifted our attention to a potentially modulatory role of H2S in this viral respiratory disease. Recent Advances: H2S levels at hospital admission may be of importance since this gasotransmitter has been shown to be protective against lung damage through its antiviral, antioxidant, and anti-inflammatory actions. Furthermore, many COVID-19 cases have been described demonstrating remarkable clinical improvement upon administration of high doses of N-acetylcysteine (NAC). NAC is a renowned pharmacological antioxidant substance acting as a source of cysteine, thereby promoting endogenous glutathione (GSH) biosynthesis as well as generation of sulfane sulfur species when desulfurated to H2S. Critical Issues: Combining H2S physiology and currently available knowledge of COVID-19, H2S is hypothesized to target three main vulnerabilities of SARS-CoV-2: (i) cell entry through interfering with functional host receptors, (ii) viral replication through acting on RNA-dependent RNA polymerase (RdRp), and (iii) the escalation of inflammation to a potentially lethal hyperinflammatory cytokine storm (toll-like receptor 4 [TLR4] pathway and NLR family pyrin domain containing 3 [NLRP3] inflammasome). Future Directions: Dissecting the breakdown of NAC reveals the possibility of increasing endogenous H2S levels, which may provide a convenient rationale for the application of H2S-targeted therapeutics. Further randomized-controlled trials are warranted to investigate its definitive role. | other | https://www.liebertpub.com/doi/10.1089/ars.2020.8247 |
| Performance and operational feasibility of antigen and antibody rapid diagnostic tests for COVID-19 in symptomatic and asymptomatic patients in Cameroon: a clinical, prospective, diagnostic accuracy study | Yap Boum, PhD, Karl Njuwa Fai, MD, Birgit Nikolay, PhD, Akenji Blaise Mboringong, MD, Lisa M Bebell, MD, Mark Ndifon, MSc, Aristide Abbah, MD, Rachel Essaka, MSc, Lucrèce Eteki, MPH, Francisco Luquero, PhD, Céline Langendorf, MD, Nicole Fouda Mbarga, MD , Rene Ghislain Essomba, PhD, Bongkiyung Donald Buri, MSc, Tchoula Mamiafo Corine, MSc, Bertrand Tchualeu Kameni, MSc, Nadia Mandeng, MD, Mahamat Fanne, MD, Anne-Cécile Zoung-Kani Bisseck, MD, Clement B Ndongmo, PhD, Sara Eyangoh, PhD, Achta Hamadou, MD, Jean Patrick Ouamba, MD, Modeste Tamakloé Koku, MD, Richard Njouom, PhD, Okomo Marie Claire, PhD, Linda Esso, MD, Emilienne Epée, MD, Georges Alain Etoundi Mballa, MD | The Lancet Infectious Diseases | March 25, 2021 | https://doi.org/10.1016/S1473-3099(21)00132-8 | Background Real-time PCR is recommended to detect SARS-CoV-2 infection. However, PCR availability is restricted in most countries. Rapid diagnostic tests are considered acceptable alternatives, but data are lacking on their performance. We assessed the performance of four antibody-based rapid diagnostic tests and one antigen-based rapid diagnostic test for detecting SARS-CoV-2 infection in the community in Cameroon. Methods In this clinical, prospective, diagnostic accuracy study, we enrolled individuals aged at least 21 years who were either symptomatic and suspected of having COVID-19 or asymptomatic and presented for screening. We tested peripheral blood for SARS-CoV-2 antibodies using the Innovita (Biological Technology; Beijing, China), Wondfo (Guangzhou Wondfo Biotech; Guangzhou, China), SD Biosensor (SD Biosensor; Gyeonggi-do, South Korea), and Runkun tests (Runkun Pharmaceutical; Hunan, China), and nasopharyngeal swabs for SARS-CoV-2 antigen using the SD Biosensor test. Antigen rapid diagnostic tests were compared with Abbott PCR testing (Abbott; Abbott Park, IL, USA), and antibody rapid diagnostic tests were compared with Biomerieux immunoassays (Biomerieux; Marcy l'Etoile, France). We retrospectively tested two diagnostic algorithms that incorporated rapid diagnostic tests for symptomatic and asymptomatic patients using simulation modelling. Findings 1195 participants were enrolled in the study. 347 (29%) tested SARS-CoV-2 PCR-positive, 223 (19%) rapid diagnostic test antigen-positive, and 478 (40%) rapid diagnostic test antibody-positive. Antigen-based rapid diagnostic test sensitivity was 80·0% (95% CI 71·0–88·0) in the first 7 days after symptom onset, but antibody-based rapid diagnostic tests had only 26·8% sensitivity (18·3–36·8). Antibody rapid diagnostic test sensitivity increased to 76·4% (70·1–82·0) 14 days after symptom onset. Among asymptomatic participants, the sensitivity of antigen-based and antibody-based rapid diagnostic tests were 37·0% (27·0–48·0) and 50·7% (42·2–59·1), respectively. Cohen's κ showed substantial agreement between Wondfo antibody rapid diagnostic test and gold-standard ELISA (κ=0·76; sensitivity 0·98) and between Biosensor and ELISA (κ=0·60; sensitivity 0·94). Innovita (κ=0·47; sensitivity 0·93) and Runkun (κ=0·43; sensitivity 0·76) showed moderate agreement. An antigen-based retrospective algorithm applied to symptomatic patients showed 94·0% sensitivity and 91·0% specificity in the first 7 days after symptom onset. For asymptomatic participants, the algorithm showed a sensitivity of 34% (95% CI 23·0–44·0) and a specificity of 92·0% (88·0–96·0). Interpretation Rapid diagnostic tests had good overall sensitivity for diagnosing SARS-CoV-2 infection. Rapid diagnostic tests could be incorporated into efficient testing algorithms as an alternative to PCR to decrease diagnostic delays and onward viral transmission. | "Virology, Immunology and Diagnostics" | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00132-8/fulltext?dgcid=hubspot_email_newsletter_lancetcovid21&utm_campaign=lancetcovid21&utm_medium=email&_hsmi=118014855&_hsenc=p2ANqtz-9LouHuJZgM0wtzI5srfSKvPv6tY8h1W0lOF27x46FaNq0eyN0ZUKZ0x-Dz76bGRkxnl405RzI_5ONOVivgmvQlHaFImQ&utm_content=118003535&utm_source=hs_email |
| Key considerations on the potential impacts of the COVID-19 pandemic on AMR research and surveillance | Jesús Rodríguez-Baño, Gian Maria Rossolini, Constance Schultsz, Evelina Tacconelli, Srinivas Murthy, Norio Ohmagari, Alison Holmes, Till T Bachmann, Herman Goossens, Rafael Canton, Adam P Roberts, Birgitta Henriques-Normark, Cornelius J Clancy, Benedikt Huttner, Patriq Fagerstedt, Shawon Lahiri, Charu Kaushic, Steven J. Hoffman, Margo Warren, Ghada Zoubiane Sabiha Essack, Ramanan Laxminarayan, Laura Plant | Journal of global antimicrobial resistance | March 27, 2021 | https://doi.org/10.1093/trstmh/trab048 | Antibiotic use in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients during the COVID-19 pandemic has exceeded the incidence of bacterial coinfections and secondary infections, suggesting inappropriate and excessive prescribing. Even in settings with established antimicrobial stewardship (AMS) programmes, there were weaknesses exposed regarding appropriate antibiotic use in the context of the pandemic. Moreover, antimicrobial resistance (AMR) surveillance and AMS have been deprioritised with diversion of health system resources to the pandemic response. This experience highlights deficiencies in AMR containment and mitigation strategies that require urgent attention from clinical and scientific communities. These include the need to implement diagnostic stewardship to assess the global incidence of coinfections and secondary infections in COVID-19 patients, including those by multidrug-resistant pathogens, to identify patients most likely to benefit from antibiotic treatment and identify when antibiotics can be safely withheld, de-escalated or discontinued. Long-term global surveillance of clinical and societal antibiotic use and resistance trends is required to prepare for subsequent changes in AMR epidemiology, while ensuring uninterrupted supply chains and preventing drug shortages and stock outs. These interventions present implementation challenges in resource-constrained settings, making a case for implementation research on AMR. Knowledge and support for these practices will come from internationally coordinated, targeted research on AMR, supporting the preparation for future challenges from emerging AMR in the context of the current COVID-19 pandemic or future pandemics. | "Virology, Immunology and Diagnostics" | https://academic.oup.com/trstmh/advance-article/doi/10.1093/trstmh/trab048/6195536 |
| Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. | Barbara Chmielewska, Imogen Barratt, Rosemary Townsend, Erkan Kalafat, Jan van der Meulen, Ipek Gurol-Urganci, Pat O’Brien, Edward Morris, Tim Draycott, Shakila Thangaratinam, Kirsty Le Doare, Shamez Ladhani, Peter von Dadelszen, Laura Magee, Asma Khalil. | The Lancet Global Health. | March 31, 2021 | https://doi.org/10.1016/S2214-109X(21)00079-6 | none | "Maternal, Newborn and Child Health" | https://www.hikarukubo.net/blog/entry/48495 |
| Research priorities for Long Covid: refined through an international multi-stakeholder forum. | Gail Carson & Long Covid Forum Group | BMC Med | March 31, 2021 | https://doi.org/10.1186/s12916-021-01947-0 | none | other | https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01947-0 |
| How can community engagement in health research be strengthened for infectious disease outbreaks in Sub-Saharan Africa? A scoping review of the literature | Samantha Vanderslott, Manya Van Ryneveld, Mark Marchant, Shelley Lees, Sylvie Kwedi Nolna & Vicki Marsh | BMC Public Health | April 1, 2021 | https://doi.org/10.1186/s12889-021-10348-0 | Background Community engagement (CE) is a well-established practical and scholarly field, recognised as core to the science and ethics of health research, for which researchers and practitioners have increasingly asked questions about desired standards and evaluation. In infectious disease outbreak contexts, questions may be more complex. However, it is unclear what body of knowledge has been developed for CE specifically as it applies to emerging infectious diseases. This scoping review seeks to describe (1) How CE has been conceptualised and understood; and (2) What conclusions have research teams reached on the effectiveness of CE in these settings, including challenges and facilitators. Methods We used a scoping review framework by Arksey and O’Malley (Int J Soc Res Methodol 8:19–32, 2005) to structure our review. We conducted a brainstorming session and initial trial search to inform the protocol, search terms, and strategy. Three researchers discussed, developed and applied agreed screening tools and selection criteria to the final search results. Five researchers used the screening tools to screen abstracts and full text for inclusion by consensus. Additional publications were sought from references of retrieved publications and an expert call for literature. We analysed and reported emerging themes qualitatively. Results We included 59 papers from a total of 722 articles derived from our trial and final literature searches, as well as a process of “citation chasing” and an expert call for grey literature. The core material related exclusively to health research trials during the 2014–2016 West Africa Ebola outbreak. We synthesized reports on components of effectiveness of CE to identify and propose three themes as essential elements of effective CE. Conclusions While there is a large volume of literature documenting CE activities in infectious disease research settings generally, there are few accounts of effectiveness dimensions of CE. Our review proposes three themes to facilitate the effectiveness of CE initiatives as essential elements of CE activities in infectious diseases studies: (1) Communication towards building collaborative relationships; (2) Producing contextual knowledge; and (3) Learning lessons over time. As there were relatively few in-depth accounts of CE from our literature review, documentation and accounts of CE used in health research should be prioritised. | Social Science | https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10348-0#Abs1 |
| Intellectual property rights need to be subverted to ensure global vaccine access | Salla Sariola | BMJ Global Health | April 1, 2021 | doi:10.1136/ | Ethics,Vaccines,Social Science | https://gh.bmj.com/content/6/4/e005656 | |
| How can community engagement in health research be strengthened for infectious disease outbreaks in Sub-Saharan Africa? A scoping review of the literature | Samantha Vanderslott, Manya Van Ryneveld, Mark Marchant, Shelley Lees, Sylvie Kwedi Nolna & Vicki Marsh | BMC Public Health | April 1, 2021 | https://doi.org/10.1186/s12889-021-10348-0 | Background Community engagement (CE) is a well-established practical and scholarly field, recognised as core to the science and ethics of health research, for which researchers and practitioners have increasingly asked questions about desired standards and evaluation. In infectious disease outbreak contexts, questions may be more complex. However, it is unclear what body of knowledge has been developed for CE specifically as it applies to emerging infectious diseases. This scoping review seeks to describe (1) How CE has been conceptualised and understood; and (2) What conclusions have research teams reached on the effectiveness of CE in these settings, including challenges and facilitators. Methods We used a scoping review framework by Arksey and O’Malley (Int J Soc Res Methodol 8:19–32, 2005) to structure our review. We conducted a brainstorming session and initial trial search to inform the protocol, search terms, and strategy. Three researchers discussed, developed and applied agreed screening tools and selection criteria to the final search results. Five researchers used the screening tools to screen abstracts and full text for inclusion by consensus. Additional publications were sought from references of retrieved publications and an expert call for literature. We analysed and reported emerging themes qualitatively. Results We included 59 papers from a total of 722 articles derived from our trial and final literature searches, as well as a process of “citation chasing” and an expert call for grey literature. The core material related exclusively to health research trials during the 2014–2016 West Africa Ebola outbreak. We synthesized reports on components of effectiveness of CE to identify and propose three themes as essential elements of effective CE. Conclusions While there is a large volume of literature documenting CE activities in infectious disease research settings generally, there are few accounts of effectiveness dimensions of CE. Our review proposes three themes to facilitate the effectiveness of CE initiatives as essential elements of CE activities in infectious diseases studies: (1) Communication towards building collaborative relationships; (2) Producing contextual knowledge; and (3) Learning lessons over time. As there were relatively few in-depth accounts of CE from our literature review, documentation and accounts of CE used in health research should be prioritised. | Ethics,Social Science,Public Health | https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10348-0 |
| Global coalition to accelerate COVID-19 clinical research in resource-limited settings | COVID-19 Clinical Research Coalition | The Lancet | April 2, 2021 | https://doi.org/10.1016/S0140-6736(20)30798-4 | none | other,Coalition publications | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30798-4/fulltext |
Considerations for COVID-19 vaccination in pregnancy. | Jarrod Zamparini, Lyle Murray, Robin T Saggers, Amy J Wise, Hendrik Lombaard. | South African Medical Journal | April 6, 2021 | http://dx.doi.org/10.7196/samj.2021.v111i6.15660 | Pregnant women are at greater risk of severe COVID-19 than non-pregnant women. Despite limited safety data on use of COVID-19 vaccines in pregnancy, many international societies have recommended their use when pregnant women are at particularly high risk of acquiring COVID-19, or have suggested that vaccines should not be withheld from pregnant women where no other contraindications to COVID-19 vaccination exist. A number of vaccines, including those against influenza, tetanus and pertussis, have been shown to reduce both maternal and infant morbidity and mortality when used antenatally. We explore the role of COVID-19 vaccination in the setting of pregnancy, discuss the limited data available, and summarise current international guidelines. | "Maternal, Newborn and Child Health",Vaccines | http://www.samj.org.za/index.php/samj/article/view/13267 |
| Randomized clinical trial to compare the efficacy of ivermectin versus placebo to negativize nasopharyngeal PCR in patients with early COVID-19 in Peru (SAINT-Peru): a structured summary of a study protocol for randomized controlled trial. | Patricia J. Garcia, Hansel Mundaca, Cesar Ugarte-Gil, Patricia Leon, German Malaga, Carlos Chaccour & Cesar P. Carcamo | Trials | April 9, 2021 | https://doi.org/10.1186/s13063-021-05236-2 | Objectives The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: 1. 1. 2. To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab on days 4, 7, 14 and 21 post-treatment initiation 3. 4. 2. 5. To assess the efficacy of ivermectin on the improvement of symptoms 6. 7. 3. 8. To assess the proportion of seroconversions at day 21 9. 10. 4. 11. To assess the safety of ivermectin at the proposed dose 12. 13. 5. 14. To determine the magnitude of the immune response against SARS-CoV-2 15. 16. 6. 17. To assess correlation of the presence of intestinal helminths on participants on baseline and day 14 with COVID-19 progression and treatment. | Clinical Pharmacology and Drug Candidates,Study Design and Analytics | https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05236-2#citeas |
| RBD-specific polyclonal F(ab´)2 fragments of equine antibodies in patients with moderate to severe COVID-19 disease: A randomized, multicenter, double-blind, placebo-controlled, adaptive phase 2/3 clinical trial | Gustavo Lopardo, Waldo H. Belloso, Esteban Nannini, Mariana Colonna, Santiago Sanguineti, Vanesa Zylberman, Luciana Muñoz, Martín Dobarro, Gabriel Lebersztein, Javier Farina, Gabriela Vidiella, Anselmo Bertetti, Favio Crudo, Maria Fernanda Alzogaray, Laura Barcelona, Ricardo Teijeiro, Sandra Lambert, Darío Scublinsky, Marisa Iacono, Vanina Stanek, Rubén Solari, Pablo Cruz, Marcelo Martín Casas, Lorena Abusamra, Héctor Lucas Luciardi, Alberto Cremona, Diego Caruso, Bernardo de Miguel, Santiago Perez Lloret, Susana Millán, Yael Kilstein, Ana Pereiro, Omar Sued, Pedro Cahn, Linus Spatz, Fernando Goldbaum, on behalf of INM005 Study Group | EClinicalMedicine | April 11, 2021 | https://doi.org/10.1016/j.eclinm.2021.100843 | Background passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2. Methods we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984). Findings between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 (n = 118) or placebo (n = 123). Median age was 54 years old, 65•1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5•28% [-3•95; 14•50]; p = 0•15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14•2 (± 0•7) days in the INM005 group and 16•3 (± 0•7) days in the placebo group, hazard ratio 1•31 (95% CI 1•0 to 1•74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6•9% the INM005 group and 11•4% in the placebo group (risk difference [95% IC]: 0•57 [0•24 to 1•37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported. Interpretation Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease. | Clinical Management,Clinical Pharmacology and Drug Candidates,"Virology, Immunology and Diagnostics" | https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00123-1/fulltext |
| SARS‑CoV-2 RBD219-N1C1: A yeast-expressed SARS-CoV-2 recombinant receptor-binding domain candidate vaccine stimulates virus neutralizing antibodies and T-cell immunity in mice | Wen-Hsiang Chen, Leroy Versteeg, Brian Keegan, Bin Zhan, Junfei Wei, Zhuyun Liu, Jungsoon Lee, Rahki Kundu, Rakesh Adhikari, Cristina Poveda, Maria Jose Villar, Ana Carolina de Araujo Leao, Joanne Altieri Rivera, Zoha Momin, Portia M. Gillespie, Jason T. Kimata, Ulrich Strych, Peter J. Hotez & Maria Elena Bottazzi. | Human Vaccines & Immunotherapeutics | April 13, 2021 | https://doi.org/10.1080/21645515.2021.1901545 | There is an urgent need for an accessible and low-cost COVID-19 vaccine suitable for low- and middle-income countries. Here, we report on the development of a SARS-CoV-2 receptor-binding domain (RBD) protein, expressed at high levels in yeast (Pichia pastoris), as a suitable vaccine candidate against COVID-19. After introducing two modifications into the wild-type RBD gene to reduce yeast-derived hyperglycosylation and improve stability during protein expression, we show that the recombinant protein, RBD219-N1C1, is equivalent to the wild-type RBD recombinant protein (RBD219-WT) in an in vitro ACE-2 binding assay. Immunogenicity studies of RBD219-N1C1 and RBD219-WT proteins formulated with Alhydrogel® were conducted in mice, and, after two doses, both the RBD219-WT and RBD219-N1C1 vaccines induced high levels of binding IgG antibodies. Using a SARS-CoV-2 pseudovirus, we further showed that sera obtained after a two-dose immunization schedule of the vaccines were sufficient to elicit strong neutralizing antibody titers in the 1:1,000 to 1:10,000 range, for both antigens tested. The vaccines induced IFN-γ IL-6, and IL-10 secretion, among other cytokines. Overall, these data suggest that the RBD219-N1C1 recombinant protein, produced in yeast, is suitable for further evaluation as a human COVID-19 vaccine, in particular, in an Alhydrogel® containing formulation and possibly in combination with other immunostimulants. | Vaccines | https://www.tandfonline.com/doi/full/10.1080/21645515.2021.1901545?scroll=top&needAccess=true |
| Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. | Axfors, Cathrine, et al. | Nature communications | April 15, 2021 | https://doi.org/10.1038/s41467-021-22446-z | Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https:// osf.io/QESV4/). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities | Clinical Pharmacology and Drug Candidates | https://www.nature.com/articles/s41467-021-22446-z?fbclid=IwAR1bEQcuHU34MXj1XMhQJSoRDekbh9lWx0m0fYZuVR82gF9ZJ4jnfK0VvHc |
| Urgently seeking efficiency and sustainability of clinical trials in global health | Jay J H Park, Rebecca F Grais, Monica Taljaard, Etheldreda Nakimuli-Mpungu, Fyezah Jehan, Jean B Nachega, Nathan Ford, Denis Xavier, Andre P Kengne, Per Ashorn, Maria Eugenia Socias, Zulfiqar A Bhutta, Edward J Mills | The Lancet Global Health | April 15, 2021 | https://doi.org/10.1016/S2214-109X(20)30539-8 | This paper shows the scale of global health research and the context in which we frame the subsequent papers in the Series. In this Series paper, we provide a historical perspective on clinical trial research by revisiting the 1948 streptomycin trial for pulmonary tuberculosis, which was the first documented randomised clinical trial in the English language, and we discuss its close connection with global health. We describe the current state of clinical trial research globally by providing an overview of clinical trials that have been registered in the WHO International Clinical Trial Registry since 2010. We discuss challenges with current trial planning and designs that are often used in clinical trial research undertaken in low-income and middle-income countries, as an overview of the global health trials landscape. Finally, we discuss the importance of collaborative work in global health research towards generating sustainable and culturally appropriate research environments. | Study Design and Analytics,Ethics,Social Science,other | https://www.sciencedirect.com/science/article/pii/S2214109X20305398#ceab10 |
| Ethical and policy considerations for COVID-19 vaccination modalities: delayed second dose, fractional dose, mixed vaccines | Jonathan Wolff , Caesar Atuire, Anant Bhan, Ezekiel Emanuel, Ruth Faden, Prakash Ghimire, Dirceu Greco, Calvin W L Ho, Sonali Kochhar, Surie Moon, Owen G Schaefer , Ehsan Shamsi-Gooshki, Jerome Amir Singh, Maxwell J Smith , Beatriz Thomé, Aissatou Touré, Ross Upshar | BMJ Global Health | April 16, 2021 | doi:10.1136/bmjgh-2021-005912 | none | Ethics,Social Science | https://gh.bmj.com/content/bmjgh/6/5/e005912.full.pdf |
| Guérir en Afrique : promesses et transformations. | Alice Desclaux, Aïssa Diarra, Sandrine Musso | L'Harmattan | April 23, 2021 | https://hal.archives-ouvertes.fr/hal-03206678 | Alors qu'à propos de l'Afrique le poids des maladies chroniques et des épidémies domine les discours internationaux, les avancées majeures en matière de santé au cours des trente dernières années restent dans l'ombre. Le projet de cet ouvrage est d'analyser les formes individuelles et collectives du "guérir" dans l'Afrique contemporaine. Dans une approche anthropologique, la guérison n'est pas définie seulement d'un point de vue médical, mais elle est une production matérielle et idéelle dans des cultures thérapeutiques qui articulent le local et le global, mais aussi le sanitaire, le religieux et l'économique. Les auteurs apportent des éclairages sur des questions telles que : la promesse de guérison et les effets de l'absence de notion d'incurabilité dans les offres thérapeutiques locales ; les capacités et limites du système médical dans la construction de la guérison clinique ; les tensions entre acteurs sanitaires et patients dans les perceptions de la guérison ; les interprétations et dissonances locales d'un discours d'éradication en santé publique. Au final, l'ouvrage éclaire non seulement les dimensions idéelles de la guérison dans leurs contextes sociaux mais aussi les effets des dissonances dans ses approches, du personnel au politique. | Social Science | https://hal.archives-ouvertes.fr/hal-03206678/ |
| Accelerated vaccine rollout is imperative to mitigate highly transmissible COVID-19 variants | Pratha Sah, Thomas N. Vilches, Seyed M. Moghadas, Meagan C. Fitzpatrick, Burton H. Singer, Peter J. Hotez, Alison P. Galvania | EClinicalMedicine | April 25, 2021 | https://doi.org/10.1016/j.eclinm.2021.100865 | Supply and Market Dynamics; Medicine Quality | https://www.sciencedirect.com/science/article/pii/S2589537021001450#abs0001 | |
| Childhood immunization during the COVID-19 pandemic in Texas | Tasmiah Nuzhath, Kobi V.Ajayi, Qiping Fana, Peter Hotez, Brian Colwella, Timothy Callaghan, Annette K. Regan | Vaccines | April 27, 2021 | https://doi.org/10.1016/j.vaccine.2021.04.050 | In 2020, the state of Texas implemented coronavirus disease 2019 (COVID-19) social distancing guidelines in order to prevent surges at Texas hospital emergency rooms and in intensive care units. As noted in other states, an unintended consequence of these activities was significant declines in childhood immunizations. After analyzing state-wide immunization register data for Texas, we observed a 47% relative decline in immunization rates between 2019 and 2020 among 5-month-olds and a 58% decline among 16-month-olds. We observed a small decline (5%) among 24-month-olds, and no decline in vaccines received at birth (Hepatitis B). Declines were larger in rural counties compared to urban. These declines are superimposed on increases in state vaccine exemptions over the last five years due to an aggressive anti-vaccine movement in Texas. There are concerns that continued declines in childhood immunization coverage due to COVID-19 could lead to co-endemics of measles and other vaccine preventable diseases. | Vaccines,"Virology, Immunology and Diagnostics" | https://www.sciencedirect.com/science/article/pii/S0264410X21005090 |
| Evaluation of RT-qPCR and Loop-Mediated Isothermal Amplification (LAMP) Assays for the Detection of SARS-CoV-2 in Argentina | María Dolores Fellner, Romina Bonaventura, Jorge Basiletti, Martín Avaro, Estefanía Benedetti, Ana Campos, María Elena Dattero, Mara Russo, Sara Vladmirsky, Viviana Molina, Lucía Irazu, Marcelo A. Rodriguez, Andrea Pontoriero, Daniel M. Cisterna, and Elsa G. Baumeister | Genes | April 28, 2021 | https://doi.org/10.3390/genes12050659 | Our aim was to evaluate the analytical and clinical performance of the SARS-CoV-2 molecular detection kits used in Argentina. Nine real-time reverse-transcription polymerase chain reaction (RT-qPCR) and three reverse-transcription loop-mediated isothermal amplification (RT-LAMP) assays were evaluated using the World Health Organization (WHO) recommended test as reference method. A secondary standard calibrated for the E, N and RdRp genes against the Pan American Health Organization—World Health Organization—International Standard was used to calculate the limit of detection (LoD). A panel of artificial clinical samples, 32 positive and 30 negative for SARS-CoV-2, were analyzed to estimate the kappa concordance (κ) and the diagnostic performance. Differences among the LoD values for the target genes amplified by each kit were >1 log copies/reaction. The κ for the RT-qPCR kits was greater than 0.9, whereas that for the RT-LAMP assays ranged from 0.75 to 0.93. The clinical performance of RT-qPCR kits showed 100% specificity and high sensitivity, although with variations according to the gene analyzed. The E and N genes provided greater clinical sensitivity, whereas the RdRp gene increased the clinical specificity. The RT-LAMP assays revealed a variable diagnostic performance. The information provided can be useful to choose the most appropriate diagnostic test and may contribute to the establishment of a consensus in the diagnosis of SARS-CoV-2 in Argentina and the region. | "Virology, Immunology and Diagnostics" | https://www.mdpi.com/2073-4425/12/5/659/htm |
| Investigation of SARS-CoV-2 infection in dogs and cats of humans diagnosed with COVID-19 in Rio de Janeiro, Brazil | Guilherme Amaral Calvet, Sandro Antonio Pereira, Maria Ogrzewalska, Alex Pauvolid-Corrêa, Paola Cristina Resende, Wagner de Souza Tassinari, Anielle de Pina Costa, Lucas Oliveira Keidel, Alice Sampaio Barreto da Rocha, Michele Fernanda Borges da Silva, Shanna Araujo dos Santos,Ana Beatriz Machado Lima, Isabella Campos Vargas de Moraes, Artur Augusto Velho Mendes Junior, Thiago das Chagas Souza, Ezequias Batista Martins, Renato Orsini Ornellas, Maria Lopes Corrêa, Isabela Maria da Silva Antonio, Lusiele Guaraldo, Fernando do Couto Motta, Patrícia Brasil, Marilda Mendonça Siqueira, Isabella Dib Ferreira Gremião, Rodrigo Caldas Menezes | PLoS ONE | April 28, 2021 | https://doi.org/10.1371/journal.pone.0250853 | Background Infection by SARS-CoV-2 in domestic animals has been related to close contact with humans diagnosed with COVID-19. Objectives: To assess the exposure, infection, and persistence by SARS-CoV-2 of dogs and cats living in the same households of humans that tested positive for SARS-CoV-2, and to investigate clinical and laboratory alterations associated with animal infection. Methods Animals living with COVID-19 patients were longitudinally followed and had nasopharyngeal/oropharyngeal and rectal swabs collected and tested for SARS-CoV-2. Additionally, blood samples were collected for laboratory analysis, and plaque reduction neutralization test (PRNT90) to investigate specific SARS-CoV-2 antibodies. Results Between May and October 2020, 39 pets (29 dogs and 10 cats) of 21 patients were investigated. Nine dogs (31%) and four cats (40%) from 10 (47.6%) households were infected with or seropositive for SARS-CoV-2. Animals tested positive from 11 to 51 days after the human index COVID-19 case onset of symptoms. Three dogs tested positive twice within 14, 30, and 31 days apart. SARS-CoV-2 neutralizing antibodies were detected in one dog (3.4%) and two cats (20%). In this study, six out of thirteen animals either infected with or seropositive for SARS-CoV-2 have developed mild but reversible signs of the disease. Using logistic regression analysis, neutering, and sharing bed with the ill owner were associated with pet infection. Conclusions The presence and persistence of SARS-CoV-2 infection have been identified in dogs and cats from households with human COVID-19 cases in Rio de Janeiro, Brazil. People with COVID-19 should avoid close contact with their pets during the time of their illness. | Transmission,other | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250853 |
| The Impact of COVID-19 Pandemic on Critical Care Systems in Low- and Middle-Income Countries | Ged Williams, Elizabeth Kusi-Appiah, Elizabeth Papathanassoglou | Connect: The World of Critical Care Nursing | May 1, 2021 | doi:10.1891/wfccn-d-21-00004 | none | other | https://www.scilit.net/article/8ac559570043bc287e344887f57d4291 |
| High Mobility Group Box 1 and Interleukin 6 at Intensive Care Unit Admission as Biomarkers in Critically Ill COVID-19 Patients. | Sivakorn C, Dechsanga J, Jamjumrus L, Boonnak K, Schultz MJ, Dorndorp AM, Phumratanaprapin W, Ratanarat R, Naorungroj T, Wattanawinitchai P, Siripoon T, Duangdee C, Techarang T | The American Journal of Tropical Medicine and Hygiene | May 3, 2021 | https://doi.org/10.4269/ajtmh.21-0165 | Exuberant inflammation manifesting as a "cytokine storm" has been suggested as a central feature in the pathogenesis of severe coronavirus disease 2019 (COVID-19). This study investigated two prognostic biomarkers, the high mobility group box 1 (HMGB1) and interleukin-6 (IL-6), in patients with severe COVID-19 at the time of admission in the intensive care unit (ICU). Of 60 ICU patients with COVID-19 enrolled and analyzed in this prospective cohort study, 48 patients (80%) were alive at ICU discharge. HMGB1 and IL-6 plasma levels at ICU admission were elevated compared with a healthy control, both in ICU nonsurvivors and ICU survivors. HMGB1 and IL-6 plasma levels were higher in patients with a higher Sequential Organ Failure Assessment (SOFA) score (> 10), and the presence of septic shock or acute kidney injury. HMGB1 and IL-6 plasma levels were also higher in patients with a poor oxygenation status (PaO2/FiO2 < 150 mm Hg) and a longer duration of ventilation (> 7 days). Plasma HMGB1 and IL-6 levels at ICU admission also correlated with other prognostic markers, including the maximum neutrophil/lymphocyte ratio, D-dimer levels, and C-reactive protein levels. Plasma HMGB1 and IL-6 levels at ICU admission predicted ICU mortality with comparable accuracy to the SOFA score and the COVID-GRAM risk score. Higher HMGB1 and IL-6 were not independently associated with ICU mortality after adjustment for age, gender, and comorbidities in multivariate analysis models. In conclusion, plasma HMGB1 and IL6 at ICU admission may serve as prognostic biomarkers in critically ill COVID-19 patients. | Clinical Management,Clinical Pharmacology and Drug Candidates | https://europepmc.org/article/med/33939645 |
| The operational feasibility of vaccination programs targeting influenza risk groups in the WHO African and South-East Asian Regions | Justin R Ortiz, Stephen L Yu, Amanda J Driscoll, Sarah R Williams, Joanie Robertson, Jui-Shan Hsu, Wilbur H Chen, Robin J Biellik, Samba Sow, Sonali Kochhar, Kathleen M Neuzil | Clinical Infectious Diseases | May 5, 2021 | https://doi.org/10.1093/cid/ciab393 | Background Influenza vaccination is uncommon in low-resource settings. We evaluated aspects of operational feasibility of influenza vaccination programs targeting risk groups in the WHO African (AFR) and South-East Asian (SEAR) Regions. Methods We estimated routine immunization and influenza vaccination campaign doses, doses per vaccinator, and cold storage requirements for one simulated country in each region using evidence-based population distribution, vaccination schedule, and vaccine volumes. Influenza vaccination targeted persons <5 years, pregnant women, persons with chronic diseases, persons ≥65 years, and healthcare workers (HCW). For the AFR country, we compared vaccine volumes to actual storage capacities. Results Targeting HCW had a small operational impact, and subsequent findings exclude this group. During three-month influenza vaccination campaigns, monthly doses delivered in the AFR country increased from 15.0% for ≥65 years to 93.1% for <5 years and in the SEAR country from 19.6% for pregnant women to 145.0% for persons with chronic diseases. National-level cold storage capacity requirements increased in the AFR country from 4.1% for ≥65 years to 20.3% for <5 years and in the SEAR country from 3.9% for pregnant women to 28.8% for persons with chronic diseases. Subnational-level cold storage capacity requirements increased in the AFR country from 5.9% for ≥65 years to 36.8% for <5 years and the SEAR country from 17.6% for pregnant women to 56.0% for persons with chronic diseases. Conclusions Influenza vaccination of most risk groups will require substantial increases in doses, doses per vaccinator, and cold storage capacity in countries where infrastructure and resources are limited. | Vaccines | https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab393/6265274?login=true |
| Priorities for COVID-19 research response and preparedness in low-resource settings | The members of the GloPID-R, UKCDR, and COVID-19 Clinical Research Coalition Cross-Working Group on COVID-19 Research in LMICs are *Alice Norton, Charles S Wiysonge, Jean-Marie Vianney Habarugira, Nick White, Marta Tufet Bayona, Hans-Eckhardt Hagen, Julie Archer, Moses Alobo, Gail Carson, Patricia Garcia, Rui M B Maciel, Uma Ramakrishnan, Choong-Min Ryu, Helen Rees, Francine Ntoumi, Akhona Tshangela, M Abul Faiz, Valerie A Snewin, Sheila Mburu, Rachel Miles, Brenda Okware, Richard Vaux, Stefanie Sowinski, Caesar Atuire, and Charu Kaushic. | The Lancet | May 6, 2021 | https://doi.org/10.1016/S0140-6736(21)00980-6 | none | Study Design and Analytics,Coalition publications | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00980-6/fulltext |
| Lives and Costs Saved by Expanding and Expediting COVID-19 Vaccination | Sarah M Bartsch, MPH, Patrick T Wedlock, MSPH, Kelly J O’Shea, BSFS, Sarah N Cox, MSPH, Ulrich Strych, PhD, Jennifer B Nuzzo, DrPH, SM, Marie C Ferguson, MSPH, Maria Elena Bottazzi, PhD, Sheryl S Siegmund, MS, Peter J Hotez, MD, PhD, Bruce Y Lee, MD, MBA | The Journal of Infectious Diseases | May 6, 2021 | https://doi.org/10.1093/infdis/jiab233 | Background With multiple COVID-19 vaccines available, understanding the epidemiologic, clinical, and economic value of increasing coverage levels and expediting vaccination is important. Methods We developed a computational model (transmission and age-stratified clinical and economics outcome model) representing the US population, COVID-19 coronavirus spread (02/2020-12/2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage. Results When achieving a given vaccination coverage in 270 days (70% vaccine efficacy), every 1% increase in coverage can avert an average of 876,800 (217,000–2,398,000) cases, varying with the number of people already vaccinated. For example, each 1% increase between 40%-50% coverage can prevent 1.5million cases, 56,240 hospitalizations, 6,660 deaths, gain 77,590 QALYs, save $602.8 million in direct medical costs and $1.3 billion in productivity losses . Expediting to 180 days could save an additional 5.8 million cases, 215,790 hospitalizations, 26,370 deaths, 206,520 QALYs, $3.5 billion in direct medical costs, and $4.3 billion in productivity losses. Conclusion Our study quantifies the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the Fall/Winter. | Vaccines | https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab233/6267841 |
| Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study | Thomas M Drake, Cameron J Fairfield, Riinu Pius, Stephen R Knight, Lisa Norman, Michelle Girvan, Hayley E Hardwick, Annemarie B Docherty, Ryan S Thwaites, Peter J M Openshaw, Kenneth Baillie, Ewen M Harrison, Malcolm G Semple for the ISARIC4C Investigators† | The Lancet Rheumatology | May 7, 2021 | https://doi.org/10.1016/S2665-9913(21)00104-1 | none | Clinical Pharmacology and Drug Candidates,Clinical Management | https://www.sciencedirect.com/science/article/pii/S2665991321001041 |
| Assessments of the quality systems of pharmaceutical distributors: a remote approach to be applied in times of COVID-19 and beyond | Anthony Bourasseau, Laurine Lavergne & Raffaella Ravinetto | Journal of Pharmaceutical Policy and Practice | May 10, 2021 | https://doi.org/10.1186/s40545-021-00323-w | Background Adequate quality systems throughout pharmaceutical supply chains are crucial to protect individuals and communities from substandard and falsified medical products. Thus, pharmaceutical distributors are regularly assessed by qualified experts. Since the COVID-19 pandemic has forced a suspension of normal activities, remote assessments via videoconferencing may represent a temporary alternative to on-site audits. We exploratorily evaluated the feasibility of remote assessments of pharmaceutical distributors, located in a low- or middle-income country hard-to reach during the COVID-19 pandemic. Methods We conducted pilot remote assessments of four conveniently selected distributors. The expert was remotely connected via videoconference, and supported by an in-country assessment facilitator (ICAF), who had received ad hoc training and was present at the assessed facility. First, the remote expert assessed the quality assurance (QA) activities and rated their compliance with the standards of the World Health Organization Good Storage & Distribution Practices (GSDP), as per routine practice. Second, s/he assessed the completeness, clarity and accuracy of data collected remotely, first per distributor, and then in aggregated form. Results Data completeness was assessed by the expert as excellent, while clarity and accuracy were good. Overall data quality (a combination of completeness, clarity and accuracy) was good, with no major differences across QA activities, nor across distributors. Contextual limitations included poor internet connection, language barriers, and distributors’ lack of familiarity with QA terminology. Conclusions Our findings are exploratory and cannot be extrapolated to other contexts, nor to other types of audits. Nonetheless, this pilot experience suggests that a well-planned remote assessment of pharmaceutical distributors, conducted with the support of a well-trained onsite ICAF, can provide data of acceptable quality, allowing to assess GSDP-compliance and to make temporary decisions about licensing or purchasing. Purchasers and policy makers should read the results of remote assessments in light of their intrinsic limitations. At the moment, onsite assessments remain the gold standards, but this could change in the longer term, with improved information technology and in light of the need to avoid unnecessary travels. Furthermore, remote assessments could be considered for routine pre-screening candidates for on-site assessments, and for targeted follow-up of on-site assessment. | Supply and Market Dynamics; Medicine Quality | https://rdcu.be/cmcSk |
| A randomized double-blind controlled trial of convalescent plasma in adults with severe COVID-19 | Max R. O’Donnell, Beatriz Grinsztejn, Matthew J. Cummings, Jessica E. Justman, Matthew R. Lamb, Christina M. Eckhardt, Neena M. Philip, Ying Kuen Cheung, Vinay Gupta, Esau João, Jose Henrique Pilotto, Maria Pia Diniz, Sandra Wagner Cardoso, Darryl Abrams, Kartik N. Rajagopalan, Sarah E. Borden, Allison Wolf, Leon Claude Sidi, Alexandre Vizzoni, Valdilea G. Veloso, Zachary C. Bitan, Dawn E. Scotto, Benjamin J. Meyer, Samuel D. Jacobson, Alex Kantor, Nischay Mishra, Lokendra V. Chauhan, Elizabeth F. Stone, Flavia Dei Zotti, Francesca La Carpia, Krystalyn E. Hudson, Stephen A. Ferrara, Joseph Schwartz, Brie A. Stotler, Wen-Hsuan W. Lin, Sandeep N. Wontakal, Beth Shaz, Thomas Briese, Eldad A. Hod, Steven L. Spitalnik, Andrew Eisenberger, Walter I. Lipkin | The Journal of Clinical Investigation | May 11, 2021 | https://doi.org/10.1172/JCI150646 | BACKGROUND Although convalescent plasma has been widely used to treat severe coronavirus disease 2019 (COVID-19), data from randomized controlled trials that support its efficacy are limited.METHODS We conducted a randomized, double-blind, controlled trial among adults hospitalized with severe and critical COVID-19 at 5 sites in New York City (USA) and Rio de Janeiro (Brazil). Patients were randomized 2:1 to receive a single transfusion of either convalescent plasma or normal control plasma. The primary outcome was clinical status at 28 days following randomization, measured using an ordinal scale and analyzed using a proportional odds model in the intention-to-treat population.RESULTS Of 223 participants enrolled, 150 were randomized to receive convalescent plasma and 73 to receive normal control plasma. At 28 days, no significant improvement in the clinical scale was observed in participants randomized to convalescent plasma (OR 1.50, 95% confidence interval [CI] 0.83–2.68, P = 0.180). However, 28-day mortality was significantly lower in participants randomized to convalescent plasma versus control plasma (19/150 [12.6%] versus 18/73 [24.6%], OR 0.44, 95% CI 0.22–0.91, P = 0.034). The median titer of anti–SARS-CoV-2 neutralizing antibody in infused convalescent plasma units was 1:160 (IQR 1:80–1:320). In a subset of nasopharyngeal swab samples from Brazil that underwent genomic sequencing, no evidence of neutralization-escape mutants was detected.CONCLUSION In adults hospitalized with severe COVID-19, use of convalescent plasma was not associated with significant improvement in day 28 clinical status. However, convalescent plasma was associated with significantly improved survival. A possible explanation is that survivors remained hospitalized at their baseline clinical status.TRIAL REGISTRATION ClinicalTrials.gov, NCT04359810.FUNDING Amazon Foundation, Skoll Foundation. | Clinical Management | https://www.jci.org/articles/view/150646/pdf |
| Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low- and Middle-Income Countries | Suzanna Awang Bono, Edlaine Faria de Moura Villela, Ching Sin Siau, Won Sun Chen, Supa Pengpid, M Tasdik Hasan, Philippe Sessou, John D. Ditekemena, Bob Omoda Amodan, Mina C. Hosseinipour, Housseini Dolo, ,Joseph Nelson Siewe Fodjo, Wah Yun Low and Robert Colebunders | Vaccines | May 17, 2021 | https://doi.org/10.3390/vaccines9050515 | Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low- and Middle-Income Countries (LMICs; N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness.Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs. | Vaccines,Public Health,Social Science | https://www.mdpi.com/2076-393X/9/5/515#abstractc |
| Remote non-pharmacologic interventions for sleep problems in healthcare workers during the COVID-19 pandemic | Fernando Manuel Torrente, Pablo Luis López, Daniel Comandé, Delfina Ailan, Simon E. Fernandez Nievas, Lindsay Robertson, Agustín Ciapponi | Cochrane Database of Systematic Reviews | May 18, 2021 | https://doi.org/10.1002/14651858.CD015132 | Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects of remote non-pharmacologic interventions, compared with other specific intervention, non-intervention or alternative intervention for sleep problems in in healthcare workers during the coronavirus disease 2019 outbreak. | other | https://covid19.elsevierpure.com/en/publications/remote-non-pharmacologic-interventions-for-sleep-problems-in-heal |
| Urgent needs to accelerate the race for COVID-19 therapeutics | Carolina Batista, Shmuel Shoham, Onder Ergonul, Peter Hotez, Maria Elena Bottazzi, J. Peter Figueroa, Sarah Gilbert, Mayda Gursel, Mazen Hassanain, Gagandeep Kang, David Kaslow, Jerome H Kim, Bhavna Lall, Heidi Larson, Denise Naniche, Timothy Sheahan, Annelies Wilder-Smith, Samba O. Sow, Prashant Yadav, Nathalie Strub-Wourgaft | EClinicalMedicine | May 21, 2021 | https://doi.org/10.1016/j.eclinm.2021.100911 | none | Clinical Pharmacology and Drug Candidates,Regulatory,Supply and Market Dynamics; Medicine Quality,other | https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00191-7/fulltext |
| COVID-19 Vaccine Acceptability and Adherence to Preventive Measures in Somalia: Results of an Online Survey | Ahmed, M.A.M.; Colebunders, R.; Gele, A.A.; Farah, A.A.; Osman, S.; Guled, I.A.; Abdullahi, A.A.M.; Hussein, A.M.; Ali, A.M.; Siewe Fodjo, J.N. | Vaccines | May 21, 2021 | https://doi.org/10.3390/vaccines9060543 | Most countries are currently gravitating towards vaccination as mainstay strategy to quell COVID-19 transmission. Between December 2020 and January 2021, we conducted a follow-up online survey in Somalia to monitor adherence to COVID-19 preventive measures, and COVID-19 vaccine acceptability and reasons for vaccine hesitancy. Adherence was measured via a composite adherence score based on four measures (physical distancing, face mask use, hand hygiene, and mouth covering when coughing/sneezing). We analyzed 4543 responses (mean age: 23.5 ± 6.4 years, 62.4% males). The mean adherence score during this survey was lower than the score during a similar survey in April 2020. A total of 76.8% of respondents were willing to receive the COVID-19 vaccine. Flu-like symptoms were more frequently reported in the current survey compared to previous surveys. Multiple logistic regression showed that participants who experienced flu-like symptoms, those in the healthcare sector, and those with higher adherence scores had higher odds for vaccine acceptability while being a female reduced the willingness to be vaccinated. In conclusion, our data suggest that the decreasing adherence to COVID-19 preventive measures may have caused increased flu-like symptoms over time. COVID-19 vaccine acceptance in Somalia is relatively high but could be improved by addressing factors that contribute to vaccine hesitancy | Vaccines,Public Health,Social Science | https://www.mdpi.com/2076-393X/9/6/543 |
| The Dark Side of the Moon: Global challenges in the distribution of vaccines and implementation of vaccination plans against COVID-19 | Cristina Mesa-Vieira, Felipe Botero-Rodríguez, Andrea Padilla-Muñoz, Oscar H. Franco, Carlos Gómez-Restrepo | Maturitas | May 26, 2021 | https://doi.org/10.1016/j.maturitas.2021.05.012 | none | Vaccines | https://www.maturitas.org/article/S0378-5122(21)00073-6/fulltext |
| Machine learning prediction of COVID-19 mortality in cancer patients. | Rodrigo Dienstmann, Marcia Menezes, Matheus Costa e Silva, Heloisa Cruz, Rafael Paes, Jussaine Alves da Silva, Anna Carolina R Messias, Pedro De Marchi, Jorge Alexandre Canedo, Andreia Cristina De Melo, Alexandre A. Jácome, Tomas Reinert, Barbara Sodre Figueiredo Ferreira, Clarissa Mathias, Carlos H. Barrios, Carlos G. M. Ferreira, Bruno Lemos Ferrari | Journal of Clinical Oncology | May 28, 2021 | DOI: 10.1200/JCO.2021.39.15 | Background: COVID-19 is a challenge for clinical decision-making in cancer patients and the allocation of healthcare resources. An accurate prognosis prediction to effectively triage patients is needed, especially in the community oncology practice. Methods:Nationwide cohort from Oncoclínicas Brazil was used to validate previously developed multivariable logistic regression (mLR) model (Ferrari et al, JCO GO 2021) and to construct a machine learning Random Forest (RF) algorithm as predictor of 30-day mortality after SARS-CoV-2 detection by RT-PCR in cancer patients diagnosed in an outpatient setting. To find the most important baseline clinical determinants of early COVID-19-related death via Gini index, a RF with 100,000 trees was trained in 75% of the dataset, and the performance was assessed in the remaining 25%. We then compared the accuracy of different models in terms of sensitivity, specificity and area under the receiver operating characteristics curves (AUC). Results:From March to December 2020, 533 patients with COVID-19 were prospectively registered in the database. Median age was 60 years (19-93) and 67% were female. Most frequent cancers were breast in 34%, hematological in 16%, and gastrointestinal in 15%. Comorbidities were common (52%), as was current/former smoking history (17%). Most patients were on active systemic therapy or radiotherapy (84%) in the advanced or metastatic disease setting (55%). The overall mortality rate was 15% (CI95% 12%-18%). We validated the original mLR model trained in the first 198 patients: management in a non-curative setting (odds ratio [OR] 3.7), age ≥ 60 years (OR 2.3), and current/former smoking (OR 1.9) were significant predictors of death in the expanded cohort. Presence of comorbidities (OR 1.9) also defined poor outcome in the updated mLR model, which yielded low sensitivity (74%), specificity (68%) and AUC (0.78). With RF modeling, the most significant predictors of 30-day death after COVID-19 (in decreasing order) were older age, treatment of advanced or metastatic disease, tumor type (respiratory tract, brain and unknown primary cancers had higher mortality), COVID-related symptom burden at baseline evaluation and treatment regimen (immunotherapy combinations had higher mortality). The RF model demonstrated high sensitivity (89%), specificity (88%) and AUC (0.96). Conclusions:The results highlight the possibility that machine learning algorithms are able to predict early mortality after COVID-19 in cancer patients with high accuracy. The proposed prediction model may be helpful in the prompt identification of high-risk patients based on clinical features alone, without having to wait for the results of additional tests such as laboratory or radiologic studies. It can also help prioritize medical resources and redefine vaccination strategies. A web-based mortality risk calculator will be created for clinical decision support. | other,Public Health | https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.1558 |
| How to monitor cardiovascular function in critical illness in resource-limited settings. | Chaisith Sivakorn, Marcus J. Schultz, and Arjen M. Dondorp | Current Opinion in critical care | June 1, 2021 | doi: 10.1097/MCC.0000000000000830 | Purpose of review Hemodynamic monitoring is an essential component in the care for critically ill patients. A range of tools are available and new approaches have been developed. This review summarizes their availability, affordability and feasibility for hospital settings in resource-limited settings. Recent findings Evidence for the performance of specific hemodynamic monitoring tools or strategies in low-income and middle-income countries (LMICs) is limited. Repeated physical examination and basic observations remain a cornerstone for patient monitoring and have a high sensitivity for detecting organ hypoperfusion, but with a low specificity. Additional feasible approaches for hemodynamic monitoring in LMICs include: for tissue perfusion monitoring: urine output, skin mottling score, capillary refill time, skin temperature gradients, and blood lactate measurements; for cardiovascular monitoring: echocardiography and noninvasive or minimally invasive cardiac output measurements; and for fluid status monitoring: inferior vena cava distensibility index, mini-fluid challenge test, passive leg raising test, end-expiratory occlusion test and lung ultrasound. Tools with currently limited applicability in LMICs include microcirculatory monitoring devices and pulmonary artery catheterization, because of costs and limited added value. Especially ultrasound is a promising and affordable monitoring device for LMICs, and is increasingly available. Summary A set of basic tools and approaches is available for adequate hemodynamic monitoring in resource-limited settings. Future research should focus on the development and trialing of robust and context-appropriate monitoring technologies. | Clinical Management | https://journals.lww.com/co-criticalcare/Fulltext/2021/06000/How_to_monitor_cardiovascular_function_in_critical.11.aspx?context=LatestArticles |
| Ethical factors determining ECMO allocation during the COVID-19 pandemic | Bernadine Dao, Julian Savulescu, Jacky Y. Suen, John F. Fraser & Dominic J. C. Wilkinson | BMC Medical Ethics | June 1, 2021 | https://doi.org/10.1186/s12910-021-00638-y | Background ECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations. Methods An online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic. Results When initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%). Conclusions We found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. | Ethics,Clinical Management | https://link.springer.com/article/10.1186/s12910-021-00638-y |
| Correlation Between SARS-Cov-2 Vaccination, COVID-19 Incidence and Mortality: Tracking the Effect of Vaccination on Population Protection in Real Time | Kiyoshi F. Fukutani, Mauricio L. Barreto, Bruno B. Andrade and Artur T. L. Queiroz | Frontiers in Genetics | June 2, 2021 | https://doi.org/10.3389/fgene.2021.679485 | Coronavirus disease 19 (COVID-19) has struck the world since the ending of 2019. Tools for pandemic control were scarce, limited only to social distance and face mask usage. Today, upto 12 vaccines were approved and the rapid development raises questions about the vaccine efficiency. We accessed the public database provided by each country and the number of death, active cases, and tests in order to evaluate how the vaccine is influencing the COVID-19 pandemic. We observed distinct profiles across the countries and it was related to the vaccination start date and we are proposing a new way to manage the vaccination. | Clinical Epidemiology,Vaccines,other | https://www.frontiersin.org/articles/10.3389/fgene.2021.679485/full?utm_source=S-TWT&utm_medium=SNET&utm_campaign=ECO_FGENE_XXXXXXXX_auto-dlvrit |
| Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative | Leena N Patel, Samantha Kozikott, Rodrigue Ilboudo, Moreen Kamateeka, Mohammed Lamorde, Marion Subah, Fatima Tsiouris, Anna Vorndran, Christopher T Lee On behalf of the African Primary Health Care IPC Strengthening Community of Practice | BMJ Global Health | June 3, 2021 | http://dx.doi.org/10.1136/bmjgh-2021-005833 | Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve. | Research governance,Public Health | https://gh.bmj.com/content/6/6/e005833 |
| High Prevalence of Anti–Severe Acute Respiratory Syndrome Coronavirus 2 (Anti–SARS-CoV-2) Antibodies After the First Wave of Coronavirus Disease 2019 (COVID-19) in Kinshasa, Democratic Republic of the Congo: Results of a Cross-sectional Household-Based Survey | Antoine N. Nkuba, Sheila M. Makiala, Emilande Guichet, Paul M. Tshiminyi, Yannick M. Bazitama, Marc K. Yambayamba, Benito M. Kazenza, Trésor M. Kabeya, Elysee B. Matungulu, Lionel K. Baketana, Naomi M. Mitongo, Guillaume Thaurignac, Fabian H. Leendertz, Veerle Vanlerberghe, Raphaël Pelloquin, Jean-François Etard, David Maman, Placide K. Mbala, Ahidjo Ayouba, Martine Peeters, Jean-Jacques T. Muyembe, Eric Delaporte, and Steve M. Ahuka | Clinical Infectious Diseases | June 5, 2021 | https://doi.org/10.1093/cid/ciab515 | Background. In October 2020, after the first wave of coronavirus disease 2019 (COVID-19), only 8290 confirmed cases were reported in Kinshasa, Democratic Republic of the Congo, but the real prevalence remains unknown. To guide public health policies, we aimed to describe the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in the general population in Kinshasa. Methods. We conducted a cross-sectional, household-based serosurvey between 22 October 2020 and 8 November 2020. Participants were interviewed at home and tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins in a Luminexbased assay. A positive serology was defined as a sample that reacted with both SARS-CoV-2 proteins (100% sensitivity, 99.7% specificity). The overall weighted, age-standardized prevalence was estimated and the infection-to-case ratio was calculated to determine the proportion of undiagnosed SARS-CoV-2 infections. Results. A total of 1233 participants from 292 households were included (mean age, 32.4 years; 764 [61.2%] women). The overall weighted, age-standardized SARS-CoV-2 seroprevalence was 16.6% (95% CI: 14.0–19.5%). The estimated infection-to-case ratio was 292:1. Prevalence was higher among participants ≥40 years than among those <18 years (21.2% vs 14.9%, respectively; P < .05). It was also higher in participants who reported hospitalization than among those who did not (29.8% vs 16.0%, respectively; P < .05). However, differences were not significant in the multivariate model (P = .1). Conclusions. The prevalence of SARS-CoV-2 is much higher than the number of COVID-19 cases reported. These results justify the organization of a sequential series of serosurveys by public health authorities to adapt response measures to the dynamics of the pandemic. | "Virology, Immunology and Diagnostics",Transmission,Clinical Epidemiology | https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab515/6293985 |
| Analysis of Perceptions and Emotional Repercussions in Twitter Users in Colombia During the COVID-19 Pandemic. | Botero-Rodríguez F, Mosquera-Quiñónez M, Martínez Torres LM, Bolívar-Moná S, Jover T G, Vargas C L, Franco OH, Gómez-Restrepo C | Revista Colombiana de Psiquiatria | June 17, 2021 | https://doi.org/10.1016/j.rcp.2021.05.005 | Introduction The COVID-19 pandemic has negatively impacted mental health. Up to a quarter of the population has reported mental health disorders. This has been studied mainly from a nosological perspective, according to diagnostic criteria. Nevertheless, we did not find studies that have explored the daily expressions of the population. Our objective was to evaluate the perceptions of the COVID-19 pandemic and its repercussions on the emotional well-being of the Colombian population. Methods We performed a Twitter metrics and trend analysis. Initially, in the trend analysis, we calculated the average duration in hours of the 20 most popular trending topics of the day in Colombia and we grouped them into trends related to COVID-19 and unrelated trends. Subsequently, we identified dates of events associated with the pandemic relevant to the country, and they were related to the behaviour of the trends studied. Additionally, we did an exploratory analysis of these, selected the tweets with the greatest reach and categorised them in an inductive way to analyse them qualitatively. Results Issues not related to COVID-19 were more far-reaching than those related to coronavirus. However, a rise in these issues was seen on some dates consistent with important events in Colombia. We found expressions of approval and disapproval, solidarity and accusation. Inductively, we identified categories of informative tweets, humour, fear, stigma and discrimination, politics and entities, citizen complaints, and self-care and optimism. Conclusions The impact of the COVID-19 pandemic generates different reactions in the population, which increasingly have more tools to express themselves and know the opinions of others. Social networks play a fundamental role in the communication of the population, so this content could serve as a public health surveillance tool and a useful and accessible means of communication in the management of health crises. | other,Social Science | https://europepmc.org/article/med/34229899 |
| Extensive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission Associated With Low Mortality in Kinshasa, Democratic Republic of the Congo: For How Long? | Robert L Colebunders, Chris Kenyon | Clinical Infectious Diseases | June 21, 2021 | https://doi.org/10.1093/cid/ciab593 | none | Clinical Epidemiology | https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab593/6310791?login=false |
| Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue | Roy, Steven, Inigo Soteras, Alison Sheets, Richard Price, Kazue Oshiro, Simon Rauch, Don McPhalen, Maria Antonia Nerin, Giacomo Strapazzon, Myron Allen, Alistair Read, and Peter Paal | High Altitude Medicine and Biology | June 23, 2021 | https://doi.org/10.1089/ham.2021.0032 | Background: In mountain rescue, uncertainty exists on the best practice to prevent coronavirus disease 2019 (COVID-19) transmission. The aim of this work was to provide a state-of-the-art overview of the challenges caused by the COVID-19 pandemic in mountain rescue. Methods: Original articles or reviews, published until December 27, 2020 in Cochrane COVID-19 Study Register, EMBASE, PubMed, and Google Scholar were included. Articles were limited to English, French, German, or Spanish with the article topic COVID-19 or other epidemics, addressing transmission, transport, rescue, or cardiopulmonary resuscitation. Results: The literature search yielded 6,190 articles. A total of 952 were duplicates and 5,238 were unique results. After exclusion of duplicates and studies that were not relevant to this work, 249 articles were considered for this work. Finally, 72 articles and other sources were included. Conclusions: Recommendations are provided for protection of the rescuer (including screening, personal protective equipment [PPE], and vaccination), protection of the patient (including general masking if low risk, specific PPE if high risk), equipment hygiene (including disinfection after every mission), use of single-use products, training and medical measures under COVID-19 precautions, and psychological wellbeing of rescuers during the COVID-19 pandemic. Adapted COVID-19 precautions for low-and-medium-income countries are also discussed. | other | https://www.liebertpub.com/doi/pdfplus/10.1089/ham.2021.0032 |
| Beyond the numbers: understanding the diversity of covid-19 epidemiology and response in South Asia | Zulfiqar A Bhutta, Sameen Siddiqi, Assad Hafeez, Muhammad Islam, Samiran Nundy, Firdausi Qadri, Faisal Sultan | BMJ | June 25, 2021 | doi: https://doi.org/10.1136/bmj.n1544 | Analysis Beyond the numbers: understanding the diversity of covid-19 epidemiology and response in South Asia BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1544 (Published 25 June 2021) Cite this as: BMJ 2021;373:n1544 Read our latest coverage of the coronavirus pandemic - Article - Related content - Metrics - Responses - Peer review 1. Zulfiqar A Bhutta, professor1 2 3, Sameen Siddiqi, professor4, Assad Hafeez, professor5, Muhammad Islam, researcher2, Samiran Nundy, professor6, Firdausi Qadri, researcher7, Faisal Sultan, health administrator8 2. Author affiliations 3. Correspondence to: Z A Bhutta zulfiqar.bhutta@aku.edu Zulfiqar A Bhutta and colleagues compare the response in South Asian countries and consider what is needed to contain covid-19 and manage future pandemics | Clinical Management,Clinical Epidemiology,Public Health | https://www.bmj.com/content/373/bmj.n1544.abstract |
| Neurochemical biomarkers to study CNS effects of COVID-19: A narrative review and synthesis | Arvid Edén, Joel Simrén, Richard W. Price, Henrik Zetterberg, Magnus Gisslén | Journal of Neurochemistry | June 25, 2021 | https://doi.org/10.1111/jnc.15459 | Neurological symptoms are frequently reported in patients suffering from COVID-19. Common CNS-related symptoms include anosmia, caused by viral interaction with either neurons or supporting cells in nasal olfactory tissues. Diffuse encephalopathy is the most common sign of CNS dysfunction, which likely results from the CNS consequences of the systemic inflammatory syndrome associated with severe COVID-19. Additionally, microvascular injuries and thromboembolic events likely contribute to the neurologic impact of acute COVID-19. These observations are supported by evidence of CNS immune activation in cerebrospinal fluid (CSF) and in autopsy tissue, along with the detection of microvascular injuries in both pathological and neuroimaging studies. The frequent occurrence of thromboembolic events in patients with COVID-19 has generated different hypotheses, among which viral interaction with perivascular cells is particularly attractive, yet unproven. A distinguishing feature of CSF findings in SARS-CoV-2 infection is that clinical signs characteristic of neurotropic viral infections (CSF pleocytosis and blood–brain barrier injury) are mild or absent. Moreover, virus detection in CSF is rare and often of uncertain significance. In this review, we provide an overview of the neurological impact that occurs in the acute phase of COVID-19, and the role of CSF biomarkers in the clinical management and research to better treat and understand the disease. In addition to aiding as diagnostic and prognostic tools during acute infection, the use of comprehensive and well-characterized CSF and blood biomarkers will be vital in understanding the potential impact on the CNS in the rapidly increasing number of individuals recovering from COVID-19. | other | https://onlinelibrary.wiley.com/doi/10.1111/jnc.15459 |
| The role of epidemiologists in communicating SARS-CoV-2 evidence: a call for adopting standards | Meredith Y Smith, Priya Bahri, James A Gaudino, Jr, Rafael S Moreira, Gregory M Danyluk, Sheila L Palevsky | International Journal of Epidemiology | June 28, 2021 | https://doi.org/10.1093/ije/dyab128 | - Epidemiologists have a key role to play in conducting research to promote uptake of vaccination and other protective personal and social behaviors to combat SARS-CoV-2. - It is important that evidence from epidemiological research on COVID-19 be easily accessible to the public and to policy-makers, and that any gaps in public understanding in this regard are identified and addressed. - Towards that end, epidemiologists should communicate epidemiological terms, concepts, research findings and recommendations in clear, transparent and actionable terms so that the public can understand and apply the information to guide their behavioral choices in response to the SARS-CoV-2 pandemic. | Ethics,Public Health | https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyab128/6310301?login=true |
| COVID-19 Vaccine Acceptance in Azuay Province, Ecuador: A Cross-Sectional Online Survey | Julio Jaramillo-Monge, Michael Obimpeh, Bernardo Vega, David Acurio, Annelies Boven, Veronique Verhoeven and Robert Colebunders | Vaccines | June 28, 2021 | https://doi.org/10.3390/vaccines9060678 | We investigated the COVID-19 vaccination acceptance level in Azuay province, Ecuador through an online survey from 12th to 26th February (before the start of the COVID-19 vaccination campaign in Ecuador). Overall, 1219 respondents participated in the survey. The mean age was 32 ± 13 years; 693 participants (57%) were female. In total, 1109 (91%) of the participants indicated they were willing to be vaccinated with a COVID-19 vaccine, if the vaccine is at least 95% effective; 835 (68.5%) if it is 90% effective and 493 (40.5%) if it is 70% effective; 676 (55.5%) participants indicated they feared side effects and 237 (19.4%) thought the vaccine was not effective. Older age, having had a postgraduate education, a history of a negative COVID-19 test, a high level of worry of contracting COVID-19, believing that COVID-19 infection can be prevented with a vaccine and understanding there is currently an effective vaccine against COVID-19 were associated with higher vaccination acceptance. A vaccination education campaign will be needed to increase the knowledge of Ecuadorians about the COVID-19 vaccine and to increase their trust in the vaccine. People with a lower education level and living in rural areas may need to be targeted during such a campaign. | Vaccines,Social Science | https://www.mdpi.com/2076-393X/9/6/678 |
| The role of epidemiologists in communicating SARS-CoV-2 evidence: a call for adopting standards | Meredith Y Smith, Priya Bahri,James A Gaudino, Jr,, Rafael S Moreira, Gregory M Danyluk and Sheila L Palevsky | International Journal of Epidemiology | June 28, 2021 | https://doi.org/10.1093%2Fije%2Fdyab128 | none | Clinical Epidemiology | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344488/ |
| Vaccine hesitancy in the COVID-19 era | Bipin Adhikari, Phaik Yeong Cheah | The Lancet Infectious Diseases | July 1, 2021 | https://doi.org/10.1016/S1473-3099(21)00390-X | none | Vaccines,Social Science,Public Health | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00390-X/fulltext |
| Vaccine hesitancy in the COVID-19 era | Bipin Adhikari, Phaik Yeong Cheah | The Lancet Infectious Diseases | July 1, 2021 | https://doi.org/10.1016/S1473-3099(21)00390-X | none | Social Science,Public Health | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00390-X/fulltext |
| What's yours is ours: waiving intellectual property protections for COVID-19 vaccines | Nancy S Jecker, Caesar A Atuire | Journal of medical ethics | July 7, 2021 | doi: 10.1136/medethics-2021-107555 | This paper gives an ethical argument for temporarily waiving intellectual property (IP) protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization (WTO): the India/South Africa proposal and the WTO Director General proposal. Section I explains the background leading up to the WTO debate. Section II rebuts ethical arguments for retaining current IP protections, which appeal to benefiting society by spurring innovation and protecting rightful ownership. It sets forth positive ethical arguments for a temporary waiver that appeal to standing in solidarity and holding companies accountable. After examining built-in exceptions to existing agreements and finding them inadequate, the paper replies to objections to a temporary waiver and concludes, in section III, that the ethical argument for temporarily waiving IP protection for COVID-19 vaccines is strong. | Ethics,Public Health | https://pubmed.ncbi.nlm.nih.gov/34233956/ |
| Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya | Sassy Molyneux, Priya Sukhtankar, Johnstone Thitiri, Rita Njeru, Kui Muraya, Gladys Sanga, Judd L Walson, James Berkley, Maureen Kelley, Vicki Marsh | BMJ Global Health | July 8, 2021 | http://dx.doi.org/10.1136/bmjgh-2021-004937 | Health research in low-resource settings often involves individuals and populations defined as ‘vulnerable’. There is growing attention in the literature to the ethical dilemmas that frontline research staff face while conducting such research. However, there is little documented as to how research staff might support one another in identifying and handling these dilemmas in different contexts. Over the course of conducting empirical ethics research embedded in the Childhood Acute Illness & Nutrition Network, we developed an approach to examine and respond to the ethical issues and dilemmas faced by the study teams, particularly frontline staff. In this paper we describe the specific tools and approach we developed, which centred on regular cross-team ethics reflection sessions, and share lessons learnt. We suggest that all studies involving potentially vulnerable participants should incorporate activities and processes to support frontline staff in identifying, reflecting on and responding to ethical dilemmas, throughout studies. We outline the resources needed to do this and share piloted tools for further adaptation and evaluation. Such initiatives should complement and feed into—and certainly not in any way replace or substitute for—strong institutional ethics review, safeguarding and health and safety policies and processes, as well broader staff training and career support initiatives. | Ethics,Public Health | https://gh.bmj.com/content/6/7/e004937 |
| Younger Brazilians hit by COVID-19 – What are the implications? | Raphael Mendonça Guimarães, DSc PhDa,∗ , Margareth Crisóstomo Portela, PhDa , Daniel Antunes Maciel Villela, PhDa , Gustavo Correa Matta, DSc a , Carlos Machado de Freitas, DSc | The Lancet Regional Health - Americas | July 14, 2021 | https://doi.org/10.1016/j.lana.2021.100014 | none | Clinical Epidemiology,Public Health | https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00006-5/fulltext#articleInformation |
| Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study | Thomas M Drake, Aya M Riad, Cameron J Fairfield, Conor Egan, Stephen R Knight, Riinu Pius, Hayley E Hardwick, Lisa Norman, Catherine A Shaw, Kenneth A McLean, Roger Thompson, Antonia Ho, Olivia V Swann, Michael Sullivan, Felipe Soares, Karl A Holden, Laura Merson, Daniel Plotkin, Louise Sigfrid, Thushan I de Silva, Michelle Girvan, Clare Jackson, Clark D Russell, Jake Dunning, Tom Solomon, Gail Carson, Piero Olliaro, Jonathan S Nguyen-Van-Tam, Lance Turtle, Annemarie B Docherty, Peter JM Openshaw, Kenneth Baillie, Ewen M Harrison, Malcolm G Semple, on behalf of the ISARIC4C investigators | The Lancet | July 17, 2021 | https://doi.org/10.1016/S0140-6736(21)00799-6 | Background COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK. Methods We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. Findings Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported. Interpretation Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19. Funding National Institute for Health Research and the UK Medical Research Council. | Clinical Epidemiology,Clinical Management | https://www.sciencedirect.com/science/article/pii/S0140673621007996#fn3 |
| Examining drivers of COVID-19 vaccine hesitancy in Ghana | Ken Brackstone, Laud Ampomah Boateng, Kirchuffs Atengble, Michael HeadMichael Head, Herve Akinocho, Kingsley Osei, Kwabena Nuamah | figshare | July 18, 2021 | https://doi.org/10.6084/m9.figshare.14494851.v3 | We conducted a nationally representative online survey in Ghana (N = 1295) throughout June 2021. In our analyses, we operationalised vaccine hesitancy as respondents who answered ‘no’ and ‘I don’t know’ to the question: “When a COVID-19 vaccine becomes available to you, would you like to get vaccinated?” Some top-level findings to share - willingness to vaccinate dropped from 82% in March, to 71% in June 2021 - Therefore, to phrase another way, there was an observed and significant increase in hesitancy, from 18% to 29% across this time period. - 32% of respondents reported that they had recently seen or heard stories about the indecision surrounding the Oxford Astrazeneca vaccine rollout in Europe and North America. Of this 32% subgroup, 62.0% of them indicated that these stories made them feel worried about accepting the COVID-19 vaccine in the future. - our main predictors of hesitancy continue to include: i) education (more educated people were more likely to be hesitant; one hypothesis is perhaps more likely to have greater access to the internet and thus availability of misinformation via social media); ii) females more hesitant than males; and iii) political allegiance (voting for the opposition parties was greater predictor of hesitancy). We hope that this information can be helpful with informing the health promotion efforts from the GHS, Ministry of Health and other stakeholders. | Vaccines | https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851 |
| Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia | Anne Osterrieder, Giulia Cuman, Wirichada Pan-Ngum, Phaik Kin Cheah, Phee-Kheng Cheah, Pimnara Peerawaranun, Margherita Silan, Miha Orazem, Ksenija Perkovic, Urh Groselj, Mira Leonie Schneiders, Tassawan Poomchaichote, Naomi Waithira, Supa-at Asarath, Bhensri Naemiratch, Supanat Ruangkajorn, Lenart Skof, Natinee Kulpijit, Constance R S Mackworth-Young, Darlene Ongkili, Rita Chanviriyavuth, Mavuto Mukaka, Phaik Yeong Cheah | BMJ Open | July 20, 2021 | https://doi.org/10.1136/bmjopen-2020-046863 | Objectives To understand the impact of COVID-19 and public health measures on different social groups, we conducted a mixed-methods study in five countries (‘SEBCOV—social, ethical and behavioural aspects of COVID-19’). Here, we report the results of the online survey. Study design and statistical analysis Overall, 5058 respondents from Thailand, Malaysia, the UK, Italy and Slovenia completed the self-administered survey between May and June 2020. Poststratification weighting was applied, and associations between categorical variables assessed. Frequency counts and percentages were used to summarise categorical data. Associations between categorical variables were assessed using Pearson’s χ2 test. Data were analysed in Stata 15.0 Results Among the five countries, Thai respondents reported having been most, and Slovenian respondents least, affected economically. The following factors were associated with greater negative economic impacts: being 18–24 years or 65 years or older; lower education levels; larger households; having children under 18 in the household and and having flexible/no income. Regarding social impact, respondents expressed most concern about their social life, physical health, mental health and well-being. There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents who self-reported a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work. Many respondents reported seeing news perceived to be fake, the proportion varying between countries, with education level and self-reported levels of understanding of COVID-19. Conclusions Our data showed that COVID-19 and public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences. Trial registration number TCTR20200401002. | Social Science,Public Health | https://bmjopen.bmj.com/content/11/7/e046863 |
| Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey | Edith Kamaru Kwobah, Ann Mwangi, Kirtika Patel, Thomas Mwogi, Robert Kiptoo and Lukoye Atwoli | Frontiers in Psychiatry | July 22, 2021 | http://dx.doi.org/10.3389/fpsyt.2021.665611 | Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic. Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant. Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers <35 years old compared to older ones (38.1 vs. 26.4%, p < 0.001), and those who were not married compared to those who were married (40.6 vs. 27.6%, p < 0.001). Generalized anxiety was commoner among workers aged <35 years (43.5 vs. 29.3%, p < 0.001), females (41.7 vs. 29.2%, p < 0.001), those who mere not married compared to the married (45.2 vs. 31.2%, p < 0.001) and those with <10 years working experience (41.6 to 20.5%, p < 0.001). Younger health care professional had a higher proportion of insomnia compared to the older ones (30.3 vs. 18.6%, p < 0.001). Insomnia was higher among those with <10 years' experience compared to those with more than 20 years' experience(27.3 vs. 17.6%, p = 0.043) Conclusion: Many Kenyan healthcare workers in the early phase of COVID-19 pandemic suffered from various common mental disorders with young, female professionals who are not married bearing the bigger burden. This data is useful in informing interventions to promote mental and psychosocial wellbeing among Kenyan healthcare workers responding to the pandemic. | other,Mental Health,Public Health | https://www.frontiersin.org/articles/10.3389/fpsyt.2021.665611/full |
| Key social science priorities for long-term COVID-19 response | Shelley Lees, Salla Sariola, Megan Schmidt-Sane, Luisa Enria, Kit-Aun Tan, Angel Aedo, Koen Peeters Grietens, David Kaawa-Mafigiri8 | BMJ Global Health | July 26, 2021 | http://dx.doi.org/10.1136/bmjgh-2021-006741 | Summary box - The COVID-19 response continues to be driven by epidemiological priorities, and yet, the epidemic and responses are situated within specific political and health system contexts. Social science brings an understanding of context and draws attention to politics, power and social difference. - There are four critical social science priorities for COVID-19 research and policy in the long term. First, political-economic insights can support the design of public health measures and elucidate how public health responses are produced by political systems. - Second, a better understanding of the political and social structures that relate to vaccine confidence will improve public trust, acceptability, effectiveness and uptake of COVID-19 vaccines and therapeutics. - Third, development of social science perspectives on health and governance is vital to inform and untangle the complicated ways in which nationalism interacts with public health measures. - Finally, social science inquiry can reveal how individuals and communities perceive, understand and construct COVID-19 risk and severity and seek help. - These insights support building trust and good relations between local and international research and programme teams and between communities and researchers that will enhance confidence in the development, research and deployment of vaccines and other COVID-19 control measures. | Social Science,Coalition publications | https://gh.bmj.com/content/6/7/e006741.full |
| Global public health security and justice for vaccines and therapeutics in the COVID-19 pandemic | Peter J. Hotez, Carolina Batista, Yanis Ben Amor, Onder Ergonul, J Peter Figueroa, Sarah Gilbert, Mayda Gursel, Mazen Hassanain, Gagandeep Kang, David C. Kaslow, Jerome H. Kim, Bhavna Lall, Heidi Larson, Denise Naniche, Timothy Sheahan, Shmuel Shoham, Annelies Wilder-Smith, Samba O. Sow, Nathalie Strub-Wourgaft, Prashant Yadav, Maria Elena Bottazzi | The Lancet | August 3, 2021 | https://doi.org/10.1016/j.eclinm.2021.101053 | A Lancet Commission for COVID-19 task force is shaping recommendations to achieve vaccine and therapeutics access, justice, and equity. This includes ensuring safety and effectiveness harmonized through robust systems of global pharmacovigilance and surveillance. Global production requires expanding support for development, manufacture, testing, and distribution of vaccines and therapeutics to low- and middle-income countries (LMICs). Global intellectual property rules must not stand in the way of research, production, technology transfer, or equitable access to essential health tools, and in context of pandemics to achieve increased manufacturing without discouraging innovation. Global governance around product quality requires channelling widely distributed vaccines through WHO prequalification (PQ)/emergency use listing (EUL) mechanisms and greater use of national regulatory authorities. A World Health Assembly (WHA) resolution would facilitate improvements and consistency in quality control and assurances. Global health systems require implementing steps to strengthen national systems for controlling COVID-19 and for influenza vaccinations for adults including pregnant and lactating women. A collaborative research network should strive to establish open access databases for bioinformatic analyses, together with programs directed at human capacity utilization and strengthening. Combating anti-science recognizes the urgency for countermeasures to address a global-wide disinformation movement dominating the internet and infiltrating parliaments and local governments. | Ethics,other,Public Health | https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00333-3/fulltext |
| Will science deliver needed therapeutics for covid-19—and how can equitable access be ensured? | Rachel Cohen, Michelle Childs, Monique Wasunna, Michel Lotrowska, Kavita Singh, Nathalie Strub-Wourgaft, Bernard Pécoul | The British Medical Journal | August 6, 2021 | Global vaccine equity for covid-19 is the defining challenge of 2021, but we cannot neglect the need for therapeutics, write Rachel Cohen and colleagues | other | https://blogs.bmj.com/bmj/2021/08/06/will-science-deliver-needed-therapeutics-for-covid-19-and-how-can-equitable-access-be-ensured/ | |
| Willingness to Get the COVID-19 Vaccine among Residents of Slum Settlements | Juan P. Aguilar Ticona, Nivison Nery, Jr., Renato Victoriano, Mariam O. Fofana, Guilherme S. Ribeiro, Emanuele Giorgi, Mitermayer G. Reis, Albert I. Ko and Federico Costa | Vaccines | August 26, 2021 | https://doi.org/10.3390/vaccines9090951 | Slum residents are more vulnerable to COVID-19 infection. Without a specific treatment, vaccination became the main strategy against COVID-19. In this study, we determined the rate and factors associated with the willingness to get vaccinated against COVID-19 among slum residents and their main reasons associated with the vaccine intention. The study was conducted in Pau da Lima, a slum community in Salvador Brazil. In total, 985 residents were interviewed. Among them 66.0% (650/985) were willing to get vaccinated, 26.1% (257/985) were hesitant to take the vaccine and 7.9% (78/285) were not sure. The main reasons cited for vaccine hesitancy or being unsure were concerns about vaccine efficacy and potential side effects. In contrast, the main reasons cited for wanting the vaccine were the high incidence of COVID-19 cases and participants’ self-perception of their own health history. Multivariate analysis identified that COVID-19 vaccine hesitancy was associated with younger age and low social capital, summarized as low perceived importance of vaccination to protect one’s family, friends and community. Slum residents have been less willing to vaccinate than the general population. Social capital presents a critical opportunity in the design of communication campaigns to increase COVID-19 vaccine acceptance in slum settings. | Social Science,Public Health,Vaccines | https://www.mdpi.com/2076-393X/9/9/951 |
| A call for COVID-19 immunization campaigns that address the specific circumstances of indigenous peoples of Latin America and the Caribbean | Zeus Aranda, Marcos Arana-Cedeño, David Mariano Meléndez-Navarro, Sergio Meneses-Navarro, Héctor Javier Sánchez-Pérez | The Lancet Regional Health Americas | September 10, 2021 | https://doi.org/10.1016/j.lana.2021.100074 | none | Vaccines,other | https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00070-3/fulltext |
| Co-exploring the effects of COVID-19 pandemic on the livelihood of persons with disabilities in Bangladesh | Adity Shayontony Das, Fatema Akter Bonny, Arifa Bente Mohosin, Sabina Faiz Rashid, Md Tanvir Hasan | Disability Studies Quarterly | September 13, 2021 | http://dx.doi.org/10.18061/dsq.v41i3.8377 | Background: According to World Health Organization (WHO), vulnerable groups such as persons with disabilities are facing severe impacts of the pandemic. There has always been significant challenges and hurdles in terms of achieving adequate and equitable inclusivity of persons with disabilities in all sections of social life. Education and employment of persons with disabilities were least focused which created more marginalization for the community. The long term impact of these marginalization has also led to the lack of jobs and social security of persons with disabilities, which is very clear now given the crisis in place. In low and middle income countries like Bangladesh the situation is even worse. To better understand the conditions of persons with disabilities in this crisis situation, the present study was initiated to explore the dimensions of livelihood with respect to income and wellbeing of persons with disabilities and to generate evidence for developing policies around these issues. Methods: A qualitative study was undertaken among 30 persons with disabilities from 8 different geographical divisions of Bangladesh. The interviews were conducted through telephone calls due to the existing COVID-19 crisis and mobility restrictions. The respondents were purposively selected based on gender, type of disability, area of resident (urban, rural) and their ability to communicate, therefore most (25/30) respondents were persons with physical disability. Thematic analysis was conducted to generate the findings of the study. Findings: Study findings revealed that majority of the respondents were involved in informal jobs. Predominantly males were daily wage-earners and often the sole breadwinner of the families, very few females were involved in economic activities. Since they had no stable income, the economic shock from the COVID-19 pandemic had affected them badly even leading to household level famine. The study identifies low level of education and informal job security as the primary causes of socio-economic insecurity among persons with disabilities, resulting in challenges in ensuring a stable livelihood during crisis situations, such as COVID-19. Conclusion: Constant alienation of persons of disabilities from the formal sector results in the deterioration of their livelihood standards which even worsen during any emergency crisis such as COVID-19. The study pinpoints that only aided services are not adequate to ensure persons with disabilities' rights rather there is an urgent need of disability inclusion in formal job sector and livelihood training for persons with disabilities. To achieve the Sustainable Development Goals 2030 and to irradiate the inequality towards persons with disabilities in the society it is important for the Government and concern bodies to focus on the inclusiveness with better implementation and monitoring strategies. | Social Science,other,Public Health | https://dsq-sds.org/article/view/8377 |
| Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey | Melanie Etti, Jackeline Alger, Sofía P. Salas, Robin Saggers, Tanusha Ramdin, Margit Endler, Kristina Gemzell-Danielsson, Tobias Alfvén, Yusuf Ahmed, Allison Callejas, Deborah Eskenazi, Asma Khalil, Kirsty Le Doare, On behalf of the Maternal, Newborn and Child Health Working Group of the COVID-19 Clinical Research Coalition | PLOS ONE | September 24, 2021 | https://doi.org/10.1371/journal.pone.0257516 | Background The World Health Organization’s “Coordinated Global Research Roadmap: 2019 Novel Coronavirus” outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health. Method This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged. Results Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes which emerged from the analysis were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection. Conclusion The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally. | "Maternal, Newborn and Child Health",Coalition publications | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257516#abstract0 |
| Beneficial Effect of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 | Zaaqoq, Akram M. MD, MPH; Barnett, Adrian G. PhD; Griffee, Matthew J. MD; MacLaren, Graeme MD, MSc; Jacobs, Jeffrey P. MD; Heinsar, Silver MD; Suen, Jacky Y. PhD; Bassi, Gianluigi Li MD, PhD; Fraser, John F. MD, PhD; Dalton, Heidi J. MD; Peek, Giles J. MD, FRCS CTh, FFICM on behalf of the COVID-19 Critical Care Consortium (COVID Critical) | Critical Care Medicine | September 27, 2021 | doi: 10.1097/CCM.0000000000005296 | Objectives: The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome. Design: An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders. Setting: Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry. Patients: Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period. Intervention: None. Measurements and Main Results: There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14–0.68). Conclusions: Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings. | Clinical Management | https://journals.lww.com/ccmjournal/Abstract/9000/Beneficial_Effect_of_Prone_Positioning_During.95069.aspx |
| The Lancet Commission on diagnostics: transforming access to diagnostics | Kenneth A Fleming, FRCPath, Prof Susan Horton, PhD, Prof Michael L Wilson, MD, Prof Rifat Atun, FRCP, Prof Kristen DeStigter, MD, John Flanigan, MD, Shahin Sayed, MMed Pierrick Adam, MD, Bertha Aguilar, BA, Savvas Andronikou, PhD, Catharina Boehme, MD, William Cherniak, MD, Prof Annie NY Cheung, MD, Bernice Dahn, MD, Prof Lluis Donoso-Bach, MD, Prof Tania Douglas, PhD, Prof Patricia Garcia, MD, Sarwat Hussain, FRCR, Hari S Iyer, ScD, Mikashmi Kohli, PhD, Prof Alain B Labrique, PhD, Prof Lai-Meng Looi, FRCPath, Prof John G Meara, MD, John Nkengasong, PhD, Prof Madhukar Pai, MD, Kara-Lee Pool, MD, Kaushik Ramaiya, MD, Lee Schroeder, MD, Devanshi Shah, BSc, Prof Richard Sullivan, MD, Prof Bien-Soo Tan, FRCR, Kamini Walia, PhD | The Lancet | October 6, 2021 | https://doi.org/10.1016/S0140-6736(21)00673-5 | "Virology, Immunology and Diagnostics" | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00673-5/fulltext | |
| Clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 infection in a Latin American country: Results from the ECCOVID multicenter prospective study | Ezequiel Cordova, Analia Mykietiuk, Omar Sued, Lautaro De Vedia, Natalia Pacifico, Matias H. Garcia Hernandez, Natalia M. Baeza, Franco Garibaldi, Maria Fernanda Alzogaray, Rosa Contreras, Lucrecia Soler Puy, Pablo G. Scapellato, Laura Barcelona, Mariana L. Golikow, Maria Florencia Piñeiro, Hugo J. Miño, Maria Fernanda Consalvo, Corina Nemirovsky, Marisa Sanchez, Myrna Cabral, Lucia Lamponi Tappata, Mariano Blasco, Jamile Ballivian, Gustavo Lopardo, Martin E. Stryjewski, on behalf of the ECCOVID study group | PLOS ONE | October 8, 2021 | https://doi.org/10.1371/journal.pone.0258260 | Background Clinical features and outcomes of SARS-CoV-2 infections diverge in different countries. The aim of this study was to describe clinical characteristics and outcomes in a cohort of patients hospitalized with SARS-CoV-2 in Argentina. Methods Multicenter prospective cohort study of ≥18 years-old patients with confirmed SARS-CoV-2 infection consecutively admitted to 19 hospitals in Argentina. Multivariable logistic regression models were used to identify variables associated with 30-day mortality and admission to intensive care unit (ICU). Results A total of 809 patients were analyzed. Median age was 53 years, 56% were males and 71% had at least one comorbidity. The most common comorbidities were hypertension (32%), obesity (23%) and diabetes (17%). Disease severity at admission was classified as mild 25%, moderate 51%, severe 17%, and critical 7%. Almost half of patients (49%) required supplemental oxygen, 18% ICU, and 12% invasive ventilation. Overall, 30-day mortality was 11%. Factors independently associated with ICU admission were male gender (OR 1.81; 95%CI 1.16–2.81), hypertension (OR 3.21; 95%CI 2.08–4.95), obesity (OR 2.38; 95%CI 1.51–3.7), oxygen saturation ≤93% (OR 6.45; 95%CI 4.20–9.92) and lymphopenia (OR 3.21; 95%CI 2.08–4.95). Factors independently associated with 30-day mortality included age ≥60 years-old (OR 2.68; 95% CI 1.63–4.43), oxygen saturation ≤93% (OR 3.19; 95%CI 1.97–5.16) and lymphopenia (OR 2.65; 95%CI 1.64–4.27). Conclusions This cohort validates crucial clinical data on patients hospitalized with SARS-CoV-2 in Argentina. | Clinical Epidemiology | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258260 |
| Clinical characteristics and risk factors for COVID-19-associated Candidemia | Ali S Omrani, Junais Koleri, Fatma Ben Abid, Joanne Daghfel, Thasneem Odaippurath, Mohamed Zuhail Peediyakkal, Anas Baiou, Enas Sarsak, Mahmoud Elayana, Anvar Kaleeckal, Muna A Almaslamani | Medical Mycology | October 8, 2021 | https://doi.org/10.1093/mmy/myab056 | Patients with COVID-19-associated candidemia (CAC) in an intensive care unit (ICU) were matched 1:2 with those without candidemia, based on ICU admission date and length of stay in ICU being at least equal to that before candidemia in the corresponding case. The incidence rate of CAC was 2.34 per 1000 ICU days. Eighty cases could be matched to appropriate controls. In the multivariate conditional logistic regression analysis, age (P 0.001), and sequential organ failure assessment score (P 0.046) were the only risk factors independently associated with CAC. Tocilizumab and corticosteroids therapy were not independently associated with candidemia. | Clinical Management | https://academic.oup.com/mmy/advance-article/doi/10.1093/mmy/myab056/6384832?login=true |
| Identification of priority groups for COVID-19 vaccination in Brazil | Raquel Martins Lana, Laís Picinini Freitas, Cláudia Torres Codeço, Antônio Guilherme Pacheco, Luiz Max Fagundes de Carvalho, Daniel Antunes Maciel Villela, Flávio Codeço Coelho, Oswaldo Gonçalves Cruz, Roberta Pereira Niquini, Victor Bertollo Gomes Porto, Caroline Gava, Marcelo Ferreira da Costa Gomes, Leonardo Soares Bastos | Cadernos de Saúde Pública | October 8, 2021 | https://doi.org/10.1590/0102-311X00049821 | Em um contexto de transmissão comunitária e escassez de vacinas, a vacinação contra a COVID-19 deve focar na redução direta da morbidade e da mortalidade causadas pela doença. Portanto, é fundamental a definição de grupos prioritários para a vacinação pelo Programa Nacional de Imunizações (PNI), baseada no risco de hospitalização e óbito pela doença. Para tal, calculamos o sobrerrisco por sexo, faixa etária e comorbidades por meio dos registros de hospitalização e óbito por síndrome respiratória aguda grave com confirmação de COVID-19 (SRAG-COVID) em todo o Brasil nos primeiros seis meses de epidemia. Apresentaram maior sobrerrisco pessoas do sexo masculino (hospitalização = 1,1 e óbito = 1,2), pessoas acima de 45 anos para hospitalização (SRfe variando de 1,1 a 8,5) e pessoas acima de 55 anos para óbitos (SRfe variando de 1,5 a 18,3). Nos grupos de comorbidades, doença renal crônica, diabetes mellitus, doença cardiovascular e pneumopatia crônica conferiram sobrerrisco, enquanto para asma não houve evidência. Ter doença renal crônica ou diabetes mellitus e 60 anos ou mais mostrou-se um fator ainda mais forte, alcançando sobrerrisco de óbito 14 e 10 vezes maior do que na população geral, respectivamente. Para todas as comorbidades, houve um sobrerrisco mais alto em idades maiores, com um gradiente de diminuição em faixas mais altas. Esse padrão se inverteu quando consideramos o sobrerrisco em relação à população geral, tanto para hospitalização quanto para óbito. O presente estudo forneceu evidências a respeito do sobrerrisco de hospitalização e óbito por SRAG-COVID, auxiliando na definição de grupos prioritários para a vacinação contra a COVID-19. | Vaccines,Public Health | https://www.scielo.br/j/csp/a/LNMHF8qcTVGtbmXL4KpSRhw/?lang=en |
| Prevalence of COVID-19 in Bangladesh, April to October 2020 - A cross-sectional study | Arifa Nazneen, Rebeca Sultana, Mahmudur Rahman, Mahbubur Rahman, Firdausi Qadri, Nadia Ali Rimi, Md. Kamal Hossain, Muhammad Rashedul Alam, Mustafizur Rahman, Nitai Chakraborty, Shariful Amin Sumon, Enayet Hussain, Mohammad Zakiul Hasan, Sazzad Hossain Khan, Md. Hasnatuzzaman Prodhan, Arifur Rahman Bablu, Kajal Chandra Banik, Md. Habibullah Fahad, Marjahan Akhtar, Syed Moinuddin Satter, Shahriar Ahmed, Ahmed Ehsanur Rahman, Taufiqur Rahman Bhuiyan, A.S.M. Alamgir, Shams El Arifeen, Tahmina Shirin, Sayera Banu, Meerjady Sarbrina Flora | IJID Regions | October 14, 2021 | https://doi.org/10.1016/j.ijregi.2021.10.003 | Objective: We aimed to estimate the proportion of symptomatic and asymptomatic laboratory-confirmed COVID-19 cases among Bangladesh's population. Design: We conducted a cross-sectional survey in Dhaka City and other districts of Bangladesh between April 18 and October 12, 2020. We randomly selected 32 districts outside Dhaka, where one village and one mahalla from each district, and from Dhaka City, selected 25 mahallas. From each village or mahalla, we enrolled 120 households through systematic random sampling. Results: A total of 44,865 individuals were interviewed from 10,907 households. The majority (70%, n-31488) of the individuals were <40 years of age. Almost half of the individuals (49%, n=21,888) reported >4 members in their households. We estimated, 12.6% (n=160) of the households had ≥1 COVID-19 infected individuals, among them, 0.9% (n=404) individuals had at least one COVID-19 like symptom at the national level. Prevalence of COVID-19 was 6.4% among the general population. Among the COVID-19 positive individuals, 87% were asymptomatic. Page 4 of 27 Conclusions: The substantial high number of asymptomatic cases all over Bangladesh suggests that community-level containment and mitigation measures to combat COVID-19. Future studies to understand the transmission capability could help to define mitigation and control measures. | Clinical Epidemiology | https://www.sciencedirect.com/science/article/pii/S2772707621000163 |
| Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia The COVID STEROID 2 Randomized Trial | The COVID STEROID 2 Trial Group (including members of the coalition) | JAMA | October 21, 2021 | doi:10.1001/jama.2021.18295 | Importance A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. Objective To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. Design, Setting, and Participants A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021. Interventions Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n = 503) or 6 mg/d of intravenous dexamethasone (n = 497) for up to 10 days. Main Outcomes and Measures The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and ≥1 serious adverse reactions at 28 days). Results Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P = .07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]). Conclusions and Relevance Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference. Trial Registration ClinicalTrials.gov Identifier: NCT04509973 and ctri.nic.in Identifier: CTRI/2020/10/028731 | Clinical Management | https://jamanetwork.com/journals/jama/fullarticle/2785529 |
| Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone | Luisa Enria, Joseph S. Bangura, Hassan M. Kanu, Joseph A. Kalokoh, Alie D. Timbo, Mohamed Kamara, Maligie Fofanah, Alhassan N. Kamara, Adikalie I. Kamara, Morlai M. Kamara, Ibrahim Sorie Suma, Osman M. Kamara, Alusine M. Kamara, Alhajie O. Kamara, Abu B. Kamara, Emmah Kamara, Shelley Lees, Mark Marchant, Mariama Murray | PLOS ONE | October 22, 2021 | https://doi.org/10.1371/journal.pone.0258252 | Background Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust’s qualitative determinants. This includes expanding the geographic focus beyond current studies’ focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. Methods We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. Results Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. Conclusion There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence. | Social Science,Vaccines | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258252 |
| A live measles-vectored COVID-19 vaccine induces strong immunity and protection from SARS-CoV-2 challenge in mice and hamsters. | Phanramphoei N. Frantz, Aleksandr Barinov, Claude Ruffié, Chantal Combredet, Valérie Najburg, Guilherme Dias de Melo, Florence Larrous, Lauriane Kergoat, Samaporn Teeravechyan, Anan Jongkaewwattana, Emmanuelle Billon-Denis, Jean-Nicolas Tournier, Matthieu Prot, Laurine Levillayer, Laurine Conquet, Xavier Montagutelli, Magali Tichit, David Hardy, Priyanka Fernandes, Hélène Strick-Marchand, James Di Santo, Etienne Simon-Lorière, Hervé Bourhy & Frédéric Tangy | Nature Communications | November 1, 2021 | https://doi.org/10.1038/s41467-021-26506-2 | Several COVID-19 vaccines have now been deployed to tackle the SARS-CoV-2 pandemic, most of them based on messenger RNA or adenovirus vectors.The duration of protection afforded by these vaccines is unknown, as well as their capacity to protect from emerging new variants. To provide sufficient coverage for the world population, additional strategies need to be tested. The live pediatric measles vaccine (MV) is an attractive approach, given its extensive safety and efficacy history, along with its established large-scale manufacturing capacity. We develop an MV-based SARS-CoV-2 vaccine expressing the prefusion-stabilized, membrane-anchored full-length S antigen, which proves to be efficient at eliciting strong Th1-dominant T-cell responses and high neutralizing antibody titers. In both mouse and golden Syrian hamster models, these responses protect the animals from intranasal infectious challenge. Additionally, the elicited antibodies efficiently neutralize in vitro the three currently circulating variants of SARS-CoV-2. | Vaccines | https://www.nature.com/articles/s41467-021-26506-2 |
| Mecanismos del COVID-19 en el cuerpo humano: Lo que sabemos hasta ahora | Ashutosh Kumar, Ravi K. Narayana,Pranav Prasoona, Chiman Kumaria, Gurjot Kaura, Santosh Kumara, Maheswari Kulandhasamya, Kishore Seshama,Vikas Pareeka, Muneeb A. Faiqa, Sada N. Pandeya, Himanshu N. Singha,Kamla Kanta,Prakash S. Shekhawata,Khursheed Razaa,Sujeet Kumar | Kompass Neumología | November 1, 2021 | DOI: 10.1159/000521507 | Ha transcurrido más de un año y medio desde el inicio de la pandemia debida a la enfermedad por coronavirus 2019 (COVID-19), y el mundo se esfuerza por contenerla. Al ser causada por un virus hasta ahora desconocido, en el periodo inicial hubo una escasez extrema de conocimientos sobre los mecanismos de la enfermedad, lo que dificultó las medidas preventivas y terapéuticas contra el COVID-19. En un esfuerzo por comprender sus mecanismos patogénicos, se han llevado a cabo extensos estudios experimentales en todo el mundo con experimentos basados en cultivos celulares, organoides de tejidos humanos y modelos animales, enfocados en varios aspectos de la enfermedad, como las propiedades del virus, su tropismo tisular y su patogénesis específica en ciertos órganos, la implicación de los sistemas fisiológicos y la respuesta inmunitaria humana contra la infección. El enorme conocimiento científico Correspondencia: Ashutosh Kumar, drashutoshkumar@aiimspatna.org Kompass Neumol • DOI: 10.1159/000521507 acumulado sobre todos los aspectos del COVID-19 cambió el escenario, de una gran desolación, a la esperanza. A pesar de que se han producido avances espectaculares en todos estos aspectos, quedan múltiples lagunas de conocimiento que deben abordarse en futuros estudios. Además, desde el inicio de la primera oleada de COVID-19 han surgido en todo el mundo múltiples variantes del coronavirus tipo 2 del síndrome respiratorio agudo severo (SARSCoV-2), que parecen tener mayor transmisibilidad/virulencia y capacidad de escape inmunológico que la cepa de tipo salvaje. En esta revisión narramos los avances realizados desde el inicio de la pandemia en nuestros conocimientos sobre los mecanismos del COVID-19 en el cuerpo humano, incluyendo las interacciones virus-huésped, las manifestaciones pulmonares y sistémicas, las desregulaciones inmunológicas, las complicaciones, la vulnerabilidad específica del huésped y las consecuencias a largo plazo en los supervivientes. Además, ofrecemos una breve revisión de las pruebas actuales que explican los mecanismos moleculares que confieren mayor transmisibilidad, virulencia y capacidad de escape inmunológico a las variantes emergentes del SARS-CoV-2. | "Virology, Immunology and Diagnostics" | https://www.karger.com/Article/FullText/521507 |
| Traditional healers to improve access to quality health care in Africa | Yap Boum, Sylvie Kwedi-Nolna, Jessica E Haberer, Rose R G Leke | The Lancet Global Health | November 1, 2021 | https://doi.org/10.1016/S2214-109X(21)00438-1 | none | Public Health | https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00438-1/fulltext |
| The Impact of COVID-19 Pandemic on Blood Transfusion Services: A Perspective from Health Professionals and Donors | Elhadi Miskeen, Amar Ibrahim Omer Yahia, Tarig Babikir Eljack, and Hatim Khalifa Karar | Journal of Multidisciplinary Healthcare | November 2, 2021 | https://dx.doi.org/10.2147%2FJMDH.S337039 | Purpose Since the emergence of the COVI9-19 pandemic, there has been concern about the availability and sufficiency of blood transfusions to meet patient needs. Also, the adequate and safe blood supply is a major issue to fulfill present demands. This study aims to determine the impact of the COVID-19 pandemic on the blood transfusion service and identify solutions to overcome this impact from the perspective of blood donors and healthcare professionals. Methods This study was conducted prospectively among Saudi Arabian blood donors and healthcare professionals between May 2020 and May 2021. A group of professional health care professionals and blood donors participated in this study to determine the impact of the COVID-19 pandemic on blood transfusion services and identify possible solutions to overcome the adverse effects on blood system activities. Results To understand the impact of pandemic COVID-19 on blood transfusion services in Saudi Arabia, we investigated population dynamics and statistical analysis from different age groups and health care professionals. A total of 424 blood donors and 372 healthcare professionals participated in this study. The suggested solution by the participants to overcome the blood shortage during pandemics was the organization of mobile blood drives at donors’ homes, work, and educational sites. Statically significant associations were found between blood donation during this pandemic and age (p=0.019) and marital status (p=0.001). Conclusion The findings of this study highlight the main problems of blood transfusion due to the onset of COVID-19. Hence, the data could be a source of improving blood transfusion and blood donation systems by healthcare centers and on an individual basis. Healthcare professionals use this public management system in hospitals to minimize the adverse effects of the pandemic. | other | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572088/ |
| Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study | Li Bassi, Gianluigi MD, Suen, Jacky Y., White, Nicole, Dalton, Heidi J. Fanning, Jonathon, Corley, Amanda RN, Shrapnel, Sally, Hinton, Samuel, Forsyth, Simon, Parsons, Rex, Laffey, John G., Fan, Eddy, Bartlett, Robert, Brodie, Daniel, Burrell, Aidan, Chiumello, Davide, Elhazmi, Alyaa, Grasselli, Giacomo, Hodgson, Carol PT, Ichiba, Shingo Luna, Carlos, Marwali, Eva, Merson, Laura, Murthy, Srinivas, Nichol, Alistair, Panigada, Mauro, Pelosi, Paolo, Torres, Antoni, Pauline Yeung, Ogino, Mark, Fraser, John F., on behalf of the COVID-19 Critical Care Consortium | Critical Care Explorations | November 5, 2021 | doi: 10.1097/CCE.0000000000000567 | IMPORTANCE: Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated. OBJECTIVES: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021. MAIN OUTCOMES AND MEASURES: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality. RESULTS: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16–1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H2O increase; 95% CI, 0.67–0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15–1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11–1.34; p < 0.001), Paco2 (hazard ratio, 1.63 per doubling; 95% CI, 1.19–2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8–14; p = 0.041), Pao2/Fio2 (hazard ratio, 0.58 per doubling; 95% CI, 0.52–0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88–0.97; p = 0.003). CONCLUSIONS AND RELEVANCE: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes. | Clinical Management,Clinical Epidemiology | https://journals.lww.com/ccejournal/Fulltext/2021/11000/Assessment_of_28_Day_In_Hospital_Mortality_in.9.aspx |
| An Intelligent Model for Rapid Diagnosis of Patients with COVID-19 Based on ANFIS | Aya Hossam, Ahmed Fawzy, Basem E. Elnaghi, Ahmed Magdy | Proceedings of the International Conference on Advanced Intelligent Systems and Informatics 2021Lecture Notes on Data Engineering and Communications Technologies | November 9, 2021 | https://doi.org/10.1007/978-3-030-89701-7_30 | Early classification of coronavirus disease (COVID-19) has a vital role in controlling the rapid spread of this disease and saving patients’ lives. The fast spread of COVID-19 increased the diagnostic encumbrance of radiologists. Computed tomography (CT) imaging is an effective tool to detect COVID-19 but requires a radiology expert and takes a large time. The machine learning (ML) based models are considered as one of the important ways to analyze the CT images to detect the COVID-19 cases. Therefore, this paper has been focused on finding a suitable machine learning algorithm that can automatically analyze CT images to extract and detect COVID-19 pneumonia features with higher accuracy. This research used classifiers as the Artificial Neural Network (ANN), Support Vector Machine (SVM), Decision tree (DT) to classify CT images into COVID-19 and NonCOVID-19. This paper also designed an Adaptive Neuro-Fuzzy Inference System (ANFIS) based model to achieve a fast and accurate diagnosis of Covid-19. The CT exams of other lung diseases were included in the dataset to improve the model performance. So, the NonCOVID-19 results of the proposed models include the other lung diseases. Confusion matrices and ROC analyses of the proposed models are analyzed using 5-fold cross-validation. During the study and testing of several proposed models, the experimental results showed that the performance of the ANFIS proposed model achieved the best performance with an accuracy of 98.63% and 0.02 s testing time. In the main purpose of this study is to shed light on the ML-based COVID-19 detection models for researchers working with ML techniques and help avoid proven failures, especially for small imprecise datasets. | "Virology, Immunology and Diagnostics" | https://link.springer.com/chapter/10.1007%2F978-3-030-89701-7_30 |
| Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement? | Zulfiqar A Bhutta, Arun Mitra, Afsah Salman, Fawad Akbari, Suraya Dalil, Fyezah Jehan, Mushtaque Chowdhury, Saroj Jayasinghe, Purnima Menon, Samiran Nundy, Firdausi Qadri, Md Taufiqul Islam, Kul Gautam | BMJ | November 15, 2021 | http://dx.doi.org/10.13039/501100006126 | none | Social Science,other | https://www.bmj.com/content/bmj/375/BMJ-2021-067384.full.pdf |
| Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials | Cathrine Axfors, Perrine Janiaud, Andreas M. Schmitt, Janneke van’t Hooft, Emily R. Smith, Noah A. Haber, Akin Abayomi, Manal Abduljalil, Abdulkarim Abdulrahman, Yeny Acosta-Ampudia, Manuela Aguilar-Guisado, Farah Al-Beidh, Marissa M. Alejandria, Rachelle N. Alfonso, Mohammad Ali, Manaf AlQahtani, Alaa AlZamrooni, Juan-Manuel Anaya, Mark Angelo C. Ang, Ismael F. Aomar, Luis E. Argumanis, Alexander Averyanov, Vladimir P. Baklaushev, Olga Balionis, Thomas Benfield, Scott Berry, Nadia Birocco, Lynn B. Bonifacio, Asha C. Bowen, Abbie Bown, Carlos Cabello-Gutierrez, Bernardo Camacho, Adrian Camacho-Ortiz, Sally Campbell-Lee, Damon H. Cao, Ana Cardesa, Jose M. Carnate, German Jr. J. Castillo, Rossana Cavallo, Fazle R. Chowdhury, Forhad U. H. Chowdhury, Giovannino Ciccone, Antonella Cingolani, Fresthel Monica M. Climacosa, Veerle Compernolle, Carlo Francisco N. Cortez, Abel Costa Neto, Sergio D’Antico, James Daly, Franca Danielle, Joshua S. Davis, Francesco Giuseppe De Rosa, Justin T. Denholm, Claudia M. Denkinger, Daniel Desmecht, Juan C. Díaz-Coronado, Juan A. Díaz Ponce-Medrano, Anne-Françoise Donneau, Teresita E. Dumagay, Susanna Dunachie, Cecile C. Dungog, Olufemi Erinoso, Ivy Mae S. Escasa, Lise J. Estcourt, Amy Evans, Agnes L. M. Evasan, Christian J. Fareli, Veronica Fernandez-Sanchez, Claudia Galassi, Juan E. Gallo, Patricia J. Garcia, Patricia L. Garcia, Jesus A. Garcia, Mutien Garigliany, Elvira Garza-Gonzalez, Deonne Thaddeus V. Gauiran, Paula A. Gaviria García, Jose-Antonio Giron-Gonzalez, David Gómez-Almaguer, Anthony C. Gordon, André Gothot, Jeser Santiago Grass Guaqueta, Cameron Green, David Grimaldi, Naomi E. Hammond, Heli Harvala, Francisco M. Heralde, Jesica Herrick, Alisa M. Higgins, Thomas E. Hills, Jennifer Hines, Karin Holm, Ashraful Hoque, Eric Hoste, Jose M. Ignacio, Alexander V. Ivanov, Maike Janssen, Jeffrey H. Jennings, Vivekanand Jha, Ruby Anne N. King, Jens Kjeldsen-Kragh, Paul Klenerman, Aditya Kotecha, Fiorella Krapp, Luciana Labanca, Emma Laing, Mona Landin-Olsson, Pierre-François Laterre, Lyn-Li Lim, Jodor Lim, Oskar Ljungquist, Jorge M. Llaca-Díaz, Concepción López-Robles, Salvador López-Cárdenas, Ileana Lopez-Plaza, Josephine Anne C. Lucero, Maria Lundgren, Juan Macías, Sandy C. Maganito, Anna Flor G. Malundo, Rubén D. Manrique, Paola M. Manzini, Miguel Marcos, Ignacio Marquez, Francisco Javier Martínez-Marcos, Ana M. Mata, Colin J. McArthur, Zoe K. McQuilten, Bryan J. McVerry, David K. Menon, Geert Meyfroidt, Ma. Angelina L. Mirasol, Benoît Misset, James S. Molton, Alric V. Mondragon, Diana M. Monsalve, Parastoo Moradi Choghakabodi, Susan C. Morpeth, Paul R. Mouncey, Michel Moutschen, Carsten Müller-Tidow, Erin Murphy, Tome Najdovski, Alistair D. Nichol, Henrik Nielsen, Richard M. Novak, Matthew V. N. O’Sullivan, Julian Olalla, Akin Osibogun, Bodunrin Osikomaiya, Salvador Oyonarte, Juan M. Pardo-Oviedo, Mahesh C. Patel, David L. Paterson, Carlos A. Peña-Perez, Angel A. Perez-Calatayud, Eduardo Pérez-Alba, Anastasia Perkina, Naomi Perry, Mandana Pouladzadeh, Inmaculada Poyato, David J. Price, Anne Kristine H. Quero, Md. M. Rahman, Md. S. Rahman, Mayur Ramesh, Carolina Ramírez-Santana, Magnus Rasmussen, Megan A. Rees, Eduardo Rego, Jason A. Roberts, David J. Roberts, Yhojan Rodríguez, Jesús Rodríguez-Baño, Benjamin A. Rogers, Manuel Rojas, Alberto Romero, Kathryn M. Rowan, Fabio Saccona, Mehdi Safdarian, Maria Clariza M. Santos, Joe Sasadeusz, Gitana Scozzari, Manu Shankar-Hari, Gorav Sharma, Thomas Snelling, Alonso Soto, Pedrito Y. Tagayuna, Amy Tang, Geneva Tatem, Luciana Teofili, Steven Y. C. Tong, Alexis F. Turgeon, Januario D. Veloso, Balasubramanian Venkatesh, Yanet Ventura-Enriquez, Steve A. Webb, Lothar Wiese, Christian Wikén, Erica M. Wood, Gaukhar M. Yusubalieva, Kai Zacharowski, Ryan Zarychanski, Nina Khanna, David Moher, Steven N. Goodman, John P. A. Ioannidis & Lars G. Hemkens | BMC Infectious Diseases | November 20, 2021 | https://doi.org/10.1186/s12879-021-06829-7 | Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care. | Clinical Management,other | https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06829-7#Abs1 |
| Clinical evaluation of SARS-CoV-2 antigen-based rapid diagnostic test kit for detection of COVID-19 cases in Bangladesh | Md. Mahfuzur Rahman, Ananya Ferdous Hoque, Yeasir Karim, Zannat Kawser, Abu Bakar Siddik, Mariya Kibtiya, Sumiya, Ayesha Siddika, Md. Shaheen Alam, Ahmed Nawsher Alam, Muntasir Alam, Mohammad Enayet Hossain Sayera Banu, Firdausi Qadri, Tahmina Shirin, Mustafizur Rahman, Mohammed Ziaur Rahman | Heliyon | November 21, 2021 | https://doi.org/10.1016/j.heliyon.2021.e08455 | The rapid and early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is key to control the current Coronavirus disease 2019 (COVID-19) pandemic. The present study was conducted to clinically evaluate a rapid diagnostic test (RDT) kit, Standard Q COVID-19 Ag Test (SD Biosensor®, Republic of Korea), with reference to the standard real-time RT-PCR for detection of COVID-19 cases in Bangladesh. Naso- pharyngeal swabs were taken from 900 COVID-19 suspected patients. Among them, 34.11% (n ¼ 307) were diagnosed as COVID-19 cases by RT-PCR assay, of which 85% (n ¼ 261) were also detectable using the RDT. The overall sensitivity and specificity of the RDT compared to RT-PCR were 85.02% and 100%, respectively, regardless of age, sex, and type of SARS-CoV-2 variants. Most of the RT-PCR positive cases (94%) were found within the first five days of disease onset, and the sensitivity of RDT was 85.91% for the same samples. The positive predictive value (PPV) of the RDT was 100%, and the negative predictive value (NPV) was 92.8%. The Cohen's kappa value of 0.882 indicated excellent agreement between the RDT and RT-PCR assays. The findings of this study showed the potential use of SARS-CoV-2 antigen-based RDT to expedite the diagnostic process and onward COVID-19 management in Bangladesh. | "Virology, Immunology and Diagnostics",other | |
| Epidemiology and Health Services (Epidemiologia e Serviços de Saúde) journal, its role and contributions in the pandemic context | Cynthia Braga, Barbara Reis-Santos | Scielo Public Health | November 26, 2021 | https://doi.org/10.1590/S1679-497420210004000022 | none | other,Public Health | https://www.scielosp.org/article/ress/2021.v30n4/e2021035/en/ |
| Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries | Zeus Aranda, Thierry Binde2 Katherine Tashman, Ananya Tadikonda, Bill Mawindo, Daniel Maweu, Emma Jean Boley, Isaac Mphande, Isata Dumbuya, Mariana Montaño, Mary Clisbee, Mc Geofrey Mvula, Melino Ndayizigiye, Meredith Casella Jean-Baptiste, Prince F Varney, Sarah Anyango, Karen Ann Grépin, Michael R Law, Jean Claude Mugunga, Bethany Hedt-Gauthier, Isabel R Fulcher on behalf of the Cross-site COVID-19 Syndromic Surveillance Working Group | BMJ Global Health | December 10, 2021 | doi:10.1136/ bmjgh-2021-007247 | The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies. | "Maternal, Newborn and Child Health" | https://gh.bmj.com/content/7/1/e007247 |
| Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico | Ana Cecilia Ortega, Erika Valtierra, Fátima Gabriela Rodríguez-Cuevas, Zeus Aranda, Gisela Preciado & Sebastián Mohar | Global Health Action | December 10, 2021 | https://doi.org/10.1080/16549716.2021.1997410 | Background The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes. Objective The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico. Methods To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed. Results Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed. Conclusions The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations. | Mental Health | https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1997410 |
| Governing the Access to COVID-19 Tools Accelerator: towards greater participation, transparency, and accountability. | Suerie Moon, Jana Armstrong, Brian Hutler, Ross Upshur, Rachel Katz, Caesar Atuire, Anant Bhan, Ezekiel Emanuel, Ruth Faden, Prakash Ghimire, Dirceu Greco, Calvin WL Ho, Sonali Kochhar, G Owen Schaefer, Ehsan Shamsi-Gooshki, Jerome Amir Singh, Maxwell J Smith, Jonathan Wolf | The Lancet | December 10, 2021 | https://doi.org/10.1016/S0140-6736(21)02344-8 | The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to a catastrophic breakdown in global cooperation. ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of broad public importance. We traced the evolution of ACT-A's governance through publicly available documents and analysed it against three principles embedded in the founding mission statement of ACT-A: participation, transparency, and accountability. We found three challenges to realising these principles. First, the roles of the various organisations in ACT-A decision making are unclear, obscuring who might be accountable to whom and for what. Second, the absence of a clearly defined decision making body; ACT-A instead has multiple centres of legally binding decision making and uneven arrangements for information transparency, inhibiting meaningful participation. Third, the nearly indiscernible role of governments in ACT-A, raising key questions about political legitimacy and channels for public accountability. With global public health and billions in public funding at stake, short-term improvements to governance arrangements can and should now be made. Efforts to strengthen pandemic preparedness for the future require attention to ethical, legitimate arrangements for governance. | Ethics | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02344-8/fulltext |
| Effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir and combinations thereof in hospitalized patients with COVID-19: a pragmatic, open-label randomized trial. | H.G. Gaitan-Duarte, MD MSc. , C. Alvarez-Moreno, MD PhD., C.J. Rincon-Rodríguez, MSc., N. Yomayusa-Gonzalez, MD., J.A. Cortes, MD., J.C. Villar, MD PhD., J.S. Bravo-Ojeda, MD., A. García-Pena, MD MSc. ~ ,W. Adarme-Jaimes, PhD., V.A. Rodríguez-Romero, PhD., S.L. Villate-Soto, MSc., G. Buitrago, MD PhD., J. Chacon-Sarmiento, MD., M. Macias-Quintero, MSc., C.P. Vaca, MSc., C. Gomez-Restrepo, MD PhD., and N. Rodríguez-Malagon, MPH. | eClinicalMedicine | December 20, 2021 | https://doi.org/10.1016/j.eclinm.2021.101242 | Background The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. Methods This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095 Findings Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. Interpretation The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use. | Therapeutics | https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00523-X/fulltext |
| The European clinical research response to optimise treatment of patients with COVID-19: lessons learned, future perspective, and recommendations | Prof Herman Goossens, Lennie Derde, Prof Peter Horby, Prof Marc Bonten, MD | The Lancet Infectious Diseases | December 21, 2021 | https://doi.org/10.1016/S1473-3099(21)00705-2 | Clinicians have worked feverishly to treat patients with COVID-19 while also carrying out clinical research studies. We discuss how the clinical research community responded to the pandemic in Europe, what lessons were learned, and provide recommendations for future clinical research response during pandemics. We focused on two platform trials: RECOVERY and REMAP-CAP. Both trials were able to enrol patients very rapidly during the beginning of the pandemic because of pre-established structures and procedures, and because they share simple execution and flexibility to adjust when evidence emergences. However, contracting, regulatory hurdles, and competition with (often inadequately designed or underpowered) national trials was a major challenge in several EU countries. We recommend the creation of structures and partnerships that facilitate prioritisation of clinical research, simplification of clinical trial delivery, development of digital models and procedures for data collection and sharing, development of a mechanism to rapidly leverage pandemic funding and to connect EU funding with national funding, and investment in clinical trial networks, platform trials, and master protocols. Finally, the future pandemic clinical research response of the EU should be embedded in the global response. We believe that globally connected clinical trial networks will be essential to respond more effectively to future infectious diseases outbreaks. | other,Research governance | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00705-2/fulltext |
| High level of compliance to handwashing during the early phase of COVID-19 epidemic in Uganda: A nationwide cross-sectional survey | Richard Migisha, Bob Omoda Amodan, Lilian Bulage, Elizabeth B. Katana, Joseph N. Siewe Fodjo, Robert Colebunders, Alex Riolexus Ario, and Rhoda K. Wanyenze | Quarterly Epidemiological Bulletin | December 22, 2021 | Public Health | https://uniph.go.ug/high-level-of-compliance-to-handwashing-during-the-early-phase-of-covid-19-epidemic-in-uganda-a-nationwide-cross-sectional-survey/ | ||
| Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka, Bangladesh | Afroza Akter, Tasnuva Ahmed, Imam Tauheed, Marjahan Akhtar, Sadia Isfat Ara Rahman, Fatema Khaton, Faisal Ahmmed, Jannatul Ferdous, Mokibul Hassan Afrad, Zannat Kawser, Mohabbat Hossain, Rabeya Khondaker, Mohammad Abul Hasnat, Mostafa Aziz Sumon, Asif Rashed, Shuvro Ghosh, Stephen B. Calderwood, Richelle C. Charles, Edward T. Ryan, Purvesh Khatri, Holden Terry Maecker, Gerlinde Obermoser, Bali Pulendran, John D. Clemens, Sayera Banu, Tahmina Shirin, Regina C. LaRocque, Jason B. Harris, Taufiqur Rahman Bhuiyan , Fahima Chowdhury, Firdausi Qadri | Plos Neglected Tropical Diseases | January 4, 2022 | https://doi.org/10.1371/journal.pntd.0010102 | Background COVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients. Methodology/Principal findings This longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases. Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases. Conclusion/Significance We report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection. | Clinical Epidemiology,"Virology, Immunology and Diagnostics" | https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010102 |
| Critical care nursing role in low and lower middle-income settings: a scoping review | Andy Macey, Gerard O'Reilly, Ged Williams, Peter Cameron | BMJ Open | January 4, 2022 | doi: 10.1136/bmjopen-2021-055585 | Objectives A scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)? Design Scoping review guided by the JBI Manual for Evidence Synthesis. Data sources Six electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021. Review methods The search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country. Results Literature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives. Conclusions Despite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes. | Clinical Management | https://bmjopen.bmj.com/content/12/1/e055585 |
| COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa | Charles S Wiysonge, Samuel M Alobwede, Patrick de Marie C Katoto, Elvis B Kidzeru,Evelyn N Lumngwena, Sara Cooper, Rene Goliath, Amanda Jackson & Muki S Shey | Expert Review of Vaccines | January 6, 2022 | https://doi.org/10.1080/14760584.2022.2023355 | Background We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa’s vaccination roll-out. Research Design and Methods We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions. Results We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029). Conclusions COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education. | Vaccines,Social Science | https://www.tandfonline.com/doi/full/10.1080/14760584.2022.2023355#.YddCjDVZTQs.twitter |
| COVID-19 vaccine trials with children: ethics pointers | Caesar Alimisnya Atuire, Sofía P Salas, Katharine Wright, Radeino Ambe, Jantina de Vries | BMJ Global Health | January 10, 2022 | doi:10.1136/ bmjgh-2021-007466 | As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children. We set out some of the ethical questions to keep in mind before, during, and after the implementation of phase III COVID-19 vaccine trials in limited resource settings. Specifically, we discuss and offer succinct answers to the following questions: How relevant will the trial vaccine be for the population participating in the trial? Should vaccines that have not been approved for use among adults be approved for use in trials with children? Which children should be involved in COVID-19 vaccine trials? What criteria of informed consent are to be adopted with minors? Placebo versus an existing already approved vaccine? What specific duties of ancillary care should be taken into consideration for COVID-19 vaccines especially in low-income and middleincome countries? The answers we offer are considerations that can serve as ‘things to think about’ when reviewing or implementing COVID-19 trials involving children in low-income settings. | "Maternal, Newborn and Child Health",Ethics,Coalition publications | https://gh.bmj.com/content/7/1/e007466 |
| SARS-CoV-2 Seroprevalence before Delta Variant Surge, Chattogram, Bangladesh, March-June 2021 | Taufiqur Rahman Bhuiyan, Juan Dent Hulse, Sonia T Hegde, Marjahan Akhtar, Taufiqul Islam, Zahid Hasan Khan, Ishtiakul Islam Khan, Shakeel Ahmed, Mamunur Rashid, Rumana Rashid, Emily S Gurley, Tahmina Shirin, Ashraful Islam Khan, Andrew S Azman, Firdausi Qadri | Emerging Infectious Diseases | January 10, 2022 | DOI: 10.3201/eid2802.211689 | A March–June 2021 representative serosurvey among Sitakunda subdistrict (Chattogram, Bangladesh) residents found an adjusted prevalence of severe acute respiratory syndrome coronavirus 2 antibodies of 64.1% (95% credible interval 60.0%–68.1%). Before the Delta variant surge, most residents had been infected, although cumulative confirmed coronavirus disease incidence was low. | "Virology, Immunology and Diagnostics",Clinical Epidemiology | https://pubmed.ncbi.nlm.nih.gov/35076007/ |
| High Infection Attack Rate after SARS-CoV-2 Delta Surge, Chattogram, Bangladesh | Sonia T Hegde, Taufiqur Rahman Bhuiyan, Marjahan Akhtar, Taufiqul Islam, Juan Dent Hulse, Zahid Hasan Khan, Ishtiakul Islam Khan, Shakeel Ahmed, Mamunur Rashid, Rumana Rashid, Emily S Gurley, Tahmina Shirin, Ashraful Islam Khan, Andrew S Azman, Firdausi Qadri | Emerging Infectious Diseases | January 10, 2022 | DOI: 10.3201/eid2802.212417 | none | Clinical Epidemiology,"Virology, Immunology and Diagnostics" | https://pubmed.ncbi.nlm.nih.gov/35076367/ |
| COVID-19 vaccine trials with children: ethics pointers. | Caesar Alimisnya Atuire, Sofía P Salas, Katharine Wright, J Radeino Ambe, Jantina de Vries | BMJ Global Health | January 10, 2022 | http://dx.doi.org/10.1136/bmjgh-2021-007466 | As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children. We set out some of the ethical questions to keep in mind before, during, and after the implementation of phase III COVID-19 vaccine trials in limited resource settings. Specifically, we discuss and offer succinct answers to the following questions: How relevant will the trial vaccine be for the population participating in the trial? Should vaccines that have not been approved for use among adults be approved for use in trials with children? Which children should be involved in COVID-19 vaccine trials? What criteria of informed consent are to be adopted with minors? Placebo versus an existing already approved vaccine? What specific duties of ancillary care should be taken into consideration for COVID-19 vaccines especially in low-income and middle-income countries? The answers we offer are considerations that can serve as ‘things to think about’ when reviewing or implementing COVID-19 trials involving children in low-income settings. | Ethics,Vaccines | https://gh.bmj.com/content/7/1/e007466 |
| Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries | Zeus Aranda, Thierry Binde, Katherine Tashman, Ananya Tadikonda, Bill Mawindo, Daniel Maweu, Emma Jean Boley, Isaac Mphande, Isata Dumbuya,2 Mariana Montaño, Mary Clisbee, Mc Geofrey Mvula, Melino Ndayizigiye, Meredith Casella Jean-Baptiste, Prince F Varney, Sarah Anyango, Karen Ann Grépin, Michael R Law, Jean Claude Mugunga, Bethany Hedt-Gauthier, Isabel R Fulcher | BMJ Global Health | January 10, 2022 | http://dx.doi.org/10.1136/bmjgh-2021-007247 | The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies. | "Maternal, Newborn and Child Health" | https://gh.bmj.com/content/7/1/e007247 |
| Vaccines to prevent COVID-19: A living systematic review with Trial Sequential Analysis and network meta-analysis of randomized clinical trials | Steven Kwasi Korang, Elena von Rohden, Areti Angeliki Veroniki, Giok Ong, Owen Ngalamika, Faiza Siddiqui, Sophie Juul, Emil Eik Nielsen, Joshua Buron Feinberg, Johanne Juul Petersen, Christian Legart, Afoke Kokogho, Mathias Maagaard, Sarah Klingenberg, Lehana Thabane, Ariel Bardach, Agustín Ciapponi, Allan Randrup Thomsen, Janus C. Jakobsen, Christian Gluud | PLOS ONE | January 21, 2022 | https://doi.org/10.1371/journal.pone.0260733 | Background COVID-19 is rapidly spreading causing extensive burdens across the world. Effective vaccines to prevent COVID-19 are urgently needed. Methods and findings Our objective was to assess the effectiveness and safety of COVID-19 vaccines through analyses of all currently available randomized clinical trials. We searched the databases CENTRAL, MEDLINE, Embase, and other sources from inception to June 17, 2021 for randomized clinical trials assessing vaccines for COVID-19. At least two independent reviewers screened studies, extracted data, and assessed risks of bias. We conducted meta-analyses, network meta-analyses, and Trial Sequential Analyses (TSA). Our primary outcomes included all-cause mortality, vaccine efficacy, and serious adverse events. We assessed the certainty of evidence with GRADE. We identified 46 trials; 35 trials randomizing 219 864 participants could be included in our analyses. Our meta-analyses showed that mRNA vaccines (efficacy, 95% [95% confidence interval (CI), 92% to 97%]; 71 514 participants; 3 trials; moderate certainty); inactivated vaccines (efficacy, 61% [95% CI, 52% to 68%]; 48 029 participants; 3 trials; moderate certainty); protein subunit vaccines (efficacy, 77% [95% CI, −5% to 95%]; 17 737 participants; 2 trials; low certainty); and viral vector vaccines (efficacy 68% [95% CI, 61% to 74%]; 71 401 participants; 5 trials; low certainty) prevented COVID-19. Viral vector vaccines decreased mortality (risk ratio, 0.25 [95% CI 0.09 to 0.67]; 67 563 participants; 3 trials, low certainty), but comparable data on inactivated, mRNA, and protein subunit vaccines were imprecise. None of the vaccines showed evidence of a difference on serious adverse events, but observational evidence suggested rare serious adverse events. All the vaccines increased the risk of non-serious adverse events. Conclusions The evidence suggests that all the included vaccines are effective in preventing COVID-19. The mRNA vaccines seem most effective in preventing COVID-19, but viral vector vaccines seem most effective in reducing mortality. Further trials and longer follow-up are necessary to provide better insight into the safety profile of these vaccines. | Vaccines,Clinical Epidemiology | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260733 |
| The impact of COVID-19 non-pharmaceutical interventions on the lived experiences of people living in Thailand, Malaysia, Italy and the United Kingdom: A cross-country qualitative study | Mira L. Schneiders, Bhensri Naemiratch, Phaik Kin Cheah, Giulia Cuman, Tassawan Poomchaichote, Supanat Ruangkajorn, Silvia Stoppa, Anne Osterrieder, Phee-Kheng Cheah, Darlene Ongkili, Wirichada Pan-ngum, Constance R. S. Mackworth-Young, Phaik Yeong Cheah | PLOS ONE | January 21, 2022 | https://doi.org/10.1371/journal.pone.0262421 | This qualitative study explores the impact of non-pharmaceutical interventions (NPIs), including social distancing, travel restrictions and quarantine, on lived experiences during the first wave of the COVID-19 pandemic in Thailand (TH), Malaysia (MY), Italy (IT) and the United Kingdom (UK). A total of 86 interviews (TH: n = 28; MY: n = 18; IT: n = 20; UK: n = 20) were conducted with members of the public, including healthcare workers (n = 13). Participants across countries held strong views on government imposed NPIs, with many feeling measures lacked clarity. Most participants reported primarily negative impacts of NPIs on their lives, including through separation, isolation and grief over missed milestones; work-related challenges and income loss; and poor mental health and wellbeing. Nonetheless, many also experienced inadvertent positive consequences, including more time at home to focus on what they most valued in life; a greater sense of connectedness; and benefits to working life. Commonly employed coping strategies focused on financial coping (e.g. reducing spending); psycho-emotional coping (e.g. engaging in spiritual practices); social coping and connectedness (e.g., maintaining relationships remotely); reducing and mitigating risks (e.g., changing food shopping routines); and limiting exposure to the news (e.g., checking news only occasionally). Importantly, the extent to which participants’ lived experiences were positive or negative, and their ability to cope was underpinned by individual, social and economic factors, with the analysis indicating some salient differences across countries and participants. In order to mitigate negative and unequal impacts of NPIs, COVID-19 policies will benefit from paying closer attention to the social, cultural and psychological—not just biological—vulnerabilities to, and consequences of public health measures. | Clinical Epidemiology,Social Science,Public Health | https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262421 |
| COVID-19 vaccine hesitancy and associated factors according to sex: A population-based survey in Salvador, Brazil | Nivison Nery, Jr., Juan P. Aguilar TiconaI, Cristiane W. Cardoso, Ana Paula Pitanga Barbuda Prates, Helena Cristina Alves Vieira, Andrea Salvador de Almeida, Mirela Maisa da Silva Souza, Olivete Borba dos Reis, Maysa Pellizzaro, Moyra, Machado Portilho, Renan Rosa da Anunciac, Renato Victoriano, Rosangela Oliveira dos Anjos, Herna´n Dario Argibay, Douglas Oliveira Carmo Lima, Isadora Lima Mesquita, Wesley Mota Conceicão, Perla Machado Santana, Elaine Carvalho Oliveira, Pamela Santos Nascimento Santana, Claudia Ida Brodskyn, Deborah Bittencourt Mothe´ Fraga, Manuela da Silva Solcà, Mitermayer Galvão Reis, Federico Costa, Guilherme S. Ribeiro | PLOS ONE | January 21, 2022 | https://doi.org/10.1371/journal.pone.0262649 | Vaccination is a major strategy to prevent the coronavirus disease 2019 (COVID-19). However, information about factors associated with men and women intention to be vaccinated are scarce. To determine COVID-19 vaccine acceptance and identify factors associated vaccine hesitancy according to sex, we performed a cross-sectional population-based random survey in Salvador, Brazil between Nov/2020-Jan/2021. Participants were interviewed to obtain data on intention to receive and pay for a COVID-19 vaccine, as well as on demographics, comorbidities, influenza vaccination history, previous diagnosis of COVID-19, and exposures and perception of COVID-19 risk. Among 2,521 participants, 2,053 (81.4%) reported willingness to use a COVID-19 vaccine and 468 (18.6%) hesitated to take it. Among those intending to get vaccinated, 1,400 (68.2%) would pay for the vaccine if necessary. Sex-stratified multivariable analysis found that men who were working and who had comorbidities were less likely to hesitate about using the vaccine. Among women, higher educational level and high perception of COVID-19 risk were associated with less vaccine hesitancy. In both groups, reporting influenza vaccination in 2020 reduced the chance of COVID-19 vaccine hesitancy. COVID-19 vaccine campaigns targeting to reduce vaccine hesitancy are urgently needed. These campaigns should consider gender differences in order to be successful. | Social Science,Public Health | https://www.arca.fiocruz.br/bitstream/icict/51583/2/Nery%20Junior%2C%20N.%20%20Covid-19....pdf |
| SARS-CoV-2 infections and public health responses in schools and early childhood education and care centres in Victoria, Australia: An observational study | Kathleen Ryan, Kathryn Snow, Margie Danchin, Kim Mulholland, Sharon Goldfeld, Fiona Russell | The Lancet Regional Health - Western Pacific | January 24, 2022 | ttps://doi.org/10.1016/j.lanwpc.2021.100369 | Background The epidemiology of SARS-CoV-2 in children is an important consideration for control measures. To inform the safe re-opening of Victorian schools and early childhood education and care (ECEC) in late 2020, a detailed analysis of local data was undertaken. Methods Data on all Victorian SARS-CoV-2 confirmed cases, their close contacts, and ECEC/school events from the first case in Victoria to the end of the third school term (25/01/2020 – 18/09/2020) were analysed. We compared temporal and geographic trends in cases linked to ECEC/school events and community cases; and describe events with onward transmission by age of first case, and public health actions. Findings Victoria recorded 20,049 SARS-CoV-2 cases during the study period. In total, 1,691 cases and 18,423 contacts were linked to 339 events in ECEC/schools. Many (n=224, 66·1%) events had no evidence of onward transmission, and most (96·5%) involved <10 cases. Onward transmission was more common when the first case was older: when first case was aged 0-5 years, 14·1% events involved additional cases, compared to 30·5% (6-12 years), 33·3% (13-15 years), 42·9% (16-18 years), and 39·1% when the first case was an adult. ECEC/schools were closed within a median of one day (IQR 0-2) from laboratory notification of the first case. Interpretation Mitigation measures and rapid responses prevented most SARS-CoV-2 cases in ECEC/schools from becoming outbreaks in Victoria in 2020. As new variants emerge and vaccination coverage increases, ECEC/school mitigation strategies should be tailored to local community transmission and educational level. Funding The Victorian Department of Health and Human Services. | Clinical Epidemiology,"Maternal, Newborn and Child Health" | https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(21)00278-9/fulltext |
| The importance of accessory protein variants in the pathogenicity of SARS-CoV-2 | Sk. Sarif Hassan, Pabitra Pal Choudhury, Guy W. Dayhoff II, Alaa A.A. Aljabali, Bruce D. Uhal, Kenneth Lundstrom, Nima Rezaei, Damiano Pizzol, Parise Adadi, Amos Lal, Antonio Soares, Tarek Mohamed Abd El-Aziz, Adam M. Brufsky, Gajendra Kumar Azad, Samendra P. Sherchan, Wagner Baetas-da-Cruz, Kazuo Takayama, Angel Serrano-Aroca, Gaurav Chauhan, Giorgio Palu, Yogendra Kumar Mishra, Debmalya Barh, Raner Jose Santana Silva, Bruno Silva Andrade, Vasco Azevedo, Aristoteles Goes-Neto, Nicolas G. Bazan, Elrashdy M. Redwan, Murtaza Tambuwala, Vladimir N. Uversky | Archives of Biochemistry and Biophysics | January 24, 2022 | https://doi.org/10.1016/j.abb.2022.109124 | The coronavirus disease 2019 (COVID-19) is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS- CoV-2) with an estimated fatality rate of less than 1%. The SARS-CoV-2 accessory proteins ORF3a, ORF6, ORF7a, ORF7b, ORF8, and ORF10 possess putative functions to manipulate host immune mechanisms. These involve interferons, which appear as a consensus function, immune signaling receptor NLRP3 (NLR family pyrin domain-containing 3) inflammasome, and inflammatory cytokines such as interleukin 1β (IL-1β) and are critical in COVID-19 pathology. Outspread variations of each of the six accessory proteins were observed across six continents of all complete SARS-CoV-2 proteomes based on the data reported before November 2020. A decreasing order of percentage of unique variations in the accessory proteins was determined as ORF3a > ORF8 > ORF7a > ORF6 > ORF10 > ORF7b across all continents. The highest and lowest unique variations of ORF3a were observed in South America and Oceania, respectively. These findings suggest that the wide variations in accessory proteins seem to affect the pathogenicity of SARS-CoV-2. | "Virology, Immunology and Diagnostics" | https://www.sciencedirect.com/science/article/pii/S0003986122000091#! |
| A Pediatric Case of Sensory Predominant Guillain-Barré Syndrome Following COVID-19 Vaccination | Yunsung Kim, Zahra Zhu, Puneet Kochar, Patrick Gavigan, Divpreet Kaur, Ashutosh Kumar | Child Neurology Open | January 25, 2022 | https://doi.org/10.1177%2F2329048X221074549 | Over six billion doses of Coronavirus Disease 2019 (COVID-19) vaccines have been administered worldwide. Amidst the global COVID-19 vaccination campaign, vaccine-related side effects are of ongoing concern and investigation. According to the Centers for Disease Control and Prevention (CDC) and the United States Department of Health and Human Services, three main conditions in adults have surfaced in association with receiving the COVID-19 vaccines. These include thrombosis with thrombocytopenia syndrome (TTS), a rare syndrome involving venous or arterial thrombosis and thrombocytopenia, Guillain-Barre syndrome (GBS), and myocarditis. While a number of GBS cases in adults have been published, to our knowledge, only one pediatric case of COVID-19 vaccine-related GBS has been reported. Herein we describe a case of sensory predominant GBS following the Pfizer-BioNTech COVID-19 vaccine in a 16-year-old female presenting with bilaterally ascending upper and lower extremity numbness and paresthesia. | "Maternal, Newborn and Child Health",Vaccines | https://journals.sagepub.com/doi/full/10.1177/2329048X221074549 |
| Effects in vitro and in vivo of hesperidin administration in an experimental model of acute lung inflammation | Ana Beatriz Farias de Souza, Natália Alves de Matos, Thalles de Freitas Castro, Guilherme de Paula Costa, Laser Antônio Machado Oliveira, Katiane de Oliveira Pinto Coelho Nogueira, Iara Mariana Léllis Ribeiro, André Talvani, Sílvia Dantas Cangussú, Rodrigo Cunha Alvimde Menezes, Frank Silva Bezerra | Free Radical Biology and Medicine | January 26, 2022 | https://doi.org/10.1016/j.freeradbiomed.2022.01.027 | Mechanical ventilation (MV) is a tool used in critical patient care. However, it can trigger inflammatory and oxidative processes capable of causing or aggravating lung injuries, which is known as ventilator-induced lung injury (VILI). Hesperidin is a flavonoid with antioxidant and anti-inflammatory properties in various diseases. The role of hesperidin in the process triggered by MV is poorly studied. Thus, we hypothesize hesperidin could protect the lung of mice submitted to mechanical ventilation. For that, we evaluated cell viability and reactive oxygen species (ROS) formation in macrophages using different hesperidin concentrations. We observed hesperidin did not reduce cell viability, however; it attenuated the production of intracellular ROS in cells stimulated with lipopolysaccharide (LPS). We further evaluated the effects of hesperidin in vivo in animals submitted to MV. In the bronchoalveolar lavage fluid, there were higher levels of macrophage, lymphocyte and neutrophil counts in animals submitted to MV, indicating an inflammatory process. In the lung tissue, MV induced oxidative damage and increased myeloperoxidase activity, though the antioxidant enzyme activity decreased. MV also induced the production of the inflammatory mediators CCL-2, TNF-α and IL-12. Pretreatment with hesperidin resulted in less recruitment of inflammatory cells to the airways and less oxidative damage. Also, it reduced the formation of CCL-2 and IL-12. Our results show pretreatment with hesperidin can protect the lungs of mice submitted to mechanical ventilation by modulating the inflammatory response and redox imbalance and may act to prevent MV injury. | Clinical Management | https://www.sciencedirect.com/science/article/abs/pii/S0891584922000387#! |
| Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021 | COVID-19 National Preparedness Collaborators (including Charles Shey Wiysonge) | The Lancet | February 1, 2022 | https://doi.org/10.1016/S0140-6736(22)00172-6 | Background National rates of COVID-19 infection and fatality have varied dramatically since the onset of the pandemic. Understanding the conditions associated with this cross-country variation is essential to guiding investment in more effective preparedness and response for future pandemics. Methods Daily SARS-CoV-2 infections and COVID-19 deaths for 177 countries and territories and 181 subnational locations were extracted from the Institute for Health Metrics and Evaluation's modelling database. Cumulative infection rate and infection-fatality ratio (IFR) were estimated and standardised for environmental, demographic, biological, and economic factors. For infections, we included factors associated with environmental seasonality (measured as the relative risk of pneumonia), population density, gross domestic product (GDP) per capita, proportion of the population living below 100 m, and a proxy for previous exposure to other betacoronaviruses. For IFR, factors were age distribution of the population, mean body-mass index (BMI), exposure to air pollution, smoking rates, the proxy for previous exposure to other betacoronaviruses, population density, age-standardised prevalence of chronic obstructive pulmonary disease and cancer, and GDP per capita. These were standardised using indirect age standardisation and multivariate linear models. Standardised national cumulative infection rates and IFRs were tested for associations with 12 pandemic preparedness indices, seven health-care capacity indicators, and ten other demographic, social, and political conditions using linear regression. To investigate pathways by which important factors might affect infections with SARS-CoV-2, we also assessed the relationship between interpersonal and governmental trust and corruption and changes in mobility patterns and COVID-19 vaccination rates. Findings The factors that explained the most variation in cumulative rates of SARS-CoV-2 infection between Jan 1, 2020, and Sept 30, 2021, included the proportion of the population living below 100 m (5·4% [4·0–7·9] of variation), GDP per capita (4·2% [1·8–6·6] of variation), and the proportion of infections attributable to seasonality (2·1% [95% uncertainty interval 1·7–2·7] of variation). Most cross-country variation in cumulative infection rates could not be explained. The factors that explained the most variation in COVID-19 IFR over the same period were the age profile of the country (46·7% [18·4–67·6] of variation), GDP per capita (3·1% [0·3–8·6] of variation), and national mean BMI (1·1% [0·2–2·6] of variation). 44·4% (29·2–61·7) of cross-national variation in IFR could not be explained. Pandemic-preparedness indices, which aim to measure health security capacity, were not meaningfully associated with standardised infection rates or IFRs. Measures of trust in the government and interpersonal trust, as well as less government corruption, had larger, statistically significant associations with lower standardised infection rates. High levels of government and interpersonal trust, as well as less government corruption, were also associated with higher COVID-19 vaccine coverage among middle-income and high-income countries where vaccine availability was more widespread, and lower corruption was associated with greater reductions in mobility. If these modelled associations were to be causal, an increase in trust of governments such that all countries had societies that attained at least the amount of trust in government or interpersonal trust measured in Denmark, which is in the 75th percentile across these spectrums, might have reduced global infections by 12·9% (5·7–17·8) for government trust and 40·3% (24·3–51·4) for interpersonal trust. Similarly, if all countries had a national BMI equal to or less than that of the 25th percentile, our analysis suggests global standardised IFR would be reduced by 11·1%. Interpretation Efforts to improve pandemic preparedness and response for the next pandemic might benefit from greater investment in risk communication and community engagement strategies to boost the confidence that individuals have in public health guidance. Our results suggest that increasing health promotion for key modifiable risks is associated with a reduction of fatalities in such a scenario. Funding Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies. | Clinical Epidemiology,Public Health | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00172-6/fulltext#%20 |
| TNF-a Levels in Respiratory Samples Are Associated with SARS-CoV-2 Infection | Matias J. Pereson, Maria Noel Badano, Natalia Aloisi, Roberto Chuit, M. M. E. de Bracco, Patricia Barea | Microbiology Spectrum | February 9, 2022 | https://doi.org/10.1128/spectrum.01411-21 | none | "Virology, Immunology and Diagnostics" | https://journals.asm.org/doi/10.1128/spectrum.01411-21 |
| The oral protease inhibitor (PF-07321332) protects Syrian hamsters against infection with SARS-CoV-2 variants of concern | Rana Abdelnabi, Caroline S Foo, Dirk Jochmans, Laura Vangeel, Steven De Jonghe, Patrick Augustijns, Raf Mols, Birgit Weynand, Thanaporn Wattanakul, Richard M Hoglund, Joel Tarning, Charles E Mowbray, Peter Sjö, Fanny Escudié, Ivan Scandale, Eric Chatelain, Johan Neyts | Nature Communications | February 15, 2022 | DOI: 10.1038/s41467-022-28354-0 | There is an urgent need for potent and selective antivirals against SARS-CoV-2. Pfizer developed PF-07321332 (PF-332), a potent inhibitor of the viral main protease (Mpro, 3CLpro) that can be dosed orally and that is in clinical development. We here report that PF-332 exerts equipotent in vitro activity against the four SARS-CoV-2 variants of concerns (VoC) and that it can completely arrest replication of the alpha variant in primary human airway epithelial cells grown at the air-liquid interface. Treatment of Syrian Golden hamsters with PF-332 (250 mg/kg, twice daily) completely protected the animals against intranasal infection with the beta (B.1.351) and delta (B.1.617.2) SARS-CoV-2 variants. Moreover, treatment of SARS-CoV-2 (B.1.617.2) infected animals with PF-332 completely prevented transmission to untreated co-housed sentinels. | Clinical Pharmacology and Drug Candidates | https://pubmed.ncbi.nlm.nih.gov/35169114/ |
| The feminization of medicine in Latin America: ‘More-the-merrier’ will not beget gender equity or strengthen health systems | Felicia Marie Knaul, Héctor Arreola-Ornelas, Beverley M. Essue, Renu Sara Nargunda, Patricia García, Uriel Salvador Acevedo Gómez, Roopa Dhatt, Alhelí Calderón-Villarreal, Pooja Yerramilli, Ana Langer | The Lancet Regional Health – Americas | February 22, 2022 | https://doi.org/10.1016/j.lana.2022.100201 | This viewpoint addresses the lack of gender diversity in medical leadership in Latin America and the gap in evidence on gender dimensions of the health workforce. While Latin America has experienced a dramatic change in the gender demographic of the medical field, the health sector employment pipeline is rife with entrenched and systemic gender inequities that continue to perpetuate a devaluation of women; ultimately resulting in an under-representation of women in medical leadership. Using data available in the public domain, we describe and critique the trajectory of women in medicine and characterize the magnitude of gender inequity in health system leadership over time and across the region, drawing on historical data from Mexico as an illustrative case. We propose recommendations that stand to disrupt the status quo to more appropriately value women and their representation at the highest levels of decision making for health. We call for adequate measurement of equity in medical leadership as a matter of national, regional, and global priority and propose the establishment of a regional observatory to monitor and evaluate meaningful progress towards gender parity in the health sector as well as in medical leadership. | other | https://www.sciencedirect.com/science/article/pii/S2667193X22000187 |
| Addressing Vaccine Inequity — Covid-19 Vaccines as a Global Public Good | David J. Hunter, Salim S. Abdool Karim, Lindsey R. Baden, Jeremy J. Farrar, Mary Beth Hamel, Dan L. Longo, Stephen Morrissey, and Eric J. Rubin | The New England Journal of Medicine | February 23, 2022 | DOI: 10.1056/NEJMe2202547 | none | Public Health | https://www.nejm.org/doi/full/10.1056/NEJMe2202547?query=TOC&cid=NEJM%20eToc,%20February%2024,%202022%20DM758850_NEJM_Non_Subscriber&bid=841679947 |
| Defining post-COVID condition | Juan Carlos Villar, Nolbert Gumisiriza, Lucas Guimarães Abreu, Richard J Maude, Robert Colebunders | The Lancet Infectious Diseases | March 1, 2022 | DOI:https://doi.org/10.1016/S1473-3099(22)00060-3 | none | Clinical Epidemiology,Coalition publications | https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00060-3/fulltext |
| Comparison of Seroconversion in Children and Adults With Mild COVID-19 | Zheng Quan Toh, PhD; Jeremy Anderson, BSc; Nadia Mazarakis, PhD; Melanie Neeland, PhD; Rachel A. Higgins, BBiomed; Karin Rautenbacher, BAppSc; Kate Dohle, BSc; Jill Nguyen, BSc; Isabella Overmars, MPH; Celeste Donato, PhD; Sohinee Sarkar, PhD; Vanessa Clifford, PhD; Andrew Daley, PhD; Suellen Nicholson, BSc; Francesca L. Mordant, MSc; Kanta Subbarao, MBBS; David P. Burgner, PhD; Nigel Curtis, MD; Julie E. Bines, MD; Sarah McNab, MD; Andrew C. Steer, PhD; Kim Mulholland, MD; Shidan Tosif, PhD; Nigel W. Crawford, MD; Daniel G. Pellicci, PhD; Lien Anh Ha Do, PhD, Paul V. Licciardi | JAMA Network Open | March 9, 2022 | doi:10.1001/jamanetworkopen.2022.1313 | Importance The immune response in children with SARS-CoV-2 infection is not well understood. Objective To compare seroconversion in nonhospitalized children and adults with mild SARS-CoV-2 infection and identify factors that are associated with seroconversion. Design, Setting, and Participants This household cohort study of SARS-CoV-2 infection collected weekly nasopharyngeal and throat swabs and blood samples during the acute (median, 7 days for children and 12 days for adults [IQR, 4-13] days) and convalescent (median, 41 [IQR, 31-49] days) periods after polymerase chain reaction (PCR) diagnosis for analysis. Participants were recruited at The Royal Children’s Hospital, Melbourne, Australia, from May 10 to October 28, 2020. Participants included patients who had a SARS-CoV-2–positive nasopharyngeal or oropharyngeal swab specimen using PCR analysis. Main Outcomes and Measures SARS-CoV-2 immunoglobulin G (IgG) and cellular (T cell and B cell) responses in children and adults. Seroconversion was defined by seropositivity in all 3 (an in-house enzyme-linked immunosorbent assay [ELISA] and 2 commercial assays: a SARS-CoV-2 S1/S2 IgG assay and a SARS-CoV-2 antibody ELISA) serological assays. Results Among 108 participants with SARS-CoV-2–positive PCR findings, 57 were children (35 boys [61.4%]; median age, 4 [IQR, 2-10] years) and 51 were adults (28 women [54.9%]; median age, 37 [IQR, 34-45] years). Using the 3 established serological assays, a lower proportion of children had seroconversion to IgG compared with adults (20 of 54 [37.0%] vs 32 of 42 [76.2%]; P < .001). This result was not associated with viral load, which was similar in children and adults (mean [SD] cycle threshold [Ct] value, 28.58 [6.83] vs 24.14 [8.47]; P = .09). In addition, age and sex were not associated with seroconversion within children (median age, 4 [IQR, 2-14] years for both seropositive and seronegative groups; seroconversion by sex, 10 of 21 girls [47.6%] vs 10 of 33 boys [30.3%]) or adults (median ages, 37 years for seropositive and 40 years for seronegative adults [IQR, 34-39 years]; seroconversion by sex, 18 of 24 women [75.0%] vs 14 of 18 men [77.8%]) (P > .05 for all comparisons between seronegative and seropositive groups). Symptomatic adults had 3-fold higher SARS-CoV-2 IgG levels than asymptomatic adults (median, 227.5 [IQR, 133.7-521.6] vs 75.3 [IQR, 36.9-113.6] IU/mL), whereas no differences were observed in children regardless of symptoms. Moreover, differences in cellular immune responses were observed in adults compared with children with seroconversion. Conclusions and Relevance The findings of this cohort study suggest that among patients with mild COVID-19, children may be less likely to have seroconversion than adults despite similar viral loads. This finding has implications for future protection after SARS-CoV-2 infection in children and for interpretation of serosurveys that involve children. Further research to understand why seroconversion and development of symptoms are potentially less likely in children after SARS-CoV-2 infection and to compare vaccine responses may be of clinical and scientific importance. | "Virology, Immunology and Diagnostics" | https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789845 |
| End COVID-19 in low- and middle-income countries | Ahmed Mushfiq Mobarak, Edward Miguel, Jason Abaluck, Amrita Ahuja, Marcella Alsan, Abhijit Banerjee, Emily Breza, Arun G. Chandrasekhar, Esther Duflo, James Dzansi, Denise Garrett, Paul Goldsmith-Pinkham, Gregg S. Gonsalves, Muhammad Maqsud Hossain, Aleksandra Jakubowski, Gagandeep Kang, Arjun Kharel, Michael Kremer, Niccolo Meriggi, Carol Nekesa, Benjamin A. Olken, Saad B. Omer, Firdausi Qadri, Helen Rees, Babatunde Salako, Maarten Voors, Shana Warren, Witold Więcek | Science | March 10, 2022 | DOI: 10.1126/science.abo4089 | Vaccines are changing the course of the COVID-19 pandemic, but in grossly uneven ways. Low- and middle-income countries (LMICs) face considerable obstacles in both receiving and distributing doses. To limit virus transmission, its devastating impacts, and opportunities for further mutations, this must change. Until it does, nonpharmaceutical interventions such as masking must remain a priority. Science invited global experts to highlight research and innovations aimed at quickening the end of COVID-19 in LMICs. —Brad Wible | Social Science,Public Health,other | https://www.science.org/doi/10.1126/science.abo4089#con28 |
| Effectiveness of the Ad26.COV2.S vaccine in health-care workers in South Africa (the Sisonke study): results from a single-arm, open-label, phase 3B, implementation study | Linda-Gail Bekker, Nigel Garrett, Ameena Goga, Lara Fairall, Tarylee Reddy, Nonhlanhla Yende-Zuma, Reshma Kassanjee Shirley Collie, HonsqIan Sanne, Andrew Boulle, Ishen Seocharan, Imke Engelbrecht, Mary-Ann Davies, Jared Champion, Tommy Chen, Sarah Bennett, Selaelo Mametja, Mabatlo Semenya, Honsaa Harry Moultrie, Tulio de Oliveira, Richard John Lessells, Cheryl Cohen, Waasila Jassat, Michelle Groome, Anne Von Gottberg, Engelbert Le Roux, Kentse Khuto, Dan Barouch, Hassan Mahomed, Milani Wolmarans, Petro Rousseau Debbie Bradshaw, Michelle Mulder, Jessica Opie, Vernon Louw, Barry Jacobson, Pradeep Rowji, Jonny G Peter, Azwi Takalani, Jackline Odhiambo, Fatima Mayat, Simbarashe Takuva, Lawrence Corey, Glenda E Gray Sisonke Protocol Team on behalf of the Sisonke Study Team | The Lancet | March 17, 2022 | https://doi.org/10.1016/S0140-6736(22)00007-1 | Background We aimed to assess the effectiveness of a single dose of the Ad26.COV2.S vaccine (Johnson & Johnson) in health-care workers in South Africa during two waves of the South African COVID-19 epidemic. Methods In the single-arm, open-label, phase 3B implementation Sisonke study, health-care workers aged 18 years and older were invited for vaccination at one of 122 vaccination sites nationally. Participants received a single dose of 5 × 1010 viral particles of the Ad26.COV2.S vaccine. Vaccinated participants were linked with their person-level data from one of two national medical insurance schemes (scheme A and scheme B) and matched for COVID-19 risk with an unvaccinated member of the general population. The primary outcome was vaccine effectiveness against severe COVID-19, defined as COVID-19-related admission to hospital, hospitalisation requiring critical or intensive care, or death, in health-care workers compared with the general population, ascertained 28 days or more after vaccination or matching, up to data cutoff. This study is registered with the South African National Clinical Trial Registry, DOH-27-022021-6844, ClinicalTrials.gov, NCT04838795, and the Pan African Clinical Trials Registry, PACTR202102855526180, and is closed to accrual. Findings Between Feb 17 and May 17, 2021, 477 102 health-care workers were enrolled and vaccinated, of whom 357 401 (74·9%) were female and 119 701 (25·1%) were male, with a median age of 42·0 years (33·0–51·0). 215 813 vaccinated individuals were matched with 215 813 unvaccinated individuals. As of data cutoff (July 17, 2021), vaccine effectiveness derived from the total matched cohort was 83% (95% CI 75–89) to prevent COVID-19-related deaths, 75% (69–82) to prevent COVID-19-related hospital admissions requiring critical or intensive care, and 67% (62–71) to prevent COVID-19-related hospitalisations. The vaccine effectiveness for all three outcomes were consistent across scheme A and scheme B. The vaccine effectiveness was maintained in older health-care workers and those with comorbidities including HIV infection. During the course of the study, the beta (B.1.351) and then the delta (B.1.617.2) SARS-CoV-2 variants of concerns were dominant, and vaccine effectiveness remained consistent (for scheme A plus B vaccine effectiveness against COVID-19-related hospital admission during beta wave was 62% [95% CI 42–76] and during delta wave was 67% [62–71], and vaccine effectiveness against COVID-19-related death during beta wave was 86% [57–100] and during delta wave was 82% [74–89]). Interpretation The single-dose Ad26.COV2.S vaccine shows effectiveness against severe COVID-19 disease and COVID-19-related death after vaccination, and against both beta and delta variants, providing real-world evidence for its use globally. Funding National Treasury of South Africa, the National Department of Health, Solidarity Response Fund NPC, The Michael & Susan Dell Foundation, The Elma Vaccines and Immunization Foundation, and the Bill & Melinda Gates Foundation. | Vaccines,"Virology, Immunology and Diagnostics" | https://www.sciencedirect.com/science/article/pii/S0140673622000071 |
| Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings | Arjun Chandna, Raman Mahajan, Priyanka Gautam, Lazaro Mwandigha, Karthik Gunasekaran, Divendu Bhusan, Arthur T L Cheung, Nicholas Day, Sabine Dittrich, Arjen Dondorp, Tulasi Geevar, Srinivasa R Ghattamaneni, Samreen Hussain, Carolina Jimenez, Rohini Karthikeyan, Sanjeev Kumar, Shiril Kumar, Vikash Kumar, Debasree Kundu, Ankita Lakshmanan, Abi Manesh, Chonticha Menggred, Mahesh Moorthy, Jennifer Osborn, Melissa Richard-Greenblatt, Sadhana Sharma, Veena K Singh, Vikash K Singh, Javvad Suri, Shuichi Suzuki, Jaruwan Tubprasert, Paul Turner, Annavi M G Villanueva, Naomi Waithira, Pragya Kumar, George M Varghese, Constantinos Koshiaris, Yoel Lubell, Sakib Burza | Clinical Infectious Diseases | March 21, 2022 | https://doi.org/10.1093/cid/ciac224 | Background In locations where few people have received COVID-19 vaccines, health systems remain vulnerable to surges in SARS-CoV-2 infections. Tools to identify patients suitable for community-based management are urgently needed. Methods We prospectively recruited adults presenting to two hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO2 < 94%; respiratory rate > 30 bpm; SpO2/FiO2 < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex and SpO2) and one of seven shortlisted biochemical biomarkers measurable using commercially-available rapid tests (CRP, D-dimer, IL-6, NLR, PCT, sTREM-1 or suPAR), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration and clinical utility of the models in a held-out temporal external validation cohort. Results 426 participants were recruited, of whom 89 (21.0%) met the primary outcome. 257 participants comprised the development cohort and 166 comprised the validation cohort. The three models containing NLR, suPAR or IL-6 demonstrated promising discrimination (c-statistics: 0.72 to 0.74) and calibration (calibration slopes: 1.01 to 1.05) in the validation cohort, and provided greater utility than a model containing the clinical parameters alone. Conclusions We present three clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources. | Clinical Management | https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac224/6551704?login=false |
| WHO guidance on COVID-19 vaccine trial designs in the context of authorized COVID-19 vaccines and expanding global access: Ethical considerations. | Jerome Amir Singh, Sonali Kochhar, Jonathan Wolff, Caesar Atuire, Anant Bhan, Ezekiel Emanuel, Ruth Faden, Prakash Ghimire, Dirceu Greco, Calvin Ho, Suerie Moon, Ehsan Shamsi- Gooshki, Aissatou Touré, Beatriz Thomé, Maxwell J. Smith, Ross E.G. Upshur | Vaccine | March 25, 2022 | https://doi.org/10.1016%2Fj.vaccine.2022.02.038 | While the degree of COVID-19 vaccine accessibility and uptake varies at both national and global levels, increasing vaccination coverage raises questions regarding the standard of prevention that ought to apply to different settings where COVID-19 vaccine trials are hosted. A WHO Expert Group has developed guidance on the ethical implications of conducting placebo-controlled trials in the context of expanding global COVID-19 vaccine coverage. The guidance also considers alternative trial designs to placebo controlled trials in the context of prototype vaccines, modified vaccines, and next generation vaccines. | Ethics | https://www.sciencedirect.com/science/article/pii/S0264410X2200175X?via%3Dihub |
| COVID-19, vaccine hesitancy and child vaccination: Challenges from Brazil | Michelle Fernandez, Gustavo Matta, Ester Paiva | The Lancet Regional Health Americas | April 1, 2022 | https://doi.org/10.1016/j.lana.2022.100246 | none | Vaccines,Social Science | https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00063-1/fulltext |
| Cooperation in Countering Artemisinin Resistance in Africa: Learning from COVID-19 | Philip J Rosenthal, Anders Björkman, Mehul Dhorda, Abdoulaye Djimde, Arjen M Dondorp, Oumar Gaye, Philippe J Guerin, Elizabeth Juma, Dominic P Kwiatkowski, Laura Merson, Francine Ntoumi, Ric N Price, Jaishree Raman, David S Roos, Feiko Ter Kuile, Halidou Tinto, Sheena S Tomko, Nicholas J White, Karen I Barnes | American Journal of Tropical Medicine & Hygiene | April 12, 2022 | doi: 10.4269/ajtmh.22-0148 | none | other | https://pubmed.ncbi.nlm.nih.gov/35413688/ |
| High COVID-19 Vaccine Acceptance among Eye Healthcare Workers in Uganda | Juliet Otiti-Sengeri,Omaido Blair Andrew ,Rebecca Claire Lusobya, ,Immaculate Atukunda,Caroline Nalukenge, Abubakar Kalinaki,John Mukisa, Damalie Nakanjako, and Robert Colebunders | Vaccines | April 14, 2022 | https://doi.org/10.3390/vaccines10040609 | Background: Protecting healthcare workers against COVID-19 disease is crucial, and COVID-19 vaccination is the most effective method to do so. Eye healthcare workers provide routine care in proximity, increasing infection risk, hence their need for full vaccination. This study determined COVID-19 vaccine acceptance and barriers to its uptake among eye healthcare workers practicing in Uganda. Methods: This was a cross-sectional online and telephone survey based on the health belief model (HBM), conducted in June–August 2021. A modified Poisson regression model with robust standard errors was used to determine the factors associated with COVID-19 vaccine acceptance. Results: In total, 300 (85%) of the 357 eye healthcare workers participated in the study with mean age 43 ± 8 years and 182 (60.7%) were men. Overall, 97.6% (95% CI: 95.9–99.4) had accepted and/or were willing to take the COVID-19 vaccine, 65.3% had received a shot of the COVID-19 vaccine, and 97 (32.3%) reported the intention to accept the vaccine when it became available. Among the HBM constructs, high perceived susceptibility and high perceived benefits were significantly associated with COVID-19 vaccine acceptance. Conclusions: The acceptance of the COVID-19 vaccine among eye healthcare workers in Uganda is very high. There is a dire need to make vaccines available to developing nations like Uganda. | Vaccines,Social Science | https://www.mdpi.com/2076-393X/10/4/609 |
| Platelet-monocyte interaction amplifies thromboinflammation through tissue factor signaling in COVID-19 | Eugenio Damaceno Hottz, Remy Martins-Gonçalves, Lohanna Palhinha, Isaclaudia G. Azevedo-Quintanilha, Dr., Mariana M. de Campos, Carolina Q. Sacramento, Dr, Jairo R. Temerozo, Dr, Vinicius Cardoso Soares, Suelen Silva Gomes Dias, Lívia Teixeira, Icaro Maia Santos Castro, Cássia Righy, Thiago Moreno Lopes Souza, Pedro Kurtz, Bruno Andrade, Helder Nakaya, Robson Q Monteiro, Fernando Augusto Bozza, Patricia Torres Bozza | Blood Advances | April 14, 2022 | https://doi.org/10.1182/bloodadvances.2021006680 | none | Clinical Management | https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2021006680/484924/Platelet-monocyte-interaction-amplifies |
| Herpesvirus and neurological manifestations in patients with severe coronavirus disease | Vanessa Cristine de Souza Carneiro, Soniza Vieira Alves Leon, Dmitry J. S. Sarmento, Wagner L. C. N. Coelho, Otacilio C. Moreira, Andreza L. Savio, Carlos Henrique Ferreira Ramos Filho, Carla A. B. Marques, Joao Paulo da Cosa Gonçalves, Luciane A. Amado Leon, Vanessa Salete Paula | April 18, 2022 | https://doi.org/10.21203/rs.3.rs-1534929/v1 | Background .Certain clinical manifestations of coronavirus disease (COVID-19) mimic those associated with human herpesvirus (HHV) infection. In this study, we estimated the prevalence of herpesvirus in patients with COVID-19 and determined if coinfection is associated with poorer outcomes and neurological symptoms. Methods We analyzed samples of 53 patients diagnosed with COVID-19. The samples were evaluated for the presence of alphaherpesviruses, betaherpesviruses, and gammaherpesviruses, and the viral loads were quantified using quantitative polymerase chain reaction (qPCR) method. Results Among the patients, in 73.6% had detection at least one type of herpesvirus. HHV-6 (47.2%), cytomegalovirus (43.3%), and HHV-7 (39.6%) showed the highest detection rates. Patients with a high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) load were more likely to show herpes simplex virus 1 detection (p = 0.037). Among patients coinfected with SARS-CoV-2 and HHVs, 26.4% showed central nervous system-associated neurological symptoms and herpetic manifestations. A statistically significant association was observed between neurological changes and HHV-6 detection (p = 0.034). Conclusions The findings showed a high prevalence of herpesvirus in patients with COVID-19. Furthermore,even though SARS-CoV-2 and HHV coinfection was not associated with poorer outcomes, the findings demonstrated the association between neurological symptoms and HHV-6 detection. | Clinical Epidemiology | https://www.researchsquare.com/article/rs-1534929/v1 | |
| A critical examination of research narratives ‘rumours’ and passive community resistance in medical research. | Deborah Nyirenda, Salla Sariola, Nicola Desmond | BMJ Global Health | April 22, 2022 | http://dx.doi.org/10.1136/bmjgh-2021-007563 | Several studies in Africa have reported effects of ‘rumours, misconceptions or misinformation’ on medical research participation and uptake of health interventions. As such, community engagement has sometimes been used for instrumental purposes to enhance acceptability of research or interventions and prevent ‘rumours’. This paper seeks to highlight the value of ongoing engagement with communities to understand research narratives ‘rumours’ reproduced in medical research. We demonstrate that ‘rumours’ are a form of divergent communication or local interpretation of medical research that needs critical attention, and we question the ethics of dismissing such divergent communication. This paper draws on experiences from ethnographical research, which aimed to understand community engagement in medical research projects conducted in Malawi. We observed that even though community meetings were held to improve participation, ‘rumours’ about research influenced decision making. ‘Rumours’ presented local critiques of medical research, legitimate concerns informed by historical experiences and local conceptualisation of health. Structural inequalities, negative outcomes or absence of visible benefits following research participation informed unmet expectations, discontent with research and consequently passive resistance. The sociocultural context where participating research communities often rely on social networks for information nurtured propagation of these divergent perspectives to inform lay discourse around medical research. We conclude that ongoing engagement, critical selfreflection and attempts to decode deeper meaning of ‘rumours’ throughout research implementation is necessary, to show respect and address community concerns expressed through ‘rumours’, enhance informed participation and adoption of future health interventions. | Social Science | https://gh.bmj.com/content/7/4/e007563 |
| Ethical challenges experienced by healthcare workers delivering clinical care during health emergencies and disasters: a rapid review of qualitative studies and thematic synthesis | Mariana Dittborn, Constanza Micolich, Daniela Rojas, Sofia P. Salas | AJOB Empirical Bioethics | April 25, 2022 | https://doi.org/10.1080/23294515.2022.2063996 | Background: The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers’ experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances. Objectives: To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic. Methods: A rapid review of qualitative studies and thematic synthesis was conducted. Medline and Embase were searched from inception to December 2020 using “public health emergency” and “ethical challenges” related keywords. Empirical studies examining ethical challenges experienced by frontline HCWs during health emergencies or disasters were included. We considered that ethical challenges were present when participants and/or authors were uncertain regarding how one should behave, or when different values or ethical principles are compromised when making decisions. Outcome: After deduplication 10,160 titles/abstracts and 224 full texts were screened. Twenty-two articles were included, which were conducted in 15 countries and explored eight health emergency or disaster events. Overall, a total of 452 HCWs participants were included. Data were organized into five major themes with subthemes: HCWs’ vulnerability, Duty to care, Quality of care, Management of healthcare system, and Sociocultural factors. Conclusion: HCWs experienced a great variety of clinical ethical challenges in health emergencies and disaster scenarios. Core themes identified provide evidence-base to inform the development of more comprehensive and supportive ethical guidelines and training programmes for future events, that are grounded on actual experiences of those providing care during emergency and disasters. | Ethics | https://www.tandfonline.com/doi/full/10.1080/23294515.2022.2063996 |
| Global sharing of COVID-19 therapies during a "New Normal" | Nancy S. Jecker, Caesar A. Atuire | bioethics WILEY | April 25, 2022 | https://doi.org/10.1111/bioe.13028 | This paper argues for global sharing of COVID-19 treatments during the COVID-19 pandemic and beyond based on principles of global solidarity. It starts by distinguishing two types of COVID-19 treatments and models sharing strategies for each in small-group scenarios, contrasting groups that are solidaristic with those composed of self-interest maximizers to show the appeal of solidaristic reasoning. It then extends the analysis, arguing that a similar logic should apply within and between nations. To further elaborate global solidarity, the paper distinguishes morally voluntary, sliding-scale, and mandatory versions. It argues for an all-hands-on-deck approach and gives examples to illustrate. The paper concludes that during the COVID-19 crisis, global solidarity is a core value, and global sharing of COVID-19 treatments should be considered a duty of justice, not of charity. | Ethics | https://onlinelibrary.wiley.com/doi/full/10.1111/bioe.13028 |
| Covishield vaccine induces robust immune responses in Bangladeshi adults | Taufiqur Rahman, Bhuiyan, Marjahan Akhtar, Fatema Khaton, Sadia Isfat Ara Rahman, Jannatul Ferdous, A S M Alamgir, Mahbubu Rahman, Zannat Kawser, Imrul Hasan, Stephen B Calderwood, Jason B Harris, Richelle C Charles, Regina C La Rocque, Edward T. Ryan Sayera Banu, Tahmina Shirin, Firdausi Qadri | IJID Regions | April 29, 2022 | https://doi.org/10.1016/j.ijregi.2022.04.006 | Objectives : SARS-CoV-2 specific antibody responses after Covishield vaccination has been evaluated until 6 months after vaccination. Design : We assessed SARS-CoV-2 specific antibody responses by ELISA to recombinant receptor-binding domain of SARS-CoV-2 in 381 adults given the Covishield vaccine at baseline (n=119), 1 month (n=126) and 2 months (n=75) after the 1st dose, 1 month after the 2nd dose (n=161) and monthly for 3 additional months. Results : Over 51% of the vaccinees were seropositive at baseline before vaccination with Covishield and almost all participants (159/161) became seropositive 1 month after 2nd dose. The levels of antibodies peaked at 1 month after receipt of the second dose and then subsequently decreased by 4 months after the first dose; the lowest responses were found at 6 months after first vaccine dose, although significantly higher antibody responses and responder frequencies remained (P<0.0001) compared to baseline. Compared to younger participants, older participants had lower levels (P<0.05) of antibody responses 6 months after first vaccination. Participants who had previous infection with SARS-CoV-2 showed a robust higher antibody response after vaccination. Conclusions : These findings help elucidate longevity of vaccine-specific antibody responses following Covishield and provide information relevant to planning boosting after initial two dose vaccination. | "Virology, Immunology and Diagnostics",Vaccines | https://www.sciencedirect.com/science/article/pii/S2772707622000595?via%3Dihub |
| HIV and COVID-19: juxtaposition of two pandemics | John Nkengasong | The Lancet HIV | May 1, 2022 | https://doi.org/10.1016/S2352-3018(22)00095-9 | none | other,Public Health | https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(22)00095-9/fulltext |
| The assistance gaps in combating COVID-19 in Brazil: for whom, where and when vaccination occurs | Rafael da Silveira Moreira, Emilly Guaris Costa, Lucas Fernando Rodrigues dos Santos, Luiz Henrique Lélis Miranda, Raiany Rodrigues de Oliveira, Ricardo Fusano Romão, Rodolfo Ferreira Cozer and Sarah Cavalcanti Guedes | BMC Infectious Diseases | May 17, 2022 | https://doi.org/10.1186/s12879-022-07449-5 | Background: Following the emergence of the COVID-19 pandemic, the number of infected Brazilian people has increased dramatically since February 2020, with Brazil being amongst the countries with the highest number of cases and deaths. Brazilian vaccination began in January 2021, aimed at priority groups. This study analysed the spatial and temporal evolution of vaccination in Brazil between the 3rd and 21st epidemiological weeks (EW) of 2021. Methods: Spatial and temporal analyses were performed comprising 19 EW. Cases were structured into priority groups—elderly population (EP); healthcare workers (HW); indigenous and quilombola populations (I/Q), dose, vaccine (CoronaVac or AstraZeneca), and place of vaccination. A sweep test was performed to identify vaccination rate clusters. Vaccination rates (VR) were calculated according to a spatial window for each Health Region, indicating clusters above/below expected VR. Based on the discrete Poisson probability model, spatial analysis was performed to detect high/low VR clusters, which were converted into Kernel maps. Points were generated from SaTScan analyses associated with Health Region centroids. Temporal analysis of VR was carried out to identify signifcant trends, and results were converted into temporal cluster graphs. P-value≤0.05 was adopted. Results: Southeast region concentrated most of the vaccines of EP and HW, followed by the Northeast. The latter region had the largest contingent of I/Q vaccinated. In all priority age groups and all regions, a higher percentage of complete CoronaVac vaccination schedules were observed compared with AstraZeneca. The temporal analysis identifed high VR clusters of CoronaVac frst and second dose in the early weeks, except for the EP; of AstraZeneca frst dose, only for HW in the early weeks, and for EP and I/Q in the fnal weeks; of AstraZeneca second dose for all priority groups in the fnal weeks. I/Q populations had the lowest general VR. The spatial profle of VR indicated signifcant regional cluster diferences between the priority groups. Conclusion: This study highlights the importance of establishing vaccination priority groups, considering the asymmetries that a pandemic can trigger, notably in vast geographic areas, to contemplate the main objective of vaccination: to prevent casualties | Clinical Epidemiology | https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07449-5 |
| Redesigning an Electronic Health Record in Argentina to Improve Comprehensive Health Care and Clinical Research | Studies in Health Technology and Informatics | June 1, 2022 | https://doi.org/10.3233/shti220234 | Updating electronic health record systems to meet new clinic needs and government regulations presents an ongoing challenge for health care organizations. To redesign an existing system for two HIV clinics in Argentina, we employed a three-phase approach of exploration, participatory design, and prototyping. The process and resulting architecture of the HIV-centered "RedClin" electronic health record may inform electronic health records at other clinics in Latin America and worldwide. | Clinical Management,other | https://pubmed.ncbi.nlm.nih.gov/35673172/ | |
| Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil: a respondent-driven sampling approach | Maria de Fátima Pessoa Militão de Albuquerque, Wayner Vieira de Souza, Ulisses Ramos Montarroyos, Cresio Romeu Pereira, Cynthia Braga, Thalia Velho Barreto de Araújo, Ricardo Arraes de Alencar Ximenes, Demócrito de Barros Miranda-Filho, Celia Landmann Szwarcwald, Paulo Roberto Borges de Souza-Junior, Morgana Nascimento Xavier, Clarice Neuenschwander Lins de Morais, Gabriela Diniz Militao de Albuquerque, Cristiane Bresani-Salvi, Carolline Araújo Mariz, Noemia Teixeira de Siqueira-Filha, Jadson Mendonça Galindo, Cláudio Luiz França-Neto, Jessyka Mary Vasconcelos Barbosa, Maria Amelia Sousa Mascena Veras, Luana Nepomuceno Gondim Costa Lima, Luciane Nascimento Cruz, Carl Kendall, Ligia Regina Franco Sansigolo Kerr 16, Celina Maria Turchi Martelli 17 | BMJ Open | June 6, 2022 | https://doi.org/10.1136/bmjopen-2021-058369 | Objectives: We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). Design, setting and participants: Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. Outcome measures: The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. Results: We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). Conclusions: This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies. | Clinical Epidemiology | https://pubmed.ncbi.nlm.nih.gov/35667719/ |
| A blank check or a global public good? A qualitative study of how ethics review committee members in Colombia weigh the risks and benefits of broad consent for data and sample sharing during a pandemic | María Consuelo Miranda Montoya, Jackeline Bravo Chamorro, Luz Marina Leegstra, Deyanira Duque Ortiz, Lauren Maxwell | Plos Global Public Health | June 6, 2022 | https://doi.org/10.1371/journal.pgph.0000364 | Broad consent for future use facilitates the reuse of participant-level data and samples, which can conserve limited resources by confirming research findings and facilitate the development and evaluation of public health and clinical advances. Ethics review committees (ERCs) have to balance different stakeholder concerns when evaluating the risks and benefits associated with broad consent for future use. In this qualitative study, we evaluated ERC members’ concerns about different aspects of broad consent, including appropriate governance, community engagement, evaluation of risks and benefits, and communication of broad consent for future use in Colombia, which does not currently have national guidance related to broad consent for future use. We conducted semi-structured, in-depth interviews with 24 ERC members from nine Colombian ERCs. We used thematic analysis to explore ERC members’ concerns related to broad consent for future use. Most ERC members expressed concern about the idea of not specifying the purposes for which data would be used and by whom and suggested that pre-specifying governance procedures and structure would address some of their concerns about broad consent. ERC members emphasized the need for engaging communities and ensuring research participants understood broad consent for future use-related language in informed consent forms. Researchers and research institutions are under increasing pressure to share public health-related data. ERC members play a central role in balancing the priorities of different stakeholders and maintaining their community’s trust in public health research. Further work is needed on guidelines for developing language around broad consent, evaluating community preferences related to data sharing, and developing standards for describing governance for data or sample sharing in the research protocol to address ERC members’ concerns around broad consent for future use. | Data Sharing,Ethics | https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000364 |
| Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study | Dorairaj Prabhakaran , Kavita Singh, Dimple Kondal, Lana Raspail, Bishav Mohan, Toru Kato, Nizal Sarrafzadegan, Shamim Hayder Talukder, Shahin Akter, Mohammad Robed Amin, Fastone Goma, Juan Gomez-Mesa, Ntobeko Ntusi, Francisca Inofomoh, Surender Deora, Evgenii Philippov, Alla Svarovskaya, Alexandra Konradi, Aurelio Puentes, Okechukwu S. Ogah, Bojan Stanetic, Aurora Issa, Friedrich Thienemann, Dafsah Juzar, Ezequiel Zaidel, Sana Sheikh, Dike Ojji, Carolyn S.P. Lam, Junbo Ge, Amitava Banerjee, L. Kristin Newby, Antonio Luiz P. Ribeiro, Samuel Gidding, Fausto Pinto, Pablo Perel, Karen Sliwa, On Behalf of the WHF COVID-19 Study Collaborators | Global Heart | June 15, 2022 | http://doi.org/10.5334/gh.1128 | Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). Methods: Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. Results: Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2–4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2–3 times increased risk of death. Conclusions: The LIC, LMIC, and UMIC’s have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally. | Clinical Epidemiology | https://globalheartjournal.com/articles/10.5334/gh.1128/ |
| Pre-clinical evaluation of antiviral activity of nitazoxanide against SARS-CoV-2. | Jean-Sélim Driouich, Maxime Cochin, Franck Touret, Paul-Rémi Petit, Magali Gilles, Grégory Moureau, Karine Barthélémy, Caroline Laprie, Thanaporn Wattanakul, Palang Chotsiri, Richard M. Hoglund, Joel Tarning, Laurent Fraisse, Peter Sjö, Charles E. Mowbray, Fanny Escudié, van Scandale, Eric Chatelain, Xavier de Lamballerie, Caroline Solas, Antoine Nougairède | eBioMedicine | July 10, 2022 | https://doi.org/10.1016/j.ebiom.2022.104148 | Background To address the emergence of SARS-CoV-2, multiple clinical trials in humans were rapidly started, including those involving an oral treatment by nitazoxanide, despite no or limited pre-clinical evidence of antiviral efficacy. Methods In this work, we present a complete pre-clinical evaluation of the antiviral activity of nitazoxanide against SARS-CoV-2. Findings First, we confirmed the in vitro efficacy of nitazoxanide and tizoxanide (its active metabolite) against SARS-CoV-2. Then, we demonstrated nitazoxanide activity in a reconstructed bronchial human airway epithelium model. In a SARS-CoV-2 virus challenge model in hamsters, oral and intranasal treatment with nitazoxanide failed to impair viral replication in commonly affected organs. We hypothesized that this could be due to insufficient diffusion of the drug into organs of interest. Indeed, our pharmacokinetic study confirmed that concentrations of tizoxanide in organs of interest were always below the in vitro EC50. Interpretation These preclinical results suggest, if directly applicable to humans, that the standard formulation and dosage of nitazoxanide is not effective in providing antiviral therapy for Covid-19. Funding This work was supported by the Fondation de France “call FLASH COVID-19”, project TAMAC, by “Institut national de la santé et de la recherche médicale” through the REACTing (REsearch and ACTion targeting emerging infectious diseases), by REACTING/ANRS MIE under the agreement No. 21180 (‘Activité des molécules antivirales dans le modèle hamster’), by European Virus Archive Global (EVA 213 GLOBAL) funded by the European Union's Horizon 2020 research and innovation program under grant agreement No. 871029 and DNDi under support by the Wellcome Trust Grant ref: 222489/Z/21/Z through the COVID-19 Therapeutics Accelerator”. | Clinical Pharmacology and Drug Candidates | https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00329-2/fulltext |
| Solidarity, Afro-communitarianism, and COVID-19 vaccination. | Cornelius Ewuoso, Tom Obengo, Caesar Atuire | journal of global health | August 9, 2022 | https://doi.org/10.7189%2Fjogh.12.03046 | none | Ethics,Vaccines | https://jogh.org/2022/jogh-12-03046 |
| Ownership of individual-level health data, data sharing, and data governance | Jan Piasecki, Phaik Yeong Cheah | BMC Medical Ethics | October 29, 2022 | https://doi.org/10.1186/s12910-022-00848-y | Background The ownership status of individual-level health data affects the manner in which it is used. In this paper we analyze two competing models of the ownership status of the data discussed in the literature recently: private ownership and public ownership. Main body In this paper we describe the limitations of these two models of data ownership with respect to individual-level health data, in particular in terms of ethical principles of justice and autonomy, risk mitigation, as well as technological, economic, and conceptual issues. We argue that undifferentiated application of neither private ownership nor public ownership will allow us to resolve all the problems associated with effective, equitable, and ethical use of data. We suggest that, instead of focusing on data ownership, we should focus on the institutional and procedural aspects of data governance, such as using Data Access Committees (DACs) or equivalent managed access processes, which can balance the elements of these two ownership frameworks. Conclusion Undifferentiated application of the ownership concept (private or public) is not helpful in resolving problems associated with sharing individual-level health data. DACs or equivalent managed access processes should be an integral part of data governance. They can approve or disapprove data access requests after considering the potential benefits and harms to data subjects, their communities, primary researchers, and the wider society. | Data Sharing | https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00848-y |
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