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High case counts after the Gamma (P. 1) variant of severe acute respiratory syndrome coronavirus 2 emerged in Brazil raised concerns that previously infected persons might become reinfected. Investigation of a cluster of coronavirus disease cases in Parintins, in the Brazilian Amazon, suggested household transmission but did not identify high rates of reinfection.

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant has been hypothesized to cause more severe illness than previous variants, especially in children. Successive SARS-CoV-2 IgG serosurveys in the Brazilian Amazon showed that age-specific attack rates and proportions of symptomatic SARS-CoV-2 infections were similar before and after Gamma variant emergence.

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A 38-year-old woman with confirmed SARS-CoV-2 infection developed dysphagia to both solids and liquids. A fiberoptic nasolaryngoscopy and a videofluoroscopy swallowing study showed right vocal cord paresis, tenth cranial nerve neuropathy, as well as oral, hypopharynx, and supraglottic hypoesthesia. Orotracheal intubation was not required. The patient was fully recovered after undergoing a multidisciplinary rehabilitation program that included speech and deglutition therapy.

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We documented 4 cases of severe acute respiratory syndrome coronavirus 2 reinfection by non-variant of concern strains among healthcare workers in Campinas, Brazil. We isolated infectious particles from nasopharyngeal secretions during both infection episodes. Improved and continued protection measures are necessary to mitigate the risk for reinfection among healthcare workers.

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Patients with severe coronavirus disease (COVID-19) may have COVID-19-associated invasive mold infection (CAIMI) develop. We report 16 cases of CAIMI among 146 nonimmunocompromised patients with severe COVID-19 at an academic hospital in Santiago, Chile. These rates correspond to a CAIMI incidence of 11%; the mortality rate for these patients was 31.2%.

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SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription-polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.

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In December 2020, research surveillance detected the B.1.1.7 lineage of severe acute respiratory syndrome coronavirus 2 in São Paulo, Brazil. Rapid genomic sequencing and phylogenetic analysis revealed 2 distinct introductions of the lineage. One patient reported no international travel. There may be more infections with this lineage in Brazil than reported.

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ABSTRACT SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription-polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.

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INTRODUCTION: SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. AIM: This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. METHODS: A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. RESULTS: A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. CONCLUSION: A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.

INTRODUCCIÓN: La pandemia por SARS CoV-2 está presionando fuertemente la capacidad de respuesta de los sistemas de salud en todo el mundo, siendo uno de los aspectos más importantes el aumento masivo de pacientes que requerirán utilizar camas hospitalarias de cuidados intensivos. OBJETIVO: Este estudio propone una metodología para estimar el momento de saturación de las camas de cuidados intensivos hospitalarios (camas críticas) y determinar el número de unidades requeridas para compensar dicha saturación. MÉTODO: Se analizaron 22 016 pacientes con confirmación diagnóstica para COVID-19 provocada por SARS-CoV-2, entre el 4 de marzo y el 5 de mayo de 2020 a nivel nacional. Sobre la base de información del Ministerio de Salud de Chile y a anuncios ministeriales en medios de prensa, se estimó una disponibilidad total actual de 1900 a 2200 camas críticas totales. Se utilizó la función de Gompertz para estimar el número esperado de pacientes COVID-19 y evaluar su exposición a la oferta disponible de camas de cuidados intensivos en varios escenarios posibles. Para ello se tomó en cuenta la oferta de camas críticas totales, el índice ocupacional promedio, y la demanda de pacientes COVID-19 que requerirán cama de cuidados intensivos. RESULTADOS: Considerando diferentes escenarios, entre el 11 y el 27 de mayo podría ser alcanzado el 100% de ocupación de camas críticas totales. Esta condición podría extenderse por unos 48 días dependiendo como se maneje la sobredemanda esperada. CONCLUSIÓN: Se puede establecer una ventana de operaciones relativamente estrecha, de 4 a 8 semanas, para mitigar la inminente saturación de camas críticas hospitalarias, producto de la demanda de pacientes COVID-19.

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INTRODUCCIÓN: La pandemia por SARS CoV-2 está presionando fuertemente la capacidad de respuesta de los sistemas de salud en todo el mundo, siendo uno de los aspectos más importantes el aumento masivo de pacientes que requerirán utilizar camas hospitalarias de cuidados intensivos. OBJETIVO: Este estudio propone una metodología para estimar el momento de saturación de las camas de cuidados intensivos hospitalarios (camas críticas) y determinar el número de unidades requeridas para compensar dicha saturación. MÉTODO: Se analizaron 22 016 pacientes con confirmación diagnóstica para COVID-19 provocada por SARS-CoV-2, entre el 4 de marzo y el 5 de mayo de 2020 a nivel nacional. Sobre la base de información del Ministerio de Salud de Chile y a anuncios ministeriales en medios de prensa, se estimó una disponibilidad total actual de 1900 a 2200 camas críticas totales. Se utilizó la función de Gompertz para estimar el número esperado de pacientes COVID-19 y evaluar su exposición a la oferta disponible de camas de cuidados intensivos en varios escenarios posibles. Para ello se tomó en cuenta la oferta de camas críticas totales, el índice ocupacional promedio, y la demanda de pacientes COVID-19 que requerirán cama de cuidados intensivos. RESULTADOS: Considerando diferentes escenarios, entre el 11 y el 27 de mayo podría ser alcanzado el 100% de ocupación de camas críticas totales. Esta condición podría extenderse por unos 48 días dependiendo como se maneje la sobredemanda esperada. CONCLUSIÓN: Se puede establecer una ventana de operaciones relativamente estrecha, de 4 a 8 semanas, para mitigar la inminente saturación de camas críticas hospitalarias, producto de la demanda de pacientes COVID-19.

INTRODUCTION: SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. AIM: This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. METHODS: A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. RESULTS: A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. CONCLUSION: A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.

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It has been speculated that some drugs can be used against SARS-CoV-2. As for antiretrovirals, the follow-up of pre-exposure prophylaxis (PrEP) users during the coronavirus disease 2019 (COVID-19) outbreak may help to understand the potential protective effect of PrEP against SARS-CoV-2. We aimed to identify associations between oral PrEP use and COVID-19-related symptoms self-reporting. Phone call interviews or digital investigation (through WhatsApp® or e-mail) about oral PrEP regular use, social distancing, exposure to suspected or confirmed cases of SARS-CoV-2 infection and COVID-19-related symptoms. Among 108 individuals, the majority were cisgender, white and gay men. Although most of the individuals engaged in social distancing (68.52%), they kept on taking PrEP (75.93%). Few people have had contact with suspected or confirmed cases of COVID-19 (12.04%), but some had COVID-19-related symptoms the month before the interview (27.78%) including rhinorrheoa (56.67%), cough (53.33%), asthaenia (50.00%) and headache (43.33%). Also, oral PrEP was associated with lower self-reporting COVID-19-symptoms (OR 0.26, 95% CI 0.07-0.96, P = 0.04; h = 0.92) even after controlling confounders as social distancing, age, body-mass index and morbidities . In our sample, the regular use of oral PrEP was associated with lower self-reporting of COVID-19-related symptoms during the outbreak in São Paulo, Brazil.

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RESUMEN La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

ABSTRACT During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

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RESUMEN La enfermedad del coronavirus 2019 (COVID-19) es poco frecuente en niños y su salud se ve poco comprometida en la mayoría de casos. La presentación clínica más común es tos, fiebre y eritema faríngeo, los casos graves suelen presentarse con taquipnea. El curso de la enfermedad es de una a dos semanas. Los hallazgos de laboratorio son inespecíficos, entre ellos, linfopenia, elevación de la proteína C reactiva y la procalcitonina. En fases iniciales, la radiografía torácica es usualmente normal, y los hallazgos tomográficos más comunes son consolidaciones con signo del halo, vidrio esmerilado y nódulos pequeños, que afectan principalmente las zonas subpleurales. El manejo es sintomático y, en los casos graves, debe estar enfocado a brindar soporte respiratorio. Se recomienda que la manipulación de las secreciones respiratorias sea limitada y que se tengan las mismas precauciones para evitar contaminación que en pacientes adultos.

ABSTRACT COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.

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