RESUMO
BACKGROUND: Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus. METHODS: A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of SARS-CoV-2 following a reactive self-test result. Bivariate and multivariate regression analyses were performed. RESULTS: Overall, 417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of SARS-CoV-2 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%). CONCLUSION: Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases, self-testing could be a good approach for mass case detection by Brazil's already overstretched Unified Health System.
Assuntos
COVID-19 , SARS-CoV-2 , Atitude , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Autoteste , Inquéritos e QuestionáriosRESUMO
With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.
Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Quarentena , SARS-CoV-2/genéticaRESUMO
Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.
RESUMO
RESUMEN Se validó y evaluó un método de RT-PCR en tiempo real usando cebadores y sondas específicas para los genes RdRP de SARS-CoV-2 y GAPDH de humanos; este último fue usado como control endógeno. Se evaluó la especificidad y sensibilidad; además, se evaluó otros parámetros como la robustez, la repetibilidad, reproducibilidad, comparabilidad y el límite de detección. La sensibilidad, especificidad, los valores predictivos positivo y negativo, la robustez, comparabilidad y la repetibilidad-reproducibilidad de la prueba de RT-PCR en tiempo real dúplex fue de 100%, con un límite de detección de 100 copias/µL, de acuerdo con los criterios de aceptación establecidos para validación del protocolo. Esta prueba estandarizada es una buena alternativa para el diagnóstico de COVID-19; además, la prueba fue aplicada de manera exitosa en personas sospechosas de la enfermedad permitiendo controlar el número de falsos negativos.
ABSTRACT The present work validated and evaluated a duplex real-time RT-PCR using specific primers and probes for genes RdRp from SARS-CoV-2 and GAPDH from humans; the latter was used as an endogenous control in all reactions. We evaluated the specificity, the sensitivity, the robustness, the reproducibility, the repeatability, the comparability, and the limit of detection. The predictive positive and negative values (PPV and PNV, respectively) and all the parameters evaluated using our duplex real-time RT-PCR was 100%. The detection limit was 100 copies/µL according to the acceptance criteria established for the validation of this protocol. Our duplex real-time RT-PCR demonstrated to be a good alternative for the diagnosis of COVID-19; in addition, this PCR was used adequately in suspicion of COVID-19, allowing it to control the number of false-negatives.
Assuntos
Estudo de Validação , Técnicas de Diagnóstico Molecular , SARS-CoV-2 , Teste para COVID-19 , COVID-19RESUMO
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19 (Coronavirus disease 2019). This disease was detected in the city of Wuhan in China in December 2019. People infected with COVID-19 shows varying manifestations, depending on their health and age. The most common symptoms are fever, cough, myalgia, fatigue, odynophagia, and dyspnea. Infected adults older 60 years of age are the group of patients most susceptible to severe COVID-19 states and present comor-bidity in the presence of chronic diseases. On the other hand, it is also essential to have tests to detect SARS-COV-2 in people and follow the evolution of COVID-19 quickly, reliably, and cheap. To achieve this, there are real-time reverse transcription pol-ymerase chain reaction (RT-PCR) tests, isothermal nucleic acid amplification, and enzyme immunostimulation. Currently, there are no drug treatments to prevent infection and to combat the virus's effects. However, different research groups that are conduct-ing in vitro, in vivo, and in silico tests to find drugs able to provide an immune response and to control infection in humans with SARS-CoV-2. Chloroquine, hydroxychloroquine, remdesivir, interferon-ï¡2b, and oseltamivir are some pharmacological options evaluated in clinical trials for prophylaxis of COVID-19. The purpose of this review is to establish a reference framework for taxonomic classification of SARS-CoV-2 and the relationship they have with other CoVs, as well as their structure and propaga-tion pathways in humans. The characteristics and symptoms presented by patients with COVID-19, the detection methods, and possible treatments are also presented.
El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) es responsable de la enfermedad denominada COVID-19 (acrónimo del inglés Coronavirus Disease-2019). Esta enfermedad fue detectada inicialmente en la ciudad de Wuhan, China en diciembre de 2019. Las personas contagiadas con COVID-19 presentan síntomas variados, dependiendo de su estado de salud y edad. Los síntomas más comunes son fiebre, tos, mialgia, fatiga, odinofagia y disnea. También se ha observado que en algunos pacientes, la infección es asintomática. Los adultos mayores de 60 años infectados son el grupo de pacientes más susceptibles a desarrollar estados severos de COVID-19 y se presenta comorbilidad en presencia de enfermedades crónicas. Por otra parte, también es importante disponer de pruebas que permitan detectar al SARS-COV-2 y seguir la evolución de COVID-19 de forma rápida, confiable y barata. Para lograr esto, existen pruebas de reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR), de amplificación isotérmica de ácido nucleico y de inmunoestimulación enzimática. Actualmente, no existen tratamientos para la prevención del contagio y combatir los efectos del virus en la salud humana. Sin embargo, en el mundo hay grupos de investigación que están realizando pruebas in vitro, in vivo e in silico para encontrar fármacos que sean capaces de prevenir y/o controlar la infección en humanos con SARS-CoV-2. La cloroquina, hidroxicloroquina, remdesivir, interferon-ï¡2b y oseltamivir son algunas de las opciones farmacológicas que están siendo evaluadas en pruebas clínicas para la profilaxis de COVID-19. El objetivo de la presente revisión consiste en establecer un marco de referencia de la clasificación taxonómica del SARS-CoV-2 y la relación que guardan con otros coronavirus, así como su estructura y forma de propagarse en el ser humano. También se presentan las características y síntomas de pacientes con COVID-19, los métodos de detección y potenciales tratamientos.
Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Fatores Etários , Betacoronavirus/classificação , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Vacinas contra COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Fatores de Risco , SARS-CoV-2 , Tratamento Farmacológico da COVID-19RESUMO
Background: The coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 has challenged obstetrical care providers. Universal testing on labor and delivery units has been implemented by many hospitals to ensure patient and staff safety. Asymptomatic carrier rates are expected to vary based on geographic differences in disease prevalence, although differences within the same city have not been reported previously. In addition, clinical follow-up of women who had a negative result for severe acute respiratory syndrome coronavirus 2 during obstetrical hospitalization has not been included in any previous reports. Objective: This study aimed to describe the prevalence of positive severe acute respiratory syndrome coronavirus 2 test results among asymptomatic pregnant women at 2 Philadelphia obstetrical hospitals, characterize the clinical course of those who had a positive result, and report symptom development among all women tested in the 2 weeks after hospitalization. Study Design: This is an observational study of asymptomatic pregnant women who underwent severe acute respiratory syndrome coronavirus 2 testing at 2 academic health centers (Hospital of the University of Pennsylvania and Pennsylvania Hospital) in Philadelphia, Pennsylvania, between April 13, 2020, and April 26, 2020. All women tested were contacted via telephone for symptom follow-up at 1 and 2 weeks after discharge. Asymptomatic positive test rates are reported for the overall population and by hospital. The hospital and 2-week posthospital course are described for women who had a positive result for severe acute respiratory syndrome coronavirus 2. Posthospital symptom development among women who had a negative result for severe acute respiratory syndrome coronavirus 2 is also described. Results: A total of 318 asymptomatic women underwent severe acute respiratory syndrome coronavirus 2 testing during this 2-week period; 8 women had a positive result. The overall asymptomatic test positive rate was 2.5%. The rate at Hospital of the University of Pennsylvania was 3.8% compared with 1.3% at Pennsylvania Hospital (P=.283). Of note, 3 women (37.5%) who were initially asymptomatic developed mild symptoms in the 2 weeks after a positive test result. Repeat severe acute respiratory syndrome coronavirus 2 testing was performed in 14 of the 310 women (4.5%) who initially had a negative result; 2 women (0.6%) had a positive result on repeat testing. Moreover, 242 (78.1%) and 213 (68.7%) of the 310 women who had a negative result for severe acute respiratory syndrome coronavirus 2 at the time of the initial hospitalization were followed up via telephone at 1 and 2 weeks after admission, respectively. Viral symptoms, including fevers, chills, shortness of breath, or cough, were self-reported in 4.5% and 4.2% of these women at 1 and 2 weeks after discharge, respectively. Conclusion: The asymptomatic positive severe acute respiratory syndrome coronavirus 2 test rate among an obstetrical population in Philadelphia differed between 2 hospitals and was lower than that described in other geographic regions. This supports the importance of institution-specific testing protocols. The development of symptomatic severe acute respiratory syndrome coronavirus 2 infection after hospitalization among women with initial negative test results is uncommon.
Assuntos
COVID-19 , Portador Sadio , Hospitalização/estatística & dados numéricos , Complicações Infecciosas na Gravidez , SARS-CoV-2/isolamento & purificação , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/fisiopatologia , Teste para COVID-19/métodos , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Feminino , Humanos , Philadelphia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Prevalência , Avaliação de Sintomas/estatística & dados numéricosRESUMO
Coronaviruses (CoV) are pathogens that are transmitted to animals and humans; they spread around the world. Six types of coronavirus have been identified as causing human disease: four cause mild respiratory symptoms, while two types, the Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS), have caused epidemics with high mortality rates. Human coronaviruses cause common cold, lead to lower respiratory tract infections and are involved in pediatric gastroenteritis. Currently, the coronavirus SARS-CoV-2 has been transmitted between species, included humans, and is a very virulent respiratory virus, causing the disease known as COVID-19, which to date, has not an authorized medical treatment. The World Health Organization announced that the outbreak of COVID-19 has been upgraded from a health emergency to a pandemic. Therefore, the objectives of this paper are to mention the basic concepts of coronavirus (structure, genome, mutation and recombination), its epidemiological description, animal-human transmission mechanism, pathogenesis and therapeutics.
Los coronavirus (CoV) son patógenos que se transmiten a los animales y a los humanos; tienen una distribución mundial. Se han identificado seis tipos de CoV como causantes de enfermedades humanas: cuatro causan síntomas respiratorios leves, mientras que dos tipos, el síndrome respiratorio del Medio Oriente (MERS) y el síndrome respiratorio agudo severo (SARS), han causado epidemias con altas tasas de mortalidad. Los coronavirus humanos causan el resfriado común, provocan infecciones de las vías respiratorias inferiores y están implicados en la gastroenteritis infantil. En la actualidad, el coronavirus SARS-CoV-2 se ha transmitido entre especies, incluido el hombre, y tiene la característica de ser un virus respiratorio muy virulento que causa la enfermedad conocida como COVID-19, la cual hasta la fecha no tiene un tratamiento médico autorizado. La Organización Mundial de la Salud anunció que el brote de COVID-19 ha pasado de ser una emergencia sanitaria a una pandemia. Por lo tanto, los objetivos de este documento son mencionar las generalidades de los coronavirus (estructura, genoma, mutación y recombinación), la descripción epidemiológica, el mecanismo de transmisión entre animales y humanos, la patogénesis y la terapéutica.
RESUMO
El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) es responsable de la enfermedad denominada COVID-19 (acrónimo del inglés Coronavirus Disease-2019). Esta enfermedad fue detectada inicialmente en la ciudad de Wuhan, China en diciembre de 2019. Las personas contagiadas con COVID-19 presentan síntomas variados, dependiendo de su estado de salud y edad. Los síntomas más comunes son fiebre, tos, mialgia, fatiga, odinofagia y disnea. También se ha observado que en algunos pacientes, la infección es asintomática. Los adultos mayores de 60 años infectados son el grupo de pacientes más susceptibles a desarrollar estados severos de COVID-19 y se presenta comorbilidad en presencia de enfermedades crónicas. Por otra parte, también es importante disponer de pruebas que permitan detectar al SARS-COV-2 y seguir la evolución de COVID-19 de forma rápida, confiable y barata. Para lograr esto, existen pruebas de reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR), de amplificación isotérmica de ácido nucleico y de inmunoestimulación enzimática. Actualmente, no existen tratamientos para la prevención del contagio y combatir los efectos del virus en la salud humana. Sin embargo, en el mundo hay grupos de investigación que están realizando pruebas in vitro, in vivo e in silico para encontrar fármacos que sean capaces de prevenir y/o controlar la infección en humanos con SARS-CoV-2. La cloroquina, hidroxicloroquina, remdesivir, interferon-ï¡2b y oseltamivir son algunas de las opciones farmacológicas que están siendo evaluadas en pruebas clínicas para la profilaxis de COVID-19. El objetivo de la presente revisión consiste en establecer un marco de referencia de la clasificación taxonómica del SARS-CoV-2 y la relación que guardan con otros coronavirus, así como su estructura y forma de propagarse en el ser humano. También se presentan las características y síntomas de pacientes con COVID-19, los métodos de detección y potenciales tratamientos.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19 (Coronavirus disease 2019). This disease was detected in the city of Wuhan in China in December 2019. People infected with COVID-19 shows varying manifestations, depending on their health and age. The most common symptoms are fever, cough, myalgia, fatigue, odynophagia, and dyspnea. Infected adults older 60 years of age are the group of patients most susceptible to severe COVID-19 states and present comor-bidity in the presence of chronic diseases. On the other hand, it is also essential to have tests to detect SARS-COV-2 in people and follow the evolution of COVID-19 quickly, reliably, and cheap. To achieve this, there are real-time reverse transcription pol-ymerase chain reaction (RT-PCR) tests, isothermal nucleic acid amplification, and enzyme immunostimulation. Currently, there are no drug treatments to prevent infection and to combat the virus's effects. However, different research groups that are conduct-ing in vitro, in vivo, and in silico tests to find drugs able to provide an immune response and to control infection in humans with SARS-CoV-2. Chloroquine, hydroxychloroquine, remdesivir, interferon-ï¡2b, and oseltamivir are some pharmacological options evaluated in clinical trials for prophylaxis of COVID-19. The purpose of this review is to establish a reference framework for taxonomic classification of SARS-CoV-2 and the relationship they have with other CoVs, as well as their structure and propaga-tion pathways in humans. The characteristics and symptoms presented by patients with COVID-19, the detection methods, and possible treatments are also presented.