Back to the medical classes-Part I- Strategy for return to the presential practices during COVID-19 pandemics in a Brazilian Medical School

Introduction: In Brazil, practices of medical students have been interrupted due to COVID-19 to meet emergency demands. Aim: To describe a strategy for a controlled return to the presential practices for medical students. Methods: We developed a standardized protocol to be applied before and during the return of the practical classes in medical students of Universidade Federal Fluminense, in the follow months after COVID-19 pandemic beginning. The protocol was comprised in three parts: Remote training on COVID-19 prevention; Face-to-face training focused in COVID-19 prevention, handwashing and personal protective equipment use; Investigation of students COVID-19 status before starting practical activities and weekly monitoring for COVID-19 during seven weeks. The training was done by medical teachers in small groups for medical students of the last lective semester. Results: The classes were interrupted on March 12, 2020 and returned in August 10, 2020. Seventy-one students were trained and followed. The mean age was 26.6 years (26.7 +/- 0.835) and 54% were female. Forty-nine (69%) students over 71 had a private health insurance, 60 (84.5%) shared a house/apartment with one or more person and 12(16.9%) reported a previous comorbidity. Eighteen (25.4%) over 71 reported previous symptoms of COVID-19, being positive in two students. During the follow-up, fourteen (19.7%) over 71 students were placed in quarantine due to signals/symptoms compatible with COVID-19 or contact with symptomatic case. Only two cases (2.8%) were confirmed and occurred in Brazilian epidemiological week 37. Conclusion: The protocol was successful in minimizing COVID-19 acquisition during practical classes of medical students.

Measuring odds of various COVID-19 infection prevention & control measures among the contacts traced during trace test and quarantine activities at district Quetta (An un-matched case control study).

Background: The second wave of COVID-19 pandemic has started globally, right now globally 220 countries are infected and a total of 71351695 confirmed cases and 1612372 deaths due to COVID-19 has been reported so far1. As of today i.e. (16th Dec 2020) a total of 11430955 new COVID-19 confirmed cases have been reported across the south-east asia1. These cases are showing an increasing trend in all the Asian countries including Pakistan1. Across Pakistan till date 440787 new confirmed COVID-19 cases have been reported across the Pakistan showing a doubling time of 10.63 days (95% C.I 9.68- 11.8), while a total of 8832 new deaths have been reported across the Pakistan making the double time for death as 11.11 days (95% C.I 4.04-14.86) 1. Till the development and availability of a vaccine the only tools that can help prevent the spread of COVID-19 are IPC measures violating them can result in a quick spread across the population3. This study was conducted to assess the odds of various COVID-19 IPC measures among the Contacts of an index COVID-19 case traced by Provincial Disease Surveillance & Response unit Quetta. Methodology: Sample Size & Sampling technique: Using the detailed epidemiological reports of 600 COVID-19 contacts identified during the trace test and quarantine field activities form 1st October till 30th October 2020 in district Quetta, from this data a sample of 300 individuals was selected for this study using Simple random sampling technique. Study Design: Considering different exposure rates and pandemic situation an Un-matched Case control study study was conducted where Cases were defined as Every PCR positive contact (Symptomatic or asymptomatic) for any index case similarly Controls were defined as Every PCR negative contact (Symptomatic or asymptomatic) for any index case who was home quarantined for 14 days based on suspicion by PDSRU team. A set ratio of 1:2 for cases & controls respectively was used for this study. Results: The odds for various IPC measures like Knowingly and intentionally Contacted with a COVID-19 positive case, Family member of the index COVID-19 case, Knowingly and intentionally received an object handed over by a COVID-19 Positive case, Touched the same surface/surfaces after it was touched by the index case, Not doing regular Hand washing, Knowingly and intentionally did not follow the government SOPs of Social Distancing During encounter with a positive symptomatic case, Knowingly and intentionallydid not Follow the government SOPs of Social Distancing During sharing of bedroom and toilet with positive symptomatic case, used the same vehicle after it was used by the COVID-19 index case ,Spoke with Positive COVID-19 index case for more than 15mins few days before catching the disease, Individual did not use a face mask during all of his contact episodes with the positive index case, Participating in gathering or social events were all found to be poorly followed by the PCR positive contacts.

Genomic epidemiological analysis of SARS-CoV-2 household transmission

Family clusters have contributed significantly to the onward spread of SARS-CoV-2. However, the dynamics of viral transmission in this setting remain incompletely understood. We describe the clinical and viral-phylogenetic characteristics of a family cluster of SARS-CoV-2 infections with a high attack rate, and explore how whole-genome sequencing (WGS) can inform outbreak investigations in this context. In this cluster, the first symptomatic case was a 22-month-old infant who developed rhinorrhoea and sneezing 2 days prior to attending a family gathering. Subsequently, seven family members in attendance at this event were diagnosed with SARS-CoV-2 infections, including the infant described. WGS revealed indistinguishable SARS-CoV-2 genomes recovered from the adults at the gathering, which were closely related genetically to B.1 lineage viruses circulating in the local community. However, a divergent viral sub-lineage was recovered from the infant and another child, each harbouring a distinguishing spike substitution (N30S). This suggested that the infant was unlikely to be the primary case, despite displaying symptoms first, and additional analysis of her nasopharyngeal swab revealed a picornavirus co-infection to account for her early symptoms. Our findings demonstrate how WGS can elucidate the transmission dynamics of SARS-CoV-2 infections within household clusters and provide useful information to support outbreak investigations. Additionally, our description of SARS-CoV-2 viral lineages and notable variants circulating in Ireland to date provides an important genomic-epidemiological baseline in the context of vaccine introduction.

Impact of Corona virus Outbreak on Climate and air Quality

All over the world, there is a new target of public health emergency looming the world along with an appearance and distribution of the novel coronavirus disease (2019-nCoV) also known as Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). This Virus initially generated in bats and then after transferred to a human being over unknown animal playing the role of mediator in Wuhan, China in December 2019. This virus is passed by breathing or in contact with an infected person’s droplets. The Incubation period is between 2 to 14 days for COVID-19, that is the time between exposure of the virus (person becoming infected) and symptom on that person, is on an average of 5-6 days, however it can goes up to 14 days. Throughout this period, which can be also known as “pre-symptomatic” period, some of the infected patients or persons can be contagious. That is why, transferal from a pre-symptomatic case can happen before the symptoms onset. Where there is few number of case studies and reports, pre-symptomatic transferal has been documented via contact with someone who is diagnosed with virus and increase investigation of that particular clusters of total confirmed cases. The main problem is that the symptoms are just like the regular flu that are cough, fever, sore throat, fatigue and breathlessness. This virus is moderate or mild in most of the people, but in elder ones, it may proceed to pneumonia, multi-organ dysfunction and Acute Respiratory Distress Syndrome (ARDS). Coronavirus has significant consequences on the Health system, mainly on cardiovascular diseases and on the environment.

Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China

As of February 13, 2020, there have been 59,863 laboratory-confirmed cases of COVID-19 infections in mainland China, including 1,367 deaths. A key public health priority during the emergence of a novel pathogen is estimating clinical severity. Here we estimated the symptomatic case-fatality risk (sCFR; the probability of dying from the infection after developing symptoms) of COVID-19 in Wuhan using public and published information. We estimated that sCFR was 0.5% (0.1%-1.3%), 0.5% (0.2%-1.1%) and 2.7% (1.5%-4.7%) for those aged 15-44, 45-64 and >64 years. The overall sCFR among those aged ≥15 years was 1.4% (0.8%-2.0%). Authors Joseph T Wu and Kathy Leung contributed equally to this work