Mese: Giugno 2020

Du Z, Xu X, Wang L, et al. Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China. Emerg Infect Dis. 2020;26(9):10.3201/eid2609.201932.

Cities across China implemented stringent social distancing measures in early 2020 to curb coronavirus disease outbreaks. We estimated the speed with which these measures contained transmission in cities. A 1-day delay in implementing social distancing resulted in a containment delay of 2.41 (95% CI 0.97-3.86) days.

Fang FC, Naccache SN, Greninger AL. The Laboratory Diagnosis of COVID-19– Frequently-Asked Questions. Clin Infect Dis. 2020;ciaa742.

Diagnostic testing has played and will continue to play a major role in the COVID-19 pandemic. The ability to detect the SARS-CoV-2 coronavirus in respiratory secretions is essential to determine when an individual is infected and potentially infectious to others. Viral detection is used for the identification, management and isolation of individual patients. Viral detection is also used to determine when the virus has entered a community and how rapidly it is spreading. As communities attempt to re-open following periods of shutdown, the detection of both SARS-CoV-2 and specific antibodies recognizing the virus will become increasingly important as a means to assess infection and immunity in individuals and communities. Here we discuss questions commonly asked by clinicians about COVID-19 diagnostic testing.

Lazzarin P, Avagnina I, Divisic A, Agosto C, Giacomelli L, Benini F. Management strategies adopted by a pediatric palliative care network in northern Italy during the COVID-19 pandemic [published online ahead of print, 2020 Jun 13]. Acta Paediatr. 2020;10.1111/apa.15411.

The Veneto region of northern Italy, which has about 5 million inhabitants, was the second area of the country, after Lombardy, to face the spread of COVID-19. After the first case on 21 February 2020, the number of cases increased exponentially, and lockdown was enforced. The regional healthcare system was forced to implement appropriate measures to protect patients and healthcare providers from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes COVID-19, while ensuring continued care.

Long DR, Gombar S, Hogan CA, et al. Occurrence and Timing of Subsequent SARS-CoV-2 RT-PCR Positivity Among Initially Negative Patients [published online ahead of print, 2020 Jun 7]. Clin Infect Dis. 2020;ciaa722.

Using data for 20,912 patients from two large academic health systems, we analyzed the frequency of SARS-CoV-2 RT-PCR test-discordance among individuals initially testing negative by nasopharyngeal swab who were retested on clinical grounds within 7 days. The frequency of subsequent positivity within this window was 3.5% and similar across institutions.

Li H, Xu XL, Dai DW, Huang ZY, Ma Z, Guan YJ. Air Pollution and temperature are associated with increased COVID-19 incidence: a time series study [published online ahead of print, 2020 Jun 2]. Int J Infect Dis. 2020;S1201-9712(20)30383-0.

Objectives: Although the COVID-19 is known to cause by human-to-human transmission, it remains largely unclear whether ambient air pollutants and meteorological parameters could promote its transmission.

Methods: A retrospective study is conducted to study whether air quality index (AQI), four ambient air pollutants (PM2.5, PM10, NO2 and CO) and five meteorological variables (daily temperature, highest temperature, lowest temperature, temperature difference and sunshine duration) could increase COVID-19 incidence in Wuhan and XiaoGan between Jan 26th to Feb 29th in 2020.

Results: First, a significant correlation was found between COVID-19 incidence and AQI in both Wuhan (R2 = 0.13, p < 0.05) and XiaoGan (R2 = 0.223, p < 0.01). Specifically, among four pollutants, COVID-19 incidence was prominently correlated with PM2.5 and NO2 in both cities. In Wuhan, the tightest correlation was observed between NO2 and COVID-19 incidence (R2 = 0.329, p < 0.01). In XiaoGan, in addition to the PM2.5 (R2 = 0.117, p < 0.01) and NO2 (R2 = 0.015, p < 0.05), a notable correlation was also observed between the PM10 and COVID-19 incidence (R2 = 0.105, p < 0.05). Moreover, temperature is the only meteorological parameter that constantly correlated well with COVID-19 incidence in both Wuhan and XiaoGan, but in an inverse correlation (p < 0.05).

Conclusions: AQI, PM2.5, NO2, and temperature are four variables that could promote the sustained transmission of COVID-19.

Nyholm S, Edner A, Myrelid Å, Janols H, Dörenberg R, Diderholm B. Invasive mechanical ventilation in a former preterm infant with COVID-19 . Acta Paediatr. 2020;10.1111/apa.15437.

The consensus to date is that most infants and children only have mild COVID-19 symptoms and few require intensive care. However, there are some described exceptions and this brief report looks at a set of preterm twins born at the University Children’s Hospital in Uppsala Sweden. The girl only had mild respiratory symptoms and stayed 24-hours at the paediatric ward and was then cared for at home, but the boy required intensive care and invasive ventilatory support.

Mithal LB, Machut KZ, Muller WJ, Kociolek LK. SARS-CoV-2 Infection in Infants Less than 90 Days Old . J Pediatr. 2020;S0022-3476(20)30750-2

This is a single-center US case series of 18 infants <90 days old who tested positive for SARS-CoV-2. These infants had a mild febrile illness without significant pulmonary disease. One half were hospitalized; one had bacterial urinary tract co-infection. Nasopharyngeal viral loads were notably high. Latinx ethnicity was overrepresented.

Tscherning C, Sizun J, Kuhn P. Promoting attachment between parents and neonates despite the COVID-19 pandemic. Acta Paediatr. 2020;10.1111/apa.15455.

Social distancing is the only option available during the COVID-19 pandemic until a vaccine is developed. However, this is having a major impact on human relationships and bonding between parents and neonates is a major concern. Separation during this health emergency could have lifelong consequences for offspring and there are even greater concerns if newborn infants are sick or vulnerable and need intensive care. We look at how bonding can be safely supported and maintained without risking infecting neonates, by comparing the international guidelines and proposing safe actions within those frameworks.

Sentilhes L, De Marcillac F, Jouffrieau C, et al. COVID-19 in pregnancy was associated with maternal morbidity and preterm birth . Am J Obstet Gynecol. 2020;S0002-9378(20)30639-6

Background: Despite the mainly reassuring outcomes for pregnant women with COVID-19 infection reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of COVID-19 on pregnancy outcomes. This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with COVID-19 disease.

Study design: This retrospective single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to version 7.0 of the Chinese management guideline) COVID-19 infection, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1 to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records.

Results: The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) COVID-19 infection. Of these, 32 had an ongoing pregnancy, one a miscarriage, and 21 live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their COVID-19-related condition for 23.8% (5/21): 14.3% (3/21) before 32 weeks’ gestation and 9.5% (2/21) before 28 weeks. Oxygen support was required for 24.1% (13/54), including high flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, three, aged 35 years or older with positive COVID-19 RT-PCR, had respiratory failure requiring indicated delivery before 29 weeks’ gestation. All three women were overweight or obese, and two had an additional comorbidity.

Conclusion: COVID-19 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in noninfected pregnant women, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.
The consensus to date is that most infants and children only have mild COVID-19 symptoms and few require intensive care. However, there are some described exceptions and this brief report looks at a set of preterm twins born at the University Children’s Hospital in Uppsala Sweden. The girl only had mild respiratory symptoms and stayed 24-hours at the paediatric ward and was then cared for at home, but the boy required intensive care and invasive ventilatory support.

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