[신간의 별자리x] 우리/미술, 그리고 ‘슬픔의 박물관’

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Sustainable Development Goals

Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage.

Background The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our approach Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing activities Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.

/pdf/response-to-the-novel-corona-virus-covid-19-pandemic-across-3opsajuer9.pdf

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Coronavirus disease 2019 (Covid-19) poses an important occupational health risk to health workers (HWs) that has attracted global scrutiny. To date, several thousand HWs globally have been reported as infected with the severe acute respiratory syndrome coronavirus 2 virus that causes the disease. It is therefore a public health priority for policymakers to understand risk factors for this vulnerable group to avert occupational transmission. A rapid review was carried out on 20 April 2020 on Covid-19 risk factors among HWs in PubMed, Google Scholar, and EBSCOHost Web (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, CINAHL with Full Text, APA PsycInfo, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition) and WHO Global Database. We also searched for preprints on the medRxiv database. We searched for reports, reviews, and primary observational studies (case control, case cross-over, cross-sectional, and cohort). The review included studies conducted among HWs with Covid-19 that reported risk factors irrespective of their sample size. Eleven studies met the inclusion criteria. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions were identified as risk factors for Covid-19 among HWs. In the context of Covid-19, HWs face an unprecedented occupational risk of morbidity and mortality. There is need for rapid development of sustainable measures that protect HWs from the pandemic.

COVID-19 Risk Factors Among Health Workers: A Rapid Review

COVID-19 Vaccine Roll-Out in South Africa and Zimbabwe: Urgent Need to Address Community Preparedness, Fears and Hesitancy

Global powerhouses with tried and tested health systems have struggled to contain the COVID-19 pandemic. One is left to wonder what will be left of Africa, the second most populous continent after Asia, which is torn by civil wars, hunger, and diseases like AIDS and TB and, in recent years, the Ebola Virus Disease (EVD). The majority of countries' health systems, already dependent on donor aid, are ill-equipped and under-resourced to deal with the raging pandemic. There is a lack of isolation and intensive care infrastructure, ventilators, and financial resources to bankroll the fight against COVID-19 pandemic. However, there is some cause for optimism, for example, in West Africa where infrastructure like diagnostic testing facilities, intensive care units, surveillance, and systems for reporting emergencies used during the EVD outbreak of 2013-2016 can be leveraged to fight the COVID-19 pandemic. Further, a number of African countries have responded swiftly by activating the necessary political and financial tools to combat the pandemic. Technical support from continental bodies like the Africa Centers for Disease Control and global development partners has improved the capacity of the continent to handle the pandemic. In this article, the authors unpack, review, and share a perspective on Africa's capacity to contain and control the COVID-19 pandemic and review the current response.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.26159

COVID-19: A perspective on Africa's capacity and response.

Coronavirus disease 2019 (COVID-19) has infected over nineteen million people globally with over 700 ​000 fatalities as of 9 August 2020. To date, Africa has recorded the least amount of COVID-19 confirmed cases. As of 9 August 2020, Africa has 1, 037, 135 cases compared to 10, 615, 855 in Americas and 3, 061, 264 in Europe. In this piece, the authors unpack the low numbers of laboratory confirmed COVID-19 cases in Africa - is it a case of limited testing capacity due to poor health systems or otherwise?

COVID-19: Unpacking the low number of cases in Africa

In December 2019, China reported the emergence of a pneumonia of unknown cause in Wuhan [1]. By 7 January 2020, the etiology of the pneumonia was attributed to a virus of the coronavirus family, and later on the disease was named coronavirus disease (COVID-19) on 11 February 2020 by the WHO [2, 3]. The symptoms of COVID-19 appear after an average incubation period of 5.2 days [1]. The median period from the onset of the disease to death is 14 days (range 6 to 41) [3]. Transmission of the virus is human to human through direct contact, or air droplets from infected persons spread by coughing or sneezing. The infection droplets can also contaminate surfaces, and the virus can remain infectious for several days in the environment, providing a reservoir for the infection [4]. The majority of infections go into remission without intervention, while approximately 15% will require hospitalization, with approximately 5% of these requiring intensive care [3, 4]. Unmitigated spread of COVID-19 creates pressure on health systems, and diverts resources that could have otherwise been better utilized for other health conditions. Sub-Saharan Africa health systems are already strained and are characterized by poor health outcomes with high mortality rates linked to the triple burden of disease (HIV, tuberculosis, and non-communicable diseases) and out of pocket healthcare. In response to the epidemic China imposed restriction such as quarantine (lockdown) of the whole city of Wuhan. This model proved efficacious, resulting in some Sub-Saharan Africa countries implementing the same. The lockdown measures are in no way aimed at ending the pandemic but seek to protect the health systems of countries from being overwhelmed by flood of infected and sick patients needing medical care. However, the restrictions come with unintended consequences, such as widening inequalities, mental health problems, and exacerbating poor medical outcomes that are not COVID-19-related. Of particular interest to this paper, The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) have announced that the number of AIDS-related deaths in Sub-Saharan Africa could double if access to healthcare for people living with HIV (PLWH) is interrupted during the COVID-19 pandemic. While interruption to the supply of ARV drugs would have by far the largest impact of any potential disruptions [5], suspension of HIV testing would also have significant population impact.

/pdf/covid-19-lockdowns-impact-on-facility-based-hiv-testing-and-4v3r3lnfa8.pdf

Tafadzwa Dzinamarira

Papers

COVID-19 Risk Factors Among Health Workers: A Rapid Review

COVID-19 Vaccine Roll-Out in South Africa and Zimbabwe: Urgent Need to Address Community Preparedness, Fears and Hesitancy

COVID-19: A perspective on Africa's capacity and response.

COVID-19: Unpacking the low number of cases in Africa

COVID-19 Lockdowns: Impact on Facility-Based HIV Testing and the Case for the Scaling Up of Home-Based Testing Services in Sub-Saharan Africa.