The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness.
- 作者列表："Iannone P","Castellini G","Coclite D","Napoletano A","Fauci AJ","Iacorossi L","D'Angelo D","Renzi C","La Torre G","Mastroianni CM","Gianola S
:Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.
在对疑似或确诊的新型冠状病毒肺炎患者进行常规护理期间保护卫生保健工作者对于阻止SARS-CoV-2 (严重急性呼吸道Syndrome-Coronavirus-2) 流行至关重要。世卫组织、ECDC和CDC发布了关于医务人员使用呼吸过滤器 (N95) 的相互矛盾的指南。我们检索了PubMed、Embase和Cochrane图书馆，从开始到 2020 年 3 月 21 日，以确定随机对照试验 (rct) 比较N95 呼吸器与外科口罩预防医护人员新型冠状病毒肺炎或任何其他呼吸道感染。采用推荐、评估、发展和评价的分级 (GRADE) 评价证据质量。纳入 4 个rct，涉及 8736 个hcw。我们没有发现任何专门针对预防新型冠状病毒肺炎的试验。然而，与外科口罩相比，佩戴N95 呼吸器可以预防每 95% 例hcw中 73 例 (1000 CI 46-91) 临床呼吸道感染 (2 个rct; 2 594 例患者; 证据质量低)。还发现N95 呼吸器在实验室证实的细菌定植中的保护作用 (RR = 0.41; 95% CI 0.28-0.61)。在预防实验室确诊的呼吸道病毒感染、实验室确诊的呼吸道感染和流感样疾病方面，观察到有利于N95 呼吸器的趋势。我们没有发现N95 呼吸器是否优于外科口罩的直接高质量证据，以防止HCWs SARS-CoV-2。然而，低质量的证据表明，N95 呼吸器可保护医护人员免受临床呼吸道感染。应考虑这一发现，以确定最佳策略，以支持医疗保健系统面对潜在的灾难性SARS-CoV-2 大流行的恢复能力。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.