Emerging from the other end: Key measures for a successful COVID-19 lockdown exit strategy and the potential contribution of pharmacists

As the world edges towards relaxing the lockdown measures taken to control the spread of the novel coronavirus SARS-CoV-2 (COVID-19), governments have started putting in place a variety of measures to avoid a second peak in the number of infections. The implementation of and adherence to such measures will be key components of any successful lockdown exit strategy. Ranging from expanded testing and widespread use of technology to building the public's trust in the post COVID-19 world, there is a role for pharmacists to play. In this commentary, these measures and the potential contribution of pharmacists to their successful implementation are outlined and discussed.     

金华市甲型H1N1流感病例类型特征与确诊时间间关系对应分析

目的分析金华市甲型H1N1流感确诊病例的人群分布特征,探讨确诊时间与病例类型分布间关联性。方法采用描述流行病学方法分析金华市2009-2010年报告的687例甲型H1N1流感确诊病例人群分布和发病至确诊间隔天数（d）分布特征,然后应用多重对应分析方法探讨发病到确诊间隔天数（d）、性别、年龄、职业和病例类型间关联性。结果 687例确诊病例中,轻症579例、重症81例,危重27例,分别占84.3%、11.8%和3.9%,死亡6例,占0.9%。轻症病例中,25岁以下占83.4%;重症病例中,0-5岁、15-24岁、6-14岁和35-44岁年龄组分别占39.5%,18.5%,14.8%,13.6%;危重病例中,0-5岁、35-44岁、15-24岁和65岁及以上年龄组分别占25.9%,22.2%,14.8%,14.8%。6-24岁和65岁及以上年龄组、学生等人群d-Z分值均数小于零,而0-5岁、25-64岁、散居儿童、幼托儿童、商业服务者、农民及民工、工作人员等人群d-Z分值均数大于零。多重对应分析图显示,6-24岁,学生,与d≤1、轻症病例之间有关联;0-5岁,散居儿童、托幼儿童,与d=5、重症病例有关联;≥25岁、农民及民工、工作人员、商业人员,与d≥6、危重病例有关联。结论促进检测,缩短诊治时间一定程度上改变和降低了此次甲型H1N1流感流行的严重程度。     

Physical activity and mental well-being during COVID-19 pandemic

The corona virus disease 2019 (COVID-19) pandemic has resulted in most nations deciding upon self-isolation and social distancing policies for their citizens to control the pandemic and reduce hospital admission. This review aimed at evaluating the effect of physical activity on mental well-being during the COVID-19 pandemic. It was concluded that the COVID-19 pandemic may lead to augmented levels of angiotensin-converting enzyme (ACE)-2 that led to cardiovascular and neurological disorders associated with highly inflammatory effects of viral infection affecting the brain tissues leading to damage of the nervous system and resulting in cognition dysfunction, insulin sensitivity reduction, and behavioral impairments. Anxiety and depression may lead to negative effects on various quality of life domains, such as being physically inactive. Regular physical activities may reduce inflammatory responses, improve ACE-2 responses, and improve mental well-being during self-isolation and social distancing policies related to the COVID-19 pandemic. Further studies should be conducted to assess the different intensities of physical activities on cardiovascular function, and mental well-being during the COVID-19 pandemic.     

Safety and immunogenicity of 2010-2011 H1N12009-containing trivalent inactivated influenza vaccine in children 12-59 months of age previously given AS03-adjuvanted H1N12009 pandemic vaccine: a PHAC/CIHR Influenza Research Network (PCIRN) study

Background

Concern arose in 2010 that reactogenicity, particularly febrile seizures, to influenza A/H1N1-containing 2010–2011 trivalent seasonal inactivated influenza vaccine (TIV) could occur in young children who had been previously immunized and/or infected with the pandemic strain. We conducted a pre-season study of 2010–2011 TIV safety and immunogenicity in children 12–59 months of age to inform public health decision making.

Methods

Children immunized with 1 or 2 doses of the pandemic vaccine, with or without the 2009–10 TIV, received 1 or 2 doses of 2010–11 TIV in an observational, multicentre Canadian study. Standard safety monitoring was enhanced by a telephone call at ∼24 h post-TIV when adverse events were expected to peak. Summary safety reports were rapidly reported to public health before the launch of public programs. TIV immunogenicity was assessed day 0, and 21 days after final vaccination. Clinical Trials Registration NCT01180621.

Results

Among 207 children, a general adverse event was reported by 60.9% of children post-dose one and by 58.3% post-dose two. Only severe fever (>38.5 °C) was more common in two-dose compared to one dose recipients (16.7%, n = 4 v. 1.0%, n = 2). At baseline 99.0% of participants had A/H1N1 hemagglutinin inhibition (HAI) titers ≥10, and 85.5% had a protective titer of ≥40 (95% CI 80.0, 90.0). Baseline geometric mean titers (GMT) were higher in recipients of a 2-dose schedule of pandemic vaccine compared to one-dose recipients: 153.1 (95% CI 126.2, 185.7) v. 78.8 ((58.1, 106.8, p < 0.001). At 21 days, all regulatory criteria for influenza vaccine immunogenicity were exceeded for A/H1N1 and H3N2, but responses to the B antigen were poor. No correlations between reactogenicity and either baseline high influenza titers or serologic response to revaccination were evident.

Conclusions

Infants and toddlers who received AS03-adjuvanted A/H1N1 2009 vaccine up to 11 months earlier retained high titers in the subsequent season but re-exposure to A/H1N1 2009 antigen in TIV resulted in no unusual adverse effects and 100% were sero-protected for A/H1N1 after receipt of the 2010–11 TIV.     

Enfermement carcéral,confinement socio-sanitaire et moyens d’évasion. Danser sa peine et au-delà…

Jail incarceration and social confinement due to a sanitary stay-at-home law against the ongoing COVID-19 pandemic are compared to the introduction of dance workshops for imprisoned women charged with long sentences, then followed by an outside performance Soul Kitchen. The whole experience, organized by a famous contemporary choreographer Angelin Preljocaj, is filmed by Valérie Müller, producing Danser sa peine (To dance her sentence/her sorrow), nominated for an award. The sessions are planned: two hours and a half, 2 times a week, for four months, no technique required. A group of five women start with ordinary easy functional movements, gaining in innovative and expressive qualities, spatial perceptions, feelings and interpersonal interactions, lead by A. Preljocaj in a helpful and empathic mood. At the same time, he discovers the cooking authorization in their jail cell. The relevant results shift into a dynamic successful piece Soul Kitchen (2019) performed in town (Dance Festival in Montpellier, south of France) with dancing and cooking occurrences on stage. It makes sense, specially about self-esteem, body image and positive opinion from the audience. The women's physical and psychological states linked with a long lack of space and sensitivity… move to a better self-balance and feelings of well-being. In a similar state of mind, the French confined population – youth to elderly – try to find different and imaginative strategies at home as moving in a restrictive area, enjoying family cooking… through trainings provided by Internet, looking for reducing anxiety, depressive disorders and other social problems. A panel of situations goes from deleterious conflictual relationships, dramatic isolation, to funny and positive ones using creativeness to escape, facing the disruption of daily life.     

Effect of the COVID-19 Pandemic on Surgical Breast Cancer Care in the Netherlands: A Multicenter Retrospective Cohort Study

BackgroundCoronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. In the Netherlands, the national screening programs, including for breast cancer, were halted temporarily. This posed a challenge to breast cancer care, because ∼40% of cases are detected through national screening. Therefore, the aim of the present study was to evaluate the effects of the COVID-19 pandemic on the surgical care of patients with breast cancer in the Netherlands.Materials and MethodsThe present multicenter retrospective cohort study investigated the effects of COVID-19 on patients with breast cancer who had undergone surgery from March 9 to May 17, 2020. The primary endpoints were the number of surgical procedures performed during the study period, tumor characteristics, surgery type, and route of referral. The secondary endpoint was the incidence of postoperative complications during the study period.ResultsA total of 217 consecutive patients with breast cancer requiring surgery were included. We found an overall decrease in the number of patients with breast cancer who were undergoing surgery. The most significant decline was seen in surgery for T1-T2 and N0 tumors. A decline in the number of referrals from both the national screening program and general practitioners was observed. The incidence of postoperative complications remained stable during the study period.ConclusionsThe temporary halt of the national screening program for breast cancer resulted in fewer surgical procedures during the study period and a pronounced decrease in surgery of the lower tumor stages.     

Afectación del sentido del olfato y el gusto en la enfermedad leve por coronavirus (COVID-19) en pacientes españoles

IntroductionCoronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Smell and/or taste disorders have emerged as a very frequent symptom as the disease has spread in Europe. Spain is one of the European countries with the highest number of infections.ObjectiveThis study aimed to investigate the clinical progression of smell and taste disorders in Spanish patients with mild COVID-19.MethodsAn online survey was used to conduct a cross-sectional study of patients who presented sudden smell and/or taste disorders during the 2 months of total lockdown due to COVID-19 in Spain.ResultsIn our sample, 91.18% of respondents with impaired smell and/or taste and who were able to undergo PCR testing were positive for SARS-CoV-2 infection. Anosmia and ageusia presented in isolation in 6.5% of participants. The remaining 93.5% presented other mild symptoms: headache (51.6%), cough (51.6%), myalgia (45.2%), asthaenia (38.7%), nasal congestion or rhinorrhoea (35.5%), fever (41.9%), low-grade fever (29.0%), odynophagia (25.8%), or diarrhoea (6.5%). The mean duration of anosmia was 8.33 days, with patients subsequently manifesting hyposmia; complete resolution occurred after a mean of 17.79 days. In 22.6% of respondents, olfactory deficits persisted. All participants recovered their sense of taste.ConclusionsOlfactory and gustatory disorders are prevalent symptoms in mild COVID-19. Most patients do not present associated nasal congestion or rhinorrhoea and a small group of patients present these alterations in isolation.     

Impacto de la pandemia COVID-19 en la atención al paciente con cefalea en España: análisis de situación con una mirada al futuro

IntroductionThe COVID-19 pandemic has had a great impact on healthcare systems. Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease.ObjectiveThis study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units.MethodsWe conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic.ResultsThe response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain. Limitations in face-to-face activity were reported by 95.8% of centres, with preferential face-to-face consultation being maintained in 60.4%, and urgent procedures in 45.8%. In 91.7% of centres, the cancelled face-to-face activity was replaced by telephone consultation. 95.8% of respondents stated that they would use personal protection equipment in the future, and 86% intended to increase the use of telemedicine. The majority foresaw an increase in waiting lists (93.8% for initial consultations, 89.6% for follow-up, and 89.4% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future.ConclusionsAs a consequence of the pandemic, headache care and research activity has reduced considerably. This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future.