31 juillet 2020 Articles scientifiques

Source : Daniel P. Oran, AM, and Eric J. Topol, MD Auteur : Annals of Internal Medicine , 2020 American College of Physicians

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout the world since the first cases of coronavirus disease 2019 (COVID-19) were observed in December 2019 in Wuhan, China. It has been suspected that infected persons who remain asymptomatic play a significant role in the ongoing pandemic, but their relative number and effect have been uncertain. The authors sought to review and synthesize the available evidence on asymptomatic SARS-CoV-2 infection. Asymptomatic persons seem to account for approximately 40% to 45% of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days. Asymptomatic infection may be associated with subclinical lung abnormalities, as detected by computed tomography. Because of the high risk for silent spread by asymptomatic persons, it is imperative that testing programs include those without symptoms. To supplement conventional diagnostic testing, which is constrained by capacity, cost, and its one-off nature, innovative tactics for public health surveillance, such as crowdsourcing digital wearable data and monitoring sewage sludge, might be helpful.  

31 juillet 2020 Articles scientifiques

Source : BMJ 2020;370:m2993 | doi: 10.1136/bmj.m2993 Auteur : Owen Dyer

Most US states are missing key indicators in the data they publish about the course of the covid-19 pandemic, says a report presented by Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC). The report by Resolve to Save Lives, a New York based non-profit group led by Frieden, examined the covid-19 “dashboards” of all 50 states and the District of Columbia.1 Indicators critical to understanding the pandemic’s course were often missing, it found. Not a single state currently reports the average turnaround time of a polymerase chain reaction (PCR) test, as press reports abound of tests in many regions taking a week or more to come back, a delay that renders testing nearly useless in controlling the disease’s spread. The test positivity rate goes unreported by 25% of states. Resolve to Save Lives, which is part of the global health organisation Vital Strategies, listed 15 indicators that are routinely used in other countries’ reporting and examined the performance of each US state on each indicator. These indicators include syndromic reporting of influenza-like illness, reported by 10 states, and covid-like illness, reported by 18 states. These two are considered leading indicators, allowing a faster response than the trailing indicators of hospital admissions and deaths.

30 juillet 2020 Articles scientifiques

Source : BMJ Global Health 2020 Auteur : Van Damme W, et al.

ABSTRACT

It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability—by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.

© Les Hôpitaux Universitaires de Strasbourg 2020 - Tous droits réservés