• Clinical profile and factors associated with COVID-19 in Cameroon: a prospective cohort study

      Mbarga, NF; Emilienne, E; Mbarga, M; Ouamba, P; Nanda, H; Kengni, A; Joseph, G; Eyong, J; Tossoukpe, S; Sosso, NS; et al. (medRxiv, 2021-02-23)
      Objectives This study explores the clinical profiles and factors associated with COVID-19 in Cameroon. Research design and methods In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. Results A total of 323 patients were admitted during the study period; 262 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (77%; N=204) to moderate (15%; N=40) to severe (7%; N=18); the case fatality rate was 1% (N=4). Dysgusia (46%; N=111) and hyposmia/anosmia (39%; N=89) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; N=53), of which hypertension was the most common (20%; N=48). Participation in a mass gathering (OR=5.47; P=0.03) was a risk factor for COVID-19. Age groups 60 to 69 (OR=7.41; P=0.0001), 50 to 59 (OR=4.09; P=0.03), 40 to 49 (OR=4.54; P=0.01), male gender (OR=2.53; P=0.04), diabetes (OR= 4.05; P= 0.01), HIV infection (OR=5.57; P=0.03), lung disease (OR= 6.29; P=0.01), dyspnoea (OR=3.70; P=0.008) and fatigue (OR=3.35; P=0.02) significantly predicted COVID-19 severity. Conclusion Unlike many high-income settings, most COVID-19 cases in this study were benign with low fatality. Such findings may guide public health decision-making.
    • Considerations for planning COVID-19 treatment services in humanitarian responses

      Garry, S; Abdelmagid, N; Baxter, L; Roberts, N; de Waroux, OL; Ismail, S; Ratnayake, R; Favas, C; Lewis, E; Checchi, F (BMC, 2020-12-01)
      The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
    • Copan eNAT Transport System to Address Challenges in COVID-19 Diagnostics in Regions with Limited Testing Access.

      Richard-Greenblatt, M; Comar, CE; Flevaud, L; Berti, M; Harris, RM; Weiss, SR; Glaser, L (American Society for Microbiology, 2021-02-12)
      Community-based healthcare clinics and hospital outreach services have the potential to expand coronavirus disease 2019 (COVID-19) diagnostics to rural areas. However, reduced specimen stability during extended transport, the absence of cold chain to centralized laboratories, and biosafety concerns surrounding specimen handling has limited this expansion. In the following study, we evaluated eNAT (Copan Italia, Brescia, Italy) as an alternative transport system to address the biosafety and stability challenges associated with expanding COVID-19 diagnostics to rural and remote regions. In this study, we demonstrated that high titer severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) lysate placed into eNAT medium cannot be propagated in cell culture, supporting viral inactivation. To account for off-site testing in these settings, we assessed the stability of contrived nasopharyngeal (NP) specimens stored for up to 14 days in various transport medium (eNAT, eSwab, viral transport media [VTM], saline and phosphate-buffered saline [PBS]) at 4°C, 22-25°C, and 35°C. Molecular detection of SARS-CoV-2 was unaffected by sample storage temperature over the 2 weeks when stored in eNAT or PBS (change in cycle threshold [ΔCT ] ≤ 1). In contrast, variable stability was observed across test conditions for other transport media. As eNAT can inactivate SARS-CoV-2, it may support COVID-19 diagnostics at the point-of-care (POC). Evaluation of compatibility of eNAT with Cepheid Xpert Xpress SARS-CoV-2 assay demonstrated equivalent diagnostic accuracy and sensitivity compared to VTM. Taken together, these findings suggest that the implementation of eNAT as a collection device has the potential to expand COVID-19 testing to areas with limited healthcare access.
    • Covid-19 and refugees, asylum seekers, and migrants in Greece

      Kondilis, E; Puchner, K; Veizis, A; Papatheodorou, C; Benos, A (BMJ, 2020-06-01)
    • COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants.

      Greenaway, C; Hargeaves, S; Barkati, S; Coyle, CM; Gobbi, F; Veizis, A; Douglas, P (Oxford University Press, 2020-07-24)
    • Critical changes to services for TB patients during the COVID-19 pandemic

      Cox, V; Wilkinson, L; Grimsrud, A; Hughes, J; Reuter, A; Conradie, F; Nel, J; Boyles, T (International Union Against Tuberculosis and Lung Disease, 2020-05-01)
    • Europe’s migrant containment policies threaten the response to covid-19

      Hargreaves, S; McKee, M; Jones, L; Veizis, A (BMJ Publishing Group, 2020-03-26)
    • Evaluating Ten Commercially-Available SARS-CoV-2 Rapid Serological Tests Using the STARD (Standards for Reporting of Diagnostic Accuracy Studies) Method.

      Dortet, L; Ronat, JB; Vauloup-Fellous, C; Langendorf, C; Mendels, DA; Emeraud, C; Oueslati, S; Girlich, D; Chauvin, A; Afdjei, A; et al. (American Society for Microbiology, 2020-11-25)
      Numerous SARS-CoV-2 rapid serological tests have been developed, but their accuracy has usually been assessed using very few samples, and rigorous comparisons between these tests are scarce. In this study, we evaluated and compared 10 commercially-available SARS-CoV-2 rapid serological tests using the STARD methodology (Standards for Reporting of Diagnostic Accuracy Studies). 250 sera from 159 PCR-confirmed SARS-CoV-2 patients (collected from 0 to 32 days after onset of symptoms) were tested with rapid serological tests. Control sera (N = 254) were retrieved from pre-COVID periods from patients with other coronavirus infections (N = 11), positive rheumatoid factors (N = 3), IgG/IgM hyperglobulinemia (N = 9), malaria (n = 5), or no documented viral infection (N = 226). All samples were tested using rapid lateral flow immunoassays (LFIA) from 10 manufacturers. Only four tests achieved ≥98% specificity, with other tests ranging from 75.7%-99.2%. Sensitivities varied by the day of sample collection, from 31.7%-55.4% (Days 0-9), 65.9%-92.9% (Days 10-14), and 81.0%-95.2% (>14 days) after the onset of symptoms, respectively. Only three tests evaluated met French Health Authorities’ thresholds for SARS-CoV-2 serological tests (≥90% sensitivity + ≥98% specificity). Overall, the performances between tests varied greatly, with only a third meeting acceptable specificity and sensitivity thresholds. Knowing the analytical performance of these tests will allow clinicians and most importantly laboratorians to use them with more confidence, could help determine the general population’s immunological status, and may help to diagnose some patients with false-negative RT-PCR results.
    • Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review.

      Toomey, E; Conway, Y; Burton, C; Smith, S; Smalle, M; Chan, X; Adisesh, A; Tanveer, S; Ross, L; Thomson, I; et al. (Cambridge University Press, 2020-10-08)
      Background: Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. Objectives: To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators. Data sources: We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews. Methods: Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized. Results: In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Conclusions: Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.
    • From China: hope and lessons for COVID-19 control

      Azman, AS; Luquero, FJ (Elsevier, 2020-04-03)
    • How COVID-19 could benefit tuberculosis and HIV services in South Africa.

      Keene, C; Mohr-Holland, E; Cassidy, T; Scott, V; Nelson, A; Furin, J; Trivino-Duran, L (Elsevier, 2020-08-03)
    • How mental health care is changing in Cameroon because of the COVID-19 pandemic

      Mviena, JLM; Fanne, M; Gondo, R; Mwamelo, AJ; Esso, L; Epee, E; Mballa, GAE; Boum, Y (Elsevier, 2020-10-01)
    • How to ensure a needs-driven and community-centred vaccination strategy for COVID-19 in Africa.

      Boum, Y; Ouattara, A; Torreele, E; Okonta, C (BMJ Publishing Group, 2021-02-15)
    • Long Duration and Resurgence of SARS-CoV-2 in Cameroonian Population

      Buri, D; Njuwa, FKG; Matchim, L; Akendji, B; Eteki, L; Fouda, NM; Bebbel, L; Ndifon, M; Hamadou, A; Tchiasso, D; et al. (BMC, 2021-02-02)
      Background Infection with SARS-CoV-2 can lead to a detectable serological immune response even though extent of its protection is still not yet well known. We report long duration and resurgence of SARS-CoV-2 in patients with COVID-19. Methods We included a cohort of 99 participants from our non-blinded non-randomized evaluation of COVID-19 tests in Cameroon. Demographic and clinical information was collected from participants including self-reported age, race, ethnicity, and gender. Qualitative data was described as proportions while quantitative data was described with means and accompanying ranges. Results Duration of PCR for SARS-CoV-2 positivity was found to range from 4 – 81 days, with mean duration of 32.8 days in patients with PCR-positive. We also identified 4 participants who also had SARS-CoV-2 resurgence within a three-month period. Conclusion These observations raise questions on clinical decision to release COVID-19 cases from isolation after 14 days.
    • Measles: the long walk to elimination drawn out by COVID-19.

      Gignoux, E; Esso, L; Boum, Y (Elsevier, 2021-03-01)
    • Now is the time: a call for increased access to contraception and safe abortion care during the COVID-19 pandemic

      Kumar, M; Daly, M; De Plecker, E; Jamet, C; McRae, M; Markham, A; Batista, C (BMJ, 2020-07-20)
    • The potential public health consequences of COVID-19 on malaria in Africa.

      Sherrard-Smith, E; Hogan, AB; Hamlet, A; Watson, OJ; Whittaker, C; Winskill, P; Ali, F; Mohammad, AB; Uhomoibhi, P; Maikore, I; et al. (Nature Research, 2020-08-07)
      The burden of malaria is heavily concentrated in sub-Saharan Africa (SSA) where cases and deaths associated with COVID-19 are rising1. In response, countries are implementing societal measures aimed at curtailing transmission of SARS-CoV-22,3. Despite these measures, the COVID-19 epidemic could still result in millions of deaths as local health facilities become overwhelmed4. Advances in malaria control this century have been largely due to distribution of long-lasting insecticidal nets (LLINs)5, with many SSA countries having planned campaigns for 2020. In the present study, we use COVID-19 and malaria transmission models to estimate the impact of disruption of malaria prevention activities and other core health services under four different COVID-19 epidemic scenarios. If activities are halted, the malaria burden in 2020 could be more than double that of 2019. In Nigeria alone, reducing case management for 6 months and delaying LLIN campaigns could result in 81,000 (44,000-119,000) additional deaths. Mitigating these negative impacts is achievable, and LLIN distributions in particular should be prioritized alongside access to antimalarial treatments to prevent substantial malaria epidemics.
    • Providing end-of-life care in the emergency department: Early experience from Médecins Sans Frontières during the Covid-19 pandemic

      Pegg, AM; Palma, M; Roberson, C; Okonta, C; Massamba, MH; Roberts, N (Elsevier, 2020-06-01)