The therapeutic itinerary of health workers diagnosed with COVID-19*
      
   
      			Translated title:
      			Itinerário terapêutico dos profissionais de saúde diagnosticados com COVID-19
      
   
      			Translated title:
      			Itinerario terapéutico de los profesionales sanitarios diagnosticados con COVID-19

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Abstract

Objective:

to analyze the therapeutic itinerary of health workers diagnosed with COVID-19.

Method:

qualitative study conducted with 132 health workers diagnosed with COVID-19. Data were collected using a semi-structured form sent through the social media and processed with the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires, according to the Descending Hierarchical Classification.

Results:

the participants included 116 women and 16 men with 14 different professions within the health field. Five classes of excerpts emerged from the text, revealing the therapeutic itinerary from the onset of symptoms, up to referrals for testing and confirming COVID-19. Additionally, the aspects that facilitated or hindered access to testing in healthcare units were identified, in addition to misinformation and the need for workers to pay for the tests to obtain a diagnosis.

Conclusion:

this study’s results show the difficulties health workers experienced to access the tests and related information and the delay in accessing the results and obtaining a sick leave to remain in isolation at home. The health workers who did not get support in terms of management and monitoring from the facilities where they worked adopted an active search.

Translated abstract

Objetivo:

analisar o itinerário terapêutico de profissionais de saúde diagnosticados com COVID-19.

Método:

pesquisa qualitativa, desenvolvida com 132 profissionais de saúde diagnosticados com COVID-19. Dados foram coletados por meio de formulário semiestruturado, enviado via mídias sociais e processados no software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires pela Classificação Hierárquica Descendente.

Resultados:

dentre os participantes, havia 116 mulheres e 16 homens de 14 categorias diferentes da área da saúde. Obtiveram-se cinco classes de segmentos de texto que evidenciaram o itinerário terapêutico desde os primeiros sintomas, com apontamento dos encaminhamentos para a realização do teste de confirmação da COVID-19. Além disso, identificaram-se facilidades e dificuldades de acesso aos exames nas unidades de saúde, bem como desinformação e até pagamento dos testes para confirmação diagnóstica.

Conclusão:

os resultados do estudo denotam as dificuldades vivenciadas pelos profissionais de saúde no acesso aos testes e à informação sobre eles, além da demora dos resultados e do atendimento para os afastamentos funcionais, com vistas ao isolamento domiciliar. Evidenciou-se, ainda, a busca ativa por parte dos profissionais de saúde que estavam desamparados quanto ao necessário gerenciamento e monitoramento pelas instituições de trabalho.

Translated abstract

Objetivo:

analizar el itinerario terapéutico de profesionales sanitarios diagnosticados con COVID-19.

Método:

investigación cualitativa, desarrollada con 132 profesionales sanitarios diagnosticados con COVID-19. Se recopilaron datos a través de formulario semiestructurado enviado vía medios sociales y procesados en el software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires por Clasificación Jerárquica Descendente.

Resultados:

los participantes fueron 116 mujeres y 16 hombres de 14 categorías diferentes del área de la salud. Se encontraron cinco clases de segmentos de texto que evidenciaron el itinerario terapéutico desde los primeros síntomas, con indicación de los encaminamientos para la realización de la prueba de confirmación de la COVID-19. Además, se identificaron facilidades y dificultades de acceso a las pruebas en los servicios de salud, así como desinformación e incluso pago de las pruebas para confirmación diagnóstica.

Conclusión:

los resultados del estudio denotan las dificultades vividas por los profesionales de la salud en el acceso a las pruebas y a la información sobre ellas, además de la demora de los resultados y de la atención para alejamientos funcionales para fines del aislamiento domiciliario. Se evidenció, además, una búsqueda activa por parte de los profesionales de la salud que estaba desamparada en términos de la gestión y el monitoreo necesarios por las instituciones de trabajo.

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Most cited references 32

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Neeltje van Doremalen, Trenton Bushmaker, Dylan H Morris … (2021)

To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. 1 We analyzed the aerosol and surface stability of SARS-CoV-2 and compared it with SARS-CoV-1, the most closely related human coronavirus. 2 We evaluated the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated their decay rates using a Bayesian regression model (see the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) and SARS-CoV-1 Tor2 (AY274119.3) were the strains used. Aerosols (<5 μm) containing SARS-CoV-2 (105.25 50% tissue-culture infectious dose [TCID50] per milliliter) or SARS-CoV-1 (106.75-7.00 TCID50 per milliliter) were generated with the use of a three-jet Collison nebulizer and fed into a Goldberg drum to create an aerosolized environment. The inoculum resulted in cycle-threshold values between 20 and 22, similar to those observed in samples obtained from the upper and lower respiratory tract in humans. Our data consisted of 10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard). All experimental measurements are reported as means across three replicates. SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A). SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). Both viruses had an exponential decay in virus titer across all experimental conditions, as indicated by a linear decrease in the log10TCID50 per liter of air or milliliter of medium over time (Figure 1B). The half-lives of SARS-CoV-2 and SARS-CoV-1 were similar in aerosols, with median estimates of approximately 1.1 to 1.2 hours and 95% credible intervals of 0.64 to 2.64 for SARS-CoV-2 and 0.78 to 2.43 for SARS-CoV-1 (Figure 1C, and Table S1 in the Supplementary Appendix). The half-lives of the two viruses were also similar on copper. On cardboard, the half-life of SARS-CoV-2 was longer than that of SARS-CoV-1. The longest viability of both viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic (Figure 1C). Estimated differences in the half-lives of the two viruses were small except for those on cardboard (Figure 1C). Individual replicate data were noticeably “noisier” (i.e., there was more variation in the experiment, resulting in a larger standard error) for cardboard than for other surfaces (Fig. S1 through S5), so we advise caution in interpreting this result. We found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested. This indicates that differences in the epidemiologic characteristics of these viruses probably arise from other factors, including high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 3,4 Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, 5 and they provide information for pandemic mitigation efforts.

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Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

Camilla Rothe, Mirjam Schunk, Peter Sothmann … (2020)

To the Editor: The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world. 1 Since identification of the virus in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period in the index patient. A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27. Before the onset of symptoms, he had attended meetings with a Chinese business partner at his company near Munich on January 20 and 21. The business partner, a Shanghai resident, had visited Germany between January 19 and 22. During her stay, she had been well with no signs or symptoms of infection but had become ill on her flight back to China, where she tested positive for 2019-nCoV on January 26 (index patient in Figure 1) (see Supplementary Appendix, available at NEJM.org, for details on the timeline of symptom development leading to hospitalization). On January 27, she informed the company about her illness. Contact tracing was started, and the above-mentioned colleague was sent to the Division of Infectious Diseases and Tropical Medicine in Munich for further assessment. At presentation, he was afebrile and well. He reported no previous or chronic illnesses and had no history of foreign travel within 14 days before the onset of symptoms. Two nasopharyngeal swabs and one sputum sample were obtained and were found to be positive for 2019-nCoV on quantitative reverse-transcriptase–polymerase-chain-reaction (qRT-PCR) assay. 2 Follow-up qRT-PCR assay revealed a high viral load of 108 copies per milliliter in his sputum during the following days, with the last available result on January 29. On January 28, three additional employees at the company tested positive for 2019-nCoV (Patients 2 through 4 in Figure 1). Of these patients, only Patient 2 had contact with the index patient; the other two patients had contact only with Patient 1. In accordance with the health authorities, all the patients with confirmed 2019-nCoV infection were admitted to a Munich infectious diseases unit for clinical monitoring and isolation. So far, none of the four confirmed patients show signs of severe clinical illness. This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific. 3 The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture. Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Lat Am Enfermagem

Journal ID (iso-abbrev): Rev Lat Am Enfermagem

Journal ID (publisher-id): rlae

Title: Revista Latino-Americana de Enfermagem

Publisher: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo

ISSN (Print): 0104-1169

ISSN (Electronic): 1518-8345

Publication date (Electronic, pub): 12 April 2021

Publication date (Electronic, collection): 2021

Volume: 29

Electronic Location Identifier: e3413

Affiliations

[1 ]Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil.

[2 ]Universidade Federal Fluminense, Departamento de Enfermagem, Rio das Ostas, RJ, Brazil.

[3 ]Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.

[4 ]Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

[5 ]Universidade Federal do Estado do Rio de Janeiro, Escola de Enfermagem Alfredo Pinto, Rio de Janeiro, RJ, Brazil

Author notes

Corresponding author: Liliane Faria da Silva. E-mail: lili.05@ 123456hotmail.com

Associate Editor: Maria Lúcia do Carmo Cruz Robazzi

Authors’ Contribution:

Study concept and design: Liliane Faria da Silva, Emília Gallindo Cursino, Euzeli da Silva Brandão, Fernanda Garcia Bezerra Góes, Jéssica Renata Bastos Depiant, Laura Johanson da Silva, Rosane Cordeiro Burla de Aguiar. Obtaining data: Liliane Faria da Silva, Emília Gallindo Cursino, Euzeli da Silva Brandão, Fernanda Garcia Bezerra Góes, Jéssica Renata Bastos Depiant, Laura Johanson da Silva, Rosane Cordeiro Burla de Aguiar. Data analysis and interpretation: Liliane Faria da Silva, Emília Gallindo Cursino, Euzeli da Silva Brandão, Fernanda Garcia Bezerra Góes, Jéssica Renata Bastos Depiant, Laura Johanson da Silva, Rosane Cordeiro Burla de Aguiar. Drafting the manuscript: Liliane Faria da Silva, Emília Gallindo Cursino, Euzeli da Silva Brandão,m Fernanda Garcia Bezerra Góes, Jéssica Renata Bastos Depiant, Laura Johanson da Silva, Rosane Cordeiro Burla de Aguiar. Critical review of the manuscript as to its relevant intellectual content: Liliane Faria da Silva, Emília Gallindo Cursino, Euzeli da Silva Brandão, Fernanda Garcia Bezerra Góes, Jéssica Renata Bastos Depiant, Laura Johanson da Silva, Rosane Cordeiro Burla de Aguiar.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Author information

Liliane Faria da Silva http://orcid.org/0000-0002-9125-1053

Emília Gallindo Cursino http://orcid.org/0000-0002-5845-9709

Euzeli da Silva Brandão http://orcid.org/0000-0001-8988-8103

Fernanda Garcia Bezerra Góes http://orcid.org/0000-0003-3894-3998

Jéssica Renata Bastos Depiant http://orcid.org/0000-0002-9157-3159

Laura Johanson da Silva http://orcid.org/0000-0002-4439-9346

Rosane Cordeiro Burla de Aguiar http://orcid.org/0000-0003-2956-9252

Article

Other ID: 00315

DOI: 10.1590/1518-8345.4691.3413

PMC ID: 8040779

PubMed ID: 33852685

SO-VID: f34255ad-b75b-4b5f-b7c8-21dc9e6e0ead

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 June 2020

Date accepted : 12 September 2020

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The therapeutic itinerary of health workers diagnosed with COVID-19* Translated title: Itinerário terapêutico dos profissionais de saúde diagnosticados com COVID-19 Translated title: Itinerario terapéutico de los profesionales sanitarios diagnosticados con COVID-19

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Abstract

Objective:

Method:

Results:

Conclusion:

Translated abstract

Translated abstract

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Novel Coronavirus Disease COVID-19

Most cited references 32

A Novel Coronavirus from Patients with Pneumonia in China, 2019

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

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