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Copyright of Disasters is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, we apply statistical methods for functional data to explore the heterogeneity in the registered number of deaths of COVID‐19, over time. The cumulative daily number of deaths in regions across Brazil is treated as continuous curves (functional data). The first stage of the analysis applies clustering methods for functional data to identify and describe potential heterogeneity in the curves and their functional derivatives. The estimated clusters are labeled with different "levels of alert" to identify cities in a possible critical situation. In the second stage of the analysis, we apply a functional quantile regression model for the death curves to explore the associations with functional rates of vaccination and stringency and also with several scalar geographical, socioeconomic and demographic covariates. The proposed model gave a better curve fit at different levels of the cumulative number of deaths when compared to a functional regression model based on ordinary least squares. Our results add to the understanding of the development of COVID‐19 death counts. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Analytical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Covid‐19 pandemic has been a massive disaster in Brazil, causing more than 350,000 deaths as of April 2021. Moreover, President Jair Bolsonaro suggested that already marginalised groups should take what came to them, as if they were an expendable surplus in his necropolitical perspective. However, civil society initiatives are emerging to tackle the impacts of this crisis. This paper adds to current literature on the forms and levels of resistance to disasters, using primary and secondary data pertaining to three key Brazilian groups: domestic workers; the urban poor in favelas; and indigenous Amazonians. The analysis indicates that their historical, political resistance has been a foundation upon which to develop disaster mitigation and their actions have built on and gone beyond previous modes of organising. More specifically, their responses have replaced a 'present–absent' federal government, entailed local, innovative adaptations, led to new public–private sector relations, and may offer the prospect of consolidation. [ABSTRACT FROM AUTHOR]

A new disease called coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) virus, was discovered in the city of Wuhan in China in December 2019, and has reached, quickly and progressively, several countries on different continents. Even before the World Health Organization recognized the COVID-19 epidemic as a pandemic, the Brazilian Ministry of Health had already declared COVID-19 a national public health emergency due to the confirmation of cases in Brazil. In this scenario, the educational sector was one of the first to suffer the effects of the pandemic soon after the announcement of social distancing as a way to prevent the collapse of the Unified Health System. The aim of this paper is to report how Brazilians dental schools are leading with the new coronavirus pandemic., (© 2020 American Dental Education Association.)

Objective: To investigate the association between occupation and severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infections within a Brazilian municipality. Methods: In this test‐negative study, cases and controls were randomly selected among individuals aged 18−65 years that were registered in a primary health care program in São Caetano do Sul, Brazil. Those who had collected samples for RT‐PCR testing between April 2020 and May 2021 were randomly selected to compose the case (positive for SARS‐CoV‐2) and control (negative for SARS‐CoV‐2) groups, frequency‐matched by sex, age group, and month of sample collection. Complementary data were collected through phone interviews. We estimated the residual effect of occupation on SARS‐CoV‐2 infection using multiple conditional logistic regression models incrementally adjusted for confounding variables. Results: 1724 cases and 1741 controls who reported being at work at the time of RT‐PCR collection were included. Cases were mainly females (52.9%), Whites/Asians (73.3%), and unvaccinated against COVID‐19 (46.6%). Compared to other university‐level professionals, the highest odds of having COVID‐19 were found for workers in police and protective services (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.27−3.84), healthcare and caregiving (OR 1.90; 95% CI 1.34−2.68), and food retail and production (OR 1.88; 95% CI = 1.14−3.11), after adjustment for age, sex, education, means of transport, household crowding, and COVID‐19 vaccination. Conclusion: Occupation played an important role in SARS‐CoV‐2 infection. Food retail and production, health care and caregiving, and police and protective services showed the highest odds of SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID‐19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID‐19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political‐ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the "early treatment" narrative for COVID‐19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs. [ABSTRACT FROM AUTHOR]

This manuscript investigates the unsuccessful case of the fiscal decentralization policy implemented by the Brazilian central government to help municipalities fight COVID‐19. Based on quantitative analyses of data available on governmental websites, we identified that the transfer policy had ignored municipalities' risk patterns and income changes. It benefited municipalities regardless of their vulnerability and population infection risks, and many municipalities reduced healthcare expenditures funded by their revenues during the pandemic. Hence, some municipalities made a "pandemic surplus" in 2020 – a municipal electoral year. Indeed, COVID‐19 killed 663,694 people in Brazil until 4 May 2022. Lessons from an unsuccessful case of response to COVID‐19 help develop resilience for other crises by emerging market economies and developing countries. The findings have implications for policymakers and literature since they represent inadequate vertical coordination that followed a path dependence on traditional decentralization policies and took place in a year of municipal elections without clear spending and accountability rules. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID‐19 pandemic. Design: Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross‐sectional analysis, with application of a questionnaire. Setting: Six Brazilian Reference Centres on gestational trophoblastic disease. Population: 2662 patients with MP/postmolar GTN treated from March–December/2015–2020 were retrospectively evaluated and 528 of these patients answered a questionnaire. Methods: Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross‐sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID‐19 pandemic compared with previous years. Main outcome measures: The incidence of MP/postmolar GTN. Results: Compared with the last 5 pre‐pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID‐19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90–3.29, P < 0.001), have a pre‐evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38–2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01–3.43, P = 0.047) when compared with 2015–2019. Conclusions: Although the incidence of MP/postmolar GTN remained stable during the COVID‐19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the most frequent determinants of contact limitation on older adults' mobility addressed by the recommendations to mitigate mobility limitation during the COVID‐19 pandemic and identify the recommendations characteristics and means of dissemination that might guide coping actions. Background: Measures for physical contact restriction were implemented to prevent COVID‐19 spread. These measures directly impacted older people, reducing their mobility, especially outside home environment. Health systems worldwide need to be prepared to implement strategies to mitigate negative effects of reduced mobility in this population. Design: Scoping review using Arksey and O′Malley's methodological framework. Method: Therefore, a scoping review was conducted in LILACS, CINAHL, MEDLINE, WEB OF SCIENCE and SCOPUS databases. Documents and reports with recommendations from government agencies were also consulted. Results were presented in a narrative synthesis based on a conceptual model of mobility proposed by Webber (The Gerontologist, 2010, 50, 443) regarding the most frequently addressed determinants, characteristics of the proposed interventions, and means of dissemination for the older person population. Findings Twenty‐eight studies were selected for the final sample. According to Webber's model, most articles (n = 14) presented the impacts on mobility from the perspective of physical determinants, relating this aspect to biological losses in the musculoskeletal system, and a minority assessed mobility in vital spaces, encompassing environmental (n = 3) and financial (n = 1) determinants. Also, the most frequent recommendation was that physical activity promotes maintenance of mobility and prevents the occurrence of adverse results, such as falls, fractures and functional decline. As to dissemination, digital technologies were recognised as a strategy to motivate, instruct and monitor exercise practice to increase mobility in older adults. Conclusion: The main conditions related to the decline in mobility of older adults during COVID‐19 pandemic were physical inactivity and sedentary lifestyle. The practice of physical activity is widespread and needs to be adapted according to individual needs. Finally, digital technologies are essential tools in this period, but other alternatives should also be considered for low‐income seniors. Implications for practice: It is hoped that the gaps identified through this scoping review can help enhance the discussion on the broader assessment of mobility in older adults and the design of interventions when contact restriction is a reality. [ABSTRACT FROM AUTHOR]

Mobile contact tracing applications have emerged as a potential solution to track and reduce the transmission of viruses such as Covid‐19. These applications require the disclosure of potentially sensitive personal information thus generating understandable implications for personal privacy. This research aims to determine the factors driving acceptance of these applications, with acceptance represented by three distinct variables, namely usage intentions, willingness to disclose personal data, and willingness to rely on health advice. The study examines the influence of perceived privacy, social influence, and benefits on acceptance of contact tracing applications among a sample of 1,114 Brazilian citizens. The study leverages social contract theory to demonstrate the importance of perceived control and perceived surveillance in the formation of individuals' perceptions of privacy. Integrating privacy calculus theory with social contract theory to include reciprocity and social influence, our findings suggest that perceived privacy, reciprocal benefits, and social influence all positively influence individuals' intentions to download or continue the use of contact tracing applications, while intentions to disclose information are influenced by adoption intentions, perceived privacy, and reciprocal benefits and individuals' willingness to rely on contact tracing applications for health advice is influenced by reciprocal benefits and disclosure intentions. [ABSTRACT FROM AUTHOR]

Coronavirus infection disease 2019 (COVID‐19) was associated with a physical‐functional and emotional decline in patients with COVID‐19 hospital internment. Objective: Evaluate the main functional changes after hospital discharge after COVID‐19 by teleconsultation. A cross‐sectional study was carried out between April and July 2020, the peak period of new cases, hospital admission, and deaths by COVID‐19, in Recife‐Brazil. We included patients (n = 89) over 18 years with positive COVID‐19 RT‐PCR tests and hospitalized for more than 7 days. Functional aspects such as muscle pain, shortness of breath, cough, weight loss >5 kg, weakness/fatigue, daily living activities, balance, walking, lying down, sensitivity, anxiety/sadness, altered memory, or understanding were assessed. Besides this, the impact of hospital admission on daily activities and the quality of information obtained by teleconsultation were quantified. The mean age was 63.5 years (±14), and in the hospital, the mean internment was 18 days (±16). The main findings of this study showed four predominant functional alterations: weight loss greater than 5 kg (60.7%), muscle fatigue/weakness (53.9%), muscle/joint pain (43.8%), and anxiety/sadness (46.1%). Of the functions analyzed, 59.6% of patients reported dysfunctions in at least three of the alterations evaluated. There were several short‐term physical‐functional and emotional changes in adults after hospital discharge. [ABSTRACT FROM AUTHOR]

Purpose: Since the World Health Organization declared the coronavirus outbreak a global pandemic several million cases and more than three million deaths have been already confirmed worldwide due to COVID‐19. Design and Methods: Early Career Psychiatrists from all over the world present an overview of what happened in their own countries and what they have learned so far by this experience in everyday clinical practice. Practice Implication: We tried to take a real time picture of this unexpected situation, drawing useful hints for now and the future. [ABSTRACT FROM AUTHOR]

Summary: Although SARS‐CoV‐2 surface contamination has been investigated in health care settings, little is known about the SARS‐CoV‐2 surface contamination in public urban areas, particularly in tropical countries. Here, we investigated the presence of SARS‐CoV‐2 on high‐touch surfaces in a large city in Brazil, one of the most affected countries by the COVID‐19 pandemic in the world. A total of 400 surface samples were collected in February 2021 in the City of Recife, Northeastern Brazil. A total of 97 samples (24.2%) tested positive for SARS‐CoV‐2 by RT‐qPCR using the CDC‐USA protocol. All the collection sites, except one (18/19, 94.7%) had at least one environmental surface sample contaminated. SARS‐CoV‐2 positivity was higher in public transport terminals (47/84, 55.9%), followed by health care units (26/84, 30.9%), beach areas (4/21, 19.0%), public parks (14/105, 13.3%), supply centre (2/21, 9.5%), and public markets (4/85, 4.7%). Toilets, ATMs, handrails, playgrounds and outdoor gyms were identified as fomites with the highest rates of SARS‐CoV‐2 detection. Taken together, our data provide a real‐world picture of SARS‐CoV‐2 dispersion in highly populated tropical areas and identify critical control points that need to be targeted to break SARS‐CoV‐2 transmission chains. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus disease‐2019 (COVID‐19) caused a sudden and unexpected increase in the number of hospital admissions and deaths worldwide. The impact of social distancing on blood stocks was significant. Data on the use of blood products by patients with COVID‐19 are scarce. Material and methods: A retrospective observational study was conducted by analysing the medical records of 3014 hospitalized COVID‐19 patients in 16 Brazilian hospitals. Individual data related to clinical, laboratory and transfusion characteristics and outcomes of these patients were collected. Patients characteristics association with mortality and transfusion need were tested independently by logistic regression models. Results: Patients mean age was 57·6 years. In 2298 (76·2%) patients, there was an underlying clinical comorbidity. A total of 1657 (55%) patients required admission to intensive care unit (ICU), and 943 (31%) patients required ventilatory support and orotracheal intubation (OTI). There was a total of 471 (15·6%) deaths among all patients. 325 patients (10·7%) required blood transfusion; 3187 blood products were transfused: 1364 red blood cells in 303 patients, 1092 platelet units in 78 patients, 303 fresh frozen plasma in 49 patients and 423 cryoprecipitates in 21 patients. The mortality among patients who received transfusion was substantially higher than that among the total study population. Conclusion: Need for transfusion was low in COVID‐19 patients, but significantly higher in patients admitted to ICU and in those who needed OTI. Knowledge of the transfusion profile of these patients allows better strategies for maintaining the blood stocks of hospitals during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the magnitude of under‐reporting the number of deaths due to COVID‐19 in Brazil in 2020, previously shown to occur due to low rate of laboratory testing for SARS‐CoV‐2, reporting delay, inadequate access to medical care, and its poor quality, leading to the low sensitivity of epidemiological surveillance and poor outcomes, often without laboratory confirmation of the cause of death. Methods: Excess mortality due to COVID‐19 was estimated directly based on various data sources, and indirectly, based on the difference between the observed and expected number of deaths from serious acute respiratory infection (SARI) and all‐natural causes in 2020 had there been no COVID‐19. The absence of laboratory testing for SARS‐CoV‐2 was adjusted based on the proportion of those who tested positive among the tested individuals whose death was attributed to COVID‐19. Least absolute shrinkage and selection operator (lasso) were used to improve prediction of likely mortality without COVID‐19 in 2020. Results: Under‐reporting of COVID‐19 deaths was 22.62%, with a corresponding mortality rate per 100 000 inhabitants of 115 by the direct method, 71–76 by the indirect methods based on the excess SARI mortality and 95–104 by excess mortality due to natural causes. COVID‐19 was the third cause of mortality that contributed directly with 18%, and indirectly with additional 10–11% to all deaths in Brazil in 2020. Conclusions: Underestimation of COVID‐19 mortality between 1:5 and 1:4 is likely its lower bound. Timely and accurate surveillance of death causes is of the essence to evaluate the COVID‐19 burden. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID‐19 patients. Methods: From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID‐19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. Results: Five critically ill COVID‐19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad‐spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30‐day mortality was 80%. The five T asahii strains from the COVID‐19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross‐transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. Conclusions: Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID‐19 patients to prevent infections by hard‐to‐treat fungi like T asahii. [ABSTRACT FROM AUTHOR]

Background and Purpose: Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID-19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID-19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID-19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS-CoV-2, in vitro, is needed.Experimental Approach: Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS-CoV-2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined.Key Results: All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml-1 , whereas LMWHs were less inhibitory by ~150-fold (IC50 range 3.4-7.8 mg·ml-1 ). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor.Conclusion and Implications: This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS-CoV-2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID-19. [ABSTRACT FROM AUTHOR]

Over the past few years, investigators in Brazil have been uncovering numerous corruption and money laundering schemes at all levels of government and in the country's largest corporations. It is estimated that between 2% and 5% of the global GDP is lost annually because of such practices, not only directly impacting public services and private sector development but also strengthening organized crime. However, most law enforcement agencies do not have the capability to carry out systematic corruption risk assessment leveraging on the availability of data related to public procurement. The currently prevailing approach employed by Brazilian law enforcement agencies to detect companies involved in potential cases of fraud consists in receiving circumstantial evidence or complaints from whistleblowers. As a result, a large number of companies involved in fraud remain undetected and unprosecuted. The decision support system (DSS) described in this work addresses these existing limitations by providing a tool for systematic analysis of public procurement. It allows the law enforcement agencies to establish priorities concerning the companies to be investigated. This DSS incorporates data mining algorithms for quantifying dozens of corruption risk patterns for all public contractors inside a specific jurisdiction, leading to improvements in the quality of public spending and to the identification of more cases of fraud. These algorithms combine operations research tools such as graph theory, clusterization, and regression analysis with advanced data science methods to allow the identification of the main risk patterns, such as collusion between bidders, conflicts of interest (e.g., a politician who owns a company contracted by the same government body where he or she was elected), and companies owned by a potentially straw person used for disguising its real owner (e.g., beneficiaries of cash conditional transfer programs). The DSS has already led to a detailed analysis of large public procurement datasets, which add up to more than 50 billion dollars. Moreover, the DSS provided strategic inputs to investigations conducted by federal and state agencies. [ABSTRACT FROM AUTHOR]

The article examines how the COVID-19 pandemic altered paediatric dentistry treatments within Brazil's National Public Health System (SUS). According to the article, child dental patients in the SUS largely went without dental care during the pandemic, and the amount of paediatric dental procedures performed decreased significantly during the pandemic.

The article discusses the role of human saliva as a COVID-19 virus diagnostic tool in paediatric patients, and it mentions saliva analysis in the detection of the SARS-CoV-2 virus in the Brazilian city of Araraquara, São Paulo. Total RNA extraction is assessed, along with symptoms such as sore throat, cough, and fever in children. According to the article, saliva collection is a less invasive strategy for COVID-19 virus surveillance.

Background: Awake prone positioning has been widely used in patients with COVID‐19 respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care. Methods: This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo. We retrieved data from all admitted patients in need of oxygen supplementation (>3 L/min) and tachypnea (>24 ipm) from March 1 to April 30, 2020, excluding those who had any contraindication to the prone position or who had an immediate need for intubation. The primary endpoint was endotracheal intubation up to 15 days. Secondary outcomes included a 6‐point clinical outcome ordinal scale, mechanical ventilation–free days, admission to the intensive care unit, and need of hemodialysis and of vasoactive drugs, all assessed at or up to 15 days. We analyzed unadjusted and adjusted effect estimates with Cox proportional hazards models, logistic regression, quantile regression, and sensitivity analyses using propensity score models. Results: Of 925 suspected COVID‐19 patients admitted off mechanical ventilation, 166 patients fulfilled inclusion and exclusion criteria: 57 were exposed to prone positioning and 109 to usual care. In the intervention group, 33 (58%) were intubated versus 53 (49%) in the control group. We observed no difference in intubation rates in the univariate analysis (hazard ratio = 1.21, 95% confidence interval [CI] = 0.78 to 1.88, p = 0.39) nor in the adjusted analysis (hazard ratio = 0.90, 95% CI = 0.55 to 1.49, p = 0.69). Results were robust to the sensitivity analyses. Secondary outcomes did not differ between groups. Conclusions: Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) collection began in two Brazilian hospitals for treatment of severe/critical patients. Methods and Materials: Mild/moderate COVID‐19 convalescents were selected as CCP donors after reverse transcription polymerase chain reaction (RT‐PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and absence of symptoms for ≥14 days plus (a) age (18‐60 years), body weight greater than 55 kg; (b) immunohematological studies; (c) no infectious markers of hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human T‐lymphotropic virus‐1/2, Chagas and syphilis infection; (d) no HLA antibodies (multiparous); (e) second RT‐PCR (nasopharyngeal swab and/or blood) negativity; (f) virus neutralization test (cytopathic effect–based virus neutralization test neutralizing antibody) and anti–nucleocapsid protein SARS‐CoV‐2 IgM, IgG, and IgA enzyme‐linked immunosorbent assays. Results: Among 271 donors (41 females, 230 males), 250 presented with neutralizing antibodies. Final RT‐PCR was negative on swab (77.0%) or blood (88.4%; P =.46). Final definition of RT‐PCR was only defined at more than 28 days after full recovery in 59 of 174 (33.9%) RT‐PCR –ve, and 25/69 RT‐PCR +ve (36.2%; 13 between 35 and 48 days). Neutralizing antibody titers of 160 or greater were found in 63.6%. Correlation between IgG signal/cutoff of 5.0 or greater and neutralizing antibody of 160 or greater was 82.4%. Combination of final RT‐PCR –ve with neutralizing antibody ≥160 was 41.3% (112/271). Serial plasma collection showed decline in neutralizing antibody titers and IgA levels (P <.05), probably denoting a "golden period" for CCP collection (≤28 days after joining the program); IgA might have an important role as neutralizing antibody. Donor's weight, days between disease onset and serial plasma collection, and IgG and IgM levels are important predictors for neutralizing antibody titer. Conclusions: RT‐PCR +ve cases are still detected in 36.2% within 28 to 48 days after recovery. High anti–nucleocapsid protein IgG levels may be used as a surrogate marker to neutralizing antibody. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical characteristics of pregnant and postpartum women with severe COVID‐19 in Brazil and to examine risk factors for mortality. Design: Cross‐sectional study based on secondary surveillance database analysis. Setting: Nationwide Brazil. Population or sample: 978 Brazilian pregnant and postpartum women notified as COVID‐19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. Methods: Data was abstracted from the Brazilian ARDS Surveillance System (ARDS‐SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. Main outcome measures: Case fatality rate. Results: We identified 124 maternal deaths, corresponding to a case fatality rate among COVID‐19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID‐19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. Conclusions: Negative outcomes of COVID‐19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. A total of 124 COVID‐19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors. A total of 124 COVID‐19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors. [ABSTRACT FROM AUTHOR]

Background The SARS-CoV-2 pandemic is having an impact on blood supply. This situation has led to new strategies to minimize the impact on blood product availability. Methods The Hemocentro UNICAMP, a regional reference centre in Brazil, has established availability strategies, respecting national and local measures to decrease transmission of SARS-CoV-2. Measures include booking donation appointments, reorganization of areas to permit social distancing, a pre-reception to reinforce donor instructions, antisepsis of donors' hands with 70% gel alcohol at each step of the process, post-donation information (PDI) reinforcement, recruitment intensification using social media/mass media, rapid replacement of cancelled mobile collections, reinforcement of collection from army units. Rational blood use was reinforced in hospitals, elective procedures were suspended and stricter blood distribution was adopted. Results A median increase of 14-5% was obtained in weekly blood donations, versus pre-crises period (1338 vs 1169) and a 15-9% decrease in blood distribution (1312 vs 1103 red blood cell units) (P < 0-0001, v2 = 28 - 8). Booked appointments corresponded to 42-2% of all donations made in the period, with a mean absence of 19% at bookings. Mobile unit blood collections cancelled in the period were 8/25 per month (vs. around 3/25 before). About 62% of the cancelled mobile collections could be replaced. Mean PDI increased from 5/week vs. 2/week in the previous period. Conclusion The strategy proved successful, although questions about the best approach to maintain blood supply during the COVID-19 pandemic remain. Such experiences may help blood centres to design strategies to maintain blood stores during pandemic situations in the future. [ABSTRACT FROM AUTHOR]

This article discusses one of the great governmental challenges of the last centuries—universalization of access to potable water and sanitation services (WSS)—in view of the geographical difficulties for the provision of services in certain regions, and differences in ability to pay for water and sanitation services. It is necessary to reinforce the various links between social and environmental conditions. A review of the literature finds that countries work differently on the approach to universal access to water and sanitation services (Marques, 2010), addressing the problem according to their laws with variable results in how these services are defined. In order to achieve the desired universalization of water and sanitation services in Brazil, in addition to the investment of significant amounts of money, coordinated administration is necessary to leverage these investments. In addition to this challenging scenario, the present moment is worrying! At the beginning of the 21st century, a new pandemic is causing deaths at an alarming rate. Most countries around the world are combating the new coronavirus that has disrupted economies, caused panic, and raised hypotheses about political hegemonies. On January 30, 2020, the World Health Organization (WHO) declared the outbreak of the disease caused by the new coronavirus (COVID‐19) to be a Public Health Emergency of International Importance—the highest alert level of the Organization, as provided for in the International Health Regulations. This study discusses the alignment of these dual challenges in Brazil and what can be done toward improved water and sanitation in this difficult context. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: Brazil ranks high in the number of coronavirus disease 19 (COVID‐19) cases and the COVID‐19 mortality rate. In this context, autopsies are important to confirm the disease, determine associated conditions, and study the pathophysiology of this novel disease. The aim of this study was to assess the systemic involvement of COVID‐19. In order to follow biosafety recommendations, we used ultrasound‐guided minimally invasive autopsy (MIA‐US), and we present the results of 10 initial autopsies. Methods and results: We used MIA‐US for tissue sampling of the lungs, liver, heart, kidneys, spleen, brain, skin, skeletal muscle and testis for histology, and reverse transcription polymerase chain reaction to detect severe acute respiratory syndrome coronavirus 2 RNA. All patients showed exudative/proliferative diffuse alveolar damage. There were intense pleomorphic cytopathic effects on the respiratory epithelium, including airway and alveolar cells. Fibrinous thrombi in alveolar arterioles were present in eight patients, and all patients showed a high density of alveolar megakaryocytes. Small thrombi were less frequently observed in the glomeruli, spleen, heart, dermis, testis, and liver sinusoids. The main systemic findings were associated with comorbidities, age, and sepsis, in addition to possible tissue damage due to the viral infection, such as myositis, dermatitis, myocarditis, and orchitis. Conclusions: MIA‐US is safe and effective for the study of severe COVID‐19. Our findings show that COVID‐19 is a systemic disease causing major events in the lungs and with involvement of various organs and tissues. Pulmonary changes result from severe epithelial injury and microthrombotic vascular phenomena. These findings indicate that both epithelial and vascular injury should be addressed in therapeutic approaches. [ABSTRACT FROM AUTHOR]

The article focuses on the Latin America experienced its first confirmed case of COVID-19 on 26 February 2020 in São Paulo, Brazil and by late July the region had the highest number of confirmed cases globally. Topics include Latin American governments have generally complied with WHO advice on lockdowns and a range of other measures put in place; and COVID-19 has had a highly detrimental impact on gender equality.