• Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study - eClinicalMedicine
    https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00013-0/fulltext
    https://www.thelancet.com/cms/asset/eaa00ef2-1f2b-47e6-aa79-cc4f03bfae4d/gr2.jpg

    Summary
    Background
    COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing.
    Methods
    To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK.
    Findings
    We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC’s response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention.
    Interpretation
    Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC.

  • Defining and conceptualising the commercial determinants of health - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00013-2/abstract

    Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors—notably the largest transnational corporations—are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health.

    #déterminants_commerciaux_de-la_santé

  • On sait enfin combien de temps on est immunisé contre le covid - Numerama
    https://www.numerama.com/sciences/1276912-on-sait-enfin-combien-de-temps-on-est-immunise-contre-le-covid.htm

    Combien de temps perdure l’immunité contre le coronavirus SARS-CoV-2, après une infection ? Plus de 3 ans après le début de la pandémie, une méta-analyse de temps long livre de précieuses données, à partir de plusieurs études.

    Après une infection virale, le corps humain développe généralement une immunité : s’il est de nouveau confronté au virus, il saura s’en protéger. Les vaccins s’inspirent de ce système. Le covid n’y échappe pas, mais celui-ci est apparu fin 2019, déclenchant une pandémie début 2020 : en l’absence de recul, la durée de l’immunité est longtemps restée complexe à évaluer.

    Plus de trois ans après, les études au long cours commencent à être publiées, avec davantage d’acuité qu’au début. C’est le cas d’une nouvelle publication, dans The Lancet, datant du 16 février 2023. Elle prend la forme d’une méta-analyse, regroupant 65 études provenant de 19 pays.

    • Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis - The Lancet
      https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02465-5/abstract


      Figure 3Estimates of protection by time since infection for ancestral, alpha, delta, omicron BA.1, and omicron BA.2 variants

      Summary
      Background
      Understanding the level and characteristics of protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease is essential for predicting future potential disease burden, for designing policies that restrict travel or access to venues where there is a high risk of transmission, and for informing choices about when to receive vaccine doses. We aimed to systematically synthesise studies to estimate protection from past infection by variant, and where data allow, by time since infection.

      Methods
      In this systematic review and meta-analysis, we identified, reviewed, and extracted from the scientific literature retrospective and prospective cohort studies and test-negative case-control studies published from inception up to Sept 31, 2022, that estimated the reduction in risk of COVID-19 among individuals with a past SARS-CoV-2 infection in comparison to those without a previous infection. We meta-analysed the effectiveness of past infection by outcome (infection, symptomatic disease, and severe disease), variant, and time since infection. We ran a Bayesian meta-regression to estimate the pooled estimates of protection. Risk-of-bias assessment was evaluated using the National Institutes of Health quality-assessment tools. The systematic review was PRISMA compliant and was registered with PROSPERO (number CRD42022303850).

      Findings
      We identified a total of 65 studies from 19 different countries. Our meta-analyses showed that protection from past infection and any symptomatic disease was high for ancestral, alpha, beta, and delta variants, but was substantially lower for the omicron BA.1 variant. Pooled effectiveness against re-infection by the omicron BA.1 variant was 45·3% (95% uncertainty interval [UI] 17·3–76·1) and 44·0% (26·5–65·0) against omicron BA.1 symptomatic disease. Mean pooled effectiveness was greater than 78% against severe disease (hospitalisation and death) for all variants, including omicron BA.1. Protection from re-infection from ancestral, alpha, and delta variants declined over time but remained at 78·6% (49·8–93·6) at 40 weeks. Protection against re-infection by the omicron BA.1 variant declined more rapidly and was estimated at 36·1% (24·4–51·3) at 40 weeks. On the other hand, protection against severe disease remained high for all variants, with 90·2% (69·7–97·5) for ancestral, alpha, and delta variants, and 88·9% (84·7–90·9) for omicron BA.1 at 40 weeks.

    • le faux (la grippette-trotinette) deviend(rai)t vrai ? avec une protection (actuellement ?) durable contre les formes graves, le discours rassuriste sur l’immunité acquise a peut-être trouvé une base matérielle. surtout si on imagine que la question qui a du mal a émerger des effets de long terme se résoudre en extrapolant le constat (pas question des post covid ou de covid long dans cet article, semble-t-il).

      c’est le moment d’écrire l’histoire des vainqueurs

      le virus n’existait plus, voire n’avait jamais existé.

      https://seenthis.net/messages/991625

      #covid_19 #immunité

  • Why we need a deeper understanding of the pathophysiology of long COVID - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00053-1/fulltext


    #covid_long

    The most recent estimate of people living with post-COVID-19 condition (also known as long COVID) globally has surpassed 65 million1
    and, without clear diagnostic or treatment options available, this number is steadily increasing. There are more than 200 reported symptoms associated with long COVID,1
    affecting virtually every organ system.

  • Real-world use of nirmatrelvir–ritonavir in outpatients with #COVID-19 during the era of omicron variants including BA.4 and BA.5 in Colorado, USA: a retrospective cohort study - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00011-7/abstract

    Le #paxlovid est efficace sur les sous variants d’#omicron

  • #COVID_LONG : 6 sous-types distincts identifiés | santé log
    https://www.santelog.com/actualites/covid-long-6-sous-types-distincts-identifies

    Le Dr Peter Robinson, du Jackson Laboratory (JAX, Main) et son équipe ont […] analysé les données des [dossiers de santé électroniques] DES de patients, diagnostiqués avec COVID long, dans le cadre du National COVID Cohort Collaborative (N3C). Grâce à ce code de diagnostic, l’équipe a pu analyser les données cliniques des patients diagnostiqués avec COVID long et définir ainsi plus précisément les caractéristiques de cette nouvelle condition. L’équipe a également regardé s’il devenait possible d’identifier plusieurs sous-types de la maladie.
     
    La définition de sous-types distincts de COVID long : l’analyse a porté sur les données de 20.532 patients diagnostiqués en situation post-COVID-19, ces participants ayant été sélectionnés à partir d’une base de données en comportant plus de 5,4 millions. Le COVID long a été précisément défini comme présent au moins 28 jours après la première date de #COVID-19 notée pour les patients COVID suivis en ambulatoire et 28 jours après la fin de l’hospitalisation pour les patients COVID hospitalisés. L’équipe a pris en compte les résultats cliniques de ces patients, développé un algorithme de calcul et ont pu
    regrouper ainsi les patients en 6 clusters, chacun représentant un sous-type de COVID long distinct, soit :
     
    1 multi-système + laboratoire (associé à une infection initiale sévère et à une fréquence élevée de symptômes multiples : neuropsychiatriques, pulmonaires, constitutionnels (par exemple, fatigue générale), cardiovasculaires et vertiges ainsi qu’anomalies des tests de laboratoire) ;

    2 hypoxémie et toux

    3 neuropsychiatrique (maux de tête, insomnie, dépression, troubles du mouvement) ;

    4 Cardiovasculaire ;

    5 Douleur/fatigue ;

    6 Douleur multi-système (similaire à 1 mais sans les anomalies aux tests de laboratoire).
     
    À chaque groupe sont également associés des facteurs privilégiés de tranche d’âge, sexe, origines ethniques, comorbidités et antécédents de santé.
     
    Des mécanismes sous-jacents variables selon les patients : l’analyse suggère ainsi que des processus différents peuvent mener aux différents sous-types de COVID long, selon les résultats et les antécédents de santé des patients. 
     
    La prochaine étape sera donc probablement de définir des sous-cohortes afin de tester et identifier des thérapies candidates mieux ciblées pour chaque sous-type. Selon ces experts, il est clair qu’une stratification des patients COVID de longue durée s’impose pour un traitement efficace, car apparaît peu probable qu’une approche unique puisse répondre à tous les sous-types.
     
    Ces 6 sous-types distincts vont donc aider à stratifier les patients et éclairer les stratégies de traitement.

    Source:
    Generalisable long COVID subtypes: findings from the NIH N3C and RECOVER programmes - eBioMedicine
    https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00595-3/abstract

    #post-covid

  • The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01540-9/abstract

    Simultaneously, oil and gas companies are registering record profits, while their production strategies continue to undermine people’s lives and wellbeing.

    #hydrocarbures #santé versus #profits

  • Paludisme : un nouveau vaccin qui pourrait changer le monde - BBC News Afrique
    https://www.bbc.com/afrique/monde-62834803

    Les résultats d’essais portant sur 409 enfants à Nanoro, au Burkina Faso, ont été publiés dans le Lancet Infectious Diseases . Il montre que trois doses initiales suivies d’un rappel un an plus tard donnent jusqu’à 80% de protection.

    Source : Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical malaria after 2 years’ follow-up in children in Burkina Faso : a phase 1/2b randomised controlled trial - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00442-X/abstract

    Résumé en français : https://www.thelancet.com/cms/10.1016/S1473-3099(22)00442-X/attachment/e2da2b83-1c59-4224-946a-3e724912d6be/mmc1.pdf

    #paludisme #vaccination #vaccins #santé

  • Understanding #COVID-19: what does viral RNA load really mean? - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30237-1/abstract

    It is noteworthy that the presence of viral RNA in specimens does not always correlate with viral transmissibility.

    In a ferret model of H1N1 infection, the loss of viral culture positivity but not the absence of viral RNA coincided with the end of the infectious period. In fact, real-time reverse transcriptase PCR results remained positive 6–8 days after the loss of transmissibility.

    For SARS #coronavirus, viral RNA is detectable in the respiratory secretions and stools of some patients after onset of illness for more than 1 month, but live virus could not be detected by culture after week 3.11

    The inability to differentiate between infective and non-infective (dead or antibody-neutralised) viruses remains a major limitation of nucleic acid detection. Despite this limitation, given the difficulties in culturing live virus from clinical specimens during a pandemic, using viral RNA load as a surrogate remains plausible for generating clinical hypotheses.

    #virus #PCR #contagiosité

  • Viral dynamics in mild and severe cases of COVID-19 - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30232-2/fulltext

    Overall, our data indicate that, similar to SARS in 2002–03,6
    patients with severe COVID-19 tend to have a high viral load and a long virus-shedding period. This finding suggests that the viral load of SARS-CoV-2 might be a useful marker for assessing disease severity and prognosis.

  • Asymptomatic cases in a family cluster with SARS-CoV-2 infection - The Lancet Infectious Diseases
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30114-6/abstract

    3 situations avec PCR SARS-Cov2 positif (sans préjuger du fait qu’il s’agisse de faux ou de vrais positifs)

    – symptomatique cliniquement (fièvre, toux, etc..) biologiquement (taux de lymphocytes diminués dans le sang) et radiologiquement (poumons anormaux au scanner)

    – asymptomatique cliniquement mais symptomatique radiologiquement (biologie non précisée ici)

    – asymptomatique pour tous les critères.

  • COVID-19 and the anti-lessons of history - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30468-2/abstract

    Meanwhile, the protests in Hong Kong from June, 2019, have been a reaction to a perceived erosion of the territory’s quasi-autonomy as a special administrative region. While ostensibly an anti-government protest against the introduction of an extradition bill, the Hong Kong protests could be viewed as an attempt to push back against Xi’s expansion of central power. Concurrently, a US–China trade war instigated by President Donald Trump’s imposition of tariffs on China in 2018 is hitting the Chinese economy. The COVID-19 outbreak is compounding this economic situation, holding out the potential for a global recession with major disruption to global supply chains.
    Taken together, these entangled circumstances have created a unique setting in which the COVID-19 outbreak is evolving.

    [...]

    Analogies of COVID-19 are rarely extended to encompass these intermeshing social and political environments. The lessons approach skates over this history, even as history’s expediency as a tool for instruction is flaunted.

    #leçons #histoire #analogies #contexte

  • Flatten the curve

    https://twitter.com/i/status/1236721200291655680
    #coronavirus #épidémie #courbe #évolution

    –----------

    The three phases of #Covid-19 – and how we can make it manageable

    How is the coronavirus likely to play out, how does it end, and does our behaviour make a difference? Here infectious diseases expert Dr Siouxsie Wiles walks us through the epidemic curve, with illustrations by Toby Morris.

    https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable

    ping @odilon @fil @reka

    • Petit commentaire :
      La ligne « healthcare system capacity » est une ligne droite, car l’échelle temporelle est courte, le temps de l’épidémie, mais ça aurait été intéressant de simuler aussi sa chute des année précédentes avec la destruction de la santé publique... car je ne suis vraiment pas sure que le système de santé actuel soit à cette hauteur et donc capable de prendre en charge les patient·es, même si celleux tombent malades de manière plus espacée dans le temps...

    • Apparemment, la source cité par Olivier Véran est un article (commentaire) du Lancet hier, 9/03/2020
      (pas de résumé - ce n’est pas un article)

      How will country-based mitigation measures influence the course of the COVID-19 epidemic ? - The Lancet
      https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/abstract

      Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread. Keeping mortality as low as possible will be the highest priority for individuals; hence governments must put in place measures to ameliorate the inevitable economic downturn. In our view, COVID-19 has developed into a pandemic, with small chains of transmission in many countries and large chains resulting in extensive spread in a few countries, such as Italy, Iran, South Korea, and Japan. Most countries are likely to have spread of COVID-19, at least in the early stages, before any mitigation measures have an impact.

      What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic. This impact of the COVID-19 response in China is encouraging for the many countries where COVID-19 is beginning to spread. However, it is unclear whether other countries can implement the stringent measures China eventually adopted. Singapore and Hong Kong, both of which had severe acute respiratory syndrome (SARS) epidemics in 2002–03, provide hope and many lessons to other countries. In both places, COVID-19 has been managed well to date, despite early cases, by early government action and through social distancing measures taken by individuals.

    • In una delle costanti mail che ricevo... - Daniele Macchini
      https://www.facebook.com/daniele.macchini.52/posts/3395152210500625

      In una delle costanti mail che ricevo dalla mia direzione sanitaria a cadenza più che quotidiana ormai in questi giorni, c’era anche un paragrafo intitolato “fare social responsabilmente”, con alcune raccomandazioni che possono solo essere sostenute.

      Dopo aver pensato a lungo se e cosa scrivere di ciò che ci sta accadendo, ho ritenuto che il silenzio non fosse affatto da responsabili. Cercherò quindi di trasmettere alle persone “non addette ai lavori” e più lontane alla nostra realtà, cosa stiamo vivendo a Bergamo in questi giorni di pandemia da Covid-19.

      Capisco la necessità di non creare panico, ma quando il messaggio della pericolosità di ciò che sta accadendo non arriva alle persone e sento ancora chi se ne frega delle raccomandazioni e gente che si raggruppa lamentandosi di non poter andare in palestra o poter fare tornei di calcetto rabbrividisco.

      Capisco anche il danno economico e sono anch’io preoccupato di quello. Dopo l’epidemia il dramma sarà ripartire. Però, a parte il fatto che stiamo letteralmente devastando anche dal punto di vista economico il nostro SSN, mi permetto di mettere più in alto l’importanza del danno sanitario che si rischia in tutto il paese e trovo a dir poco “agghiacciante” ad esempio che non si sia ancora istituita una zona rossa già richiesta dalla regione, per i comuni di Alzano Lombardo e Nembro (tengo a precisare che trattasi di pura opinione personale).

      Io stesso guardavo con un po’ di stupore le riorganizzazioni dell’intero ospedale nella settimana precedente, quando il nostro nemico attuale era ancora nell’ombra: i reparti piano piano letteralmente “svuotati”, le attività elettive interrotte, le terapie intensive liberate per creare quanti più posti letto possibili. I container in arrivo davanti al pronto soccorso per creare percorsi diversificati ed evitare eventuali contagi. Tutta questa rapida trasformazione portava nei corridoi dell’ospedale un’atmosfera di silenzio e vuoto surreale che ancora non comprendevamo, in attesa di una guerra che doveva ancora iniziare e che molti (tra cui me) non erano così certi sarebbe mai arrivata con tale ferocia.

      (apro una parentesi: tutto ciò in silenzio e senza pubblicizzazioni, mentre diverse testate giornalistiche avevano il coraggio di dire che la sanità privata non stava facendo niente).

      Ricordo ancora la mia guardia di notte di una settimana fa passata inutilmente senza chiudere occhio, in attesa di una chiamata dalla microbiologia del Sacco. Aspettavo l’esito di un tampone sul primo paziente sospetto del nostro ospedale, pensando a quali conseguenze ci sarebbero state per noi e per la clinica. Se ci ripenso mi sembra quasi ridicola e ingiustificata la mia agitazione per un solo possibile caso, ora che ho visto quello che sta accadendo.

      Bene, la situazione ora è a dir poco drammatica. Non mi vengono altre parole in mente.

      La guerra è letteralmente esplosa e le battaglie sono ininterrotte giorno e notte.

      Uno dopo l’altro i poveri malcapitati si presentano in pronto soccorso. Hanno tutt’altro che le complicazioni di un’influenza. Piantiamola di dire che è una brutta influenza. In questi 2 anni ho imparato che i bergamaschi non vengono in pronto soccorso per niente. Si sono comportati bene anche stavolta. Hanno seguito tutte le indicazioni date: una settimana o dieci giorni a casa con la febbre senza uscire e rischiare di contagiare, ma ora non ce la fanno più. Non respirano abbastanza, hanno bisogno di ossigeno.

      Le terapie farmacologiche per questo virus sono poche. Il decorso dipende prevalentemente dal nostro organismo. Noi possiamo solo supportarlo quando non ce la fa più. Si spera prevalentemente che il nostro organismo debelli il virus da solo, diciamola tutta. Le terapie antivirali sono sperimentali su questo virus e impariamo giorno dopo giorno il suo comportamento. Stare al domicilio sino a che peggiorano i sintomi non cambia la prognosi della malattia.

      Ora però è arrivato quel bisogno di posti letto in tutta la sua drammaticità. Uno dopo l’altro i reparti che erano stati svuotati, si riempiono a un ritmo impressionante. I tabelloni con i nomi dei malati, di colori diversi a seconda dell’unità operativa di appartenenza, ora sono tutti rossi e al posto dell’intervento chirurgico c’è la diagnosi, che è sempre la stessa maledetta: polmonite interstiziale bilaterale.

      Ora, spiegatemi quale virus influenzale causa un dramma così rapido. Perché quella è la differenza (ora scendo un po’ nel tecnico): nell’influenza classica, a parte contagiare molta meno popolazione nell’arco di più mesi, i casi si possono complicare meno frequentemente, solo quando il VIRUS distruggendo le barriere protettive delle nostre vie respiratorie permette ai BATTERI normalmente residenti nelle alte vie di invadere bronchi e polmoni provocando casi più gravi. Il Covid 19 causa una banale influenza in molte persone giovani, ma in tanti anziani (e non solo) una vera e propria SARS perché arriva direttamente negli alveoli dei polmoni e li infetta rendendoli incapaci di svolgere la loro funzione. L’insufficienza respiratoria che ne deriva è spesso grave e dopo pochi giorni di ricovero il semplice ossigeno che si può somministrare in un reparto può non bastare.

      Scusate, ma a me come medico non tranquillizza affatto che i più gravi siano prevalentemente anziani con altre patologie. La popolazione anziana è la più rappresentata nel nostro paese e si fa fatica a trovare qualcuno che, sopra i 65 anni, non prenda almeno la pastiglia per la pressione o per il diabete. Vi assicuro poi che quando vedete gente giovane che finisce in terapia intensiva intubata, pronata o peggio in ECMO (una macchina per i casi peggiori, che estrae il sangue, lo ri-ossigena e lo restituisce al corpo, in attesa che l’organismo, si spera, guarisca i propri polmoni), tutta questa tranquillità per la vostra giovane età vi passa.

      E mentre ci sono sui social ancora persone che si vantano di non aver paura ignorando le indicazioni, protestando perché le loro normali abitudini di vita sono messe “temporaneamente” in crisi, il disastro epidemiologico si va compiendo.

      E non esistono più chirurghi, urologi, ortopedici, siamo unicamente medici che diventano improvvisamente parte di un unico team per fronteggiare questo tsunami che ci ha travolto. I casi si moltiplicano, arriviamo a ritmi di 15-20 ricoveri al giorno tutti per lo stesso motivo. I risultati dei tamponi ora arrivano uno dopo l’altro: positivo, positivo, positivo. Improvvisamente il pronto soccorso è al collasso. Le disposizioni di emergenza vengono emanate: serve aiuto in pronto soccorso. Una rapida riunione per imparare come funziona il software di gestione del pronto soccorso e pochi minuti dopo sono già di sotto, accanto ai guerrieri che stanno al fronte della guerra. La schermata del pc con i motivi degli accessi è sempre la stessa: febbre e difficoltà respiratoria, febbre e tosse, insufficienza respiratoria ecc… Gli esami, la radiologia sempre con la stessa sentenza: polmonite interstiziale bilaterale, polmonite interstiziale bilaterale, polmonite interstiziale bilaterale. Tutti da ricoverare. Qualcuno già da intubare e va in terapia intensiva. Per altri invece è tardi...

      La terapia intensiva diventa satura, e dove finisce la terapia intensiva se ne creano altre. Ogni ventilatore diventa come oro: quelli delle sale operatorie che hanno ormai sospeso la loro attività non urgente diventano posti da terapia intensiva che prima non esistevano.

      Ho trovato incredibile, o almeno posso parlare per l’HUMANITAS Gavazzeni (dove lavoro) come si sia riusciti a mettere in atto in così poco tempo un dispiego e una riorganizzazione di risorse così finemente architettata per prepararsi a un disastro di tale entità. E ogni riorganizzazione di letti, reparti, personale, turni di lavoro e mansioni viene costantemente rivista giorno dopo giorno per cercare di dare tutto e anche di più.

      Quei reparti che prima sembravano fantasmi ora sono saturi, pronti a cercare di dare il meglio per i malati, ma esausti. Il personale è sfinito. Ho visto la stanchezza su volti che non sapevano cosa fosse nonostante i carichi di lavoro già massacranti che avevano. Ho visto le persone fermarsi ancora oltre gli orari a cui erano soliti fermarsi già, per straordinari che erano ormai abituali. Ho visto una solidarietà di tutti noi, che non abbiamo mai mancato di andare dai colleghi internisti per chiedere “cosa posso fare adesso per te?” oppure “lascia stare quel ricovero che ci penso io”. Medici che spostano letti e trasferiscono pazienti, che somministrano terapie al posto degli infermieri. Infermieri con le lacrime agli occhi perché non riusciamo a salvare tutti e i parametri vitali di più malati contemporaneamente rilevano un destino già segnato.

      Non esistono più turni, orari. La vita sociale per noi è sospesa.

      Io sono separato da alcuni mesi, e vi assicuro che ho sempre fatto il possibile per vedere costantemente mio figlio anche nelle giornate di smonto notte, senza dormire e rimandando il sonno a quando sono senza di lui, ma è da quasi 2 settimane che volontariamente non vedo né mio figlio né miei familiari per la paura di contagiarli e di contagiare a sua volta una nonna anziana o parenti con altri problemi di salute. Mi accontento di qualche foto di mio figlio che riguardo tra le lacrime e qualche videochiamata.

      Perciò abbiate pazienza anche voi che non potete andare a teatro, nei musei o in palestra. Cercate di aver pietà per quella miriade di persone anziane che potreste sterminare. Non è colpa vostra, lo so, ma di chi vi mette in testa che si sta esagerando e anche questa testimonianza può sembrare proprio un’esagerazione per chi è lontano dall’epidemia, ma per favore, ascoltateci, cercate di uscire di casa solo per le cose indispensabili. Non andate in massa a fare scorte nei supermercati: è la cosa peggiore perché così vi concentrate ed è più alto il rischio di contatti con contagiati che non sanno di esserlo. Ci potete andare come fate di solito. Magari se avete una normale mascherina (anche quelle che si usano per fare certi lavori manuali) mettetevela. Non cercate le ffp2 o le ffp3. Quelle dovrebbero servire a noi e iniziamo a far fatica a reperirle. Ormai abbiamo dovuto ottimizzare il loro utilizzo anche noi solo in certe circostanze, come ha recentemente suggerito l’OMS in considerazione del loro depauperamento pressoché ubiquitario.

      Eh sì, grazie allo scarseggiare di certi dispositivi io e tanti altri colleghi siamo sicuramente esposti nonostante tutti i mezzi di protezione che abbiamo. Alcuni di noi si sono già contagiati nonostante i protocolli. Alcuni colleghi contagiati hanno a loro volta familiari contagiati e alcuni dei loro familiari lottano già tra la vita e la morte.

      Siamo dove le vostre paure vi potrebbero far stare lontani. Cercate di fare in modo di stare lontani. Dite ai vostri familiari anziani o con altre malattie di stare in casa. Portategliela voi la spesa per favore.

      Noi non abbiamo alternativa. E’ il nostro lavoro. Anzi quello che faccio in questi giorni non è proprio il lavoro a cui sono abituato, ma lo faccio lo stesso e mi piacerà ugualmente finché risponderà agli stessi principi: cercare di far stare meglio e guarire alcuni malati, o anche solo alleviare le sofferenze e il dolore a chi non purtroppo non può guarire.

      Non spendo invece molte parole riguardo alle persone che ci definiscono eroi in questi giorni e che fino a ieri erano pronti a insultarci e denunciarci. Tanto ritorneranno a insultare e a denunciare appena tutto sarà finito. La gente dimentica tutto in fretta.

      E non siamo nemmeno eroi in questi giorni. E’ il nostro mestiere. Rischiavamo già prima tutti i giorni qualcosa di brutto: quando infiliamo le mani in una pancia piena di sangue di qualcuno che nemmeno sappiamo se ha l’HIV o l’epatite C; quando lo facciamo anche se lo sappiamo che ha l’HIV o l’epatite C; quando ci pungiamo con quello con l’HIV e ci prendiamo per un mese i farmaci che ci fanno vomitare dalla mattina alla sera. Quando apriamo con la solita angoscia gli esiti degli esami ai vari controlli dopo una puntura accidentale sperando di non esserci contagiati. Ci guadagniamo semplicemente da vivere con qualcosa che ci regala emozioni. Non importa se belle o brutte, basta portarle a casa.

      Alla fine cerchiamo solo di renderci utili per tutti. Ora cercate di farlo anche voi però: noi con le nostre azioni influenziamo la vita e la morte di qualche decina di persone. Voi con le vostre, molte di più.

      Per favore condividete e fate condividere il messaggio. Si deve spargere la voce per evitare che in tutta Italia succeda ciò che sta accadendo qua

  • COVID-19: too little, too late? - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30522-5/abstract

    So far, evidence suggests that the colossal public health efforts of the Chinese Government have saved thousands of lives. High-income countries, now facing their own outbreaks, must take reasoned risks and act more decisively. They must abandon their fears of the negative short-term public and economic consequences that may follow from restricting public freedoms as part of more assertive infection control measures.

    #santé

    • Impressionnant ! prenant parti dans le débat, l’édito du Lancet vote sans aucune hésitation pour la supériorité d’un régime autoritaire, pardon, une administration forte bénéficiant d’un consentement acquis d’avance de sa population à se soumettre à des procédures strictes…

      China’s success rests largely with a strong administrative system that it can mobilise in times of threat, combined with the ready agreement of the Chinese people to obey stringent public health procedures. Although other nations lack China’s command-and-control political economy, there are important lessons that presidents and prime ministers can learn from China’s experience. The signs are that those lessons have not been learned.

      … et la conclusion : suivez l’exemple de la Chine

      So far, evidence suggests that the colossal public health efforts of the Chinese Government have saved thousands of lives. High-income countries, now facing their own outbreaks, must take reasoned risks and act more decisively. They must abandon their fears of the negative short-term public and economic consequences that may follow from restricting public freedoms as part of more assertive infection control measures.

    • Inside China’s All-Out War on the Coronavirus - The New York Times
      https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html

      Isn’t it possible only because China is an autocracy?

      Journalists also say, “Well, they’re only acting out of fear of the government,” as if it’s some evil fire-breathing regime that eats babies. I talked to lots of people outside the system — in hotels, on trains, in the streets at night.
      They’re mobilized, like in a war, and it’s fear of the virus that was driving them. They really saw themselves as on the front lines of protecting the rest of China. And the world.

  • Selection of #pesticides to reduce human and environmental health risks: a global guideline and minimum pesticides list - The Lancet Planetary Health
    https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(19)30266-9/abstract

    We have included both human health and environmental risks in our classification system for pesticides. By undertaking a comprehensive analysis of hundreds of compounds, we have subdivided most currently used pesticides on the basis of a common platform of risk criteria. Of particular note is the identification of a group of lower risk pesticides. Although human health risks alone would justify development of this lower risk classification, there are important environmental risks that can also be mitigated or reduced if pesticides are selected from this class.

    https://www.thelancet.com/cms/10.1016/S2542-5196(19)30266-9/attachment/f07235dd-c222-4b42-a479-e0165ddb7585/mmc1.pdf

  • Improving the prognosis of health care in the USA - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/abstract

    Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).

    [...] This shift to single-payer health care would provide the greatest relief to lower-income households.

    Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.

    #santé #etats-unis #coûts

  • China coronavirus : Death toll rises as disease spreads - BBC News
    https://www.bbc.com/news/world-asia-china-51245680

    Earlier, when the death toll was 17, information from China’s National Health Commission said the youngest person who died from the virus was 48 and the oldest was 89.
    But 15 of the 17 were over 60, and more than half suffered from other chronic diseases including Parkinson’s and diabetes. Just four were women.

    Comme pour les épidémies précédentes (et la grippe saisonnière…) les décès concernent majoritairement des patients âgés pour lesquels le virus vient compliquer d’autres pathologies.

    Comme d’habitude également, la mortalité spécifique, ie le nombre de décès rapporté aux cas confirmés, est très largement surestimée le nombre de cas réels d’infection étant totalement impossible à connaître ; en particulier tout ceux ne provoquant que des symptômes bénins qui passent (et passeront) sous le radar.

    • Coronavirus : le bilan monte à 56 morts en Chine
      https://www.lemonde.fr/planete/article/2020/01/26/coronavirus-le-bilan-monte-a-54-morts-en-chine_6027240_3244.html
      Le Monde avec AFP
      Publié le 26/01/20 à 01h24, mis à jour à 09h58

      L’inquiétude grimpe encore d’un cran en Chine. Quinze nouveaux décès dus à l’épidémie de pneumonie virale ont été enregistrés dimanche 26 janvier, portant le bilan à 56 morts, et 688 nouveaux cas d’infections au coronavirus ont été confirmés, soit un total de 1 975 dans le pays, a annoncé la commission nationale de la santé.

      L’épidémie a notamment fait un mort à Shanghai, a annoncé dimanche le gouvernement local dans un communiqué, la première victime dans la grande métropole financière de l’est du pays. La victime est un homme de 88 ans qui avait déjà des problèmes de santé avant.

    • et yapakmoakildi : le CDC -> #still_unclear

      Novel Coronavirus 2019 Situation Summary, Wuhan, China | CDC
      https://www.cdc.gov/coronavirus/2019-ncov/summary.html

      Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting person-to-person spread is occurring. At this time, it’s unclear how easily or sustainably this virus is spreading between people.

      Both MERS and SARS have been known to cause severe illness in people. The situation with regard to 2019-nCoV is still unclear. While severe illness, including illness resulting in a number of deaths has been reported in China, other patients have had milder illness and been discharged.

    • As China reports a jump in coronavirus-related deaths — here’s how the illness has spread around the world so rapidly - MarketWatch
      https://www.marketwatch.com/story/how-the-mysterious-coronavirus-from-china-has-spread-so-quickly-2020-01

      A new study in the Lancet said this new strain is similar to SARS-related coronaviruses found in Chinese horseshoe bats
      […]
      But more severe coronaviruses can become more serious and progress to pneumonia. “Human coronaviruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia or bronchitis,” it added. “This is more common in people with cardiopulmonary disease, people with weakened immune systems, infants, and older adults. Two other human coronaviruses, MERS-CoV and SARS-CoV have been known to frequently cause severe symptoms.”
      […]
      A new study published in the Lancet looking at five of six family members with the virus said the it’s spreading from person to person, rather than exclusively from animals or infected food, and can be transmitted in social, family and even hospital environments. It also now being spread by people who have not been to Wuhan. “This is a novel coronavirus, which is closest to the bat severe acute respiratory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats.”

    • A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster - The Lancet
      https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract


      Figure 1 Chronology of symptom onset of the Shenzhen family cluster and their contacts in Wuhan
      Dates filled in red are the dates on which patients 1–6 had close contacts with their relatives (relatives 1–5). Dates filled in yellow are the dates on which patients 3–6 stayed with patient 7. The boxes with an internal red cross are the dates on which patients 1 and 3 or relatives 1, 2, and 3 had stayed overnight (white boxes) at or had visited (blue boxes) the hospital in which relative 1 was admitted for febrile pneumonia. The information of relatives 1–5 was provided by patient 3. No virological data were available.

      Summary
      Background
      An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, Hubei province, China. Affected patients were geographically linked with a local wet market as a potential source. No data on person-to-person or nosocomial transmission have been published to date.

      Methods
      In this study, we report the epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan. Phylogenetic analysis of genetic sequences from these patients were done.

      Findings
      From Jan 10, 2020, we enrolled a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020. Of six family members who travelled to Wuhan, five were identified as infected with the novel coronavirus. Additionally, one family member, who did not travel to Wuhan, became infected with the virus after several days of contact with four of the family members. None of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36–66 years) presented with fever, upper or lower respiratory tract symptoms, or diarrhoea, or a combination of these 3–6 days after exposure. They presented to our hospital (The University of Hong Kong-Shenzhen Hospital, Shenzhen) 6–10 days after symptom onset. They and one asymptomatic child (aged 10 years) had radiological ground-glass lung opacities. Older patients (aged >60 years) had more systemic symptoms, extensive radiological ground-glass lung changes, lymphopenia, thrombocytopenia, and increased C-reactive protein and lactate dehydrogenase levels. The nasopharyngeal or throat swabs of these six patients were negative for known respiratory microbes by point-of-care multiplex RT-PCR, but five patients (four adults and the child) were RT-PCR positive for genes encoding the internal RNA-dependent RNA polymerase and surface Spike protein of this novel coronavirus, which were confirmed by Sanger sequencing. Phylogenetic analysis of these five patients’ RT-PCR amplicons and two full genomes by next-generation sequencing showed that this is a novel coronavirus, which is closest to the bat severe acute respiatory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats.

      Interpretation
      Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions.

    • C’est un peu tôt, non ?

      À mon avis, pas grand chose à changer pour le moment. Sauf la bizarrerie coréenne sur la très forte surreprésentation des 20-29 ans dans les malades et les décès. Toujours une (très) grande incertitude sur les chiffres et donc sur la létalité.

    • Apparemment pas trop tôt pour blanchir la pauvre petite Buzyn et le général Macron :) L’écriture de l’histoire est en marche. D’où ce tag pour se souvenir de ce qu’on pensait déjà pouvoir dire avant le 14 février.

  • Il y a un mois

    #Turquie. Les poursuites contre un #lanceur_d’alerte qui a révélé des risques sanitaires doivent être abandonnées | Amnesty International
    https://www.amnesty.org/fr/latest/news/2019/09/turkey-charges-against-whistleblower-who-exposed-public-health-dangers-must

    Cet ingénieur agroalimentaire, ancien universitaire et directeur adjoint du Centre de recherche sur la sécurité alimentaire et l’agriculture à l’Université d’Akdeniz, a publié les résultats d’une étude qu’il a menée avec d’autres scientifiques pour le ministère de la #Santé entre 2011 et 2015, visant à vérifier s’il existait une corrélation entre d’une part la toxicité du #sol, de l’#eau et des denrées alimentaires et d’autre part l’incidence des #cancers dans une région de l’ouest de la Turquie. L’étude a mis en évidence des niveaux de toxicité supérieurs au seuil de risque acceptable en raison de la présence de #pesticides dans les eaux souterraines et de surface et le sol.

    #Bülent_Şık : Turkish scientist convicted - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32672-8/abstract

    Bülent Şık continues to reside in Antalya, where 60% of the food, as he noted in The Hidden Report, contains pesticide residues—the highest proportion in the country. Last year, Şık published his first book, The Chemist in the Kitchen: How Safe Is Our Food?, to inform readers about these dangers. In July, Turkey’s highest court ruled that the sentencing of the Academics for Peace amounted to a violation of their rights; court cases against scholars were dropped soon afterwards. But Şık’s sentencing from the ministry of health case still stands.

  • Ocular injuries caused by less-lethal weapons in France - The Lancet

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31807-0/abstract

    Qui aurait dit qu’un jour Macron et Castaner fasse la une the The Lancet comme éborgneurs professionnels (et accessoirement arracheurs de mains).

    Since the introduction of so-called less-lethal weapons in France in the late 1990s, there has been no legal requirement to collect data on injuries induced by kinetic impact projectiles, and no epidemiological surveys have been planned. To estimate the number of patients with ocular injuries caused by the use of these defensive tools, a retrospective survey was sent to all ophthalmology department chairs in French university hospitals, which are where the most severe cases are managed. Demographic data, date of trauma, initial ophthalmological examination and any specialised investigations, initial and immediate surgical management of the injury, follow-up, and visual prognosis were documented and transmitted anonymously.

  • Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence - The Lancet
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/abstract

    Published findings on breast cancer risk associated with different types of menopausal hormone therapy (MHT) are inconsistent, with limited information on long-term effects. We bring together the epidemiological evidence, published and unpublished, on these associations, and review the relevant randomised evidence.

    [...]

    If these associations are largely causal, then for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great.

    #cancer_mammaire #ménopause #hormones