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      Organización de la cuarentena hospitalaria en los evacuados de Wuhan al inicio de la pandemia de COVID-19 Translated title: Hospital organization quarantine in Wuhan evacuees at the start of the COVID-19 pandemic

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          Abstract

          RESUMEN Introducción: El 31 de diciembre de 2019, la Organización Mundial de la Salud fue informada de un grupo de casos de neumonía de etiología desconocida detectados en la ciudad de Wuhan (China). El 30 de enero de 2020, se declaró el brote de nCoV-2019 (posteriormente SARS-CoV-2) como una emergencia de salud pública de preocupación internacional. En este contexto, algunos países occidentales, decidieron evacuar a sus ciudadanos. Objetivos: En este artículo se describe el planteamiento llevado a cabo en el caso de las personas evacuadas desde Wuhan a su llegada a España. Material y Método: Se recopiló información sobre los criterios para seleccionar las instalaciones y el personal, el número de casos en cuarentena, la estrategia de control de infección, la duración de la cuarentena, la monitorización clínica y otros aspectos relevantes. Resultados: Las autoridades sanitarias españolas seleccionaron el Hospital Central de Defensa Gómez Ulla para realizar una cuarentena hospitalaria. Veintiuna personas fueron trasladadas de Wuhan a Madrid, incluidos dos niños. Los médicos de medicina preventiva y enfermedades infecciosas fueron seleccionados para dirigir y asistir la vigilancia. Las visitas fueron autorizadas siguiendo un protocolo establecido. Conclusiones: Este es el primer informe sobre cuarentena hospitalaria para SARS-CoV-2, diseñado específicamente para repatriados. La cuarentena hospitalaria podría ser un método útil para casos seleccionados de enfermedades altamente contagiosas. Sin embargo, se necesita un buen soporte de recursos e instalaciones, selección de personal experimentado y protocolos revisados.

          Translated abstract

          SUMMARY Introduction: On December 31, 2019, the World Health Organization was informed of a group of cases of pneumonia of unknown etiology detected in the city of Wuhan (China). On January 30, 2020, the nCoV-2019 outbreak (later SARS-CoV-2) was declared a public health emergency of international concern. In this context, some western countries decided to evacuate their citizens. Aim: This article describes the approach taken in the case of people evacuated from Wuhan upon arrival in Spain. Methods: Information was collected on the criteria for selecting facilities and personnel, the number of quarantine cases, the infection control strategy, the duration of quarantine, clinical monitoring, and other relevant aspects. Results: The Spanish health authorities selected the Gómez Ulla Central Defense Hospital to carry out a hospital quarantine. Twenty-one people were transferred from Wuhan to Madrid, including two children. Preventive medicine and infectious disease physicians were selected to direct and assist surveillance. The visits were authorized following an established protocol. Conclusions: This is the first hospital quarantine report for SARS-CoV-2, designed specifically for returnees. Hospitalarian quarantine could be a useful method for selected cases of highly contagious diseases. However, good resource and facility support, selection of experienced staff, and revised protocols are required.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

            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. Funding The Shaw Foundation Hong Kong, Michael Seak-Kan Tong, Respiratory Viral Research Foundation Limited, Hui Ming, Hui Hoy and Chow Sin Lan Charity Fund Limited, Marina Man-Wai Lee, the Hong Kong Hainan Commercial Association South China Microbiology Research Fund, Sanming Project of Medicine (Shenzhen), and High Level-Hospital Program (Guangdong Health Commission).
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              Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

              A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                June 2020
                : 76
                : 2
                : 80-85
                Affiliations
                [3] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel
                [4] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel orgdiv2Servicio de Medicina Preventiva
                [6] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel, Sección de Infecciosas orgdiv2Servicio de Medicina Interna
                [1] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel, Sección de Infecciosas orgdiv2Servicio de Medicina Interna
                [5] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel
                [2] Madrid orgnameHospital Gómez Ulla orgdiv1Unidad de Aislamiento de Alto Nivel, Sección de Infecciosas orgdiv2Servicio de Medicina Interna
                Article
                S1887-85712020000200006 S1887-8571(20)07600200006
                10.4321/s1887-85712020000200006
                6438f2dd-3a7c-4929-8526-aa946d66239c

                http://creativecommons.org/licenses/by/4.0/

                History
                : 08 June 2020
                : 18 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Spain

                Categories
                Informe

                SARS-CoV-2,COVID-19,Cuarentena,Quarantine,coronavirus
                SARS-CoV-2, COVID-19, Cuarentena, Quarantine, coronavirus

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