Introduction Although patients’ clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in São Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods This is a partial economic evaluation performed from the hospital´s perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clínicas of the University of São Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results The average cost of the 3,254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management.

Background: CoronaVac, a vaccine containing inactivated SARS-CoV-2, demonstrated efficacy of 50.39% 14 days or more after the 2nd dose. The objective of this study is to report the occurrence of symptomatic COVID-19 in a cohort of HCW vaccinated with CoronaVac and to estimate its effectiveness. Methods: CoronaVac was given to HCWs in Hospital das Clinicas on 18-21 January, 2021 (epi week 3) (22,402 HCWs), and on 14-16 February, 2021 (epi week 7) (21,652 HCWs). Weekly cases of symptomatic COVID-19 were evaluated. Using the period from 2020 epi week 24 through 2021 epi week 2 (before vaccination), a Poisson regression was fit to model the HCWs with COVID-19 of the hospital, and the officially reported cases in the city of Sao Paulo. The predicted numbers of cases among HCWs for 2021 epi weeks 3-12 were then compared to the observed numbers of cases (after vaccination). Effectiveness was estimated for weeks 9-12 (2 to 5 weeks after the 2nd dose). 142 samples after vaccination were evaluated for SARS-CoV-2 variants of concern. Results: Since the 1st dose there were 380 HCW diagnosed with COVID-19. On visual analysis, the number of cases of COVID-19 in the city increased sharply in 2021. The number of cases among the HCW did not follow. The estimated effectiveness 2 and 3 weeks after 2nd dose was 50.7% and 51.8%, respectively, and increased over the next 2 weeks. 67/142 samples (47%) were variants of concern, mostly P1 (57). Conclusion: Coronavac is effective in preventing COVID-19.

As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of São Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900-bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients.

In the article Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis Replace ''Maria José Carvalho Carmona 0

Preliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance ( p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task ( p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment ( p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system. Supplementary Information The online version contains supplementary material available at 10.1007/s00406-022-01427-3.

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IntroductionAlthough patients’ clinical conditions were previously shown to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes, their impact on hospital costs is not known. The economic evaluation of COVID-19 admissions allows the assessment of hospital costs associated with the treatment of these patients, including the main cost components and costs driven by demographic and clinical conditions. The aim of this study was to determine the COVID-19 hospitalization-related costs and their association with clinical conditions.MethodsProspective observational cohort study of the hospitalization costs of patients with COVID-19 admitted between March 30 and June 30, 2020, who were followed until discharge, death, or external transfer, using micro-costing methodology. The study was carried out in the Central Institute of the Hospital das Clinicas, affiliated with the Faculty of Medicine of the University of Sao Paulo, Brazil, which is the largest hospital complex in Latin America and was designated to exclusively admit COVID-19 patients during the pandemic response.ResultsThe average cost of the 3,254 admissions (51.7% of which involved intensive care unit (ICU) stays) was US$12,637.42. Overhead cost was the main cost component, followed by daily fixed costs and drugs. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), cancer (US$10,315.06), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic diseases (US$15,257.95) were significantly associated with higher costs. Age >69 years, RT-PCR-confirmed COVID-19, comorbidities, the use of mechanical ventilation, dialysis, or surgery, and poor outcomes remained significantly associated with higher costs after model adjustment.ConclusionKnowledge of COVID-19-associated hospital costs and their impact across different populations can aid in the development of a generalizable and comprehensive approach to hospital preparedness, decision-making and planning for future risk management. Determining the disease-associated costs is the first step in evaluating the cost-effectiveness of treatments and vaccination programs.SUMMARY BOXQuestionWhat are the COVID-19 hospitalization-related costs?FindingsIn this prospective cohort that was carried out in a single reference quaternary center designated for the treatment of severe cases of COVID-19, more than three thousand patients were included, and their costs of hospitalization were found to be directly related to the age and comorbidities. The costs were more than 50% higher in older patients, 10-24% higher in patients with comorbidities, and 24-200% higher when additional therapeutic procedures were required.MeaningDetermining the disease-associated costs is the first step in conducting future evaluations of the cost-effectiveness of treatments and vaccination programs, supporting their implementation with a comprehensive population-based approach.

The topic of tobacco smoking, in its several aspects, has been receiving increasing attention among researchers over the past few years, which has been reflected in more data and more solid scientific literature on the subject in national journals.