“…According to the Brazilian Ministry of Health, more than 17 million people have been infected with a case fatality of 2.8% [7] . Brazil has the third-highest number of cases in the world ( https://healthmap.org/covid-19/ ) [44] , [45] . Therefore, the importance of identifying and understanding the factors that affect vulnerable groups' health and wellbeing during the pandemic cannot be overstated.…”
The COVID-19 pandemic has had an unprecedented impact on people and healthcare services. The disruption to chronic illnesses, such as epilepsy, may relate to several factors ranging from direct infection to secondary effects from healthcare reorganization and social distancing measures.
Objectives
As part of the COVID-19 and Epilepsy (COV-E) global study, we ascertained the effects of COVID-19 on people with epilepsy in Brazil, based on their perspectives and those of their caregivers. We also evaluated the impact of COVID-19 on the care delivered to people with epilepsy by healthcare workers.
Methods
We designed separate online surveys for people with epilepsy and their caregivers. A further survey for healthcare workers contained additional assessments of changes to working patterns, productivity, and concerns for those with epilepsy under their care. The Brazilian arm of COV-E initially collected data from May to November 2020 during the country's first wave. We also examined national data to identify the Brazilian states with the highest COVID-19 incidence and related mortality. Lastly, we applied this geographic grouping to our data to explore whether local disease burden played a direct role in difficulties faced by people with epilepsy.
Results
Two hundred and forty-one people returned the survey, 20% were individuals with epilepsy (
n
= 48); 22% were caregivers (
n
= 53), and 58% were healthcare workers (
n
= 140). Just under half (43%) of people with epilepsy reported health changes during the pandemic, including worsening seizure control, with specific issues related to stress and impaired mental health. Of respondents prescribed antiseizure medication, 11% reported difficulty taking medication on time due to problems acquiring prescriptions and delayed or canceled medical appointments. Only a small proportion of respondents reported discussing significant epilepsy-related risks in the previous 12 months. Analysis of national COVID-19 data showed a higher disease burden in the states of Sao Paulo and Rio de Janeiro compared to Brazil as a whole. There were, however, no geographic differences observed in survey responses despite variability in the incidence of COVID-19.
Conclusion
Our findings suggest that Brazilians with epilepsy have been adversely affected by COVID-19 by factors beyond infection or mortality. Mental health issues and the importance of optimal communication are critical during these difficult times. Healthcare services need to find nuanced approaches and learn from shared international experiences to provide optimal care for people with epilepsy as the direct burden of COVID-19 improves in some countries. In contrast, others face resurgent waves of the pandemic.
“…According to the Brazilian Ministry of Health, more than 17 million people have been infected with a case fatality of 2.8% [7] . Brazil has the third-highest number of cases in the world ( https://healthmap.org/covid-19/ ) [44] , [45] . Therefore, the importance of identifying and understanding the factors that affect vulnerable groups' health and wellbeing during the pandemic cannot be overstated.…”
The COVID-19 pandemic has had an unprecedented impact on people and healthcare services. The disruption to chronic illnesses, such as epilepsy, may relate to several factors ranging from direct infection to secondary effects from healthcare reorganization and social distancing measures.
Objectives
As part of the COVID-19 and Epilepsy (COV-E) global study, we ascertained the effects of COVID-19 on people with epilepsy in Brazil, based on their perspectives and those of their caregivers. We also evaluated the impact of COVID-19 on the care delivered to people with epilepsy by healthcare workers.
Methods
We designed separate online surveys for people with epilepsy and their caregivers. A further survey for healthcare workers contained additional assessments of changes to working patterns, productivity, and concerns for those with epilepsy under their care. The Brazilian arm of COV-E initially collected data from May to November 2020 during the country's first wave. We also examined national data to identify the Brazilian states with the highest COVID-19 incidence and related mortality. Lastly, we applied this geographic grouping to our data to explore whether local disease burden played a direct role in difficulties faced by people with epilepsy.
Results
Two hundred and forty-one people returned the survey, 20% were individuals with epilepsy (
n
= 48); 22% were caregivers (
n
= 53), and 58% were healthcare workers (
n
= 140). Just under half (43%) of people with epilepsy reported health changes during the pandemic, including worsening seizure control, with specific issues related to stress and impaired mental health. Of respondents prescribed antiseizure medication, 11% reported difficulty taking medication on time due to problems acquiring prescriptions and delayed or canceled medical appointments. Only a small proportion of respondents reported discussing significant epilepsy-related risks in the previous 12 months. Analysis of national COVID-19 data showed a higher disease burden in the states of Sao Paulo and Rio de Janeiro compared to Brazil as a whole. There were, however, no geographic differences observed in survey responses despite variability in the incidence of COVID-19.
Conclusion
Our findings suggest that Brazilians with epilepsy have been adversely affected by COVID-19 by factors beyond infection or mortality. Mental health issues and the importance of optimal communication are critical during these difficult times. Healthcare services need to find nuanced approaches and learn from shared international experiences to provide optimal care for people with epilepsy as the direct burden of COVID-19 improves in some countries. In contrast, others face resurgent waves of the pandemic.
“…Tras su rápida diseminación global, el 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró la pandemia 1 . A marzo de 2021, la Región de Latinoamérica y el Caribe concentra el 18,8% del total de casos mundiales confirmados 2 .…”
“…Pango delineates a total of 1290 distinct SARS-CoV-2 lineages. Among these, 16 lineages are currently under scrutiny by international health authorities due to their widespread and sustained circulation, coupled with the presence, in the spike glycoprotein, of recurrent mutations associated with increased infectivity and/or reduced neutralization by antibodies 5,6 . Collectively these lineages are known under the acronym VOC (Variant of Concern) or VOI (Variant of Interest) and represent a substantial source of concern for the success of national vaccination campaigns and the effectiveness of measures for the containment of COVID-19 7 .…”
Section: Mainmentioning
confidence: 99%
“…It is The copyright holder for this preprint this version posted June 23, 2021. ; https://doi.org/10.1101/2021.06. 23.449558 doi: bioRxiv preprint evolutionary success of this lineage and the efficacy of contemporary approaches to SARS-CoV-2 genomic surveillance in tracking VOCs, several lines of evidence suggest that current sampling of SARS-CoV-2 genomic sequences might be substantially biased 13 due to various factors including: local incidence of COVID-19 14 , access to state of the art molecular diagnostic test and sequencing facilities 15,16 , bioinformatics bottlenecks in the analyses of the data and sharing of the results 17,18 , as well as the application of different rationales and criteria by local health authorities in the implementation of genomic surveillance strategies.…”
Accurate and timely monitoring of emerging genomic diversity is crucial for limiting the spread of potentially more transmissible/pathogenic strains of SARS-CoV-2. At the time of writing, over 1.8M distinct viral genome sequences have been made publicly available, and a sophisticated nomenclature system based on phylogenetic evidence and expert manual curation has allowed the relatively rapid classification of emerging lineages of potential concern. Here, we propose a complementary approach that integrates fine-grained spatiotemporal estimates of allele frequency with unsupervised clustering of viral haplotypes, and demonstrate that multiple highly frequent genetic variants, arising within large and/or rapidly expanding SARS-CoV-2 lineages, have highly biased geographic distributions and are not adequately captured by current SARS-CoV-2 nomenclature standards. Our results advocate a partial revision of current methods used to track SARS-CoV-2 genomic diversity and highlight the importance of the application of strategies based on the systematic analysis and integration of regional data. Here we provide a complementary, completely automated and reproducible framework for the mapping of genetic diversity in time and across different geographic regions, and for the prioritization of virus variants of potential concern. We believe that the approach outlined in this study will contribute to relevant advances to current genomic surveillance methods.
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