“NORMS FOR FOLLOW-UP MEDICAL AND EPIDEMIOLOGICAL, AND COMMUNITY TESTING DURING THE COVID-19 PANDEMIC”
GT - 6:
Patrícia Asfora Falabella Leme (CECOM)
Mara Patrícia Traina Chacon Mikahil (PRG)
Marco Antônio Santos Dias (DSO)
Daniela de Almeida Martins (DSO)
Maria Luiza Moretti (FCM/CCIH/NVE)
Carolina Carvalho Ribeiro do Valle (FCM/CCIH/NVE)
Márcia Teixeira Garcia (FCM/CCIH/NVE)
Helena Altmann (SAE)
Tânia Maron Vichi Freire de Mello (SAPPE)
Lucimara Andréia Trevizam (SAR)
Marcelo Menossi Teixeira (IB)
JULY/2020
1. INTRODUCTION
Since the beginning of the Covid-19 pandemic, declared by the WHO on 11/03/2020, the
Unicamp has been proactive in minimizing its impacts within the
university community, such as the suspension of its face-to-face activities
from March 13th (GR no 24-2020). About 2 months later - 17/05/2020 -
a three-phase plan was designed for the resumption of in-person activities
on the Campinas, Limeira and Piracicaba campuses. Even though there is no set deadline yet
for this return, the Rectory's Office published on 17/06/20 ordinances (39 to
49/2020) designating working groups to think about and establish flows and
regulations aimed at perfect attention to the demands generated during and after the
pandemic - and, thus, provide opportunities for the fulfillment of its institutional mission in a
environment of security and tranquility.
The objective of GT-6, declared through its creation Ordinance GR-044/2020, is the
to “create standards for medical and epidemiological monitoring, and testing of the
community during the Covid-19 pandemic”.
2. OBJECTIVES
2.1 GENERAL
Define general regulations for medical, epidemiological and
community testing during the Covid-19 pandemic
2.2 SPECIFICS
- Develop protocol for diagnosis and monitoring of people with
suspected or confirmed Covid-19
- Develop protocol for identifying, removing and testing people
who have had contact with confirmed cases of Covid-19
- Describe epidemiological surveillance actions related to Covid-19
- Define testing strategy for Covid-19 in the university community
- Estimate the prevalence of Covid-19 in the Unicamp community
3. METHODOLOGY
A working group with eleven members was established through an ordinance from the
Rector's Office. Created through the tool Google Drive Valid identity document
shared among group members, where they were initially inserted and
agreed premises to guide the tasks (Table 1) and a proposed plan
of action (Table 2). Over time, a
consensus built through individual and collective contributions - the latter
offered in "X" virtual meetings held by the tool Google Meet with
average duration of 2h. The meetings were recorded, and minutes were drawn up.
Another tool used throughout the working time for the
Instant sharing of messages, information and publications was a
group of Whats App.
Table 1. Work Assumptions
Take as a basis the Gradual Return to In-Person Activities Plan
State University of Campinas, respecting the autonomy and
responsibility of the Institutes and Bodies and considering the scheduling of
return
Respect the regulations of Unicamp, health authorities and others
Official bodies - legal basis
Base regulations on consolidated technical-scientific knowledge -
scientific evidence
Consider the specificities of students, employees and third parties
Consider the actions and procedures for returning to early childhood education and the relationship
with their responsible employees
Consider the interface of the activities of this GT with those of the others
instituted simultaneously (e.g., in the need to purchase PPE and other
inputs - GT1; in actions aimed at Student Housing - GT3, among others)
Table 2. Action Plan
1 - Gather regulations and guidelines established by health authorities
national and international bodies, by official Social Security and Labor Bodies and by
Official Education Bodies
2 - Gather scientific evidence related to diagnosis and monitoring
clinical doctor, mental health monitoring, epidemiological surveillance and
testing for Covid-19
3 - Establish protocol with medical and epidemiological monitoring flow
4 - Define testing strategy for the entire community
5 - Create input and cost spreadsheet
6 - Draft regulations for medical and epidemiological monitoring, and testing
community during the Covid-19 pandemic
7 - Validate the regulations established by the other working groups created
by Unicamp to combat the pandemic that have an interface with
those in this group
8 - Implement and disseminate the regulations prepared
4. RESULTS
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)
Virus responsible for causing Covid-19 disease, received this name by the Committee
International Taxonomy of Viruses, on February 11, 2020, because it is
genetically related to the coronavirus responsible for the SARS outbreak (Severe
Acute Respiratory Syndrome, or Severe Acute Respiratory Syndrome) in 2003.(1)
Transmission of SARS-CoV-2 appears to occur mainly via droplets and
close contact with symptomatic infected cases (2); a sick person eliminates
respiratory droplets or secretions containing the virus when coughing, sneezing, talking or
sing, and these come into direct or indirect contact (through touching surfaces
contaminated) with healthy people through the nose, eyes or mouth.
Pre-symptomatic people (who are in the incubation period of the virus,
especially two or three days before the onset of symptoms) and asymptomatic (in
smaller number) can also transmit SARS-CoV-2 to other people.
Another form of transmission, common in Health Units, is called
airborne transmission, and generally occurs during certain types of procedures
medical aerosol generators (respiratory droplets less than 5
micrometers in diameter, capable of remaining suspended in the air for long
periods of time), in people who are not wearing protective equipment
appropriate personal protective equipment (PPE). The WHO, together with the scientific community, has
actively discussed and evaluated whether SARS-CoV-2 can also spread through
aerosols in the absence of these procedures, particularly in environments
indoors with poor ventilation (e.g. restaurants and gyms).
Finally, intrauterine transmission and breastfeeding of the virus have not yet
have been proven through solid scientific studies.
AEROSOL GENERATING PROCEDURES (AMP) (3)
These are procedures generally carried out in healthcare establishments, and which
generate aerosols, respiratory droplets less than 5 micrometers in diameter,
that can carry SARS-CoV-2.
The following are considered PGA by the WHO: tracheal intubation, non-invasive ventilation,
tracheostomy, cardiopulmonary resuscitation, manual ventilation before
intubation, bronchoscopy, sputum induction with hypertonic saline
nebulized, and autopsy procedures.
COVID-19 (coronavirus disease)
COVID-19, or coronavirus disease, is the disease caused by the virus
SARS-CoV-2. Its first cases, presented as “a pneumonia of
unknown origin”, were identified in December 2019 in Wuhan,
capital of Hubei province, China. (4) In Brazil, the first notification of a
confirmed case of COVID-19 received by the Ministry of Health occurred on the 26th
February 2020, and on March 11, 2020, the WHO declared a state of
Covid-19 pandemic. Currently, there are 216 countries, areas or territories with
positive cases due to this disease. (5)
- EPIDEMIOLOGY(6-9)
According to a preliminary analysis of data carried out by the WHO, there is a distribution
relatively uniform number of cases between women and men (47% versus 51%,
respectively), but there appears to be a higher number of deaths among men
(58%). Among healthcare professionals, however, women are at greater risk
of infection, because they make up the majority of this professional class (more than
70%).
In Brazil, available data on gender and age group are concentrated in cases
of Severe Acute Respiratory Syndrome (SARS) due to COVID-19: around 57% are
male; The most affected age group remains between 60 and 69 years of age.
age (20,0%), and the most prevalent race/color is brown, followed by white, black,
yellow and indigenous. Regarding cases of Covid-19 in healthcare professionals, the
professions most registered among confirmed cases of Flu Syndrome by
COVID-19 are nursing technicians/aides, followed by nurses,
doctors, community health agents and receptionists at health units. Already
cases that progress to hospitalization and death affect more
nursing technicians/aides, followed by doctors and nurses.
Among the people from the Unicamp university community served by CECOM
with suspected Covid-19 until May 31, 2020, the median age of cases
Notified suspects were 40 years old, ranging from 18 to 89 years old; around 80% were
female and the most affected professional category was
nursing assistants/technicians, followed by doctors and nurses.
- CLINICAL MANIFESTATIONS (10-17)
The incubation period of the disease (time between exposure to the virus or infection and
the onset of symptoms) varies between 2 and 14 days, with an average of 5 days.
Symptoms that frequently appear in COVID-19 are fever (≥37,8oC) or
chills, cough, shortness of breath or difficulty breathing, fatigue or tiredness, aches and pains
muscle or body pain, new loss of taste or smell, headache, pain in
throat, nasal congestion or runny nose, nausea, vomiting and diarrhea. Elderly people and
immunosuppressed patients, however, may present atypical symptoms, such as a state of
reduced alertness and mobility, and delirium, and may not have a fever.
Around 80% of adults will develop a mild or moderate form of the disease.
(including people without pneumonia or with mild pneumonia). For the purpose of
epidemiological monitoring, the Ministry of Health has considered cases
mild those with onset of symptoms more than 14 days ago and who did not require
hospitalization (Bulletin); and, for clinical monitoring purposes, those who
can be fully monitored within the scope of Primary Care
(APS/ESF) due to the lesser severity of the case.
The severe form of the disease occurs in 15% of cases, with deterioration of the condition
generally after about a week of the onset of symptoms; and only 5% will evolve
to a critical phase, with respiratory failure, septic shock or failure
multiple organs. The following signs and symptoms alert you to the possibility of
worsening: emergence of respiratory difficulty, oxygen oximetry saturation
pulse <95, bluish lips or face, persistent chest pain or pressure, hypotension
arterial (with systolic below 90mmHg and/or diastolic below 60mmHg); gets worse
in the clinical conditions of underlying diseases, such as heart disease and
chronic respiratory; change in mental status, such as confusion and lethargy; It is
persistence or increase in fever for more than 3 days or return after 48 hours of
afebrile period.
Serious cases require stabilization in PHC/ESF and referral to
reference center/emergency center/hospitals for assessment or interventions that require
greater technological density.
The following are considered risk conditions for worsening:
● Age 60 or over;
● Male
● Smoking
● Obesity (BMI>30)
● Severe or decompensated heart disease (heart failure, heart disease
ischemic);
● Severe or decompensated lung diseases (moderate/severe asthma, COPD);
● Immunosuppression;
● Advanced stage chronic kidney diseases (grades 3, 4 and 5);
● Diabetes mellitus, according to clinical judgment;
● Chromosomal diseases with a state of immunological fragility;
● High-risk pregnancy; It is
● Advanced stage liver disease;
In Brazil, the most frequent comorbidities or risk factors among deaths from
SARS caused by COVID-19 reported by the Coronavirus Epidemiological Bulletin
N21 were heart disease and diabetes, with the majority of individuals who
died, had comorbidities and were 60 or more years of age.
age.
- DIAGNOSIS(12,15)
The diagnosis of COVID-19 can be made through clinical information (signs and
symptoms) and epidemiological (history of exposure to people with the disease); per
specific laboratory tests for the detection of SARS-CoV-2; or by examinations
imaging, especially chest computed tomography.
The recommended test for the laboratory diagnosis of COVID-19 is the
molecular amplification of SARS-CoV-2 nucleic acid by time PCR
real preceded by reverse transcription reaction (RT-PCR).
High-resolution computed tomography (HRCT) of the chest is, according to
Brazilian College of Radiology and Imaging Diagnosis (CBR), a tool
ally for the diagnosis of Covid-19, as it has high specificity and
moderate sensitivity. However, it should not be used alone to
identify Covid-19, nor should it be carried out to track the disease,
being indicated only for hospitalized patients with a recommendation
specific clinic when symptomatic.
DEFINITION OF A SUSPECTED CASE OF COVID-19:(16)
- DEFINITION 1: FLU SYNDROME (FS):
Individual with an acute respiratory condition, characterized by at least two (2) of the
following signs and symptoms: fever (even if reported), chills, sore throat,
headache, cough, runny nose, olfactory disorders or taste disorders.
- DEFINITION 2: SEVERE ACUTE RESPIRATORY SYNDROME (SRAG):
Individual with GS who presents: dyspnea/respiratory discomfort OR pressure
persistent chest OR O2 saturation less than 95% on room air OR
bluish discoloration of the lips or face.
DEFINITION OF CONFIRMED CASE OF COVID-19:(16)
1. BY CLINICAL DISCRETION: Case of GS or SARS with clinical confirmation
associated with anosmia (olfactory dysfunction) OR ageusia (gustatory dysfunction)
acute without any other underlying cause.
2. BY CLINICAL-EPIDEMIOLOGICAL CRITERIA: Case of SG or SARS with
history of close or household contact, in the 14 days prior to the
appearance of signs and symptoms with a confirmed case of COVID-19.
3. BY CLINICAL-IMAGING CRITERIA: Case of GS or SARS or death due to
SARS that it was not possible to confirm by laboratory criteria AND that presents
at least one (1) of the following tomographic changes:
● OPACITY IN GROUND GLASS peripheral, bilateral, with or without
consolidation or visible intralobular lines ("paving"), OU
● OPACITY IN GROUND GLASS multifocal rounded morphology with
or without consolidation or visible intralobular lines ("paving"), OU
● REVERSE HALO SIGN or other findings of pneumonia in
organization (observed later in the disease).
4. BY LABORATORY CRITERIA: Case of SG or SRAG with test of:
● MOLECULAR BIOLOGY: result DETECTABLE for SARS-CoV-2
carried out using the real-time RT-PCR method.
● IMMUNOLOGICAL: result REAGENT for IgM, IgA and/or IgG* performed
by the following methods:
❏ Enzyme immunoassay (Enzyme-Linked Immunosorbent
Assay - ELISA);
❏ Immunochromatography (quick test) for detection of antibodies;
❏ Electrochemiluminescence Immunoassay (ECLIA),
● ANTIGEN SEARCH: result REAGENT for SARS-CoV-2 by
Immunochromatography method for antigen detection.
5. BY LABORATORY CRITERIA IN ASYMPTOMATIC INDIVIDUAL:
Individual ASYMPTOMATIC with exam results:
● MOLECULAR BIOLOGY: result DETECTABLE for SARS-CoV-2
carried out using the real-time RT-PCR method.
● IMMUNOLOGICAL: result REAGENT for IgM and/or IgA carried out by
following methods:
○ Enzyme immunoassay (Enzyme-Linked Immunosorbent Assay -
ELISA);
○ Immunochromatography (quick test) for detection of antibodies.
DEFINITION OF CONTACT OR EXPOSURE OF CONTACT WITH A PERSON
SUSPICION: (17)
Every person without symptoms who had contact with a suspected case of COVID-19, among
two (02) days before and fourteen (14) days after the onset of your signs/symptoms, in
one of the situations below:
a) have contact for more than fifteen minutes less than one meter away;
b) remain less than one meter away during transport;
b) direct physical contact;
c) share the same home environment;
d) be a health professional or other person who directly takes care of a case of the
COVID-19, or laboratory worker handling samples from a COVID-XNUMX case
COVID-19 without recommended protection.
DEFINITION OF CONTACT OR EXPOSURE OF CONTACT WITH A PERSON
CONFIRMED:(17)
Every person without symptoms who had contact with a suspected case of COVID-19, among
two (02) days before and fourteen (14) days after the onset of your signs/symptoms or
of its laboratory confirmation, in one of the situations below:
a) have contact for more than fifteen minutes less than one meter away;
b) remain less than one meter away during transport;
c) share the same home environment; or
d) be a health professional or other person who directly takes care of a case of the
COVID-19, or laboratory worker handling samples from a COVID-XNUMX case
COVID-19 without recommended protection.
O risk of infection after contact with a person suspected or confirmed of
Covid-19 will depend on the level of exposure to the virus, which in turn, will be as
greater the proximity of contact (less distance, touch, conversation face to face)
face), the exposure time, and when it occurred in smaller and more
closed. (16)
DEFINITION OF RECOVERED CASE (7,8, 16)
The recovered estimate includes the number of patients hospitalized with
record high in Influenza Epidemiological Surveillance Information System
(SIVEP-Flu) Ministry of Health.
DEFINITION OF QUARANTINE AND ISOLATION (17)
A quarantine is the restriction of activities and the separation of people who are not
sick, but who were potentially exposed; and the isolation It's the separation
of a person with a disease contagious to others in order to prevent
spread of infection.
ABOUT LEAVE AND RETURN (18)
1. ABOUT REMOVAL
1.1 Any person who presents suspected symptoms of Covid-19 and is in
face-to-face work or study day must move away immediately e se
place in home isolation. In the case of an employee, communicate your
condition for immediate leadership; and, if you are a student, to the course's undergraduate coordinator
or the postgraduate course advisor.
1.2 People with symptoms and a positive test for Covid-19 should stay away for
a period of 14 (fourteen) days from the date of onset of symptoms.
1.3 People without symptoms and with a positive test for Covid-19 must stay away for
a period of 14 (fourteen) days from the date of the test. If these people
develop symptoms during the period of absence, they must adopt the
recommendations for symptomatic people.
1.4 People who are contacts of confirmed COVID-19 cases they should move away
for a period of 14 (fourteen) days counting fromthe last day of contact with the case
confirmed.
1.5 People who live with people who have tested positive for Covid-19 should
leave for a period of 14 (fourteen) days from the date of onset of symptoms of the
your home contact, supporting document must be presented.
1.6 People who are contacts of suspected COVID-19 cases don't need
remoteness.
2. ABOUT THE RETURN
2.1 For people with symptoms and a positive result for Covid-19, the return
activities must respect a minimum period of 3 days (72 hours) after the
recovery (absence of fever without the use of analgesics and improvement in other
symptoms), E 14 days have passed since the onset of symptoms.
2.2 For people with symptoms and a negative result for Covid-19, the return
activities must respect a minimum period of 3 days (72 hours) after the
recovery.
2.3 For people without symptoms and with a positive result for Covid-19, the return
activities must respect a minimum period of 10 (ten) days after collecting the
exam; If you become symptomatic during this period, consider recommendations
of item 1.
2.4 Returning before the specified period of absence may occur when
the laboratory rule out COVID-19 E there is no symptoms for longer
of 72 hours.
2.5 Return is not necessarily linked to the presence of one or more tests
negative for Covid-19.
COVID-19 EPIDEMIOLOGICAL SURVEILLANCE PROTOCOL WITHIN THE CONTEXT OF
CAMPINAS STATE UNIVERSITY (19-25)
GENERAL OBJECTIVES
Establish standards that assist the Epidemiological Surveillance system of the
State University of Campinas in identifying the occurrence of cases
COVID-19 in people from the University community, and in the prevention and
control of viral transmission in this population.
SPECIFIC OBJECTIVES
● Identify early the occurrence of cases of disease due to the new
coronavirus in people from the university community;
● Identify early the occurrence of close or household contact with
confirmed cases of COVID-19 and establish criteria for investigation
of these contacts;
● Establish criteria for referral to the Health Center of the
Community (CECOM) where clinical evaluation, notification will be carried out
to the National Disease Surveillance System, laboratory investigation and
removal, when necessary;
● Establish criteria for laboratory investigation;
● Monitor indicators that help monitor the situation
Epidemiological in this community;
● Establish criteria to identify outbreak situations, and define measures to be taken
be adopted to control viral transmission; It is
● Reduce transmission of the virus within the community.
CASE IDENTIFICATION
1 COMMUNICATION CHANNELS
Flows for care and testing must be widely publicized, in order to
delay in diagnosis and removal of suspects is avoided. It's needed
make available and publicize communication channels that will facilitate immediate contact
of the symptomatic person with the Health and Epidemiological Surveillance system of
University:
● Emergency service at CECOM
● Teleservice
● Email Address
● Website with guidance and Chat to clarify doubts
● Application
2 IDENTIFICATION OF PEOPLE AT HIGHER RISK OF COMPLICATIONS
People with comorbidities or clinical conditions at risk for developing
complications from Covid-19 should preferably carry out their activities at
distance (teleworking), until the circulation of the new coronavirus is reduced in the
community. Are they: (12)
● People aged 60 or over;
● Severe or decompensated heart disease (heart failure, heart attack,
revascularized, patients with arrhythmias, systemic arterial hypertension
decompensated);
● Severe or decompensated pneumopaths (oxygen dependent,
patients with moderate/severe asthma, COPD);
● Immunocompromised;
● Advanced stage chronic kidney disease patients (grades 3, 4 and 5);
● Diabetics, according to clinical judgment;
● High-risk pregnant women; It is
● Obesity.
3 ELECTRONIC PEOPLE TRACKING AND MONITORING
SYMPTOMATIC
In order to increase the effectiveness of this epidemiological surveillance action and
integrate the actors who are responsible for it, it is proposed to use a
integrated electronic tool (application) with the following flow:
● Teachers, students and staff must carry out a self-evaluation,
responding daily to a survey that investigates symptoms suggestive
of COVID-19 before the start of your in-person activities, whose responses
will trigger a decision tree.
● People without symptoms will be advised to remain in their place of
work/class;
● The tool will send notification to health and surveillance services
epidemiological, and to the immediate supervisor (in the case of an employee) at the time of
affirmative response to symptoms compatible with COVID-19.
● Symptomatic people should:
❏ Receive guidance on the need for immediate interruption and
removal from their face-to-face activities, even if they present
mild symptoms; and remain away for the entire period
recommended, and until symptoms resolve;
❏ Be referred to the health service corresponding to your needs
needs, according to the reported symptoms - CECOM or
Hospital de Clínicas, with the possibility of contacting this service
to clarify doubts. They should seek medical attention
for clinical evaluation, laboratory investigation, reporting and
remoteness;
❏ Receive home isolation instructions, respiratory label
(covering nose and mouth when sneezing), hand hygiene and wearing a mask
protective face;
❏ Report the positive test result for SARS-CoV-2 whenever the
diagnosis is external to the University;
● The application platform will allow the insertion of results that confirm
diagnosis, with automatic message sending to management, health
occupational, epidemiological surveillance and team contacts; and message
for the person who tested positive to complete the name of their contacts
belonging to the organization within 48 hours before the onset of symptoms.
● Data included and generated on the platform will have access permission
only for health services, epidemiological surveillance and health
occupational; a limited part of this data, aimed only at screening
of contacts and management of absences and human resources would be
made available to managers.
NOTE: Whenever necessary, individual leave must take place
without harm to students, teachers and staff.
CONTACT IDENTIFICATION AND MONITORING
The contact definition was described earlier in this document. This action, which
consists of the active search and testing of all contacts of a positive person,
with distance from those with a detected result, is of extreme importance for
the interruption of SARS-CoV-2 transmission niches within the community
university, and will be explained in detail later.
- METHODS OF CONTACT IDENTIFICATION:
● Electronic tracking by application, already described above;
● Interview with the confirmed case itself, asking them to inform their
contacts. Questions during the interview must be asked actively,
by phone or in person, based on exposure definitions
contact, already described in this document.
● Interview with the area coordinator or manager, asking him to provide the
list of professionals/students with potential exposure; It is
● List all the people who work and share the same space.
HEALTH CARE
1 SYMPTOMATIC PEOPLE
1.1 People who present mild symptoms should seek the Health Center
Community (CECOM) for clinical evaluation, notification, testing (RT-PCR
SARS-CoV-2) preferably between the third and fifth day of the onset of symptoms,
and remoteness.
1.2 People who develop worsening symptoms(12), as in the presence of
respiratory discomfort, chest pain, tachypnea (rapid breathing, frequently
respiratory rate >24), fatigue or intense tiredness, should go to a
Emergency, in order to investigate the presence of complications and the need for
hospital internment.
1.3 All symptomatic people treated at CECOM will be monitored and
monitored regarding their symptoms and clinical evolution daily by telephone,
receiving the relevant guidance for each case.
2 ASYMPTOMATIC PEOPLE, CONTACTS OF CONFIRMED CASE OF
COVID-19
2.1 Asymptomatic people who come into contact with confirmed case of
COVID-19 should seek CECOM for testing (RT-PCR SARS-CoV-2) and
leave for a period of 14 days.
2.2 These people will be monitored via teleservice to observe possible
appearance of symptoms and clinical evolution.
3 RESULTS OF DIAGNOSTIC TESTS (26-28)
3.1 Diagnostic confirmation in people with symptoms must be done through
RT-qPCR molecular biology test (Quantitative reverse transcription polymerase
chain reaction) carried out by collecting a nasopharyngeal swab, according to standard
established by WHO and followed by ANVISA. Collection must be carried out
preferably between the third and seventh day of the onset of symptoms, in order to
increase the reliability of the exam. Outside this period, even if the person
If you have the disease, the test result is more likely to be negative.
3.2 Positive RT-PCR for Covid-19 represents infection almost 100% of the time
by the new coronavirus. People who receive the results of this exam must
remain under home isolation to avoid transmission of the virus and observe
day by day the expected gradual improvement is showing.
3.3 People with negative RT-PCR for Covid-19 may be presenting
other respiratory conditions (influenza virus flu, common cold, allergy
respiratory, etc.). However, in about 20% of cases, the test may result
negative in a Covid-19 carrier; This happens due to factors related to the
collection period or technique, or due to performance limitations of the test itself.
Therefore, even in the face of a negative result, there must also be the
monitoring symptoms until they improve or disappear.
3.4 The results of laboratory tests will be forwarded preferably
by email, as well as medical certificates, in situations where it is necessary
extension of the period of absence. Exceptional cases that do not have
email address will be able to collect the documents at CECOM itself.
4. CASE NOTIFICATION (16)
4.1 THE NATIONAL SURVEILLANCE SYSTEM
Human Infection with the new Coronavirus (COVID-19) is a health event
public notice of immediate notification (within 24 hours). Suspected cases that meet the
case definition from the Ministry of Health must be notified by the
University Epidemiological Surveillance according to existing flows:
● Flu Syndrome Cases - e-SUS VE system.
● Severe Acute Respiratory Syndrome - Surveillance Information System
Epidemiology of Influenza (SIVEP-Gripe).
4.2 INTERNAL NOTIFICATION
In the event of a suspected case of COVID19, CECOM must communicate, in accordance with the
case: ● Immediate supervisors of employees
● Occupational Health Division (DSO) UNICAMP and SESMT Funcamp,
according to contractual relationship
● Undergraduate or Postgraduate Coordinator
5. EPIDEMIOLOGICAL MONITORING
5.1 MONITORING VIRAL CIRCULATION IN THE COMMUNITY
UNIVERSITY
For this purpose, serological surveys will be carried out, described below, with
estimation of the prevalence of coronavirus in the university community.
5.2 INDICATOR MONITORING
Epidemiological surveillance actions must have their effectiveness measured, monitored and
frequently analyzed through key indicators, such as:
● Number of suspected cases of COVID19 by date of service
● Cumulative number of suspected cases according to date of service
● Number of confirmed cases by date of service
● Cumulative number of confirmed cases according to service date
● Number of confirmed cases per epidemiological week at the beginning of the
symptoms
● Incidence rate of confirmed cases at the University
● Number of confirmed cases distributed by date of service and
Institute, Unit or Body where it carries out its activities
● Incidence rate of confirmed cases by Institute, Unit and Agency
● Prevalence of IgM and IgG antibodies in the university community
5.3 MONITORING OF LOCAL TRANSMISSION AND OUTBREAK SITUATIONS
RT-PCR test results will be monitored in real time, with
analysis of data relating to the positive case and the location where it carries out its activities.
In the occurrence of two or more cases in the same unit, or in the occurrence of
outbreak, administrative measures will be taken.
Depending on the current epidemiological situation, the university community
You will receive a recommendation on how you should carry out your activities - whether
in person, or remotely.
The occurrence of isolated cases of Covid-19 may result in the suspension of
face-to-face activities for short periods, while longer suspensions
Prolonged measures may be necessary in outbreak situations. In these situations, the
educational prevention work should be reinforced, as well as measures
hygiene and cleaning of environments.
6. TESTING AND SURVEILLANCE PROTOCOL IN THE CURRENT PANORAMA AND
AIMING FOR THE RETURN OF PRESENTIAL ACTIVITIES (29-33)
In our epidemiological investigation to diagnose cases and look for links
among these people, aiming at containment efforts, both tests will be used
by RT-PCR and serological tests. This complementary strategy is justified
due to the limitation of the isolated use of RT-PCR, which is only capable of detecting the
SARS-CoV-2 during the acute phase of infection, where viral shedding occurs.
In this way, the application of a serological test will help in the detection of infection
preview in people who have already recovered.
6.1 NOT BELONGING TO THE HEALTH AREA OF UNICAMP
6.1.1 For the CURRENT panorama of the UNICAMP communitythat does not belong to
health area And are you working or studying, on location, at the University,
The following action plan is proposed:
The. Survey of the real number of people who have attended the place of
work or study, at least 3 or more times during the week, with your
respective areas and functions;
B. Carrying out the RT-PCR test on all these people, as will be described
lower;
w. Planning a serum epidemiological survey for these same people,
with cost discrimination;
d. Composition of a group or team of Unicamp professionals to work
in the actions of this testing and surveillance plan, during the different phases of the
return to work/study. The professionals assigned to this work
must be from multiple areas of knowledge, including the presence of the area of
health; and they must dedicate themselves with intensity and exclusivity to this task.
This is an action that requires great dedication from teams of professionals
and, therefore, partial dedication to these teams will not be possible.
UNIVERSAL TESTING ACTIONS
Universal testing actions are being designed with a focus on
identification of people, symptomatic or not, through survey
symptoms of those currently working on-site visit (Format
in person). At the same time, a nasopharyngeal swab will be collected
with RT-PCR test for SARS-CoV-2. Exam results will be
used to apply measures to reduce the transmission of
COVID-19, in the workplace and in the Unicamp community.
DETAILS OF THE TESTING PROCESS:
1. It begins with the daily self-evaluation of people involved in work or
study on-site visit, through a survey regarding the presence of symptoms
flu
2. People with respiratory symptoms or other symptoms suggestive of
COVID-19 will be immediately removed from their in-person activities
3. At the same time, all these people are tested for SARS-CoV-2
through nasopharyngeal swab collection and RT-PCR, whether or not
not suspected of COVID-19;
4. Those who present an RT-PCR result = detected will be
away from their face-to-face activities;
5. Upon detection of a positive case for SARS-CoV-2, a
your contact list, and all contacts that are part of the community
Unicamp will be tested immediately by RT-PCR;
6. Positive contacts will be notified and removed according to existing rules
established by CECOM/DSO;
These process steps aim to prevent the occurrence of outbreaks in the
work, study.
7. Having the results of the RT-PCR exams in hand, the
prevalence of employees with RT-PCR = detected (positive) for
SARS-CoV-2 within the university community;
8. Finally, it will also be carried out serological survey of all people,
with estimated prevalence of the presence of people with antibodies in
community, as will be described below.
Further investigation of cases will be carried out by active contact tracing
through the “cluster-based approach” / “contact tracing” methodology
From the moment that everyone who is engaged in face-to-face activity at the
Unicamp are tested by RT-PCR, with the identification and management of cases
positive, and that the prevalence of people with the presence of
“protective” antibodies, an epidemiological surveillance strategy will be maintained
based on the methodologies “cluster-based approach” and “ccontact tracing”, described in
follow:
METHODOLOGIES “CLUSTER-BASED APPROACH” E “CONTACT TRACING”
The methodology proposed here for identifying positive cases of COVID-19 and
monitoring your contacts, in order to prevent the spread of the virus, is
based on the association of two complementary tools:
1. “Cluster-based approach” - in this strategy small groupings of
people confirmed with a positive result (“clusters”) are tracked in
search for rapid identification and isolation of the person with a high degree of
transmissibility that was the original source of infection in the group, preventing
spread of infection.
2. Contact tracing” means the process of identifying and managing people
who have been exposed to an infectious and communicable disease, preventing,
thus, local transmission. When applied systematically, this
tool has the great potential to break the transmission chain of
infectious disease, being valuable for controlling outbreaks in communities.
Thus, all the people in the community who were present at the same
place where a positive (RT-PCR=detected) symptomatic or
asymptomatic will be identified and tested, also without relation to the
your presence or absence of symptoms;
Therefore, the “cluster-based approach” and the "contact tracking” will require the
formation of a team of professionals, detecting and monitoring
uninterruptedly possible “clusters”, source cases and contacts for up to 14 days
from the moment of exposure to the “detected case”.
With the purpose of adhesion of members of the Unicamp community to this
ambitious collective action plan (premise for it to be successful), it will be
It is essential that everyone feels an important part of it. Furthermore, it should be emphasized
the need for solidarity and reciprocity for the common well-being of
university community.
EPIDEMIOLOGICAL SCENARIOS
In view of the availability of the molecular RT-PCR test for the community
from UNICAMP and testing for antibody detection, the entire scenario process
epidemiological will be based on testing and diagnosis.
The cycle of this surveillance action will be completed with:
● Effective identification of contacts (ways previously described)
● Information from these contacts regarding their exposure status, and
guidance for symptom self-assessment, quarantine care, and
testing
● Daily monitoring - refers to regular communication between the
contact tracing and the exposed person, to monitor symptoms of
illness. However, the exposed person should also be encouraged to
Communicate with the contact tracing team to report the onset of symptoms.
If the exposed person cannot be found, contact
Contact friends and family in your search.
● Analysis of Indicators - you must compile and analyze the indicators daily
indicators resulting from the active search for contacts and their follow-up. They are
examples of daily indicators:
INDICATOR DEFINITION APPLICATION
Proportion of contacts evaluated
No contacts evaluated/no contacts being followed up (stratified by type of contact, area, etc.)
- Monitor the
- Monitor the
Surveillance coverage - Identify areas of low surveillance - Identify low method performance “contact tracing” or “contact tracer”
Surveillance coverage - Identify areas of low surveillance - Identify low method performance “contact tracing” or “contact tracer”
Proportion of contacts lost to follow-up (e.g. > 2 days)
No contacts not evaluated for >2 consecutive days/No contacts being followed up
- Identify areas
- Identify areas
with low coverage and high risk of spread - Identify individuals who need to be located
with low coverage and high risk of spread - Identify individuals who need to be located
Proportion of contacts that became “cases”
No new confirmed cases/No contacts under follow-up
- Monitor the
- Monitor the
quality of the method “contact tracing” (the absence of suspicious contacts may suggest that monitoring is not being of quality) - Monitor the
quality of the method “contact tracing” (the absence of suspicious contacts may suggest that monitoring is not being of quality) - Monitor the
outbreak dynamics
Proportion of new cases that were known contacts
No new cases confirmed among contacts/No new cases confirmed
Trace the quality and amount of contact identification completed
Trace the quality and amount of contact identification completed
Time between symptom onset and confirmation of
In the hours/days between the onset of the symptom upon contact and the
Trace the performance of the speed in identifying the case
Trace the performance of the speed in identifying the case
case insulation
case/confirmation
[i]WHO, Contract tracing in the context of COVID-19. Interim guidance, 10 May, 2020.
DATA PROTECTION
As this methodology involves communicating problems and information about
people and their health status, they must be informed about the
privacy and confidentiality of your personal data. Likewise, all
team involved in contact tracking must be trained so that the information
collected is protected under ethical principles and the confidentiality due to it. You
data must be under the custody of UNICAMP, and must be defined by itself
University and its use for the benefit of the community.
SYMPTOMATOLOGICAL SURVEY
It must be answered daily by all students, teachers and
professionals who are engaged in on location at the University. The shape
preferred method of filling out will be through an application, which can be downloaded at
smartphone or computer; in restricted cases of impossibility, it must be
answered manually on paper form. It consists of the following steps:
● Every day, before starting your face-to-face activities, you must access
the application and enter the identification code and password. Do not access the application
will result in absence, and may be considered as a foul in the
work, study.
● Next, questions regarding the presence of
signs and symptoms, which, together, may suggest COVID-19. They are
examples:
i. Have you ever had COVID-19?
❏ Confirmed by RT-PCR or serology
❏ Just had symptoms
❏ Date of onset of the disease
ii. Have had or have contact within the family with a person suspected of COVID-19,
or with confirmed disease?
iii. Fever – measured or not
iv.Cough
v. Shortness of breathe
saw. Headache
viii. Sore throat
viii. Feeling of oppression in the chest
ix. Anosmia (not smelling)
x. Ageusia (not tasting food)
xi. Intense discomfort
xii. Fatigue
● One with should track and point out people with symptoms that
composes a suspected case of COVID-10, and sends an automatic message
to attend CECOM for the purpose of clinical evaluation and collection of
nasopharyngeal swab for SARS-CoV-2 testing by RT-PCR.
TESTING TO DETERMINE SERUM EPIDEMIOLOGICAL SURVEY
Two types of tests can be used to determine antibodies:
rapid test or test with serum antibody measurement. Serological testing
will be carried out, initially, on all professionals who are
Working on site, to determine the prevalence of employees already with
presence of “protective” antibodies. A second sero-epidemiological survey
will only be carried out if situations considered exceptional occur and after
GT-6 review.
1. Rapid test for detection of total IGG/IGM antibodies (point-of-care):
❏ Advantages: Lower cost; speed and ease of execution; does not require
specialized healthcare personnel; quick result;
❏ Disadvantages: Lower sensitivity than tests performed from
of serum; low sensitivity in the first week of the onset of infection
or symptoms (<30.1%) - sensitivity increases from the 3rd
week after the onset of infection or symptoms.
❏ It is qualitative: the reading of the result is “positive” or “negative”, through
the appearance of a band; therefore, it cannot read titles
antibody (quantitative test)
❏ It is recommended and encouraged by WHO for research purposes, until
indications are defined[i]. Not recommended for care
of the patient and for diagnostic decision.
2. Serological test with serum measurement of IGG/IGG antibodies or only
IGG[ii] antibodies:
❏ Advantage: Greater sensitivity than point-of-care tests (tests
fast);
❏ Disadvantages: Higher cost; requires specialized personnel for collection
of blood and to carry out the test; requires equipment
laboratory; greater delay in obtaining results;
❏ Sensitivity varies depending on the period after infection or onset
of symptoms and according to the type of antibody investigated (IgG,
IgM or IgA)
6.1.2 PLAN FOR THE STAGED RETURN PHASE TO
WORK, STUDY
Before starting the return of these people in a pre-defined percentage
institutionally to their work/study positions, it is important that
the current sero-epidemiological scenario of each area of the University is known,
through the attention to the current situation of each person who is working on location
(plan described in item 6.1.1).
CONSIDERATIONS:
● Testing and surveillance teams must be aware of the
areas that will be returning, as well as the name and number of each
person.
● The testing plan will be the same as that already applied to people in situations
current face-to-face.
● People must be summoned at least 48 to 72 hours before the date
scheduled for your return for evaluation of the symptom survey and
testing.
● It is very important that each person is informed about the importance of
respond (and respond daily) to the symptomatic survey, as well as the
respect for the precautionary recommendations for COVID-19 adopted by the
UNICAMP;
● RT-PCR and the serological test defined by UNICAMP will be collected;
● The person must await the results and guidance before returning to the
packing list.
● This action must be repeated for each group of people who are
returning to Unicamp.
Finally, it is recommended to maintain surveillance of symptoms and testing during
throughout the period in which the pandemic exists, hoping to improve it from the
inclusion of new knowledge about COVID-19.
6.2 TESTING PLAN FOR THE HOSPITAL AREA (34-38)
DEFINITION OF HEALTHCARE PROFESSIONAL (HP)
Every professional who works in the health area of HC and CAISM -UNICAMP,
including doctors, nursing, pharmacists, dentists, psychologists, nutrition,
cleaning (even though they are employees of a company hired by Unicamp),
physiotherapists, among others.
THE SET
According to the WHO,
“Health care professionals are on the front line of responding to the COVID-19 outbreak and, as such, are exposed to risks that put them at risk of infection. Risks include exposure to pathogens, long working hours, psychological distress, fatigue, burnout, stigma, and physical and psychological violence.” (34)
For this reason, they encourage employers and managers to assume their responsibility
ensuring that all necessary preventive and protective measures are
taken to minimize occupational health and safety risks in this class
of workers, and offer an exposure risk assessment tool,
which takes into account the presence and type of interaction with patients with
of Covid-19, and types of procedures performed on these patients, with emphasis on
aerosol generators.(35)
And this risk has scientifically proven consequences: out of 138 patients
hospitalized with COVID-19 pneumonia in Wuhan, China, 57 (41,3%) had
were presumably infected in the hospital: 17 (12,3%) were already hospitalized
for other reasons and 40 (29%) were healthcare workers. (36)
Huff & Sing also analyzed the evidence of asymptomatic transmission of the
SARS-CoV-2 for healthcare professionals in healthcare institutions in several countries,
finding worrying rates of contamination of health professionals in
Italy (10% until April 5, 2020); USA (19% of cases reported to CDC among
12/02 and 9/4/2020); China (29% of cases admitted to a hospital in Wuhan) and
United Kingdom (50% of hospital emergency room workforce).(37)
In Brazil, until May 14, 2020, health professionals represented around
16% of confirmed cases of COVID-19 (with a further 114.301 under investigation),
34% being nursing technicians, 16,9% nurses, 13,3% doctors and 4,3%
receptionists.(38)
Therefore, it was necessary to plan and implement a continuous testing plan
for professionals who work in the health area of the University, and for
patients admitted to its facilities.
ACTION PLAN
1) Carry out universal testing of all patients admitted to the HC and CAISM E
all all patients admitted to these hospitals, at the time of
hospitalization;
2) Carry out weekly testing of all patients who are hospitalized by others
reasons (“non-COVID-19), and from everyone who previously tested negative;
3) Investigate patients and professionals, in an outbreak situation, through the methodology
“cluster-based approach”, and “contact tracing”, including all professionals
involved in the medical field, nursing, nutrition, physiotherapy, cleaning (outsourced)
and any other professional who has had contact with a case of SARS-CoV-2
detected;
4) Test all other professionals in hospital areas according to their
risk rating.
The actions described above were designed with a focus on identifying individuals
with RT-PCR = DETECTED for SARS-CoV-2, to later be
appropriate measures are applied with a focus on reducing intra-hospital transmission of
COVID-19, in the current pandemic moment.
In conjunction with the RT-PCR, a serological survey will be carried out with all PSs in the
HC and CAISM, with the aim of determining the seroprevalence of antibodies against
SARS-COV-2, indicating previous (past) infection. For this, two
serological tests: a test that detects total IgM/IgG antibodies (Roche®) and,
only in those who present antibodies detected in the first test, in
A second test will then be performed to determine whether the antibodies
detected are of the IgG type (Abbott®).
1. The entire population - patients and healthcare professionals - will be
tested using the RT-PCR technique on material obtained from
swab combined gold and nasopharynx
2. All healthcare professionals will be tested for the
detection of IGM/IGG and IGG antibodies by serological tests
Based on these data, and under the previously described approach based on
clusters, each cluster is screened for a possible original source of
infection, which can be a HCW or an infected patient. People who are sick or have
RT-PCR tests = detected may present high transmissibility and should be
away and isolated to prevent the spread of infection. For this reason, it is
a molecular test was carried out, without the need for extensive testing of the entire
hospital community, at first, in contrast to approaches
adopted elsewhere. The cluster-based strategy is conditioned on a
environment where there are a number of infected people, and where clusters are
traceable from the beginning.
MAIN OBJECTIVES
1. Early detection of patients and healthcare professionals with
SARS-CoV-2, symptomatic or asymptomatic, aiming to reduce the
intra-hospital transmission of this virus and promoting the health of the entire
community of the hospitals in question; It is
2. Determine the seroprevalence of antibodies against SARS-COV-2 in HCWs.
SPECIFIC OBJECTIVES
1. Test each and every patient admitted, regardless of whether they have the
suspected of having COVID-19;
2. Determine the prevalence of hospitalized patients with RT-PCR= detected for
SARS-CoV-2;
3. Cohort patients with RT-PCR = detected/not detected/quarantine;
4. Determine the prevalence of PS with RT-PCR = detected for SARS-Cov-2;
The. Upon detection of a positive case for SARS-CoV-2, whether in a patient
or in PS, a list of contacts will be drawn up and everyone will be tested,
notifying and removing positives;
5. Promote daily self-assessment of health professionals who are
involved in patient care, in relation to the presence of symptoms
flu.
6. Carry out a serological survey assessment of all PSs at HC UNICAMP,
with identification of antibodies, as described below.
7. Remove HCWs with respiratory symptoms or symptoms suggestive of
COVID-19 and remove asymptomatic HCWs with RT-PCR results=
detected;
8. Reduce the occurrence of in-hospital outbreaks.
The results of this testing will serve to support managers in redefining
some strategies for hospital and care activities, such as in
bed resizing for COVID-19 and non-COVID-19 patients; to supply
detailed information about the current situation of the infection, both in
patients as in PS; the application of data-driven administrative measures
updated; and reducing the occurrence of outbreaks and cross-infection in HC and
CAISM-UNICAMP.
CONSIDERATIONS IN TESTING AND MANAGEMENT OF PATIENTS
ADMITTED
● Swab collection should not delay hospitalization;
● It will be done in the procedure room, or in the patient's own bed;
● There is no need for terminal cleaning after swab collection;
● In the case of a pediatric patient, a swab must also be collected from the
companion.
● Initially, all hospitalized patients will be tested with RT-PCR, in their
own hospitalization unit, with collection carried out by the
nursing area, with the aim of identifying patients who have not yet
performed molecular testing. Next, testing will be carried out
weekly, in all patients who test negative, during the ENTIRE
the length of stay.
● RT-PCR detected/not detected and quarantine
❏ Patients who present RT-PCR results = detected in
hospitalization units, whenever possible, will share the same room;
❏ Patients who present RT-PCR results = not detected, in
inpatient units, whenever possible, will share the same room;
❏ Patients who present RT-PCR results = indeterminate,
insufficient or pending, they must remain in the same bed until the result
of a second RT-PCR.
❏ Patients in Quarantine: are all patients who shared the
same room for more than 24 hours with one or more patients with
RT-PCR=detected.
DETERMINATION OF PREVALENCE OF PS with RT-PCR = DETECTED FOR
SARS-CoV-2 BASED ON METHODOLOGY “CLUSTER-BASED RESEARCH”
Upon detection of a positive case for SARS-CoV-2, whether patient or HCP,
A list will be drawn up, by area or hospital sector, of all exposed contacts
temporally-spatially, and, all will be tested; the positive ones will be removed and
notified.
The determination of the prevalence of PS will be carried out in two phases:
1. The first, in parallel with the investigation of the prevalence of patients, to
professionals who were exposed during an in-hospital outbreak or
unprotected exposure to co-worker or patient with RT-PCR=
detected (“cluster-research based”); and
2. The second will be a phase of universal testing of symptomatic or
asymptomatic, through priorities determined by risk area
CONSIDERATIONS
1. A solid and dynamic recognition strategy for the entire
patient admitted to a hospital area or from the entire PS with RT-PCR result
= detected, through daily laboratory surveillance of COVID-19.
2. Faced with a positive result for SARS-CoV-2, the nursing supervisor
should draw up a list of exposed professionals from the various
categories - nursing, physiotherapy, nutrition and cleaning (outsourced) - which
circulated in the area during the same period as the “detected case”; the chief medical officer of
specialty will do the same with the list of exposed doctors; and those responsible
other areas such as engineering, chaplaincy, IT, will also carry out
their respective lists.
3. Lists containing the names of medical and nursing professionals will be
checked, in order to verify those who have already been tested and whose
results were = “detected”; these professionals will NOT collect a new test.
4. A testing spreadsheet will then be prepared on a daily basis, to
nasopharyngeal swab collection for RT-PCR.
5. On the day and place scheduled for collection, the PS must initially be evaluated
regarding the presence of suspected symptoms of COVID-19, through
Google forms form. If the PS is symptomatic, he will be referred to the
CECOM for physical examination, swab collection and absence from work; It is,
If there are no symptoms, the patient is sent for swab collection.
6. The results will be communicated to professionals, so that action can be taken.
preventive measures for intra-hospital spread, and will be communicated to
teams that care for patients.
7. All professionals who present RT-PCR = detected will be removed
for 14 days, according to a plan drawn up jointly by
SEH-HC-UNICAMP, CECOM, CCIH-CAISM, DSO and SESMT.
DAILY SELF-ASSESSMENT OF PS INVOLVED IN ASSISTANCE
A form with a set of data will be available in each unit of
hospitalization; every professional who provides assistance, at any time, must
Fill in the details on this form as soon as you enter your unit. The answers
will serve for the early identification of symptomatic professionals, who will be
instructed to seek care and undergo testing at CECOM.
The form will also serve as material for investigating future intra-regional outbreaks.
hospitals, being used as a tracker of professionals who entered the
unit in question, and who, consequently, had potential exposure.
LEAVE OF SYMPTOMATIC RESPIRATORY OR OTHER SYMPTOMATIC PS
SUSPECTED SYMPTOMS OF COVID-19
All HCWs with symptoms compatible with COVID-19, as well as those with RT-
PCR=detected will be removed from work in accordance with the rules already
established. The entire logic of this project is based on the active search for cases
COVID-19, symptomatic or asymptomatic, from an RT-PCR= positive case.
Thus, case detection, clearance and notification are the keys to
transmission control: the removal of potential people/patients
SARS-CoV-2 transmitters is essential for controlling new
cases/infections in the hospital environment.
CONTAIN THE OCCURRENCE OF IN-HOSPITAL TRANSMISSION
Preventing the occurrence of intra-hospital outbreaks of COVID-19 and transmission
of SARS-CoV-2 among PS, will represent the effectiveness of the result of this work as
one all.
CARRY OUT SEROPREVALENCE SURVEY OF ANTIBODIES OF
SARS-CoV-2 AMONG HEALTHCARE PROFESSIONALS
Its objective is to know the seroprevalence of SARS-CoV-2 in this population by
detection of the presence of reactive antibodies.
Initially, a serological test will be carried out to detect total antibodies.
IgG/IgM (Roche-Elecsys®); if the latter is reactant, the
second confirmatory test, for IgG measurement (Abbott®), using the same
sample. Both exams are performed using the electrochemiluminescence technique.
The serological test will be collected through peripheral venipuncture from all
health professionals from HC and CAISM at the same time as swab collection for
RT-PCR, within an already established routine.
The following will be called for collection: PS who have not presented flu-like symptoms in
not at all during the pandemic; PS with a history of flu with RT-PCR
positive; and PS with a history of flu and negative RT-PCR.
conduct in relation to the result is described in the table below:
RT-PCR SEROLOGY MEANING
Non-reactive Not detected No evidence of
infection with the new coronavirus
1st Reagent
2nd IgG reagent
Not detected There is evidence of infection
previously caused by the new coronavirus
1st Reagent
2nd non-reactive IgG
Not detected There is evidence of infection
previously caused by the new coronavirus
1st Reagent
2nd non-reactive IgG
Detected There is evidence of infection
current due to the new coronavirus
Non-reactive Detected There is evidence of infection
current due to the new coronavirus
It is important to emphasize that professionals who present serological tests
reagents must maintain their work routine, carrying out the same safety measures
individual protection.
Finally, PSs with RT-PCR results=detected and those with results not
reagents for serological tests will be guided and monitored by CECOM,
DSO and SESMT.
8. PROPOSAL FOR MENTAL HEALTH FOLLOW-UP
UNICAMP COMMUNITY ON RETURN TO ITS ACTIVITIES
The Unicamp community is made up of teachers, career employees
PAEPE, undergraduate and postgraduate students, as well as special and
interns, totaling a population of approximately 50 thousand people.
The different bodies of the University present sociodemographic and
distinct mental disorders, which implies the need to have
different approaches and strategies in mental health care for this population.
8.1 MENTAL HEALTH MONITORING OF STUDENTS
The student population, for the most part, is quite familiar with the
technology and the use of digital media, in addition to having access to these media, having
in view of the fact that equipment was provided for all those who did not
7. FLOW OF MEDICAL AND EPIDEMIOLOGICAL FOLLOW-UP
they had, so that they could follow remote classes.
Furthermore, it was necessary to temporarily close the building where SAPPE
works, planning to adapt its physical space so that it is
possible to use it safely again.
Aware of these considerations, SAPPE has sought to carry out most of its
psychiatric care via telemedicine, as psychiatrists had already
provided your digital certification.
However, it is important to highlight that there is a smaller portion of students who
did not return to their cities of origin (especially indigenous people), and that
they did not adapt to the electronic medium; and still others, without privacy at home
for this type of service. Furthermore, more serious cases also
require in-person assessment. To serve this group, SAPPE has offered
face-to-face psychiatric care on a shift schedule, daily, from 11 am to
14pm, in a room in the CECOM building, which already offers hygiene conditions
needed.
8.2 MENTAL HEALTH MONITORING OF TEACHING STAFF
AND NON TEACHERS AT CECOM
The population of non-teaching employees monitored for mental health by
The CECOM team has a different sociodemographic profile than the students, with
older age group than undergraduate students and the majority of undergraduate students
postgraduate studies. It is not known for sure how many of them have access, or how many
They are adept at an approach through digital media. To cite an example, the
CECOM develops a program aimed at dementia conditions (Program
“Take Care of Your Memory”) – which has around 250 registered patients. That is, there are
a portion of the population served that suffers from cognitive impairment to some degree
(see table of psychiatric care diagnoses), and which can
represent some difficulty for this approach.
In 2019, at CECOM, 2738 psychiatric consultations were carried out and 2092
psychology services. The graph below shows its distribution by CID:
Chart – CECOM 2019 psychiatric consultations by CID
In the Occupational Health Division (DSO), in 2019, 359
employees with some mental health needs; of these, 130 had
chronic conditions related to mental disorders (CID F), which require
some type of intervention. Of these, 42 had problems related
abusive use and/or dependence on alcohol or psychoactive substances, being
monitored weekly by the DSO chemical dependency program, in
partnership with ASPA (Psychoactive Substances Outpatient Clinic at HC Unicamp), and
by CECOM, in some cases. Regarding employees on leave due to
mental disorders, around 80% of them are monitored at CECOM. During the
period of social isolation, DSO has been making contacts by telephone or
audio with patients who require closer monitoring, as
realized that they are more accessible to this modality than to care via
computer or by video call on smartphones.
In phase zero of the institutional return plan around face-to-face activities, the
Service at CECOM has been offered in the form of face-to-face shifts
of the mental health team, made up of psychiatrists and psychologists, in shifts
6am. Exceptionally, the psychology team has provided some services
remotely, through a computer. As expected, and following the
trend observed in other services, the demand and frequency of care
suffered a reduction, at least initially. However, patients maintain their
demanding conditions of attention, which suggests the existence of a
progressive damping of demand, in addition to not being possible to assess the presence
of worsening of the disease, since returns are not occurring with the
its appropriate frequency. In the context of the pandemic, in addition to the worsening of
pre-existing pathologies, adaptive disorders, grief, stress
post-traumatic, among other conditions that deserve attention from the healthcare team
mental.
Taking this scenario into account, the care proposal for patients
monitored by CECOM in the next phases involves the following strategies:
1. Active search/monitoring of the most serious patients or those in crisis through
telephone contact, which can be carried out by a member of the psychology team or
trainee;
2. Resumption of in-person care for these more serious cases or those in crisis
observing hygiene precautions, room ventilation, and especially the
separation between patient flows suspected of Covid and treated by health
mental health, with a view to reducing the exposure of the professionals involved.
MENTAL HEALTH FOLLOW-UP OF TEACHERS IN THE CONTEXT OF
PANDEMIC – SAPPE/CECOM INITIATIVE
CECOM is the reference service for Unicamp's teaching population, and
has carried out this monitoring. However, given situations that occurred in
context of the pandemic, including grief, adaptive disorders and
difficulties in handling situations involving students, it was decided to implement
a joint action between SAPPE and CECOM in the development of activities
aimed at the mental health of this population.
This initiative will consist of offering remote care in groups, conducted
by a member of the SAPPE team together with a member of the
psychology at CECOM. Service will be offered weekly, on Tuesdays –
fairs, from 12pm to 13:30pm, in an open and rotating group, with the start scheduled for the
second half of July 2020. The offer of this new share must be maintained
as long as necessary, within the context of the pandemic.
9. MAINTENANCE OF OCCUPATIONAL HEALTH OF PS AND STUDENTS
AREA AMID THE PANDEMIC (40)
The following recommendations comply with the hierarchy of controls recommended by
entities such as the International Labor Organization (ILO), the European Agency
for Safety and Health at Work (OSHA-EU), the Occupational Safety and Health
Administration (OSHA-US) and the Jorge Duprat e Figueiredo Foundation – Fundacentro
(Brazil):
9.1 ENGINEERING CONTROL MEASURES
These are changes applicable to processes and work environments to prevent
spread and reduce the concentration of infectious agents in the work environment
work, minimize the number of areas where there is exposure to SARS-CoV-2 and
reduce the number of people exposed. Among the many measures already underway, the
DSC recommends attention to the following:
● Consider the impossibility of safely establishing the areas of
COVID and non-COVID care, taking the highest level of protection from
in accordance with the precautionary principle.
● Define reception and screening flows that enable identification and
isolation) of patients suspected of COVID-19, before or immediately
upon arrival at the healthcare facility, including carrying out
SARS-Cov-2 detection tests.
● Make 70% alcohol gel devices available in all workplaces,
disposable towels, sinks with soap and water and trash cans with capacity
sized for the service.
● Signage, in a clear and easily intelligible way, at all workplaces
with appropriate personal and environmental hygiene measures.
● Provide areas designated for workers to rest
in the health area (doctors, nursing, others), and that rest is
cleaned adequately, at least, at each shift change, ensuring that
mattresses and pillows are covered with waterproof covers that are easy to
cleaning, including properly sanitized sheets and blankets and
packed in plastic bags. Whenever possible, identify beds
and/or seats with the names of the users on duty.
● Ensure that equipment and work surfaces are sanitized,
ideally three times a day, or more often if necessary.
9.2 ADMINISTRATIVE CONTROL MEASURES
These measures require actions from both the employer/contractor and the
workers. Typically, these are changes to policies or work routines that
aim to reduce or minimize exposure to a risk, its duration, frequency or
intensity. Among the many measures already underway, the DSC recommends attention
for the following:
● Wide dissemination of the service plan for contingency and coping with
COVID-19, with free access to all health workers.
● Wide dissemination of data regarding COVID-19 as a disease
related to work in the health service.
● Expansion of training programs, in a model that allows
interaction of health workers and enables interaction with
responsible for training, including three fronts:
❏ Training on COVID-19, as it is an emerging disease
within a scenario of uncertainty and new information about means
transmission, diagnosis and treatment;
❏ Training on the service, including the use of systems, workflows
care, therapeutic and examination protocols; It is
❏ Training on protective measures, not exclusively on use
of Personal Protective Equipment (PPE), but also in
in relation to collective protection measures.
● Transparent establishment of the aid chain and/or the
preceptors-supervisors of care, especially for doctors
residents and assistants.
● Review of PPE hygiene and storage protocols, especially for
those for prolonged use and/or reuse.
● Review all service flows in order to eliminate cross-flows
that increase the risk of contamination between patients and healthcare workers
health, in both senses.
● Restrict the movement of individuals who may serve as vehicles of
transmission for SARS-CoV-2, including family members and visitors from all
hospitalized patients.
● Review donning and doffing procedures, prioritizing
that these actions are carried out with the appropriate assistance of a professional
properly trained.
● Resize work teams, considering all workers in the
health, including own and outsourced, efficiently coordinating teams,
managers and Human Resources.
● Provide a daily survey on suspected COVID-19 symptoms to
all workers, at each shift start, ensuring that cases
symptomatic patients will be referred and treated at the Health Center
Community (CECOM) for proper clinical assessment and management.
● Ensure that all areas will be subject to risk assessment to ensure
transmission of SARS-CoV-2, including the often underestimated
such as restaurant, pantry, administrative areas, among others.
● Test all patients admitted to the service by RT-PCR, in order to
to ensure adequate management during hospitalization.
● Test all hospitalized patients who have not yet had it by RT-PCR
done in order to ensure adequate hospitalization management.
● Test all health workers, including third parties, by RT-PCR
in order to ensure adequate team management. Periodically retest the
negative cases.
● Train team representatives to evaluate the effectiveness of security measures
prevention and control, through field observations of the conditions of
work.
● Create listening channels for all workers, in order to identify
potential failures and get suggestions, in a safe environment (blame free
environment).
9.3 INDIVIDUAL PROTECTION MEASURES
Individual Protection Measures are essential to minimize the risks of
contact of health workers with the SARS-CoV-2 virus. They involve the use of
Personal Protective Equipment (PPE), but also support measures for
people. As they are the most fragile layer in the hierarchy of controls, they deserve
special and continuous attention to ensure its efficiency. Among the many measures
already underway, the DSC recommends attention to the following:
● Provide appropriate PPE for each indication of use.
● Identify unplanned situations where the use of PPE may be
resized.
● Ensure that the location for sanitizing reused PPE is not the same as the
place of clothing or storage and storage of unused PPE.
● Provide an adequate place to store PPE to avoid contamination
device crossover.
● Offer psychological/mental health support to all workers
potentially exposed, proactive and spontaneous search, disclosing
services already available for this purpose at the University
such as GAPS/FCM, DSO/DGRH and CECOM.
10. REGULATIONS ESTABLISHED BY THE GOVERNMENT OF THE STATE OF SÃO
PAULO FOR THE FIELD OF EDUCATION (41-43)
According to State Decree no.o. 65.061, of 13.07.2020/XNUMX/XNUMX, the resumption of classes
and other face-to-face activities in the State of São Paulo will take place in three stages,
with the presence of up to 35% of the number of students enrolled in stage I, 70%
in stage II and 100% in stage III. The implementation of the first stage will begin if the
geographical area of the teaching unit is in the yellow or green phase, and if, in the
previous period of 28 consecutive days, the following should be observed:
● In the first 14 days, areas representing 80% of the State's population
are classified in the yellow or green phases;
● In the subsequent 14 days, the entire state territory is
classified in the yellow or green phases.
As provided for in article 3, the passage of teaching units from one stage
the other is subject to the following criteria:
● For Stage II, it will depend on the classification, for 14 consecutive days, in the
green phase, in areas that concentrate at least 60% of the population of the
State;
● For Stage III, it will depend on the classification, for 14 consecutive days, in the
green phase, in areas that concentrate at least 80% of the population of the
State.
For higher education and professional education, however, some activities
may be resumed sooner, as long as the Regional Health Department
spend at least 14 days in the yellow phase of the São Paulo Plan:
Article 3, § 4 Higher education and professional education institutions
will be able to resume in-person practical and laboratory activities, as well as,
in medicine, pharmacy, nursing, physiotherapy and dentistry courses,
internship and mandatory curricular internship activities, as long as the
respective units: 1. Are located, in the previous period of 14 days
consecutive, in the yellow phase area; and 2. Limit attendance to up to 35%
the number of students enrolled.
The state government recommends that remote teaching be combined with the return
gradual phase of face-to-face activities, and that students and professionals from the
risk stay at home in the first phase.
Unicamp's return plan, published in June 2020, foresees, in principle, a
gradual return of the student body, only from period 3: with 25% of
students for 14 days, 50% of students in period 4, for 14 days, and 100% of
students from period 5 onwards.
The reality of each unit and course must be studied to define the subjects
which will require mandatory in-person supplementation. It is understood that they must be
Priority will be given to graduating students in 2020, and subsequently to incoming students.
A forecast was made, according to subject surveys
mandatory and prioritizing possible 2020 graduates, from the number of
Unicamp undergraduate students who will be attending in person
the University, during the 2nd semester of this year, and which will be shown below:
Table 1. Undergraduate, technological and technical education students at the various Unicamp campuses
who need to develop face-to-face activities at the University (priority groups with
disciplines with Practical (P) and Laboratory (L) vectors, which require face-to-face activities and
graduating in 2020).
Campus Number
students
Number
students
of the group
% of total
% of total
in the group
in the group
priority
Courses (subjects with
Courses (subjects with
Courses (subjects with
practical vectors (P) and
practical vectors (P) and
practical vectors (P) and
Laboratories (L), which
Laboratories (L), which
priority:
on
packing list
practices# e
graduates
in 2020
need activities
in-person and completing
2020
Students
de degree and
Technology
Barão
Geraldo
14812 856 5,78 Medicine, Nursing,
Pharmacy, Speech Therapy,
Mechanical Engineering, Chemistry,
Food, Agricultural, Electrical,
Chemistry, Physics, Dance, Theater,
Music
Limeira-FT 2638 127 6,14 Environmental Engineering,
engineering of
Telecommunications, Technology
Civil Construction, Technology
of Manufacturing, Analysis and
Development Systems, Technology
of Road Construction
Limeira -
FCA
1461 93 6,78 Production Engineering,
Manufacturing Engineering,
Nutrition, Sports Sciences
Piracicaba -
FOP
467 69 14,78 Dentistry
Students
of Colleges
technicians
Campinas -
COTUCA*
1931 483 25,00 Nursing, Electronics,
Mechatronics, IT,
Electrotechnical,Plastics,
Workplace safety,
Systems development,
Environment,
Telecommunications and
specializations .
Limeira -
1417 450 31,70 Nursing Construction,
COTIL*
Cartography, Mechanics,
IT, Quality.
Grand total
de students
22726 2078 9,14% of
total of
students
# Practical or laboratory & Degrees excluded (178 graduates) * Statistical Yearbook 2019.
Students' postgraduate activities involve in particular the
development of research projects, which may require that
experiments and data analysis in specialized laboratories, or data collection
data in specific environments, as occurs in the areas of health and education.
In this way, there will be a real need for some students to return to
Unicamp's postgraduate courses, which today represent around 140 thousand students
enrolled in the Master's and Doctorate programs, and professional Master's programs.
The table below contains information regarding the number of students in
postgraduate students who need to carry out their activities in person at
campuses in 2020. The table presents the total number of students by area of
knowledge, and by campus, considering: Campinas, Limeira-FCA, Limeira-FT
and Piracicaba-FOP.
Table 2. Postgraduate students, by area of knowledge at the different Unicamp Campuses
who need to develop face-to-face activities at the University (laboratories and collection sites
data).
CAMPUS AREA No STUDENTS
Campinas Arts 20
Health and Biological 413
Engineering 302
Exactly 201
Humanities 331
TOTAL - Campinas 1257
Limeira - FCA Saúde e Biológicas 35
Engineering and Technology 11
Humanities 8
TOTAL Limeira - FCA 55
Limeira - FT Engenharias e Tecnológicas 17
Piracicaba - FOP Health and Biologicals 206
Grand Total 1544
Source: survey carried out by PRPG - Unicamp - July 2020.
Remain suspended: Fairs, lectures, seminars, competitions and
sports championships, artistic and cultural shows, celebrations,
assemblies, in-person graduation ceremonies, among other activities.
Entry and exit times must be organized to avoid crowding, and,
preferably, outside peak public transport times. 1
The state government also instructs that the return calendar be published
at least seven days in advance. However, Unicamp's plan foresees
This return must be scheduled at least 30 days before the start of the
return to face-to-face teaching and research activities.
State Decree no.o. 65.061 recommends the adoption of general health protocols
and specific to the education sector, in the context of the COVID-19 pandemic:
● Students, faculty and staff should be instructed to assess their
temperature before leaving home, and must remain in their homes
if it is above 37,8° C. It is also recommended to measure
temperature at each entrance to the educational establishment; It is
● It is also suggested to separate a room or area to isolate people
who present symptoms at the educational institution, until they can return
1 SÃO PAULO, State Government. Education return plan – disclosure for the press. 24.06.2020.
to their homes. 2
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COMPLEMENTARY MATERIAL FOR SUPPORT
USE OF MASKS IN THE CONTEXT OF THE COVID-19 PANDEMIC
1. INTRODUCTION
- The new coronavirus is transmitted from one person to the next
form: The sick person exhales, coughs, sneezes, speaks or sings, and throws it into the air
respiratory droplets containing the virus; and the healthy person becomes infected when
come into contact with these droplets through your inspiration (nose and mouth), or
when you touch surfaces where droplets have settled and run your hand
in the eyes, nose and mouth.
- In Health Units, transmission can also occur through
inhalation of aerosols generated during certain types of
procedure on patients, such as inhalation, orotracheal intubation and
cardiopulmonary resuscitation.
- Recent scientific evidence strongly indicates the presence of another form
of transmission, “airborne transmission”, when very small respiratory droplets
small particles released by the infected person remain in the air, representing
a risk of exposure at distances greater than 1 or 2 meters - there is even talk
of tens of meters, being able to pass from one room to another.
- Closed places, with little ventilation and little lighting, and where
many people circulate, they are conducive to the transmission of the virus.
2. JUSTIFICATION - WHY USE MASKS?
- To reduce the spread of Covid-19.
- Healthy people wear masks to protect themselves from the virus, and people
patients use it with the aim of preventing transmission to other people.
- People without symptoms can also transmit the virus, although less than
those who feel sick. Whoever sees face, doesn't see Covid-19!
3. WHAT TYPES OF MASK ARE THERE?
There are currently 3 main types of masks, with a level of protection
increasing according to its ability to filter smaller droplets:
of fabric; medical or surgical; and the masks called
respirators, type N95, FFP2, FFP3 or equivalent.
4. FABRIC MASKS
This type of mask is mainly used to prevent the transmission of the virus.
by people who do not show symptoms.
4.1 WHO SHOULD USE IT?
- Anyone over 2 years of age without symptoms of
Covid-19, when leaving home.
- It is strongly recommended to use fabric masks when visiting
closed and busy spaces, such as supermarkets, shopping malls
centers, or on public transport; and for professions involving
physical proximity to many other people (e.g. watchmen,
receptionists, cashiers).
- Children under 2 years old should not use fabric masks;
people with difficulty breathing; and unconscious people,
disabled or unable to remove the mask without assistance.
- People who run outdoors and away from other people
can dispense with the use of masks.
4.2 CARE BEFORE, DURING AND AFTER USE
- It is for individual use and should not be shared.
- Place correctly: Initially clean your hands; put the
mask trying to completely cover the mouth and nose, leaving no gaps
on the sides, and make sure you breathe easily;
- Avoid touching the mask while using it;
- Change them whenever they are wet or visibly dirty;
- Remove properly: Initially clean your hands; just touch
in the ties or elastics behind the ears; fold the outer corners;
place in a plastic bag until it can be washed; sanitize
hands again after removal;
- Wash masks frequently; It is
- Discard masks that are torn or that appear worn.
4.3 HOW TO WASH FABRIC MASKS
- In the washing machine: they can be placed with the clothes,
using common soap.
- By hand: prepare a bleach solution (4 teaspoons of water
per liter of water), immerse the mask in this solution for 5
minutes and rinse.
- Let the mask dry completely, if possible under direct sunlight.
sun, before using it.
5. SURGICAL MASKS
This type of mask can protect healthy people from being
infected (prevention), as well as preventing those who show symptoms
infecting other people (source control).
Surgical masks are regulated devices and classified as
PPE.
5.1 WHO SHOULD USE IT?
- Health workers, throughout their shift, regardless of
direct care is being provided to patients with COVID-19;
- People with symptoms suggestive of COVID-19; It is
- People caring for suspected or confirmed cases of COVID-19.
When a distance of at least 1 meter cannot be guaranteed
other people, and if supplies are adequate, also
The use of surgical masks is recommended for:
- People aged 60 and over
- People of any age with health problems such as illness
chronic respiratory, cardiovascular disease, cancer, patients
immunocompromised or diabetes mellitus
5.2 CARE BEFORE, DURING AND AFTER USE
- Hands should be cleaned with 70% alcohol or soap and water before
put on a clean mask and then remove it;
- Place correctly: Secure the straps or elastic in the middle of the head and at the
neck; adjust the flexible strap to the bridge of the nose, and adjust to shape
comfortable for the face and below the chin, trying minimize the
spaces between the face and the mask;
- Avoid touching the mask while using it; If this occurs, clean your
hands.
- Change whenever it is dirty or damp; if you remove the mask to
eat or drink; or to care for a patient who needs
droplet/contact precautions for other reasons (e.g.
influenza), to avoid any possibility of cross-transmission.
- Remove properly: Remove straps or elastics without touching apart from
front of the mask, as it is contaminated; lean your body forward
while removing the mask; dispose of in a trash can, preferably
closed; clean your hands.
- Surgical masks are disposable and should not be reused.
6. RESPIRATORS - N95, FFP2, FFP3 MASKS
- They are indicated for use by healthcare professionals in environments where they are
aerosol-generating procedures are carried out, such as
Intensive and Semi-Intensive Treatment. Also consider use in
environments where there may be a large circulation of patients suspected of having
Covid-19 or confirmed illness, such as Emergency Units.
- The following are considered Aerosol Generating Procedures by the WHO:
tracheal intubation, non-invasive ventilation, tracheostomy, resuscitation
cardiopulmonary, manual ventilation before intubation, bronchoscopy,
sputum induction with nebulized hypertonic saline, and
autopsy procedures.
7. ABOUT AIR TRANSMISSION
- Recent scientific evidence suggests that there is a potential for
airborne spread of Covid-19. This means that the virus released into the air by
infected people may contain microparticles small enough to
remain in the air and travel for tens of meters, posing a risk
exposure at distances greater than 1 or 2 meters between people.
- Measures that must be taken to mitigate the risk of transmission
aerial include:
❏ Provide sufficient and effective ventilation (open doors and windows, carry out
necessary outdoor activities), particularly in buildings
public spaces, work environments, schools, hospitals and nursing homes;
❏ Supplement general ventilation with airborne infection controls, such as
local exhaust, high-efficiency air filtration and ultraviolet lights
germicides; It is
❏ Avoid overcrowding, especially in transport and buildings
public.
8. FINAL CONSIDERATIONS
- Don't relax because you're wearing a mask!
- The use of masks should be considered a complementary measure, and not
a replacement for compliance with other preventive measures
established, namely: minimum physical distance of 1 meter between
people; respiratory label; meticulous hand hygiene with water and
soap or 70% alcohol; cleaning and disinfecting surfaces frequently
touched - tables, doorknobs, light switches, countertops, tables,
telephones, keyboards, toilets, taps, sinks, etc.
- The use of surgical masks by healthcare professionals must be
priority over use by the general community.
BIBLIOGRAPHIC REFERENCES
1) WHO. Advice on the use of masks in the context of COVID-19. Interim
guidance (5 June 2020). Available in:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-…-
public/when-and-how-to-use-masks. Accessed on July 10, 2020.
2) WHO. Questions and Answers: Masks and Covid-19.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/questio…
nd-answers-hub/qa-detail/qa-on-covid-19-and-masks. Accessed July 10
of 2020.
3) Brazil. Ministry of Health. ANVISA. General guidelines – Masks
facials for non-professional use. Available in:
http://portal.anvisa.gov.br/documents/219201/4340788/NT+M%C3%A1scaras.
pdf/bf430184-8550-42cb-a975-1d5e1c5a10f7. Accessed on July 11,
2020.
4) CDC. Coronavirus Disease 2019 (COVID-19). Considerations for Wearing
Cloth Face Coverings. Available in:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-fa…
er-guidance.html. Accessed on July 11, 2020.
5) ECDC. Using Face Masks in the community - Reducing Covid-19
Transmission from potentially asymptomatic or pre-symptomatic people
through the use of face masks. Available in:
https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community
-reducing-covid-19-transmission. Accessed on July 10, 2020.
6) Morawska, L. & Milton, D. It is Time to Address Airborne Transmission of
COVID-19 Blink Infect Dis 2020 Jul 6; [Epub ahead of print]. Available in:
https://doi.org/10.1093/cid/ciaa939. Accessed on July 11, 2020.
