A prevenção da covid em debate
Sindicatos europeus reivindicam revisão da opinião da organização mundial de saúde sobre como se dá a transmissão.
Vejam depois dos textos em inglês, postagem em português que saiu no "OUTRA SAÚDE". O tema está na ordem do dia.
Workers are dying while WHO fails to move
Until the World Health Organisation (WHO) revises it guidance on personal protective equipment, physical distancing and other protective measures in the workplace, workers will continue to die unnecessarily, global unions have warned. WHO has denied repeatedly that there is evidence for the airborne mode of transmission, instead saying the risk was limited to droplet transmission from close contact with infected individuals. The UN body has devised its recommendations on worker protection accordingly. This has meant WHO has only recommended the higher quality protections, particularly use of N95/FFP3 or better respiratory protection, for a small proportion of almost entirely health care staff involved in a small number of particularly hazardous ‘Aerosol Generating Procedures (Risks 950 - ver post abaixo). WHO’s refusal to accept the airborne risk from normal processes like breathing or talking, or the evidence that people with no symptoms can also be spreaders, has also framed its advice on physical distancing. WHO recommends ‘at least 1 metre’ when another UN agency, the International Labour Organisation (ILO), recommends a far more protective 2 metres. ILO, unlike WHO, has a specialist workplace safety unit and consults routinely with employers and unions on its rules and guidance. UK statistics show some of the highest rates of Covid-19 have been in occupations WHO classifies as medium or low risk, including transport, construction, security and food processing workers. Global union organisations have called repeatedly for worldwide reporting, recording and recognition of Covid-19 as an occupational disease eligible for compensation.
A safe and healthy return to work during the COVID-19 pandemic, ILO policy brief, 22 May 2020. Key issues on the return to work, ITUC Covid-19 briefing, 15 May 2020. ITUC and Council of Global Unions letters calling for recognition of Covid-19 as on occupational disease.
UNION CORONAVIRUS NEWS AND ACTION
Lancet review backs better masks and physical distancing
Reducing physical distancing advice from 2 metres to 1 metre could double the risk of coronavirus infection, according to the most comprehensive study to date. The research, commissioned and part-funded by the World Health Organisation (WHO), also concludes respirators rather than less protective surgical masks should be the ‘minimum’ requirement for health care work. The study, published in the Lancet, comes in the week after Boris Johnson said he hoped to “be able to reduce that [2-metre] distance” as part of the government’s plan to ‘ease’ the lockdown. The Lancet meta-analysis of 172 observational studies across Covid-19 but also – predominately – Sars and Mers, highlights the potential consequences of a change. It found that keeping a distance of more than 1 metre from other people reduced the risk of infection or transmission to 2.6 per cent, but this risk halved at 2 metres. The results make it clear that the WHO should recommend that essential workers like nurses and emergency responders wear respirators not just surgical masks. David Michaels, a professor at George Washington University who headed the US safety regulator OSHA through the Obama administration, noted: “Reliance on surgical masks has no doubt led to many workers being infected,” adding that other workers like meatpackers also needed the higher level of protection. Current WHO guidelines do not recommend respirators for all health care workers caring for infected patients.
Derek K Chu, Elie A Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J Schünemann, on behalf of the COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis, The Lancet, published online 1 June 2020.
New York Times. The Guardian. The Independent. CNN News. The Telegraph.
‘Unacceptable risk’ to frontline workers, says expert
Health care workers are not being give the protection they deserve and are contracting deadly infections as a result, a top biohazards expert has warned. Writing in the Lancet, Raina MacIntyre, an epidemiologist at the University of New South Wales in Sydney, Australia, noted the World Health Organisation’s current Covid-19 guidance, which has been the template for health worker protection in the UK and elsewhere, is failing health workers by refusing to recommend respirators for a wide range of health care work. “This kind of denial, what purpose is it serving — except to harm health care workers?,” she told journalists, adding WHO’s current guidelines reflected shortages of respirators rather than good practice. “Guidelines should be based on evidence, not on supplies,” she noted. “It’s like telling an army, ‘Oh sorry, we’ve run out of guns, just take these bows and arrows and face the enemy.’” She said WHO’s acceptance of surgical masks was harming workers. “Although medical masks do protect, the occupational health and safety of health workers should be the highest priority and the precautionary principle should be applied. Preventable infections in health workers can result not only in deaths but also in large numbers of health workers being quarantined and nosocomial [hospital originated] outbreaks. In the National Health Service trusts in the UK, up to one in five health workers have been infected with Covid-19, which is an unacceptable risk for frontline workers.” In the commentary co-authored with Quanyi Wang, MacIntyre is scathing about WHO’s promotion of an ‘at least 1m’ physical distancing standard. “The 1–2 m distance rule in most hospital guidelines is based on out-of-date findings from the 1940s, with studies from 2020 showing that large droplets can travel as far as 8m. To separate droplet and airborne transmission is probably somewhat artificial, with both routes most likely part of a continuum for respiratory transmissible infections.” MacIntyre concluded: “Protection against presumed droplet infections by use of respirators, but not masks, supports a continuum rather than discrete states of droplet or airborne transmission. Both experimental and hospital studies have shown evidence of aerosol transmission of SARS-CoV-2.”
C Raina MacIntyre and Quanyi Wang. Physical distancing, face masks, and eye protection for prevention of COVID-19, The Lancet, published online 1 June 2020.01, 2020.
Public health experts say 2m distancing essential as firms reopen
Pressure from some business sectors to reduce social distancing between individuals to one metre rather than two metres must be resisted by government, the environmental health practitioners’ body CIEH has said. CIEH said it has demanded that the government holds its ground on the two metre distance, especially as the riskier businesses gear up to open from the beginning of July, including pubs, restaurants, and hairdressers. Citing a Lancet study that suggests that for every extra metre up to three metres, the risk of infection or transmission may halve, CIEH’s Kate Thompson said: “Protecting public health and avoiding the possibility of a second peak of infections should be key. It is therefore vital that the two metre rule is not reduced due to pressure from industry. We call on the government to stand firm in its stance on the two metre rule when it comes to social distancing, especially as the riskier businesses, like pubs and hairdressers, are set to reopen from next month.”
CIEH news release.
AQUI COMENTÁRIO DO "OUTRA SAÚDE" EM PORTUGUÊS
MUDANÇA PARCIAL
A Organização Mundial da Saúde (OMS) publicou ontem um novo informe científico em que considera o risco de transmissão do novo coronavírus pelo ar em gotículas muito pequenas, ou aerossóis. Como vimos aqui, o documento chega depois de 239 cientistas publicarem uma carta aberta elencando evidências desse tipo de transmissão e pressionando a entidade a rever suas recomendações oficiais.
O que muda? Até ontem, a OMS alertava para o risco de transmissão por gotículas maiores – as que saltam do nariz e da boca de contaminados principalmente durante a tosse ou espirros, e que caem no chão logo em seguida. Assim, só pessoas próximas correriam o risco de se contaminar. Mas se há transmissão por aerossol, isso significa que, além das gotículas que caem no chão, há outras que são muito mais leves e podem ficar suspensas no ar durante algum tempo. Em ambientes fechados com pouca circulação de ar, o vírus pode, então, percorrer distâncias maiores até encontrar uma pessoa e contaminá-la. A OMS até falava sobre esse risco antes, mas apenas em procedimentos médicos que provocam a saída de aerossóis, como o processo de intubação.
Agora, o novo texto cita relatórios de surtos relacionados à contaminação em espaços fechados, como restaurantes e academias. Não há evidências conclusivas quanto a isso, ao que levou a OMS a afirmar que "mais estudos são necessários com urgência". Mesmo assim, houve mudanças nas suas recomendações oficiais para evitar a transmissão, que passam a incluir "evitar locais fechados com pouca ventilação".
Mas nada além disso, o que desapontou alguns especialistas. Segundo a OMS, a fonte primária de transmissão continua sendo o contato direto ou as gotículas maiores de tosses e espirros, e os aerossóis produzidos rotineiramente seriam algo secundário.
O uso de máscaras segue como uma recomendação apenas quando o distanciamento social de um metro não é possível, mas, segundo os críticos, em locais fechados isso pode não ser suficiente. “A extensa pesquisa e o tremendo progresso na física e na biologia dos aerossóis desde 1940 parecem não ter tido impacto [na nova recomendação da OMS]. A afirmação de que 'gotículas respiratórias' na faixa de tamanho de cinco a dez micrômetros de diâmetro apenas viajam até um metro é incorreta. As publicações científicas revisadas por pares demonstram claramente que partículas de até 30 micrômetros podem se mover nas correntes de ar e viajar mais de dez metros em ambientes fechados", escreveu Donald Milton, professor de Saúde Pública da Universidade de Maryland e um dos autores da carta aberta publicada na segunda-feira.
Em tempo: essa discussão nos faz lembrar do fato de que o governo de São Paulo proibiu bares e restaurantes de atender na calçada. O objetivo é evitar as aglomerações vistas no Rio de Janeiro após a reabertura, mas não há evidências que a sustentem. Se a ideia é mesmo permitir o funcionamento desses locais, o mais seguro seria justamente evitar o atendimento do lado de dentro, até porque não dá para usar máscara comendo e bebendo... Por isso, em cidades como Paris, Madri e Nova Iorque a retomada se deu com mesas espaçadas ocupando calçadas e ruas. Do mesmo modo, não faz sentido abrir shoppings antes de parques. Ou permitir o comércio à "meia porta" (que dificulta a circulação de ar), embora deva haver restrições à entrada dos clientes.
- Efetue login ou registre-se para postar comentários
repercutiu na Briefing Nature: Mounting evidence suggests corona
Tema também repercutiu na Nature
https://www.nature.com/articles/d41586-020-02058-1?utm_source=Nature+Briefing&utm_campaign=d8ecc52b76-briefing-dy-20200709&utm_medium=email&utm_term=0_c9dfd39373-d8ecc52b76-45166530
Mounting evidence suggests coronavirus is airborne — but health advice has not caught up
Governments are starting to change policies amid concerns that tiny droplets can carry SARS-CoV-2. And after months of denying the importance of this, the World Health Organization is reconsidering its stance.