Última revisão: 4 Fev 2021
Última atualização: 18 Fev 2021
18 Feb 2021

Atualização sobre a pandemia de COVID-19

Mais de 109.8 milhões de casos já foram relatados mundialmente, com mais de 61.8 milhões de casos recuperados até o momento e aproximadamente 2.4 milhões de mortes de acordo com os dados compilados pelo Centro de Ciência e Engenharia de Sistemas da Universidade Johns Hopkins. Os EUA têm o maior número de infecções e mortes relatadas no mundo. A Índia tem o segundo maior número de casos relatados, seguida por Brasil, Reino Unido, Rússia, França, Espanha, Itália e Turquia.

Johns Hopkins University: coronavirus COVID-19 global cases external link opens in a new window

Número de casos de COVID-19 relatados semanalmente por região da OMS e mortes globais, até 14 de fevereiro de 2021[Figure caption and citation for the preceding image starts]: Número de casos de COVID-19 relatados semanalmente por região da OMS e mortes globais, até 14 de fevereiro de 2021World Health Organization [Citation ends].

Novidades nesta atualização

  • Epidemiologia: fatores de risco atualizados (presença de comorbidades; infecção por HIV; dislipidemia).

  • Etiologia: dados atualizados sobre variantes preocupantes e taxas de ataques secundários.

  • Investigações: o CDC alerta que a precisão da oximetria de pulso pode ser afetada pela pigmentação da pele do paciente.

  • Algoritmo de tratamento: o CDC recomenda testes e consultas adicionais antes de descontinuar o isolamento em pacientes gravemente imunocomprometidos; novas evidências de que a anticoagulação profilática reduz a mortalidade em pacientes hospitalizados.

  • Novidades: o ensaio RECOVERY do Reino Unido mostra que o tocilizumabe reduz a mortalidade nos pacientes hospitalizados que recebem oxigênio; a MHRA recomenda contra o uso da colchicina, exceto em um ensaio clínico ou se houver uma indicação licenciada para uso; o NIH recomenda contra o uso de hidroxicloroquina para profilaxia pós-exposição.

  • Prevenção: o CDC recomenda que as pessoas vacinadas não precisam entrar em quarentena após a exposição a um caso, desde que atendam a certos critérios; orientação da OMS para a vacina da AstraZeneca adicionada; dados atualizados sobre a incidência de anafilaxia pós-vacinação; dados atualizados sobre a eficácia da vacina para as variantes do SARS-CoV-2.

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Este tópico é baseado nas melhores evidências disponíveis atualmente, mas, como se trata de uma situação em rápida evolução, as evidências são limitadas e algumas recomendações podem se basear em relatos de casos, estudos observacionais e análises retrospectivas, bem como em ensaios clínicos randomizados e controlados e diretrizes.

Ver Epidemiologia

Fonte original da atualizaçãoexternal link opens in a new window

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • febre
  • tosse
  • dispneia
  • olfato/paladar alterados

Outros fatores diagnósticos

  • fadiga
  • mialgia ou artralgia
  • produção de escarro/expectoração
  • constrição torácica
  • sintomas gastrointestinais
  • faringite
  • cefaleia
  • tontura
  • sintomas neurológicos
  • sintomas oculares
  • rinorreia/congestão nasal
  • dor torácica
  • sintomas cutâneos
  • hemoptise
  • murmúrios brônquicos
  • taquipneia
  • taquicardia
  • cianose
  • estertores na ausculta

Fatores de risco

  • contato com um caso provável ou confirmado
  • residência/trabalho/viagem para local com alto risco de transmissão
  • idade avançada
  • sexo masculino
  • etnia
  • residência em unidade de cuidados de longa permanência
  • presença de comorbidades
  • doença cardiovascular
  • diabetes
  • obesidade
  • doença respiratória crônica
  • doença renal crônica
  • gestação
  • tabagismo
  • neoplasia maligna
  • transplante de órgão sólido
  • Síndrome de Down
  • distúrbios da hemoglobina
  • hipertensão
  • doença cerebrovascular
  • demência
  • doença hepática crônica
  • imunossupressão
  • crianças com certas condições subjacentes
  • deficiência de vitamina D
  • uso de inibidor da bomba de prótons
  • doença autoimune
  • Infecção pelo vírus da imunodeficiência humana (HIV)
  • dislipidemia
  • cirurgia
  • grupos sanguíneos A e B
  • disbiose intestinal
  • fatores ambientais

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real
  • oximetria de pulso
  • gasometria arterial
  • Hemograma completo
  • perfil metabólico completo
  • nível glicêmico
  • coagulograma
  • biomarcadores cardíacos
  • proteína C-reativa sérica
  • velocidade de hemossedimentação sérica
  • concentração sérica de lactato desidrogenase
  • nível sérico de interleucina-6
  • procalcitonina sérica
  • nível de ferritina sérica
  • nível de amiloide A sérica
  • creatinoquinase e mioglobina séricas
  • hemoculturas e culturas de escarro
  • radiografia torácica

Investigações a serem consideradas

  • tomografia computadorizada (TC) torácica
  • sorologia
  • teste de antígenos

Novos exames

  • amplificação isotérmica mediada por ciclo de transcrição reversa (RT-LAMP)
  • ultrassonografia do pulmão

Algoritmo de tratamento

Colaboradores

Consultores especialistasVER TUDO

Consultant and Honorary Senior Lecturer in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Declarações

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Declarações

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Declarações

RF declares that he has no competing interests.

RevisoresVER TUDO

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Declarações

WAP declares that he has no competing interests.

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China 

Declarações

XZ declares that he has no competing interests.

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Declarações

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

EditoresVER TUDO

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

Declarações

AM declares that he has no competing interests.

Lead Section Editor, BMJ Best Practice

Declarações

IC declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Declarações

JC declares that she has no competing interests.

Consultores especialistas: comorbidadesVER TUDO

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Declarações

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

Declarações

MC is a Non-Executive Director of NICE and Chair the Digital Health Committee of the European Society of Cardiology. MC’s university receives support for his research from Abbott, ResMed, Boston Scientific, and Medtronic. MC speaks at educational events and provides consultancy advice to a number of device, diagnostic, and pharmaceutical companies including Novartis, Servier, Bayer, Pfizer, AstraZeneca, Boehringer Ingelheim, Roche Diagnostics, Medtronic, Abbott, ResMed, and Boston Scientific. MC declares that none of these interests is directly related to topics advised on for this project.

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

Declarações

RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Declarações

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

Declarações

SP declares that he has no competing interests.

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Declarações

AA and MJ declare that they have no competing interests.

Revisores: comorbidadesVER TUDO

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

Declarações

AA declares that he has no competing interests.

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