Compliance with COVID-19 Prevention Measures in the Spanish Population during the New Normal: Will the Need for Greater Community Involvement Be One of the Lessons Learned?

Throughout the pandemic, national and international health authorities have called on the population to collaborate and contribute with their behavior to control the problem. The aim of this study is to analyze the implementation of the protective measures against COVID-19 and to determine the factors involved in their compliance. To respond to the objectives, a cross-sectional study was performed involving a total of 5560 individuals. An ad hoc online questionnaire was created and shared through social networks, scientific societies, and various health institutions. The probability of high or total compliance with the protective measures was higher in women (OR = 1.401) and as age increases, with an OR = 2.524 in the interval between 31 and 64 years old and an OR = 2.896 in the oldest interval (65 and over). This study shows the characteristics of the population that considers it more likely to be infected by SARS-CoV-2, thus adopting greater adherence to prevention measures. Knowing which factors are associated with adherence to protective measures is essential for establishing effective pandemic control measures. Our findings may be useful for designing future awareness campaigns adapted to different socio-demographic characteristics in settings affected by COVID-19.

Clinical outcomes and lung ultrasound findings in COVID-19 follow up: Calm comes after the storm?

INTRODUCTION: There is still an undiscovered territory about the sequelae and lung ultrasound (LUS) findings after SARS-CoV2 acute infection. This study aims to investigate the post-COVID period from a clinical, psychosocial, and radiological point of view, analyze LUS on COVID-19 follow-up and detect whether these outcomes are related to the patient situation. METHODS: We conducted an observational study on patients diagnosed with SARS-CoV2 pneumonia and admitted to the University Hospital of La Candelaria (Tenerife, Spain) from 1st March to 31st August 2020. We performed a descriptive analysis on post-COVID manifestations, LUS score, health-related quality of life measured through the Euroqol 5D-5L questionnaire, and lung function parameters on follow-up, and we compared these variables to the outcomes during the hospital admission. RESULTS: 77 patients were included; the mean age was 57 years and the follow-up mean time from hospital discharge was 16 weeks. 87% of the cases had symptoms on follow-up, the most common was dyspnea (65%); these manifestations were more frequent in females (p = 0,015). 76,5% of the cases had lung aeration alteration in LUS on follow-up; lower PaO2/FiO2 and greater CRP and IL-6 levels on admission were related to LUS score ≥1. CONCLUSIONS: Almost 90% of the patients had persistent symptoms after 16 weeks of hospital discharge due to COVID-19, the most common manifestation presented was dyspnea. Altered lung aeration pattern in LUS was observed on more than 70% of the patients on follow-up.

The Impact of the SARS-CoV-2 Pandemic on the Emergency Department and Management of the Pediatric Asthmatic Patient.

INTRODUCTION: Asthma exacerbation is among the commonest causes for pediatric emergency room visits, and respiratory viruses are frequent triggers of such exacerbations. Few studies have evaluated the consequences of the novel human coronavirus that causes the illness currently known as COVID-19, in the pediatric population. PURPOSE: The objective of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on the emergency department in the pediatric asthmatic patient. PATIENTS AND METHODS: This retrospective observational study evaluated pediatric patients treated at the Pediatric Emergency Service for wheezing episodes. Changes in the number and characteristics of these patients over the same period of 2019 as compared to 2020 during the month following the alarm declaration (March 14 to April 15) were evaluated. RESULTS: In total, data of 30 asthma patients managed in the period after the declaration of the coronavirus pandemic and of 158 asthma patients managed in the pre-COVID-19 period were included. In 2020, patient visits decreased by 82% in 2019. No statistically significant differences among age, sex, oxygen saturation, fever status, or number of severe bronchospasm episodes were found. Nebulized medication usage was reduced significantly since the alarm declaration. No significant increase in requests for complementary testing in the COVID-19 period was found. No patient requiring hospital admission was found to be PCR SARS-CoV-2 positive. Median time spent in the emergency department decreased from 180 minutes in 2019 to 85 minutes in the COVID-19 era. CONCLUSION: The COVID-19 pandemic and ensuing lockdown measures have led to an extraordinary reduction in emergency visits to the pediatric service. The ongoing pandemic has also led to improvements in the approach to asthma exacerbations and wheezing, to reduce the risk of exposure to the virus, such as increased use of pressurized metered dose inhaler and decreased time in the Emergency Department.

Criterios de derivación en asma: Actualización documento de consenso

Resumen El asma es una de las enfermedades crónicas más prevalentes en España. La Sociedad Española de Alergología e Inmunología Clínica (SEAIC), la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Médicos Generales y de Familia (SEMG) y la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) consensuaron en 2019 un documento donde se establecieron criterios de derivación y pautas de actuación en el diagnóstico, control y seguimiento del paciente asmático con el fin de facilitar la continuidad asistencial y una mejor atención en cada ámbito. Las nuevas circunstancias motivadas por la pandemia covid-19 y nuevas evidencias científicas en algunos aspectos han llevado a actualizar algunas de las recomendaciones de la anterior edición, adaptándolas a la nueva situación asistencial. Asthma is one of the most prevalent chronic diseases in Spain. In 2019, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) drafted a document laying down the criteria for referral and action guidelines in the diagnosis, control and monitoring of the asthmatic patient to facilitate ongoing care and improved attention in every setting. The new circumstances derived from the Covid-19 pandemic have demanded that some of the recommendations of the previous edition be updated and adapted to the new healthcare situation.

Recomendaciones SEPAR sobre la vacuna COVID-19 en las enfermedades respiratorias◊

Resumen La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna COVID-19 en las enfermedades respiratorias con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación por COVID-19 de estos pacientes. Las recomendaciones han sido elaboradas por un grupo de expertos en la materia tras la revisión de la literatura recopilada hasta el 7 de marzo de 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha. Podemos concluir que las vacunas para la COVID-19 no sólo son seguras y eficaces, sino que en aquellos pacientes vulnerables con enfermedades respiratorias crónicas es prioritaria. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas. The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients. The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date. We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.

Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic.

PURPOSE: To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. METHODS: Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. RESULTS: Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4-21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33-157.81), conservative treatment failure (OR 8.2, CI 95% 1.34-50.49) and AC severity were associated with an increased odd of mortality. CONCLUSION: In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.

Biomarkers of acute respiratory distress syndrome in adults hospitalised for severe SARS-CoV-2 infection in Tenerife Island, Spain.

OBJECTIVE: The dramatic spread of SARS-CoV-2 infections calls for reliable, inexpensive tools to quickly identify patients with a poor prognosis. In this study, acute respiratory distress syndrome (ARDS) was assessed within 72 h after admission of each of 153 consecutive, SARS-CoV-2 infected, adult patients to either of two hospitals in Tenerife, Spain, using suitable routine laboratory tests for lymphocyte counts, as well as ferritin, lactate dehydrogenase (LDH), and C-reactive protein levels. Results were correlated with the patients' respiratory function, defined through their pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) ratio. RESULTS: Within 72 h from admission, criteria matched ARDS (SpO2/FiO2 < 235) in 13.1% of cases. We found a significant, negative correlation between SpO2/FiO2 ratios and D-dimer, ferritin, and LDH levels (- 0.31, - 0.32, and - 0.41; p = 0.004, 0.004, and < 0.0001, respectively). In patients with ARDS, the mean LDH was 373 U/L (CI95%: 300.6-445.3), but only 298 U/L (CI95%: 274.7-323.1) when they did not develop the syndrome (p = 0.015). None of the additionally evaluated biomarkers correlated with the SpO2/FiO2 ratios. Serum LDH levels in patients hospitalised for COVID-19 correlate with ARDS, as defined by their SpO2/FiO2 ratio, and might help to predict said complication.

Risk Perception of COVID-19 Community Transmission among the Spanish Population.

On 11 March 2020 the SARS-CoV-2 virus was officially declared a pandemic and measures were set up in various countries to avoid its spread among the population. This paper aims to analyse the perception of risk of COVID-19 infection in the Spanish population. A cross-sectional, descriptive observational study was conducted with a total of 16,372 Spanish participants. An online survey was used to gather data for 5 consecutive days over the compulsory lockdown period which was established after the state of emergency was declared. There is an association between socio-demographic variables and risk perception, and a very strong relationship between this perception and contact and direct experience with the virus in a family, social or professional setting. We also found that compared to working from home, working outside the home increased the perception of risk of infection and the perception of worsening health. Understanding the public perception of the risk of COVID-19 infection is fundamental for establishing effective prevention measures.

Documento de Consenso de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) para el seguimiento clínico post-COVID-19

RESUMEN La infección por SARS-CoV-2 puede favorecer el desarrollo de diversas secuelas respiratorias, sobre todo en los pacientes que han sufrido una neumonía grave por COVID-19. Dado el elevado número de pacientes que sufrieron esta infección en un corto periodo de tiempo, se están llevando a cabo numerosas visitas de control post-COVID-19 sin que se haya establecido un protocolo de seguimiento clínico que aconseje sobre las pruebas complementarias a realizar y la frecuencia de las mismas. Este documento de consenso realizado por profesionales de distintas áreas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), pretende ayudar al profesional clínico a la identificación de las posibles complicaciones respiratorias que pueden aparecen durante los meses posteriores al cuadro agudo de la enfermedad y a protocolizar su seguimiento y las pruebas complementarias a realizar. Se sugieren las exploraciones e intervenciones a realizar en diversos momentos de la evolución post-COVID-19, con unos objetivos concretos. Por un lado, garantizar que los pacientes reciban un seguimiento clínico oportuno, con un cronograma preestablecido teniendo en cuenta la gravedad de la enfermedad y la probabilidad de secuelas a largo plazo;por otro lado, evitar sobrecargas del sistema sanitario llevando a cabo exploraciones y/o consultas en muchos casos innecesarias;por último, definir criterios para derivar a aquellos pacientes con determinadas secuelas específicas establecidas (enfermedad pulmonar intersticial, enfermedad vascular pulmonar o bronquiectasias) a las unidades monográficas correspondientes. ABSTRACT SARS-CoV-2 infection can cause a range of respiratory sequelae, especially in patients who have had severe Covid-19 pneumonia. Given the high number of patients who have developed this infection over a short period of time, numerous post-Covid-19 follow-up visits are being carried out, but no clinical follow-up protocol has been established to advise on the complementary tests to be performed and the frequency of these procedures. This consensus document was drawn up by professionals from different areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in order to assist the clinician in identifying possible respiratory complications that may occur during the months following the acute disease, and to protocolize their follow-up and additional tests to be performed. It recommends examinations and interventions to be carried out at various stages in the post-Covid-19 period, and details the specific objectives of these procedures. Primarily, we aim to ensure that patients receive timely clinical follow-up, following a pre-established schedule that takes into account the severity of the disease and the likelihood of long-term sequelae. Another objective is to avoid overloading the health system by eschewing examinations and/or consultations that are, in many cases, unnecessary. Finally, we define criteria for referring patients with specific established sequelae (interstitial lung disease, pulmonary vascular disease, bronchiectasis) to the corresponding specialized units.

SEPAR and AEER consensus recommendations on the Use of Bronchoscopy and Airway Sampling in Patients with Suspected or Confirmed COVID-19 Infection

This consensus document has been drawn up by the Techniques and Transplantation and Nursing areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Respiratory Endoscopy (AEER) with the aim of providing information on the safe and effective use of bronchoscopy in patients with suspected or confirmed COVID-19 infection. Our priority is to ensure the safety of our patients, the health workers caring for them, and the community in general. At this stage in the pandemic, our information on the use of bronchoscopy in patients of this type is based on the experience of hospitals in other countries, and scientific publications are scarce. The objective of this document is to compile these experiences, based on recommendations from official agencies, in a document offering guidance in daily clinical practice.