Night shift work and sleep deprivation in relation to vaccine induced SARS-CoV-2 antibody responses in a general population cohort (COVICAT study)

IntroductionNight shift work and sleep deprivation have been associated with lower antibody responses induced by vaccination against seasonal influenza, meningitis-C and hepatitis A. We examined the association of exposure to night shift work and sleep deprivation with antibody levels induced by COVID-19 vaccines.Materials and MethodsThis study was nested in an ongoing population-based cohort in Catalonia, Spain. Blood samples were collected in 2021 from a random subsample of 1,090 participants. We measured 3 immunoglobulins (Ig)M, IgG, and IgA antibodies against 5 SARS-CoV-2 antigens, including RBD (receptor-binding domain), S (spike-protein), and S2 (subunit 2 from spike-protein). We collected data on night shift work (current night work, frequency, duration) and sleep metrics (sleep duration, sleep problems, changes in sleep duration since the beginning of the pandemic). We adjusted linear regression estimates (% change) for individual- and area-level covariates, time since vaccination, vaccine doses and type. Analyses were restricted to participants without previous COVID-19 infection (N=639). Infection status was defined using questionnaires, SARS-CoV-2 test registry and serology information (seropositivity to N-antigen).ResultsParticipants' mean age was 57.6 years, 57% were female, 73% received 2 vaccine doses (42% Pfizer, 44% AstraZeneca),5.8% were current night workers and 36.5% of the sample reported sleep problems. No overall association pattern was observed between current? night work and vaccine-induced antibody responses. IgG levels tended to be lower (differences in the range of 3.6–53.7%) among night workers, compared to day workers but differences were not statistically significant. Participants with short sleep (<=6 hours) had significantly lower IgM antibody levels compared to those that reported 7 hours of sleep. No clear pattern was observed with sleep quality.ConclusionsFurther research in larger studies is needed to evaluate the influence of night shift work and impaired sleep on vaccine induced immune responses and risk of breakthrough infections.

Differences and similarities of occupational risk factors for COVID-19 across waves of the pandemic;extended follow-up of the COVICAT cohort

IntroductionDuring the first pandemic lockdown in Spain certain workers have been at increased risk of COVID-19. Results from published studies are heterogeneous, possibly due to differences in public health interventions, availability of personal protective equipment (PPE), virulence of variants of concern, population-wide immunity or methodological issues.MethodsThe COVICAT study (IEC approved) pooled ongoing population-based cohort studies from Catalonia. Occupational analyses of COVICAT were restricted to working age and included 8,422 participants, of which 3,563 were tested for SARS-CoV-2 antibodies during the first wave;study participants were re-contacted in mid-2021. Participants responded to a web-based or telephone survey including questions on socio-demographics, pre-pandemic health, behavioural and environmental risk factors. Occupational questions covered mode of work, job title, PPE, and mode of commuting. COVID-19 cases were defined by self-reported symptoms or hospitalisation and SARS CoV-2 seropositivity. Association of type of work, job titles and job-exposure matrix (JEM) with COVID-19 was assed using log-binomial models adjusted for potential confounders, such as age, sex, education, deprivation index, population density and survey type. Analyses for the extended follow-up were stratified by pandemic waves.ResultsThe relative risk (RR) for COVID-19 for working at the usual workplace compared to telework was 1.83 (95% CI: 1.41, 2.38), and 1.63 (95% CI: 1.05, 2.52) among the serology study participants. The RR by job title was increased for all health care workers and highest for personal health care workers in health services (6.19;3.71, 10.33);PPE was associated with a stronger protective effect by increasing protection level. Using public transport for commuting was associated with a 50% increase in COVID risk. Results for the extended follow-up will be presented.ConclusionsThe extended follow-up of the COVICAT cohort provides data to illuminate occupational risk factors for COVID-19 infection over time, which may contribute to explain heterogeneities across countries.

Long-Term Exposure to Air Pollution and COVID-19 Vaccine Antibody Response in a General Population Cohort (COVICAT Study, Catalonia).

BACKGROUND: Ambient air pollution has been associated with COVID-19 disease severity and antibody response induced by infection. OBJECTIVES: We examined the association between long-term exposure to air pollution and vaccine-induced antibody response. METHODS: This study was nested in an ongoing population-based cohort, COVICAT, the GCAT-Genomes for Life cohort, in Catalonia, Spain, with multiple follow-ups. We drew blood samples in 2021 from 1,090 participants of 2,404 who provided samples in 2020, and we included 927 participants in this analysis. We measured immunoglobulin M (IgM), IgG, and IgA antibodies against five viral-target antigens, including receptor-binding domain (RBD), spike-protein (S), and segment spike-protein (S2) triggered by vaccines available in Spain. We estimated prepandemic (2018-2019) exposure to fine particulate matter [PM ≤2.5µm in aerodynamic diameter (PM2.5)], nitrogen dioxide (NO2), black carbon (BC), and ozone (O3) using Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) models. We adjusted estimates for individual- and area-level covariates, time since vaccination, and vaccine doses and type and stratified by infection status. We used generalized additive models to explore the relationship between air pollution and antibodies according to days since vaccination. RESULTS: Among vaccinated persons not infected by SARS-CoV-2 (n=632), higher prepandemic air pollution levels were associated with a lower vaccine antibody response for IgM (1 month post vaccination) and IgG. Percentage change in geometric mean IgG levels per interquartile range of PM2.5 (1.7 µg/m3) were -8.1 (95% CI: -15.9, 0.4) for RBD, -9.9 (-16.2, -3.1) for S, and -8.4 (-13.5, -3.0) for S2. We observed a similar pattern for NO2 and BC and an inverse pattern for O3. Differences in IgG levels by air pollution levels persisted with time since vaccination. We did not observe an association of air pollution with vaccine antibody response among participants with prior infection (n=295). DISCUSSION: Exposure to air pollution was associated with lower COVID-19 vaccine antibody response. The implications of this association on the risk of breakthrough infections require further investigation. https://doi.org/10.1289/EHP11989.

Changes in Population Health-Related Behaviors During a COVID-19 Surge: A Natural Experiment.

BACKGROUND: The study of impact of lockdowns on individual health-related behaviors has produced divergent results. PURPOSE: To identify patterns of change in multiple health-related behaviors analyzed as a whole, and their individual determinants. METHODS: Between March and August 2020, we collected data on smoking, alcohol, physical activity, weight, and sleep in a population-based cohort from Catalonia who had available pre-pandemic data. We performed multiple correspondence and cluster analyses to identify patterns of change in health-related behaviors and built multivariable multinomial logistic regressions to identify determinants of behavioral change. RESULTS: In 10,032 participants (59% female, mean (SD) age 55 (8) years), 8,606 individuals (86%) modified their behavior during the lockdown. We identified five patterns of behavioral change that were heterogeneous and directed both towards worsening and improvement in diverse combinations. Patterns ranged from "global worsening" (2,063 participants, 21%) characterized by increases in smoking, alcohol consumption, and weight, and decreases in physical activity levels and sleep time, to "improvement" (2,548 participants, 25%) characterized by increases in physical activity levels, decreases in weight and alcohol consumption, and both increases and decreases in sleep time. Being female, of older age, teleworking, having a higher education level, assuming caregiving responsibilities, and being more exposed to pandemic news were associated with changing behavior (all p < .05), but did not discriminate between favorable or unfavorable changes. CONCLUSIONS: Most of the population experienced changes in health-related behavior during lockdowns. Determinants of behavior modification were not explicitly associated with the direction of changes but allowed the identification of older, teleworking, and highly educated women who assumed caregiving responsibilities at home as susceptible population groups more vulnerable to lockdowns.

Teaching lessons learnt by civil-engineering teachers from the COVID-19 pandemic at the University of Burgos, Spain.

The COVID-19 lockdown in Spain caused abrupt changes for students following the Bachelor's Degree in Civil Engineering at the University of Burgos when face-to-face classes switched to online teaching. The recovery of face-to-face teaching after lockdown meant that classes were taught with obligatory social distancing and the use of masks. Teachers were therefore unable to interact with students closely, to perceive their facial expressions during class, or to conduct group work. The changes to civil-engineering teaching linked to the COVID-19 pandemic and the lessons that civil-engineering teachers learnt from the new teaching scenarios are studied in this paper. The reflections of teachers throughout all three stages of the pandemic (pre-pandemic and lockdown, during lockdown, and post-lockdown), and the qualitative and mixed analysis of their responses to a survey of open-ended questions contributed to the identification of six major lessons: (1) asking questions and using real-time quiz tools enliven classes and help to determine which concepts to emphasize for proper student understanding; (2) autonomous student learning can be promoted through the provision of supplementary documentation and the digitalization of solutions to classroom exercises; (3) virtual site visits and real visual examples interspersed with explanations bring concepts closer to their real applications; (4) the delivery of projects in the form of audio-recorded presentations enable their distribution, so that other students can also learn from them as well as the students who created them; (5) online videoconferences, adapted to the concepts that are addressed, facilitate fast and flexible communication with students; and (6) online continuous-assessment exams can promote better student learning patterns and final-exam preparation. Nevertheless, these six lessons were drawn from the experience of teachers at a small Spanish university where the period of solely online teaching during the COVID-19 pandemic lasted only four months. Thus, it would be interesting to analyze the experience of civil-engineering teachers at larger universities and universities that had longer periods of solely online teaching. A study of the level of implementation of the six aspects when the pandemic is declared over might also be worthwhile.

Impact of COVID-19 on Students' Generic Skills - A Case Study in a University from a Developing Country.

The education sector was considerably affected by the COVID-19 pandemic, risking the learning process and forcing governments to pull out contingency actions to ensure the students' development of generic and specific skills and guarantee education quality. These actions include the shift to online and hybrid (i.e., online and in-person) classes. This work assesses the pandemic effect on the generic skills of undergraduate students in a Colombian university. The study aims to determine the effect of COVID- 19 on the development of generic skills quantitatively. Two datasets were retrieved: i) A dataset with the scores obtained by the students in an institutional Generic Skills test and in the midterm tests; ii) A dataset with the students' scores in the Colombian standardized test for undergraduate students, called the Saber Pro test. Three analysis stages were performed: i) Univariate exploratory analysis; ii) Differential analysis to compare the No COVID vs. COVID scenarios; iii) A correlation analysis. Results showed that the scores of the Generic Skills and the Midterm tests increased significantly when comparing the two scenarios, except for the Written Communication. As for the Saber Pro test, only the scores for Written Comprehension, Quantitative Reasoning, and the global scores increased significantly. On the other hand, the correlation analysis showed a strong correlation only between the scores obtained at the Generic Skills and the Saber Pro tests for the English Proficiency skill. In addition, the analysis elucidated a weak correlation between the Generic Skills test's average and the Saber Pro's global score. Finally, the results prove that online education is a feasible alternative that offers students more flexibility to ensure the development of generic and specific skills.

SARS-CoV-2 infection, vaccination, and antibody response trajectories in adults: a cohort study in Catalonia.

BACKGROUND: Heterogeneity of the population in relation to infection, COVID-19 vaccination, and host characteristics is likely reflected in the underlying SARS-CoV-2 antibody responses. METHODS: We measured IgM, IgA, and IgG levels against SARS-CoV-2 spike and nucleocapsid antigens in 1076 adults of a cohort study in Catalonia between June and November 2020 and a second time between May and July 2021. Questionnaire data and electronic health records on vaccination and COVID-19 testing were available in both periods. Data on several lifestyle, health-related, and sociodemographic characteristics were also available. RESULTS: Antibody seroreversion occurred in 35.8% of the 64 participants non-vaccinated and infected almost a year ago and was related to asymptomatic infection, age above 60 years, and smoking. Moreover, the analysis on kinetics revealed that among all responses, IgG RBD, IgA RBD, and IgG S2 decreased less within 1 year after infection. Among vaccinated, 2.1% did not present antibodies at the time of testing and approximately 1% had breakthrough infections post-vaccination. In the post-vaccination era, IgM responses and those against nucleoprotein were much less prevalent. In previously infected individuals, vaccination boosted the immune response and there was a slight but statistically significant increase in responses after a 2nd compared to the 1st dose. Infected vaccinated participants had superior antibody levels across time compared to naïve-vaccinated people. mRNA vaccines and, particularly the Spikevax, induced higher antibodies after 1st and 2nd doses compared to Vaxzevria or Janssen COVID-19 vaccines. In multivariable regression analyses, antibody responses after vaccination were predicted by the type of vaccine, infection age, sex, smoking, and mental and cardiovascular diseases. CONCLUSIONS: Our data support that infected people would benefit from vaccination. Results also indicate that hybrid immunity results in superior antibody responses and infection-naïve people would need a booster dose earlier than previously infected people. Mental diseases are associated with less efficient responses to vaccination.

Intranasal dexamethasone: a new clinical trial for the control of inflammation and neuroinflammation in COVID-19 patients.

BACKGROUND: By end December of 2021, COVID-19 has infected around 276 million individuals and caused over 5 million deaths worldwide. Infection results in dysregulated systemic inflammation, multi-organ dysfunction, and critical illness. Cells of the central nervous system are also affected, triggering an uncontrolled neuroinflammatory response. Low doses of glucocorticoids, administered orally or intravenously, reduce mortality among moderate and severe COVID-19 patients. However, low doses administered by these routes do not reach therapeutic levels in the CNS. In contrast, intranasally administered dexamethasone can result in therapeutic doses in the CNS even at low doses. METHODS: This is an approved open-label, multicenter, randomized controlled trial to compare the effectiveness of intranasal versus intravenous dexamethasone administered in low doses to moderate and severe COVID-19 adult patients. The protocol is conducted in five health institutions in Mexico City. A total of 120 patients will be randomized into two groups (intravenous vs. intranasal) at a 1:1 ratio. Both groups will be treated with the corresponding dexamethasone scheme for 10 days. The primary outcome of the study will be clinical improvement, defined as a statistically significant reduction in the NEWS-2 score of patients with intranasal versus intravenous dexamethasone administration. The secondary outcome will be the reduction in mortality during hospitalization. CONCLUSIONS: This protocol is currently in progress to improve the efficacy of the standard therapeutic dexamethasone regimen for moderate and severe COVID-19 patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04513184 . Registered November 12, 2020. Approved by La Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS) with identification number DI/20/407/04/36. People are currently being recruited.

SARS-CoV-2 infection among Mexican healthcare workers.

Dear editor: Healthcare workers (HCW) have been the first-line defense against pandemic SARS-CoV-2 infection, for this reason, they are highly exposed and possibly have the greatest risk of contagion...

Ambient Air Pollution in Relation to SARS-CoV-2 Infection, Antibody Response, and COVID-19 Disease: A Cohort Study in Catalonia, Spain (COVICAT Study).

BACKGROUND: Emerging evidence links ambient air pollution with coronavirus 2019 (COVID-19) disease, an association that is methodologically challenging to investigate. OBJECTIVES: We examined the association between long-term exposure to air pollution with SARS-CoV-2 infection measured through antibody response, level of antibody response among those infected, and COVID-19 disease. METHODS: We contacted 9,605 adult participants from a population-based cohort study in Catalonia between June and November 2020; most participants were between 40 and 65 years of age. We drew blood samples from 4,103 participants and measured immunoglobulin M (IgM), IgA, and IgG antibodies against five viral target antigens to establish infection to the virus and levels of antibody response among those infected. We defined COVID-19 disease using self-reported hospital admission, prior positive diagnostic test, or more than three self-reported COVID-19 symptoms after contact with a COVID-19 case. We estimated prepandemic (2018-2019) exposure to fine particulate matter [PM with an aerodynamic diameter of ≤2.5µm (PM2.5)], nitrogen dioxide (NO2), black carbon (BC), and ozone (O3) at the residential address using hybrid land-use regression models. We calculated log-binomial risk ratios (RRs), adjusting for individual- and area-level covariates. RESULTS: Among those tested for SARS-CoV-2 antibodies, 743 (18.1%) were seropositive. Air pollution levels were not statistically significantly associated with SARS-CoV-2 infection: Adjusted RRs per interquartile range were 1.07 (95% CI: 0.97, 1.18) for NO2, 1.04 (95% CI: 0.94, 1.14) for PM2.5, 1.00 (95% CI: 0.92, 1.09) for BC, and 0.97 (95% CI: 0.89, 1.06) for O3. Among infected participants, exposure to NO2 and PM2.5 were positively associated with IgG levels for all viral target antigens. Among all participants, 481 (5.0%) had COVID-19 disease. Air pollution levels were associated with COVID-19 disease: adjusted RRs=1.14 (95% CI: 1.00, 1.29) for NO2 and 1.17 (95% CI: 1.03, 1.32) for PM2.5. Exposure to O3 was associated with a slightly decreased risk (RR=0.92; 95% CI: 0.83, 1.03). Associations of air pollution with COVID-19 disease were more pronounced for severe COVID-19, with RRs=1.26 (95% CI: 0.89, 1.79) for NO2 and 1.51 (95% CI: 1.06, 2.16) for PM2.5. DISCUSSION: Exposure to air pollution was associated with a higher risk of COVID-19 disease and level of antibody response among infected but not with SARS-CoV-2 infection. https://doi.org/10.1289/EHP9726.

Infection induced SARS-CoV-2 seroprevalence and heterogeneity of antibody responses in a general population cohort study in Catalonia Spain.

Sparse data exist on the complex natural immunity to SARS-CoV-2 at the population level. We applied a well-validated multiplex serology test in 5000 participants of a general population study in Catalonia in blood samples collected from end June to mid November 2020. Based on responses to fifteen isotype-antigen combinations, we detected a seroprevalence of 18.1% in adults (n = 4740), and modeled extrapolation to the general population of Catalonia indicated a 15.3% seroprevalence. Antibodies persisted up to 9 months after infection. Immune profiling of infected individuals revealed that with increasing severity of infection (asymptomatic, 1-3 symptoms, ≥ 4 symptoms, admitted to hospital/ICU), seroresponses were more robust and rich with a shift towards IgG over IgA and anti-spike over anti-nucleocapsid responses. Among seropositive participants, lower antibody levels were observed for those ≥ 60 years vs < 60 years old and smokers vs non-smokers. Overweight/obese participants vs normal weight had higher antibody levels. Adolescents (13-15 years old) (n = 260) showed a seroprevalence of 11.5%, were less likely to be tested seropositive compared to their parents and had dominant anti-spike rather than anti-nucleocapsid IgG responses. Our study provides an unbiased estimate of SARS-CoV-2 seroprevalence in Catalonia and new evidence on the durability and heterogeneity of post-infection immunity.

Occupational risk factors for SARS-CoV-2 infection and COVID-19: Results from the COVICAT cohort study in Catalonia, Spain

IntroductionDuring the first lockdown in Spain (March-June, 2020) essential workers may have been at increased risk of coronavirus disease 2019 (COVID-19) via occupational exposure. Results from published studies are heterogeneous.MethodsOngoing population-based cohort studies from Catalonia were pooled to form the COVICAT study. A random sub-population donated a blood sample (May-July, 2020) for validated multiplex serology testing. Occupational analyses were restricted to working age (18–65 years). Participants responded to a web-based or telephone survey including questions on socio-demographics, pre-pandemic health, behavioural and environmental risk factors. Occupational questions covered mode of work (e.g. telework), job title, availability of personal protective equipment (PPE), and mode of commuting. Job titles were coded by an occupational hygienist to the Spanish CNO-11 and cross-walked to ISCO-08. COVID-19 cases were defined by symptoms or hospitalisation and SARS CoV-2 seropositivity based on immune responses to 15 isotype-antigen combinations (serology sub-cohort). Logistic regression models were built for type of work, job titles and job-exposure matrix (JEM), covering several dimensions and levels of SARS-CoV-2 transmission probabilities , and adjusted for age, sex, education, deprivation index, population density and survey type.ResultsThis analysis included 8,582 participants, of which 3,599 were tested for SARS-CoV-2 antibodies, median (SD) age 53.7 (6.3) years, 59.9% were women. The relative risk for COVID-19 for work in the usual workplace compared to telework was 1.87 (95% CI: 1.44, 2.42), and 1.44 (95% CI: 1.09, 1.90) among the serology study. The relative risk for nurses who worked in their usual workplace was 4.57 (95% CI: 3.12, 6.7). Detailed results by job title, JEM, availability of PPE and commuting mode will be presented.ConclusionsThis study has several strengths, including random serology testing and individual-level exposure data. Detailed results may support extended legal definitions of COVID-19 as a recognized occupational disease.

Dementia Care in Times of COVID-19: Experience at Fundació ACE in Barcelona, Spain.

BACKGROUND: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. OBJECTIVE: To share our experience in adapting our model of care to the new situation to ensure continuity of care. METHODS: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. RESULTS: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. DISCUSSION: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.