ABSTRACT
Analytic compartmental models are currently used in mathematical epidemiology to forecast the COVID-19 pandemic evolution and explore the impact of mitigation strategies. In general, such models treat the population as a single entity, losing the social, cultural and economical specificities. We present a network model that uses socio-demographic datasets with the highest available granularity to predict the spread of COVID-19 in the province of Barcelona. The model is flexible enough to incorporate the effect of containment policies, such as lockdowns or the use of protective masks, and can be easily adapted to future epidemics. We follow a stochastic approach that combines a compartmental model with detailed individual microdata from the population census, including social determinants and age-dependent strata, and time-dependent mobility information. We show that our model reproduces the dynamical features of the disease across two waves and demonstrates its capability to become a powerful tool for simulating epidemic events.
ABSTRACT
BACKGROUND AND AIMS: COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. METHOD: Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. RESULTS: A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. CONCLUSION: Thymoglobulin should be used with caution in older recipients during the present pandemic era.
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Background: Cancer p represent a high-risk population for severe COVID-19. Cancer-associated immunosuppression may hinder in the development of anti-SARS-CoV-2 antibodies. Methods: Data regarding baseline characteristics (age, cancer type, cancer activity, cancer treatment), COVID-19 infection and anti-SARS-CoV-2 IgG were collected from p with solid tumors who tested positive for COVID-19 (PCR+) between 10th March and 9th December 2020 at Catalan Institute of Oncology. We prospectively assessed anti-SARS-CoV-2 IgG seroprevalence at different timepoints (<2, 2-6, >6 months [m] since first PCR+) and explored factors associated with long-term IgG positivity. Results: Out of 79 registered p, 19 died without IgG testing (all of them <3 months after a PCR+), and 8 refused to participate, leaving 52 tested for IgG. Tested and not-tested p were similar according to baseline characteristics, cancer treatment and COVID-19. At the 1st timepoint, 19/23p were IgG+;at the 2nd, 29/33p were IgG+ and 1 inconclusive;at the 3rd timepoint, 18/22 were IgG+ (median time from PCR + to 3rd timepoint determination was 9.4 m (Interquartile range [IQR]: 8.5-9.7). Importantly, 1 p changed from IgG+ (2nd timepoint) to IgG- (3rd timepoint), and 1 inconclusive result (2nd timepoint) changed to negative (3rd timepoint). Potential factors associated to IgG+ >6 m are shown in the table. [Formula presented] Conclusions: High seroprevalence of anti-SARS-CoV-2 IgG was observed at several timepoints after COVID-19 diagnosis in solid tumor p. P with IgG+ at >6 m were older, and more likely to have required hospitalization and oxygen during prior COVID-19 in comparison to IgG- p >6m, suggesting that infection severity may promote durable immunity. Frequency of active cancer and active chemotherapy at COVID-19 diagnosis were higher among p with IgG- >6m, suggesting deeper immunosupression. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: E. Felip: Financial Interests, Personal, Other: Pfizer;Financial Interests, Personal, Other: Lilly;Financial Interests, Personal, Other: Eisai;Financial Interests, Personal, Other: Novartis;Financial Interests, Personal, Sponsor/Funding: Pfizer. M. Romeo Marin: Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: MSK;Financial Interests, Personal and Institutional, Other: MSD;Financial Interests, Personal and Institutional, Principal Investigator: AZ;Financial Interests, Personal and Institutional, Principal Investigator: GSK Tesaro;Financial Interests, Personal and Institutional, Principal Investigator: Merck. All other authors have declared no conflicts of interest.
ABSTRACT
Background: Cancer patients (pts) represent a high-risk population for severe COVID-19. Cancer-associated immunosuppression may hinder in the development of anti-SARS-CoV-2 antibodies. Methods: Data regarding baseline characteristics, COVID-19 and anti-SARS-Cov2 IgG were collected from cancer pts (solid tumors) who tested positive for COVID-19 (PCR+) between March and April 2020 at Catalan Institute of Oncology. We prospectively assessed anti-SARS-Cov2 IgG seroprevalence at 3 and 9 months post infection and explored clinico-pathologic factors associated with IgG positivity. We explored the impact of potential factors influencing antibody production at >9 months. Results: Of 49 pts registered between 10 March-26 April 2020, 21 died <3 months after the infection and 5 pts refused to participate, leaving 23 eligible pts for IgG testing. With respect to those not tested, IgG tested cohort was younger (median age: 64.0 vs 72.9 years, p = 0.001) and presented oncologic remission in 68.2% of cases (vs 34.6%, p = 0.043) at COVID-19 diagnosis. Median time from PCR+ to first and second IgG determination was 3.2 months (Interquartile range [IQR]: 2.9-4.1) and 9.5 months (IQR: 8.8-9.8), respectively. Out of 23 pts, 15 had both determinations and 8 had only one (3 in the first time point, 5 in the second one). We identified 16/18 pts IgG+ (88.9%) at 3 months and 17/20 pts IgG+ (85%) at 9 months. One IgG+ pt became IgG-at the second determination, one was IgG-at both timepoints, and one had an inconclusive result at the first but negative at the second timepoint. Key characteristics of patients by IgG result 9 months after COVID-19 diagnosis are shown in the table. Conclusions: We describe a high seroprevalence of anti-SARS-CoV-2 IgG at 3 and 9 months after COVID-19 diagnosis in solid tumour patients, irrespective of anti-cancer therapy exposure. Pts who were IgG+ at 9 months were older, and more likely to have required oxygen during prior COVID-19 in comparison to IgG-pts suggesting that infection severity may promote durable immunity. Frequency of early stage cancers was higher among IgG+ pts, suggesting less cancerrelated immunosupression. Older (>70 years) and advanced cancer pts were underrepresented in this series, warranting confirmation of these preliminary results in a larger cohort.
ABSTRACT
The new SARS-CoV-2 coronavirus is responsible for the current pandemic (COVID-19) and the consequent international health emergency. The clinical spectrum is broad, with recent reports of cases with cardiac involvement, mainly myocarditis, in COVID-19 patients. To date there are few reports of COVID-19 cases in need of heart surgery. The position of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) has been to ensure the correct care of emerging and urgent patients, according to current clinical guidelines, however, in some cases the distinction between involvement of cardiac or pulmonary etiology can make the decision-making difficult. We present the case of a man with infective endocarditis and intercurrent infection with COVID-19, in which multidisciplinary consensus was essential to set the surgical indication, because his symptomatology generated controversy with current clinical guidelines of the European Society of Cardiology (ESC) on infective endocarditis. We consider that the adaptation of the guidelines during the current health emergency and the multidisciplinary decision-making can facilitate therapeutic action in complex cases of cardiac pathologies with surgical indication and COVID-19 coinfection.