Clinical Findings and Outcomes from 1306 Patients with Covid-19 Pneumonia in an Intermediate Respiratory Care Unit: A Prospective, Observational Study

Background: An intermediate respiratory care unit (IRCU) may be a valuable tool for optimizing patient care, allowing to implement standardized algorithm management to decrease clinical failure and mortality. We aimed to describe the practice of noninvasive respiratory strategies (NRS) in a novel facility fully dedicated to COVID-19 and to establish outcomes of these patients Methods: Prospective, observational study performed at one hospital in Spain. We included consecutive patients admitted to IRCU due to COVID-19 requiring NRS between December 2020 and September 2021. Data collected included mode and usage of NRS, endotracheal intubation and mortality to day 30. A multivariable Cox proportional hazards method was used to assess risk factors associated with clinical failure and mortality Findings: 1306 patients with COVID-19 were included. Of them, 64.6% were men and mean age was 54.7 years. During IRCU stay, 345 patients presented a clinical failure, (89.6% intubated;14.5% died). Cox model showed a higher clinical failure in IRCU when time between symptoms onset and hospitalization < 10 days (HR 1.59;95% CI 1.24-2.03;p<0.001) and PaO2/FiO2 <100 (HR 1.59;95% CI 1.27-1.98;p<0.001). Conversely, these variables were not associated with an increased mortality to day 30 Interpretation: IRCU may be a useful option for the multidisciplinary management of COVID-19 patients requiring NRS;thus, reducing ICU overcharge. Men gender, gas-exchange and blood chemistry at admission are associated with worse clinical outcomes, while older age, gas-exchange and blood chemistry are associated with 30-day mortality.

The Digital Gap and New Academic Forms in Rural Schools of Spain During Lockdown

The digital divide constitutes a barrier to achieving equal opportunities for the population. In this article, we examine how the lockdown and online teaching affected rural schools. Although connectivity is poor and resources may be scarce in these schools, communication with families is fluid and the teacher-student ratio is lower. We designed a questionnaire that was administered to 157 rural schools during the lockdown process. The results show a digital gap for 30% of the student body, notable efforts by teachers to adapt to the needs of students, weekly changes in the way teaching is organized, related didactic proposals, and concern for curricular assessment. The rural schools participating in the study have tried to respond to the multiple demands arising from this new situation and narrow the digital gap by adapting to the communication needs of their students.