Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission.

BACKGROUND AND OBJECTIVES: Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS: This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS: From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION: The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

Systematic review of the epidemiological status and genomic analysis of SARS-CoV-2 isolated from domestic dogs and cats

The aim of the research was to carry out a systematic review about the epidemiology of SARS-CoV-2 infection in dogs and cats, as well as the genomic analysis of virus samples isolated from dogs and cats worldwide. For this, the systematic review was structured based on PRISMA's protocol. Articles were obtained using the following keywords: SARS-CoV-2, COVID-19, dogs, cats, epidemiology, animal transmission, pets, companion animals, animal reservoirs and zoonosis. Additionally, all of SARS-CoV-2 genomes isolated from dogs and cats worldwide, reported in GISAID's EpiCoV™ database, were selected and analyzed through Nextclade's tool for the generation of the respective phylogenetic trees. The exposure - natural infection with SARS-CoV-2 from January 2020 to October 2021 of 100 dogs and 108 cats positive by the RTq-PCR technique was reported worldwide. Furthermore, 141 SARS-CoV-2 genetic sequences have been isolated from dogs (50) and cats (91), where the following variants monitored by public health organizations were found: the variants of concern (VOC) Alpha, Gamma and Delta, and the variants of interest (VOI) Iota and Lambda. On the other hand, viral lineage B.1. has been predominantly isolated in both dogs and cats (13.3%) and North America is the region with the greatest number of SARS-CoV-2 genomes isolated from both species (43.6%). SARS-CoV-2 has the ability to infect domestic canines and felines, its exposure to VOCs: Alpha, Gamma and Delta, and VOIs: Iota and Lambda being of public health interest;probably due to a «spillover» effect from the human. However, these two species have a low capacity to transmit the virus to other susceptible species, considering that they can act as epidemiological dead-end hosts in the transmission dynamics of SARSCoV-2.

Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission⋆ Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea

Background and objectives Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. Methods This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. Results From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%;p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. Conclusion The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

The acute phase response identifies cancer patients with adverse outcomes from SARS-CoV-2 infection as quantified by the OnCovid Inflammatory Score

We sought to determine parameters of the acute phase response, a feature of innate immunity activated by infectious noxae and cancer, deranged by Covid-19 and establish oncological indices' prognostic potential for patients with concomitant cancer and Covid-19. Between 27/02 and 23/06/2020, OnCovid retrospectively accrued 1,318 consecutive referrals of patients with cancer and Covid-19 aged 18 from the U.K., Spain, Italy, Belgium, and Germany. Patients with myeloma, leukemia, or insufficient data were excluded. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and prognostic index (PI) were evaluated for their prognostic potential, with the NLR, PLR, and PNI risk stratifications dichotomized around median values and the pre-established risk categorizations from literature utilized for the mGPS and PI. 1,071 eligible patients were randomly assorted into a training set (TS, n=529) and validation set (VS, n=542) matched for age (67.9±13.3 TS, 68.5±13.5 VS), presence of 1 comorbidity (52.1% TS, 49.8% VS), development of 1 Covid-19 complication (27% TS, 25.9% VS), and active malignancy at Covid-19 diagnosis (66.7% TS, 61.6% VS). Among all 1,071 patients, deceased patients tended to categorize into poor risk groups for the NLR, PNI, mGPS, and PI (P<0.0001) with a return to pre-Covid-19 diagnosis NLR, PNI, and mGPS categorizations following recovery (P<0.01). In the TS, higher mortality rates were associated with NLR>6 (44.6% vs 28%, P<0.0001), PNI<40 (46.6% vs 20.9%, P<0.0001), mGPS (50.6% for mGPS2 vs 30.4% and 11.4% for mGPS1 and 0, P<0.0001), and PI (50% for PI2 vs 40% for PI1 and 9.1% for PI0, P<0.0001). Findings were confirmed in the VS (P<0.001 for all comparisons). Patients in poor risk categories had shorter median overall survival [OS], (NLR>6 30 days 95%CI 1-63, PNI<40 23 days 95%CI 10-35, mGPS2 20 days 95%CI 8-32, PI2 23 days 95%CI 1-56) compared to patients in good risk categories, for whom median OS was not reached (P<0.001 for all comparisons). The PLR was not associated with survival. Analyses of survival in the VS confirmed the NLR (P<0.0001), PNI (P<0.0001), PI (P<0.01), and mGPS (P<0.001) as predictors of survival. In a multivariable Cox regression model including all inflammatory indices and pre-established prognostic factors for severe Covid-19 including sex, age, comorbid burden, malignancy status, and receipt of anti-cancer therapy at Covid-19 diagnosis, the PNI was the only factor to emerge with a significant hazard ratio [HR] in both TS and VS analysis (TS HR 1.97, 95%CI 1.19-3.26, P=0.008;VS HR 2.48, 95%CI 1.47- 4.20, P=0.001). We conclude that systemic inflammation drives mortality from Covid-19 through hypoalbuminemia and lymphocytopenia as measured by the PNI and propose the PNI as the OnCovid Inflammatory Score (OIS) in this context.

Repercussion on social networks of the switched keyboard syndrome

Introduction: Covid-19 has caused numerous health problems in the general population and in health professionals. Some of these problems are not well known, as is the case of the changed keyboard syndrome. The aim of this study was to assess this syndrome among health care personnel in the health area of Cartagena. Methodology: A survey was carried out among 156 health care workers in the health area of Cartagena to assess the changed keyboard syndrome. The repercussion of this syndrome in different social networks was also assessed. Results: 45.1% of the people who responded to the survey stated that they had suffered from this syndrome at some time. As for the repercussions, 16.6% indicated that they were too concentrated and should stop, 14.1% believed that they were starting to get sick and 17.2% thought that this situation was funny. Some 52.1% stated that it does not happen to them. Conclusions: Switched keyboard syndrome is a new consequence of the pandemic that should be evaluated in greater depth to see what repercussions it may have on healthcare personnel.

CLINICAL CHARACTERISTICS AND EVOLUTION OF HEMATOLOGICAL PATIENTS AND COVID-19 IN ARGENTINA: A REPORT FROM THE ARGENTINE SOCIETY OF HEMATOLOGY

Individuals with malignancies and COVID-19 have a lower survival compared with the general population. However, the information about the impact of COVID-19 on the whole hematological population is scarce. We aimed to describe the 30th day overall survival (OS) after COVID-19 infection in patients with a hematological disease in Argentina. A completely anonymous survey from the Argentine Society of Hematology was delivered to all the hematologists in Argentina;it started in April 2020. A cut-off to analyze the data was performed in December 2020 and, finally, 419 patients were reported and suitable for the analysis (average age: 58 years, 90% with malignant diseases). After the COVID-19 diagnosis, the 30-day OS for the whole population was 80.2%. From the entire group (419), 101 (24.1%) individuals required intensive care unit admission, where the 30-day OS was 46.6%. Among allogeneic stem cell transplant recipients, the 30-day OS was 70.3%. Factors associated with a low OS were two or more comorbidities, an active hematological disease and history of chemotherapy. In individuals with the three factors, the 30-day OS was 49.6% while the 30-day OS in those without those factors was 100%. Patients with hematological diseases have a higher mortality than the general population. This group represents a challenge and requires careful decision-making of the treatment in order not to compromise the chances of cure.

Chronicle of wounds during the first wave of COVID-19 pandemic

The first wave of COVID-19 had a major impact on the Spanish healthcare system. This impact was even more accentuated for certain professional groups, such as nursing staff. This article presents the testimony of 12 nurses from 10 health centres and hospitals in the Community of Madrid on the impact of the first wave of the pandemic on wound care and evaluates the use of dressings with new technologies that have helped in the evolution of wounds during this period.

Air quality in Barcelona during the COVID-19 lockdown and the global effect on CO2 emissions

The COVID-19 pandemic is having an enormous negative impact on human health, with more than 4.44 million deaths worldwide;on the economy, with an unprecedented deep and abrupt crisis;and on society, with millions of people facing unemployment and dependent, in the best case scenario, on public welfare or social aid systems. Home confinement, measures to limit nonessential economic activity and travel restrictions in many countries during the spring of 2020 led to rapid air quality improvements in cities. A detailed analysis of Barcelona's daily immissions of seven pollutants (CO, SO2, NO, NO2, NOx, PM10 and O3) shows a clear decrease from mid -March to June, with the peak in April and the nitrogen oxides. For these pollutants the reduction of traffic density is very likely the main cause of their immissions decrease. On another note, the global reduction of CO2 emissions derived from the use of fossil fuels was estimated at approximately 8 % in 2020, which, despite constituting an unprecedented drop, will have little impact on concentrations of CO2 and other greenhouse gases in the atmosphere. The current situation must be seen as an opportunity to push, without delay, for a drastic change in the energy and economy models towards a socio-environmental paradigm based on sustainability, economic efficiency and solidarity between peoples.

[Adaptation of surgery practice during the Covid-19 pandemic. Ureteroscopy in outpatient surgery.]

OBJECTIVE: The World Health Organizationdeclared a pandemic status due to the COVID-19 disease caused by the new coronavirus SARS-Cov-2 in March 2020. This caused high health pressure that hashad an impact on the Spanish National Health System and Granada has been one of the most affected provincesnationwide. The high healthcare pressure derived from it has had an impact on the National Health System throughout the Spanish territory, with Granada beingone of the most affected provinces nation wide. The increase in the admissions of patients with COVID-19 in such a short time has forced us to optimize hospital resources, prioritizing them in patients with COVID-19 and oncological or urgent pathology. In this context, the increasingly frequent and recurrent lithiasis is treated conservatively. However, the prolongation of the pandemic situation poses the challenge of offering definitive treatment to these patients. MATERIAL AND METHODS: We present the rearrangement performed in our Lithotripsy Unit with the aim of developing a comprehensive and alternative protocol for performing ureteroscopies on an outpatient basis, assuming the patient from admission to hospital discharge, with the collaboration of the Anesthesiology service. RESULTS: In this new protocol, 35 ureteroscopies were performed without noticing intraoperative complications or during the recovery period developed in the Day Hospital integrated within the Lithotripsy Unit. CONCLUSIONS: The redistribution of our resources has allowed us to continue performing ureterorenoscopies on an outpatient basis without the need to use hospital beds and reducing the traffic of patients within the hospital itself with an adequate safety profile.

Prevalence and impact of COVID-19 sequelae on treatment pathways and survival of cancer patients who recovered from SARS-CoV-2 infection

Background: The long-term impact of COVID-19 in cancer patients (pts) is undefined. Methods: Among 2795 consecutive pts with COVID-19 and cancer registered to OnCovid between 01/2020 and 02/2021, we examined clinical outcomes of pts reassessed post COVID-19 recovery. Results: Among 1557 COVID-19 survivors, 234 (15%) reported sequelae including respiratory symptoms (49.6%), fatigue (41%) and cognitive/psychological dysfunction (4.3%). Persisting COVID-19 sequelae were more likely found in males (p=0.0407) aged ≥65 years (p=0.0489) with ≥2 comorbidities (p=0.0006) and positive smoking history (p=0.0004). Sequelae were associated with history of prior hospitalisation (p<0.0001), complicated disease (p<0.0001) and COVID-19 therapy (p=0.0002). With a median post-COVID-19 follow up of 128 days (95%CI 113-148), multivariable analysis of survival revealed COVID-19 sequelae to be associated with an increased risk of death (HR 1.76, 95%CI 1.16-2.66) after adjusting for sex, age, comorbidities, tumour characteristics, anticancer therapy and COVID-19 severity. Out of 473 patients who were on systemic anticancer therapy (SACT) at COVID-19 diagnosis;62 (13.1%) permanently discontinued therapy and 75 (15.8%) received SACT adjustments, respectively. Discontinuations were due to worsening performance status (45.1%), disease progression (16.1%) and residual organ disfunction (6.3%). SACT adjustments were pursued to avoid hospital attendance (40%), prevent immunosuppression (57.3%) or adverse events (20.3%). Multivariable analyses showed permanent discontinuation to be associated with an increased risk of death (HR 4.2, 95%CI: 1.62-10.7), whereas SACT adjustments did not adversely affect survival. Conclusions: Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely influence survival and oncological outcomes after recovery. SACT adjustments can be safely pursued to preserve oncological outcomes in patients who remain eligible to treatment. Clinical trial identification: NCT04393974. Legal entity responsible for the study: Imperial College London. Funding: Has not received any funding. Disclosure: A. Cortellini: Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Astellas;Financial Interests, Personal, Advisory Board: Sun Pharma. D.J. Pinato: Financial Interests, Personal, Advisory Board: ViiV Healthcare;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Personal, Advisory Board: Eisai;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: AstraZeneca. All other authors have declared no conflicts of interest.

Implementation of a hospital-at-home (hah) unit for hematological patients during the covid-19 pandemic: Safeness and feasibility

Background: COVID-19 fatality can be as high as 30% in patients with hematological malignancies and hematopoietic stem cell transplant (HSCT) recipients. Hospital-at-home (HAH) programs have significantly spread out in the last years and have demonstrated to improve patients satisfaction, avoid unnecessary hospital admissions and reduce healthcare costs. Aims: To describe the implementation of an HAH unit for patients with hematological malignancies and HSCT recipients during the COVID-19 pandemic. Methods: We retrospectively analysed the implementation of an HAH unit for caring hematological patients in our centre. In January 2020, we started our HAH unit, initially created for specific programs: at-home autologous HSCT for patients with multiple myeloma (MM), at-home consolidation treatment for patients with acute leukemia and intravenous treatment delivery. During March and April, simultaneously with the highest peak of the pandemic, the program expanded to other areas as part of our department strategy to ensure safe and high quality care for our patients. Besides, prevention measures were adopted to avoid cross-infection between patients and nurses. At-home episode was defined as any time a patient was included in the HAH unit for a specific program previously described until patient was discharged. Results: One hundred and five patients were included in the HAH unit between January 2020 and November 2020, with a total of 204 at-home episodes (Table1). Nine at-home autologous HSCT were performed in 8 patients with MM (1 patient received a tandem transplant). All patients were discharged the day after infusion, except one with persistent vomiting, later discharged on day +5. Engraftment was achieved in a median time of17 days (range14-29) after transplant. Febrile neutropenia and engraftment syndrome rate was 0%. Three patients were included in the at-home consolidation treatment program: 2 patients with AML and1 with high-risk acute promyelocytic leukemia (APL). They were discharged from the hematology ward the day after cytarabine was fully administered. Clinical and analytical monitoring or electrolyte replacement was performed at home in 32 patients (43 episodes). Five of these patients were autologous recipients who were discharged from HSCT unit before achieving engraftment,15 were allogeneic HSCT recipients and 2 had received CAR-T cells therapy. Azacitidine was administered at home to 22 patients (83 episodes), bortezomib to 22 patients (34 episodes) and carfilzomib to 8 patients (12 episodes). Other episodes are described in Table1. Overall, more than1000 visits were made to patients homes by nurses from the HAH unit, a median of17 (IQR13-19) days of admission per patient and a total of 239 visits to the hematology day-care hospital were avoided. In summary, 28 patients (14% of all episodes) needed admission to the hospital while being treated by HAH unit, 4 of them because of SARS-CoV-2 related pneumonia. None of the nurses from the HAH unit developed SARS-CoV-2 infection while being actively caring patients at home, thus cross-transmission was discarded. Summary/Conclusion: Implementation of a hematology HAH unit was feasible, safe and provided a thorough advanced care to a high risk population. Admissions and visits to day hospital were significantly reduced and SARS-CoV-2 infection rate was low and probably not related to cross-transmission between patients and nurses from the unit. In our experience, the use of advanced care at-home resulted crucial during times of COVID-19 to minimize treatment interruptions and reduce the risk of cross-infections.

Validation of the no presential teaching evaluation instrument in Vocational Training

The COVID-19 pandemic seriously threatens the health of humanity, causing all types of consequences. The education sector is one of the most affected. Student learning has been reduced in the last quarter of the 2019-20 school year, and if science doesn't find a quick solution to fight the virus, the teaching methods that have had to be forced during this time will likely have to be repeated over the next year. In this context, public administrations within the framework of their constitutional powers are developing different educational models so that each teaching center, thanks to its autonomy, chooses the best option according to the type of education they offer and the different educational levels they develop. The objective of this study has been to develop a valid and reliable instrument to evaluate teaching practice in times of pandemic. The methodological approach corresponds to a cross-sectional research survey of a quantitative nature. The different results of Cronbach's alpha values are offered, as well as a series of descriptive statistics. The factorial structure of this scale is analyzed by exploratory factor analysis, confirmatory analysis using a sample of 329 teachers. The studies carried out show that the scale is made up of six factors: student-teacher attitude index, attention to diversity, teacher coordination index, virtual efficiency index, orientation and tutoring index, virtual teaching practice index.

Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study.

BACKGROUND: Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU. METHODS: We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models. FINDINGS: Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts. INTERPRETATION: UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.