Effects of prone position in acute respiratory distress syndrome secondary to COVID-19: experience in a high complexity hospital

Introduction: The use of protective mechanical ventilation and prone position was recommended for the management of moderate to severe acute respiratory distress syndrome (ARDS) due to COVID-19, as a result of its reported utility on oxygenation and mortality. Our objective is to describe gasometric and mechanical behavior in subjects with ARDS due to COVID-19 managed with protective mechanical ventilation and prone position in a high complexity hospital. Method: Observational study. Subjects ≥18 years of age with ARDS due to COVID-19 were included. Protective mechanical ventilation was started from the first connection to invasive ventilation, while the prone position started with PaO2/FIO2 150. Follow-up was performed during and after the prone position. A descriptive analysis of baseline characteristics and comparison of means between groups was performed using the Dunn and Friedman test. Statistical significance corresponds to p 0.05 in all analyses. Results: 74 subjects were studied, 58% correspond to men with a mean age of 60 years. There is evidence of a significant increase in arterial oxygenation assessed by PaO2 (76 to 98 mmHg, p 0.05) and PaO2/FIO2 (100 to 161, p 0.05) during the first hour of treatment, with stability of values beyond 48 hours after supination. Pulmonary mechanics values remain constant within the established protection range (p = 0,18). Conclusion: The strategy of protective mechanical ventilation and prone position for 48 or more hours, in subjects with moderate to severe ARDS due to COVID-19, improves and maintains arterial oxygenation up to 48 hours after supination. © 2023

Open Science services and tools to get information from outreach articles

The pandemic caused by the SARS-CoV-2 virus has caused in the scientific community the need to collaborate as well as promoting Open Science practices, including the open data paradigm to stimulate resing. In this article a set of outreach articles published in The Conversation are analyzed together with some Open Science services and tools to carry out an analysis of their content and context, including information about their authors, institutions and disciplines. This information can be analyzed to better understand the entire research life cycle while facilitating the discovery of relationships at the article, topics or experts.

Web 2.0 teaching tools: the Covid-19 effect among university teachers in Spain and Italy

The COVID-19 pandemic has forced some instructors to delve more deeply into the use of Web 2.0-based teaching tools and others to start using them for the first time. This article presents the results of a survey in which 1,344 Spanish university professors and 3,930 Italian professors participated, from all fields of knowledge. The objective is to assess whether university professors perceive that the use of web 2.0 tools will increase in the coming years and thus alter the way they teach after the face-to-face classroom teaching system has been restored. The results show that the perception of change is fairly high and this perception depends mainly on psychographic characteristics, such as attitude, perceived usefulness, social norms, and affective commitment to teaching. Similarities and differences between the two samples of university professors are discussed.

Effect of COVID-19 pandemic on utilisation of community-based mental health care in North-East of Italy: A psychiatric case register study.

AIMS: WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services' utilisation, by considering psychiatric diagnoses and type of mental health contacts. METHODS: The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A 'difference in differences' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated. RESULTS: In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions. CONCLUSIONS: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

Evaluating the Endothelial Impairments in COVID-19 Patients Using Near-Infrared Spectroscopy: the HEMOCOVID-19 trial

HEMOCOVID-19 is a multi-center trial aiming to assess the microvascular and endothelial health of severe COVID-19 patients in the intensive care using near-infrared spectroscopy. Here, we present the preliminary results, showing that peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome. © 2022 The Author(s).

Effects of Risk Factors on Belizean Adolescents’ Academic Behaviors and Grit after Prolonged Absence During the COVID-19 Pandemic

This causal-comparative study explored the effects of risk factors—family status, parental marital status, family income, and parent education level—on Belizean adolescents’ academic behaviors and grit (passion and perseverance in goal achievement) following prolonged absence during the COVID-19 pandemic. Data were collected online using a demographic survey, the Grit-S Scale (Duckworth & Quinn, 2009), coupled with eight additional items to measure academic behaviors (attendance, preparedness, attention, note-taking, participation, organization, use of out-of-school time, and homework completion and submission) for success (Farrington et al., 2012) from secondary and tertiary students in Belize. With rare exception, Belizean education took place in person before the pandemic. This changed to remote teaching and learning during the pandemic. Findings showed that adolescents from the defined risk factor of single-parent households experienced greater declines across all eight academic behaviors. Additionally, this effect was more pronounced for adolescents who experienced the loss of a parent from divorce or death of a parent. For grit, there were two key outcomes: (a) adolescents from nuclear and higher income families had slightly higher levels of grit;and (b) adolescents from parents with lower educational attainment had significantly higher levels of grit than their peers. Based on these findings, recommendations include more study of schools that invest in becoming trauma responsive when evaluating engagement and performance during prolonged absences. Future research should assess adolescents’ level of academic behaviors, grit, and other noncognitive factors. © 2022 The Author(s).

maritime piracy: state of the question

Piracy continues to persist as one of the most prevalent threats to maritime security. as statistics confirm year after year, hundreds of acts of piracy and armed robberies at sea affect crews and ships, no matter if they are pleasure boats, fishing vessels or any type of merchant vessel. although certain geographical areas have been grappling with acts of piracy and armed robberies against ships for decades, new regions are emerging as sources of insecurity, confirming that insecurity on land eventually causes crimes at sea. this paper aims to analyse the current situation in the most affected regions and the latest outbreaks that have been detected in recent years. likewise, an impact analysis will be carried out on the potential effects that the coronavirus pandemic is causing on maritime security. © 2021, United Academic Journals (UA Journals). All rights reserved.

EMELAC PROJECT (MULTIPLE SCLEROSIS IN LATIN AMERICA AND THE CARIBBEAN): INCIDENCE RATE AND CLINICAL FEATURES OF INCIDENT CASES IN URUGUAY: A POPULATION-BASED STUDY

The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5-10 cases per 100.000 personyears and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 personyears in a 2015 study. Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population-based study to determine MS incidence in Uruguay. The population under study included people living in Uruguay between 7-1-2019 and 6-30- 2021, with18 years and above. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside co-author (D.O.). Results: 155 new MS cases were confirmed after review including 111 females (71.6 %). 99 of them were examined directly by the research team (63.9 %). The sex ratio was 2.5:1 female/male. Age range was 18 to 62. Median age was 33 years and the standard deviation 11.4 years. 111 (71.6 %) cases were relapsing-remitting MS, 9 (5.8 %) primary progressive MS and 2 secondary progressive MS. We have no data in 33 cases (21 %). Global incidence rate was 2.88 cases per 100.000 person-years, 3.95 in females and 1.72 in males. The highest incidence was observed in the group with 35-39 years (5.28 cases per 100.000 personyears). Discussion: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence.

The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey.

BACKGROUND: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. METHODS: An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. RESULTS: Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. CONCLUSION: While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic.

Extracorporeal membrane oxigenation in COVID-19 patients: Results of the ECMO-COVID Registry of the Spanish Society of Cardiovascular and Endovascular Surgery

Background and aim: COVID-19 patients with severe heart or respiratory failure are potential candidates for extracorporeal membrane oxygenation (ECMO). Indications and management of these patients are unclear. Our aim is to describe the results of a prospective registry of COVID-19 patients treated with ECMO. Methods: An anonymous prospective registry of COVID-19 patients treated with veno-arterial (V-A) or veno-venous (V-V) ECMO was created on march 2020. Clinical, analytical and respiratory preimplantation variables, implantation data and post-implantation course data were recorded. The primary endpoint was all cause in-hospital mortality. Secondary events were functional recovery and the combined endpoint of mortality and functional recovery in patients followed at least 3 months after discharge. Results: Three hundred and sixty-six patients from 25 hospitals were analyzed, 347 V-V ECMO and 18 V-A ECMO patients (mean age 52.7 and 49.5 years respectively). Patients with V-V ECMO were more obese, had less frequently organ damage other than respiratory failure and needed less inotropic support;Thirty three percent of V-A ECMO and 34.9% of V-A ECMO were discharged (P = NS). Hospital mortality was non-significantly different, 56.2% versus 50.9% respectively, mainly during ECMO therapy and mostly due to multiorgan failure. Other 51 patients (14%) remained admitted. Mean follow-up was 196 ± 101.7 days (95%CI: 170.8-221.6). After logistic regression, body weight (OR 0.967, 95%CI: 0.95-0.99, P = 0.004) and ECMO implantation in the own centre (OR 0.48, 95%CI: 0.27-0.88, P = 0.018) were protective for hospital mortality. Age (OR 1.063, 95%CI: 1.005-1.12, P = 0.032), arterial hypertension (3.593, 95%CI: 1.06-12.19, P = 0.04) and global (2.44, 95%CI: 0.27-0.88, P = 0.019), digestive (OR 4,23, 95%CI: 1.27-14.07, P = 0.019) and neurological (OR 4.66, 95%CI: 1.39-15.62, P = 0.013) complications during ECMO therapy were independent predictors of primary endpoint occurrence. Only the post-discharge day at follow-up was independent predictor of both secondary endpoints occurrence. Conclusions: Hospital survival of severely ill COVID-19 patients treated with ECMO is near 50%. Age, arterial hypertension and ECMO complications are predictors of hospital mortality, and body weight and implantation in the own centre are protective. Functional recovery is only predicted by the follow-up time after discharge. A more homogeneous management of these patients is warranted for clinical results and future research optimization. © 2022 Sociedad Española de Cirugía Cardiovascular y Endovascular

Multiple sclerosis incidence in latin america and the caribbean (emelac project)-uruguayan preliminary results

Introduction: The worldwide incidence of multiple sclerosis (MS) is estimated to be 0.5-10 cases per 100.000 person-years and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 person-years in a 2015 study. Objectives: To determine MS incidence in Uruguay Methods: Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population based study to determine MS incidence in Uruguay. The population studied included people living in Uruguay, older than 18 years of age, between 7-1-2019 and 6-30-2021. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside coauthor (D.O.). Results: 137 new MS cases were confirmed after review including 100 females (73%). 65 of them were examined directly by the research team (47%). The sex ratio was 2.7:1 female/male. Age range was 18 to 62 with a median of 35 and an interquartile range of 16.5 (26.5-43). 129 (94%) cases were relapsing-remitting MS, 7 (5%) primary progressive MS and 1 secondary progressive MS. Global incidence rate was 2.55 cases per 100.000 person-years, 3.55 in females and 1.45 in males. The highest incidence was observed in the 35-39 years old group (5.28 cases per 100.000 person-years). Conclusions: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence. These preliminary results will be completed in upcoming publications.

Contribution of the occupational health to the COVID-19 pandemic control

When the World Health Organization declared COVID-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Social vulnerability and health risk. Analysis in agricultural contexts with cultural diversity

Although there is a significant body of research associating levels of contagion of Covid-19 with certain social conditions, these have not been widely examined in agricultural contexts. In view of this gap, the aim of this study is to take a deep dive into the social factors impacting on high incidence rates of the pandemic among farm labourers. This situation is characterised by the convergence of significant numbers of immigrant residents, as is the case of Totana (a district in the region of Murcia). Using an action research methodology, secondary sources of information (study reviews and statistical analyses of databases) are complemented with three primary sources applied to various social agents: a) a questionnaire, administered to fruit and vegetable company workers;b) an in-depth interview with representatives from vulnerable households;and c) a discussion group with professionals from various areas of intervention involved in tackling emergencies in a health and social care setting. The results allow the town's social conditions to be linked to the lowest levels of social protection against the pandemic, and hence prevention. While the population surveyed manifests a medium or high level of knowledge of the risks concerning the pandemic, in more vulnerable groups such knowledge is severely limited on account of the deficient social, work and living conditions. Professionals point out that the pandemic has highlighted pre-existing social risks linked to the significant attraction the region has for seasonal farmworkers. The study verifies the fact that the precariousness of work and living conditions of a large part of the local population has influenced their greater rates of contagion, this being most prevalent in foreign residents, who have poorer family and/or educational resources.

Relationship between Von Willebrand factor and clinical outcome in patients with severe COVID-19

Background : COVID-19 is associated with an intense inflammatory response and an increased risk of thrombosis. High levels of D-dimer (DD), fibrinogen (Fg), von Willebrand factor (vWF) and factor VIII (FVIII) was reported among patients with severe disease. Aims : We aimed to characterize the relationship between vWF and other coagulation factors and clinical outcome among inpatients with severe COVID-19. Methods : We conducted a cross-sectional study of COVID-19 inpatients admitted in Mexico National Institute of Cardiology between April and December 2020. Patients with severe COVID-19 diagnosis who were admitted to the Intensive Care Unit were included. Blood samples were collected and processed according to the standardized institutional procedures. For patients who had anticoagulation therapy with heparin, anti-Xa level was determined. Patient's demographic and clinical characteristics, inflammatory and coagulation markers, and clinical outcome (thrombosis, mechanical ventilation, and death) were retrieved from the electronic medical records. Descriptive statistics and multivariate models were performed to assess associations between coagulation factors and clinical outcome. Results : A total of 58 patients were included during the study period. The mean age was 53.7 +14 years and 75.9% were men. Overall, 84.2% required mechanical ventilation, 25% had thrombosis (pulmonary embolism and/or deep vein thrombosis). Both vWFAg and vWFRCo were increased;the median value was 362.2% and 297.3% respectively. Among patients who died, a significantly increase in VWF measured by both methods was found. Of the 58 patients, 38 (65.5%) had mechanical ventilation and 22 (57.9%) died. Mortality was significantly higher among patients with mechanical ventilation (57.9% vs 42.1%;P < 0.001. Conclusions : In this study, we determined the levels of antigenic and RCo vWF in 58 patients with moderate-severe COVID-19. The vWF was markedly increased among patients with severe clinical presentation. Both antigenic and functional vWF were significantly associated with mechanical ventilation and death.

Heparin-induced thrombocytopenia (HIT) during extracorporeal membrane oxygenation (ECMO) in COVID-19: A case report

Background : Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction against the heparin-platelet factor 4 complex (H-PF4). Incidence in patients with extracorporeal circulation membrane (ECMO) is unknown. Aims : We describe a case of HIT confirmed during ECMO support in a COVID-19 patient. Methods : N/A A 48 year-old man with severe COVID-19 confirmed by RT-PCR for SARS-CoV2, was admitted to intensive care unit (ICU). After 21 days of the diagnosis he required mechanical ventilation support and V-V ECMO. Since his admission he received anticoagulation with enoxaparin 80 mg SC every 12 h, when ECMO started, he continued anticoagulation with intravenous infusion of 700 U/hour of unfractionated heparin (UFH). On the third day of infusion, there was a decrease in platelets > 50% (nadir 25,000/mm3 ), it was documented 6 points in a 4T HIT score having a probability 64% for HIT. It was confirmed by functional test with platelet aggregometry induced by UFH using the Born method. UFH was suspended and fondaparinux 7.5 mg SC every 24 h. We made serial measurements of anti-Xa (Stago ® ). Therapeutic response to HIT was documented at day 9 from the start of fondaparinux, without requiring an ECMO membrane change. Conclusions : The diagnosis of HIT was made by clinical suspicion, using the 4T HIT score and later confirmation platelet aggregometryUFH induced. The usual pharmacological treatment is based on argatroban, bivalirudin, and lepirudin. To our knowledge, there is only one case reported with fondaparinux as treatment in ECMO. Determination of plasma levels by antiXa activity was used to guide dosing because previous studies have reported bleeding rates between 10 to 22% with fondaparinux. This is a success case of fondaparinux as treatment for HIT in an ICU patient with ECMO support, and the first one in the clinical context of severe COVID -19 infection.

Contribution of the occupational health to the COVID-19 pandemic control

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Psychosocial risks to the infectious threat in nursing personnel in a health center in Ecuador 2020

Developing activities in a health institution, exposes nurses to multiple biological agents of potential infectious threat such as Hepatitis A, B, C, HIV / AIDS, Tuberculosis, Varicella, Tuberculosis, Rubella, Cytomegalovirus, COVID-19, among other communicable diseases, promoting a psychosocial risk to fear of being infected. To determine the psychosocial risks in the face of the infectious threat in nursing personnel of a hospital in Ecuador. It was an epidemiological-descriptive study of a cross-sectional cohort between September and December 2020, with a sample of 74 nurses. Data collection, a survey of 44 closed dichotomous questions was applied. The data were stored in Microsoft Excel and analyzed with Epidat. As a result, 68.92% were female, with ages between 31-35 (33.78%), 58.11% were married, 41.89% were single, and 60.81% had children. The characteristic psychological risks were 24.32% anxiety, 21.62% stress, 18.92% depression, 12.16% sleep disorders, 8.11% eating disorders and consumption of psychotropic drugs, 4.05% thoughts suicides and 2.70% consume alcohol, the most prominent of the social risks was family distancing with 37.84%. It is concluded that biological risk is, without a doubt, the most frequent among the occupational risks of health personnel, raising different levels of anxiety, which puts at stake even the quality of care that can be given to patients. © 2021 Instituto de Altos Estudios de Salud Publica. All rights reserved.

Self-perception of digital competence in teachers: Variations after confinement

The year 2020 will be remembered as the year in which a human, health, social and economic tragedy was experienced as a result of the COVID-19 virus. Education faced a scenario not experienced before and like the rest of society it was doomed to severe confinement. The confinement was followed by a partial reincorporation of the students and in both scenarios digital technology played a fundamental role. The formative work was forced to adopt digital methodologies with the urgency that the situation required and the teaching staff had to adapt as they go. Bimodality, synchronous education, online classes are now common terms that accompany the complex teaching work. The study that we present analyzes the starting point of Spanish and European teachers regarding attitudes and training levels in ICT, as well as the possible variations after the outbreak of the pandemic. For this, the data collected in the Teaching And Learning International Study, TALIS 2018, regarding the use of Information and Communication Technologies, have been compared, together with the data provided by the Digital Education Action Plan 2021-2027 by through the Open Public Consultation. It can be concluded that although the teachers, before COVID-19 crisis, had high participation levels on ICT training, they did not value the need to be trained with the same recognition as once the pandemic began. Even so, we propose the need for a pedagogical approach in digital training that goes beyond technical learning by proposing didactic strategies that allow the equidistance between face-to-face and virtual training. © 2021 Univ Nacional de Educacion a Distancia (UNED). All rights reserved.

Low Incidence and Mortality by SARS-CoV-2 Infection Among Healthcare Workers in a Health National Center in Mexico: Successful Establishment of an Occupational Medicine Program

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) constitute a population which is significantly affected by SARS-CoV-2 infection worldwide. In Mexico, the Instituto Nacional de Enfermedades Respiratorias (INER) is the principal national reference of respiratory diseases. Aim: To evaluate the efficiency of the INER-POL-TRAB-COVID19 program to mitigate the SARS-CoV-2 infection risk among the INER-healthcare workers (INER-HCW). Methods: Currently, the INER has 250 beds and 200 respiratory ventilators to support COVID-19 patients in critical condition. On March 1st, 2020, the INER-POL-TRAB-COVID19 program was launched to mitigate the SARS-CoV-2 infection risk among the INER-HCW. Findings: From March 1st to October 1st, 2020, 71.5% of INER-HCWs were tested for SARS-CoV-2 infection, and 77% of them were frontline workers. Among the tested INER-HCWs, 10.4% were positive for SARS-CoV-2 infection. Nonetheless, nosocomial infection represented only 3.8% of the cases and the mortality was null. Fifty-three of INER-HCWs positive to SARS-CoV-2 had a negative test 42-56 days post-diagnosis and were returned to service. Finally, although a change in the PPE implemented on May 11th, 2020, the incidence of SARS-CoV-2 infection was not affected. Conclusion: INER has a lower incidence of HCWs infected with SARS-CoV-2 as compared to the mean of the national report. The implementation of the INER-POL-TRAB-COVID19 program is efficient to decrease the risk of infection among the HCWs. Our findings suggest that the implementation of a similar program at a national level can be helpful to provide a safe environment to HCWs and to prevent the collapse of health institutions.

Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France.

BACKGROUND: The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS: The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS: A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS: In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.