Feedback on post COVID-19 rehabilitation.

The outbreak of Coronavirus Disease 19 (COVID-19) following the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) viral infection has placed particular pressure on occidental health systems, especially in terms of acute care resources and critical care skills. A number of affected patients subsequently required a rehabilitation process, due to multiple functional limitations, either as a result of an extended stay in intensive care or the consequences of the infection itself. The aim of this article is to report on the Geneva experience in post COVID19 rehabilitation, through 2 clinical vignettes, illustrating the heterogeneity of symptoms and deficits that may be encountered following this disease.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Feedback on post COVID-19 rehabilitation

The outbreak of Coronavirus Disease 19 (COVID-19) following the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) viral infection has placed particular pressure on occidental health systems, especially in terms of acute care resources and critical care skills. A number of affected patients subsequently required a rehabilitation process, due to multiple functional limitations, either as a result of an extended stay in intensive care or the consequences of the infection itself. The aim of this article is to report on the Geneva experience in post COVID19 rehabilitation, through 2 clinical vignettes, illustrating the heterogeneity of symptoms and deficits that may be encountered following this disease.

Is COVID-19 in hospital employees automatically an occupational disease? SARS-COV-2 acquisition modes and rates among employees in a long-term care facility (LTCF) during the first pandemic wave

Introduction: LTCFs are at risk of COVID-19 outbreaks but evidence regarding SARS-CoV-2 acquisition and transmission routes among their employees remains weak. Objectives: We investigated the relative contribution of occupational (vs. community) exposure for COVID-19 acquisition among employees of a university affiliated LTCF in Switzerland, from March to June 2020. Methods: This is a prospective cohort study with a nested analysis of a COVID-19 seroprevalence study among LTCF staff. We performed Poisson regression to determine risk factors for seropositivity and to measure the influence of community vs. nosocomial exposure to COVID-19 on SARS-CoV-2 seropositivity using adjusted prevalence ratios (aPR). In addition, we conducted a COVID-19 outbreak investigation in a LTCF ward using both epidemiological and genetic sequencing data. We constructed a maximum likelihood phylogenetic tree and evaluated strain relatedness to discriminate between community- vs. hospital-acquired infections among employees. Results: Among 285 LTCF employees, we included 176 participants in the seroprevalence study, of whom 30 (17%) became seropositive for SARS-CoV-2. The majority (141/176, 80%) were healthcare workers and had ≥ 1 symptom compatible with COVID-19 (127/167, 76%). Risk factors for seropositivity included exposure to a COVID- 19 patient in the LTCF (aPR 2.6;95%CI 0.9-8.1) and exposure to a SARS-CoV-2 positive person in the community (aPR 1.7;95%CI 0.8- 3.5). Among 18 employees included in the outbreak investigation, phylogenetic analysis suggests that 8 (44%) acquired their infection in the community. Conclusion: During the first pandemic wave, there was a high burden of COVID-19 among LTCF employees. Both occupational and community exposures contributed to seropositivity and infection risk. These data may allow to better assess occupational health hazards and related legal implications during the COVID-19 pandemic. (Figure Presented).

Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction.

BACKGROUND: Nosocomial outbreaks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. An outbreak investigation was undertaken using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission. METHODS: A nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic was investigated, involving patients and HCWs, with high coverage of pathogen whole-genome sequences (WGS). The time-varying reproduction number from epidemiological data (Rt) was estimated, and maximum likelihood phylogeny was used to assess genetic diversity of the pathogen. Genomic and epidemiological data were combined into a Bayesian framework to model the directionality of transmission, and a case-control study was performed to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients. FINDINGS: The outbreak lasted from 14th March to 12th April 2020, and involved 37 patients (31 with WGS) and 39 employees (31 with WGS), 37 of whom were HCWs. Peak Rt was estimated to be between 2.2 and 3.6. The phylogenetic tree showed very limited genetic diversity, with 60 of 62 (96.7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, the analyses suggest that HCWs (one of whom was the index case) played an essential role in cross-transmission, with a significantly greater fraction of infections (P<2.2e-16) attributable to HCWs (70.7%) than expected given the number of HCW cases (46.7%). The excess of transmission from HCWs was higher when considering infection of patients [79.0%; 95% confidence interval (CI) 78.5-79.5%] and frail patients (Clinical Frailty Scale score >5; 82.3%; 95% CI 81.8-83.4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted odds ratio 6.94, 95% CI 2.13-22.57). INTERPRETATION: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, this study shows that despite such uncertainty, significant transmission patterns can be observed.

Impact of isolation and adherence to treatment of argentine patients with rheumatic diseases in pandemic

Objectives: To evaluate adherence to treatment and the impact of isolation in patients with rheumatic diseases Methods: Observational and cross-sectional study, using an electronic survey (Google form®) in participants of the virtual congress of patients in 2020 over 18 years of age. Demographic data, diagnosis and factors associated with the life of the people in this period of restriction were recorded. Results: 558 patients answered the survey (95.34%women). 494 patients from Argentina (164 were from the province of Buenos Aires). 75 of the survey participants were between 40 and 70 years old. Most of the patients had rheumatoid arthritis 45%, Fibromyalgia 31%and Osteoarthritis 16%. 70% were followed in the private environment. 65% considered themselves within the risk group of suffering from COVID-19 and 23% were unsure of their risk. The majority of the population knew the necessary measures of prevention. 83% were able to connect with their doctor during this period, the most common way was in person and via Whats App, only 18% had access through tele consultation. 79.2% continued with the treatment for their disease, 14.2% had difficulties and 6.4% did not succeed. Of these two groups, lack of access to medication and lack of communication with their doctor was the cause. During this period, 50% were able to do physical activity at home. Of the surveyed population, 35 people (6.4%) had a diagnosis of COVID-19;of these only 6 (15%) required hospitalization, the rest only isolation at home. Anxiety 63% anguish 48% and sadness 42.6%were the emotions that predominated in the vast majority of people with rheumatic diseases. Regarding vaccines, 51% thought that they would be vaccinated if recommended by their rheumatologist and 28 .6% had doubts. Only 9% would not be vaccinated. These data are depincted in Figures 1 and 2. Conclusion: From this survey, we obtained information on how the pandemic impacted people's daily lives during the restriction. Although the vast majority were able to comply with their treatment and indications, a percentage could not comply with their treatment and did not have access to their rheumatologist. There is a great emotional impact from the restrictions on this group of people. Additionally, patients expressed trust in their rheumatologist, and the recommendation for COVID-19 vaccination.

(Machine) learning from the COVID-19 lockdown about electricity market performance with a large share of renewables

The negative demand shock due to the COVID-19 lockdown has reduced net demand for electricity-system demand less amount of energy produced by intermittent renewables, hydroelectric units, and net imports-that must be served by controllable generation units. Under normal demand conditions, introducing additional renewable generation capacity reduces net demand. Consequently, the lockdown can provide insights about electricity market performance with a large share of renewables. We find that although the lockdown reduced average day-ahead prices in Italy by 45%, re-dispatch costs increased by 73%, both relative to the average of the same magnitude for the same period in previous years. We estimate a deep-learning model using data from 2017 to 2019 and find that predicted re-dispatch costs during the lockdown period are only 26% higher than the same period in previous years. We argue that the difference between actual and predicted lockdown period re-dispatch costs is the result of increased opportunities for suppliers with controllable units to exercise market power in the re-dispatch market in these persistently low net demand conditions. Our results imply that without grid investments and other technologies to manage low net demand conditions, an increased share of intermittent renewables is likely to increase the costs of maintaining a reliable grid. (C) 2020 Elsevier Inc. All rights reserved.

[Issues and challenges related to COVID-19 in acute geriatric care: lessons learned from the Geneva experience]

The older patients have been the most affected by the SARS-CoV-2 pandemic. In addition, this infection has been responsible for high mortality rate in this population. In this article we wanted to describe the clinical findings we encountered in older people with COVID-19 and share some of the issues and challenges we faced during the COVID-19 pandemic.