Regional Differences in the Economic Impact of Lockdown Measures to Prevent the Spread of COVID-19: A Case Study for Colombia

This chapter analyzes the regional economic differences on the impact of lockdown measures ordered by Colombia's national government to prevent the spread of COVID-19. Using an input–output model, we estimate the regional economic losses of extracting a group of formal and informal workers from different sectors of the economy. Results show regional differences in the impact of lockdown on labor markets, local economies, and its productive sectors. We find that peripheral regions (Amazonía, Caribe, Pacífica, and Llanos and Orinoquia) concentrate a higher number of informal workers in the group of employees in lockdown than the central regions (Eje Cafetero and Antioquia, and Central). Regarding economic impact, losses range between 5,4% of GDP for the region Amazonía to 6,3% for Eje Cafetero and Antioquia. Moreover, while the sector of services concentrates the highest losses in the regions Eje Cafetero and Antioquia, Central, Caribe, and Pacífica, in Amazonía, and Llanos and Orinoquia, the economic activities mostly affected belong to mining and agriculture. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Pediatric inflammatory multisystemic syndrome temporally associated with COVID 19 (PIMS-TS): characteristics of the Sainte Justine Hospital cohort

Introduction: Since the beginning of SARS-Cov-2 pandemic, children represent a small proportion of patients with an acute disease and present with mild symptoms or are either asymptomatic. However pediatric patients might present with late, post infectious, manifestations of COVID 19, namely Pediatric Inflammatory Multisystemic Syndrome temporally associated with COVID 19 (PIMS-TS). Objectives: We aim to describe the characteristics of pediatric patients with PIMS-TS hospitalised in Sainte Justine Hospital and report their evolution according to their treatment and care. Methods: Patients were recruited prospectively since April 2020. Patient were included if they were less than 18 years old, had at least 2 days of fever, had multisystemic involvement (at least 2 systems) and had a temporal association with COVID 19. This temporal association was defined as: positive reverse transcription (RT)-PCR or antibodies to SARS-Cov2, history of contact with a confirmed or suspected SARS-Cov 2 infected individual or symptom appearance during the pandemic. Patient were excluded if they had an alternative diagnosis that explained the symptoms. Patient were sub categorized into two categories depending on their clinical presentation: 1- Complete or incomplete Kawasaki disease (KD), following the American Heart Association Criteria;or 2- Toxic shock syndrome (TSS). Data were collected during the hospitalization and the follow up. Results: Between April 30th, 2020 and April 30th, 2021, 72 patients were included, 13 (18.1%) with complete KD, 40 (55.6%) with incomplete KD and 19 (26.4%) with TSS. There was more male in the complete KD group (69.2%) and more female in the TSS group (52.6%) but there was no significative difference between the two groups (p = 0.35). Patient with TSS presentation were significatively older than those with KD presentation (10.3 years vs 4.9 years, p < 0.01). Caucasian patients are the most represented ethnic group in the cohort (26.4 %) but Afro-American patient are over-represented in the TSS group (6/19 patients, 31.6%;p= 0.2). Gastro-intestinal symptoms were seen in 50.9% (27/53) and 94.7% (18/19) patients with KD and TSS respectively (p < 0.001). Patients in the TSS group had higher mean value of PCR (239.1 mg/L vs 143.9 mg/L;p< 0.001) and more frequent lymphopenia (89.5% vs 34%;p< 0.001) than those in KD group. Only 40/72 (55.6%) patients in the cohort had either a positive RT-PCR and/or positive antibodies to SARS-Cov-2 and/or a contact with confirmed or suspected infected individual. These proportion increase to 18/19 (94.7%) in the TSS group (p < 0.001). Twenty-three patients (31.9%) required ICU hospitalization including 17 on 19 patients in the TSS group (89.5%;p < 0.001). Cardiac involvement was the most frequent complication either as coronary aneurysm, (15/72 - 20.8%) mainly in patient with KD presentation or as cardiac dysfunction (24/72 - 33.3%), mainly in patient with TSS presentation. Patient received intravenous immunoglobulins (69/72 - 95.8%), steroids (49/72 - 68.1%), sometimes both (48/72 - 66.7%). Five patients (6.9%) required biotherapy: 1 with Enbrel and 4 with Anakinra. Patient received a treatment 6.6 days after the beginning of the symptoms. After 3 months, 4 patients (0.5%) had persistent coronary dilatation and 2 (0.3%) had mitral insufficiency. Conclusion: This cohort study enables a better description of PIMS clinical and biological presentation, which can sometimes be confusing. It also highlights the importance of fast and adequate diagnosis and treatment to avoid the risk of acute and chronic complications, especially cardiac complications.

Anxiety and sleep quality in a sample of Lebanese healthcare workers during the COVID-19 outbreak.

A cross-sectional, survey based study was conducted in order to assess mental health outcomes among healthcare workers in a private university hospital involved in the COVID-19 response in Lebanon. The main objective was to quantify symptoms of anxiety and sleep quality using self-rating scales (the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) respectively), while identifying factors that might affect those symptoms. A total of 628 healthcare workers completed the survey; 409 (66.2%) were younger than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered nurses, residents, women, and younger participants presented higher scores on both scales than other categories of participants. Among factors related with COVID-19, those associated with higher scores were having relatives affected by the virus (22.2%), being excessively exposed to media (12.9%), and increasing the consumption of substances/alcohol (31.2%) during this period. Factors associated with higher risk of anxiety symptoms after multivariable logistic regression analysis were: female sex, young age, poor sleep quality, and living with elderly. Our findings contribute to the understanding of the psychological wellbeing of health care workers involved in the acute COVID-19 outbreak in Lebanon.

[Corona Virus, Breastfeeding and Guidelines - a Worldwide Review]

INTRODUCTION: The COVID-19 pandemic has forced countries worldwide to face major issues and challenges. Among those challenges is breastfeeding from the first hours after birth until late infancy, in hospitals and communities. There is a consensus throughout the world and among leading international professional medical associations that breastfeeding is of significant importance for short- and long-term health outcomes in mothers and infants, as well as for its public health impact and reduction of national health expenditures. Moreover, breastfeeding or human milk feeding have been shown to reduce morbidity, specifically respiratory infections, among infants and children. This is not the first time health systems are dealing with coronavirus outbreaks, although currently, in the COVID-19 pandemic, there is still much that is unknown. Dealing with the unknown can lead to guidelines that may not fully take into consideration relevant risk benefit ratios for individuals and groups. In this review, we aim to summarize the guidelines of different leading professional groups around the world dealing with the COVID-19 pandemic. Evidence-based medicine rests on relevant scientific evidence, patients' values and preferences and clinical judgment. We wish to propose guidelines based on available evidence concerning breastfeeding, the current pandemic and weighing in potential risks and benefits while highlighting the need for ongoing breastfeeding research.

Structural propagation of pandemic shocks: an input–output analysis of the economic costs of COVID-19

This paper explores the use of simulations in policy decision-making in the Brazilian State of São Paulo in fighting the COVID-19 pandemic. We propose a methodology for assessing the daily economic costs of control strategies for mitigating the effects of coronavirus. The method is based on the partial hypothetical extraction approach to input–output systems. Simulated daily scenarios based on different levels of compliance to the control measures are used to help guide the design of sectoral and territorial-based policies to ease lockdown against the coronavirus outbreak, taking into account the economic and sanitary trade-offs. We present examples of simulations that can substantiate top-level decision-making. © 2020 Regional Studies Association.

Are two consecutive negative RT-PCR results enough to rule out COVID-19?

The coronavirus disease 2019 (COVID-19) pandemic is redefining the world we live in, and scientists are struggling to find the best severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tool. Routine testing is currently performed using real-time reverse transcription PCR (RT-PCR) of upper or lower respiratory tract secretions. We sought to demonstrate the importance of conducting RT-PCR using deep sampling when initial upper respiratory testing is negative in cases of high index of suspicion for COVID-19. We present the case of a 47-year-old man admitted for fever and bilateral pneumonia diagnosed via chest computed tomographic scan amidst the early peak of the COVID-19 pandemic, suggesting a SARS-CoV-2 infection. Two RT-PCR results from nasopharyngeal swab samples were negative. A bronchoscopy was then performed, and RT-PCR testing on bronchoalveolar lavage samples yielded positive results, confirming the diagnosis of COVID-19 pneumonia. RT-PCR samples of the lower respiratory tract likely contain a higher virus load and thus retain a higher sensitivity for SARS-CoV-2 detection.