Integrated genomic surveillance enables tracing of person-to-person SARS-CoV-2 transmission chains during community transmission and reveals extensive onward transmission of travel-imported infections, Germany, June to July 2021

Background: Tracking person-to-person SARS-CoV-2 transmission in the population is important to under-stand the epidemiology of community transmission and may contribute to the containment of SARS-CoV-2. Neither contact tracing nor genomic surveillance alone, however, are typically sufficient to achieve this objective. Aim: We demonstrate the successful appli-cation of the integrated genomic surveillance (IGS) system of the German city of Dusseldorf for tracing SARS-CoV-2 transmission chains in the population as well as detecting and investigating travel-associated SARS-CoV-2 infection clusters. Methods: Genomic sur-veillance, phylogenetic analysis, and structured case interviews were integrated to elucidate two geneti-cally defined clusters of SARS-CoV-2 isolates detected by IGS in Dusseldorf in July 2021. Results: Cluster 1 (n = 67 Dusseldorf cases) and Cluster 2 (n = 36) were detected in a surveillance dataset of 518 high-quality SARS-CoV-2 genomes from Dusseldorf (53% of total cases, sampled mid-June to July 2021). Cluster 1 could be traced back to a complex pattern of transmission in nightlife venues following a putative importation by a SARS-CoV-2-infected return traveller (IP) in late June;28 SARS-CoV-2 cases could be epidemiologically directly linked to IP. Supported by viral genome data from Spain, Cluster 2 was shown to represent multi-ple independent introduction events of a viral strain circulating in Catalonia and other European coun-tries, followed by diffuse community transmission in Dusseldorf.

The art in medicine. Jobs with electrical risk and pandemic

This article presents a reflection about the risk by exposure to electricity for workers who work at height. This collective of workers-who are considered essential and whose activity requires a specific set of physical skills and adequacies-are now exposed to the added risks of the COVID-19 pandemic. The consequences of work related accidents or injuries also implicate their families, and this is reflected in Francisca Lita's painting, which opens a door towards present and future hope, showing her belief that the COVID-19 virus will eventually be controlled.

Cardiometabolic risk level estimated in workers with overweight/obesity. Lifestyle and sociodemographic variables

Introduction: Obesity has become a worldwide pandemic of multifactorial origin and may be more common than is diagnosed considering Body Mass Index (BMI) alone. Methodology: Cross-sectional descriptive study in 815 workers aged 18-66 years, with data collected in the periodic health surveillance examinations of the participating companies from March 2020 to June 2021. The Cardiometabolic Risk Level (CRL) of each participant is estimated from 0 to 3 according to the presence of: metabolic syndrome, elevated cardiovascular risk and values outside the range of at least two adiposity parameters. Relationships were established with sociolaboral variables and lifestyle habits (diet and physical activity). Results: More than 70% of the population studied presented some degree of risk and this was significantly related to BMI (<0.0001), which was higher in men and increased with age. Adiposity indicators are the factor most associated with NR in men and women;in NR2 there is a greater presence of Metabolic Syndrome in women and Cardiovascular risk in men (<0.0001). The level of physical activity was related to NR in both sexes, but statistically significant differences were observed between men and women in adherence to the Mediterranean diet. Conclusion: The estimated NR is related to BMI, age, gender, cultural level and physical activity. Its stratification facilitates preventive actions, control and coordinated follow-up in Spanish workers.

Social stigmatization of intensive care nurses at the start of the coronavirus pandemic

Aim: Explore the factors of social stigmatization of intensive care nurses at the start of the Covid-19 pandemic. Method: Exploratory observational study to verify the factors of social stigmatization in intensive care nurses who cared for patients with Covid-19 at the beginning of the pandemic using non-probabilistic sampling. The Referenced Stigma Questionnaire for Intensive Care Nurses was used. Results: 135 nurses participated, 82,2% women, 85,9% between 25 and 44 years old. They manifested stress (36,3%), in-somnia (32,6%) and anxiety (31,8%) as associated symptoms. The scale showed a α Cronbach coefficient 0.866, a Kaiser Mayer Olkin index of 0.886, and Bartlett´s test <0.001, with three areas of social stigma that reached 61,71% of the variability of the construct: Social Isolation, Exposure to SARS-Cov-2 and Professional vulnerability. Conclusions: Professional vulnerability is based on stress, the feeling of fragility or concern about contagion, presenting ambivalent feelings. Social isolation would be caused by negative social attitudes that stereotypes cause. Social stigma occurs in the context of care for patients with emerging infectious-contagious diseases.

[Perception of the risk of COVID-19 and preventive measures in Mexico]

BACKGROUND: The characteristics of the transmission of SARS-CoV-2 virus increased the need to implement prevention measures, in order to avoid its spread;therefore, there is an interest in the risk perception and an intention in people to adopt protective measures against COVID-19. OBJECTIVE: To show the causal factors that contribute to a high/low perception of risk during the COVID-19 pandemic. MATERIAL AND METHODS: A quantitative, analytical and explanatory exploratory study was carried out with a crosssectional design. To collect data, a self-access survey was designed, using the Dimensional Assessment of Perceived Risk procedure, based on the psychometric paradigm. For data analysis, the classification tree method was utilized. RESULTS: The descriptive analysis indicated that the surveyed population had a concern about the pandemic of 3.8 on a scale ranging from 1 to 5, which shows a medium-high perception of COVID-19 risk;however, respondents underestimated their personal risk (vulnerability) in relation to that of others. The classification tree analysis showed that the independent variables that contribute directly to the global perception of risk are the severity of the pandemic, vulnerability and catastrophic power. CONCLUSIONS: It was found a positive effect: The greater perception of severity, and susceptibility to acquiring the virus, the more taking of preventive measures.

Telemedicine multi-component weight loss program for workers in remote areas in COVID19 pandemic

Background: On October 2020 the Health and Labor Departments of Argentina decreed workers with BMI ≥ 40 kg / m2, a risk group for serious forms of COVID infection, had to suspend attendance at the workplace. On November 2020, a virtual multi-component intervention weight loss program was implemented for workers of an oil and gas company reached by the decree. The primary objective was to achieve significant weight loss to reduce health risks associated to obesity. The secondary objective was to achieve the return to work of the employees. Methods: 89 employees with grade 3 obesity from different areas of Argentina, including remote areas (Patagonia and Yungas -mountain jungle-), were invited to participate in a 3-month weight loss program. The program consisted in weekly virtual workshops on diet, physical activity and behavior change;plus telemedicine consultations based on motivational interview with physician, nutritionist, psychologist, and nurse. A cell phone app was designed to promote self-management of the disease: recording of weight progression, physical activity and meals. It also gave participants access to recorded weekly workshops, and a reservation system for appointments. Results: Average initial BMI was 46.03 kg/m2. After 3 months of intervention, 52 participants (58%) achieved a decrease in BMI < 40 kg/m2 and returned to work. 31.4% participants achieved a decrease of ≥5% and 23.6% of ≥10% of their initial weight. In the 6-month longitudinal follow-up, 66% of participants achieved BMI < 40 kg / m2. Conclusions: The context of the Covid 19 pandemic was an opportunity to install obesity as a disease in the workplace and increased awareness of employers and employees on health risks associated to it. The implementation of a structured virtual weight loss program on the workplace setting can be an effective obesity approach, including remote areas.

Measures to assess a warning vaccination level in a stochastic SIV model with imperfect vaccine

A stochastic Markovian Susceptible-Infectious-Susceptible (SIS) model, with infection reintroduction is considered to represent the evolution of an epidemic process within a finite population. Disease is assumed to be a contact disease whose effect can be prevented by a vaccine. Before the epidemic process emerges, v0 individuals got vaccinated to assure that the population is protected by herd immunity. In consequence, we formulate the model by adding a new compartment for vaccine protected individuals. The administered vaccine is not a perfect one and consequently it fails in a proportion of vaccinated individuals that are not protected against the vaccine preventable communicable disease. Hence, while the infectious process is in progress, the initial vaccine coverage declines and herd immunity could be lost. A threshold on the size of the vaccinated group is included as a warning measure on the protection of the community. Our objective is to define and study random characteristics, depending on the vaccination eligible group, that could advise health authorities when to launch a new vaccination program to recover the initial immunity level.

Impact of the Lockdown Due to COVID-19 Pandemic in the Use of Combined Hormonal Oral Contraception in Spain - Results of a National Survey: Encovid

Objective: To know the contraceptive behaviour of Spanish women who use combined oral contraception (COC) during the period of lockdown due to COVID-19. Methods: Cross-sectional, descriptive study of a sample of Spanish women who use COC based on a survey conducted through social networks using the online platform Survey Monkey. The survey was conducted during the period of home confinement. Results: A total of 1407 women answered the survey and 937 were valid for the analysis. A total of 675 women (71.8%) were confined all day at home. During confinement 96,6% of women continued to use the COC, 53.5% responded that their sexual activity decreased during this time and 54% that their physical activity had decreased. A significant percentage of women (10.3%) recognized a worsening of premenstrual symptoms. Conclusion: Despite the lockdown and the decrease in the frequency of sexual intercourse, the Spanish women who use COC did not abandon its use during the period of time analysed.

Late Breaking Abstract - IMPACT OF CONFINEMENT ON ALS PATIENTS DUE TO THE SARS-CoV-2 PANDEMIC

Introduction: The covid-19 pandemic has forced the confinement of one third of the world's population, which could have a special impact on ALS patients.Objective:To analyze the impact that the quarantine decreed by the Spanish government during the covid-19 pandemic may have had on ALS patients in relation to their clinical, functional and emotional situation.Methods: Observational, prospective study 16th March-10th May 2020 of a cohort of ALS patients being followed in a multidisciplinary consultation.Were collected: ALSFRS-R score at start and end of the confinement, continuity of: physiotherapy, contracted care, home care by a company providing respiratory therapy;need for prescription of new therapy,symptoms of stress, covid-19 patient or cohabitants, hospital admission, perception of reduced accessibility to health care.Statistical analysis was performed with T student for related samples.Results:53 patients were included(56.6% male,79.2% sporadic ALS,75.5% spinal ALS, mean age 56.92 years+/-12.98, mean ALSFRS-R(start)26.06+/-12.92, ALSFRS-R(end)25.74+/-13.03,change score:0.32 95%CI(0.054-0.585) p:0.000.34% of patients did not continue with physiotherapy.22.6% lost their caregiver.18.86% required prescription of new respiratory therapy, nebulized therapy the most prescribed.In 20.8% the company providing respiratory therapies suspended home care.37.7% of patients presented symptoms of stress. No covid case.11.3% required consultation emergency and 3.8% required hospital admission.88.7% did not perceive a decrease in accessibility to health care. No deaths have been recorded.Conclusions:In our study, ALS patients have been worsened by confinement in relation to their emotional and functional situation.

Psychological impact of the COVID-19 pandemic on five Latin American countries

Introduction: Social distancing and quarantine have proven to have negative effects on the mental health of populations, namely fear, anxiety, depression and post-traumatic stress symptoms. Resilience emerges as a buffering variable for such impact. The objective of this study was to compare the psychological impact of COVID-19 in several Latin American countries. Method: a sample of 1184 participants from Mexico, Cuba, Chile, Colombia and Guatemala was obtained;whose age ranged from 18 to 83 years old (M = 38.78, SD = 13.81). A survey on medical symptoms associated with COVID-19 and three instruments to evaluate: (1) depression, anxiety and stress, (2) impact of the event and (3) resilience were administered. Results: Younger people, with more symptoms associated with COVID-19 and those who reported higher scores of impact of event tended to present greater depressive, anxious and stress symptomatology. The impact of the event was the most determinant predictor. Resilience was protective against the impact of event, depression, anxiety and stress. Conclusions: The results show the differences in the psychological response to COVID-19 in each country and suggesting the need to develop public policies focused on prevention and promotion of integral health when facing sanitary emergencies. (C) 2021 Fundacion Universitaria Konrad Lorenz.