Cardiac Manifestations of Post-Acute COVID-19 Infection.

PURPOSE OF REVIEW: There is emerging evidence that the post-acute and chronic phases of COVID-19 infection are associated with various significant cardiovascular sequelae. RECENT FINDINGS: Long COVID has been shown to be associated with multiple cardiovascular sequelae including direct myocardial injury, arrhythmias, and cardiomyopathies. Hypotheses on the mechanism of myocardial injury include direct viral infiltration and autoimmune dysregulation. Long COVID is associated with persistent cardiac ischemia in patients with no previous history of coronary disease, atrial and ventricular arrhythmias, and the development of new-onset heart failure in previously healthy patients. Onset of long COVID may be related to severity of the initial SARS-CoV2 infection. Cardiac MRI is a valuable tool in assessing myocarditis and the development of cardiomyopathies in the setting of long COVID. Both patients with and without pre-existing cardiovascular disease are at risk of developing myocardial injury in the setting of long COVID. Future studies will elucidate both cardiovascular mortality and cardiac rehabilitation in the post-acute and chronic phases of COVID-19.

Stress levels, psychological symptoms, and C-reactive protein levels in COVID-19: A cross-sectional study.

BACKGROUND: Although many studies have pointed out a possible relationship between COVID-19 and the presence of psychiatric disorders, the majority of the studies have significant limitations. This study investigates the influence of COVID-19 infection on mental health. METHODS: This cross-sectional study included an age- and sex-matched sample of adult individuals positive (cases) or negative (controls) for COVID-19. We evaluated the presence of psychiatric conditions and C-reactive protein (CRP). RESULTS: Findings showed greater severity of depressive symptoms, higher levels of stress, and greater CRP in cases. The severity of depressive and insomnia symptoms, as well as the CRP were more remarkable in individuals with moderate/severe COVID-19. We found a positive correlation between stress and severity of anxiety, depression, and insomnia in individuals with or without COVID-19. There was a positive correlation between CRP levels and severity of depressive symptoms in cases and controls, and a positive correlation between CRP levels and the severity of anxiety symptoms and stress levels only in individuals with COVID-19. Individuals with COVID-19 and depression had greater CRP than those with COVID-19 without current major depressive disorder. LIMITATIONS: We cannot infer causality because this is a cross-sectional study, and the majority of COVID-19 sample was asymptomatic or had mild symptoms, which may limit the generalizability of our findings for moderate/severe cases. CONCLUSIONS: Individuals with COVID-19 showed greater severity of psychological symptoms, which may impact on the development of psychiatric disorders in the future. CPR seem to be a promising biomarker for earlier detection of post-COVID depression.

Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis.

PURPOSE: COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS: We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre-COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS: We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION: The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation.The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.

Role of a COVID-19 contact tracing program in identifying a false-positive nasopharyngeal RT-PCR case: A case report

(Spanish) Este articulo presenta un reporte de caso para resaltar el rol que los programas municipales de rastreo de casos tienen en identificar casos falsos positivos de COVID-19. El 19 de junio de 2020, el programa de rastreo de San German, Puerto Rico recibio una notificacion de una mujer (JB11) con resultado positivo a prueba RT-PCR realizada el 12 de junio como parte de un evento de cribado extenso. El 21 de junio, el Departamento de Salud de Puerto Rico (DSPR) emitio un comunicado a los medios de comunicacion alegando un posible brote en San German. Tras realizarse pruebas adicionales, el caso de JB11 fue recategorizado como uno falso positivo. Una contaminacion cruzada en cualquier punto del proceso de manejo de la muestra pudo haber sido la causa del falso positivo. JB11 experimento distres debido al mal manejo de la informacion por el DSPR en los medios de comunicacion. Este reporte ejemplifica como un programa municipal de rastreo bien estructurado puede ser eficaz en identificar falsos positivos a prueba RT-PCR y en reducir el riesgo de contagio, asi como en ayudar a reducir el distres y la carga al sistema sanitario generando confianza en la comunidad mediante la comunicacion efectiva basada en la evidencia. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Construction of a nomogram for predicting COVID-19 in-hospital mortality: A machine learning analysis.

Background and objectives: We aim to verify the use of ML algorithms to predict patient outcome using a relatively small dataset and to create a nomogram to assess in-hospital mortality of patients with COVID-19. Methods: A database of 200 COVID-19 patients admitted to the Clinical Hospital of State University of Campinas (UNICAMP) was used in this analysis. Patient features were divided into three categories: clinical, chest abnormalities, and body composition characteristics acquired by computerized tomography. These features were evaluated independently and combined to predict patient outcomes. To minimize performance fluctuations due to low sample number, reduce possible bias related to outliers, and evaluate the uncertainties generated by the small dataset, we developed a shuffling technique, a modified version of the Monte Carlo Cross Validation, creating several subgroups for training the algorithm and complementary testing subgroups. The following ML algorithms were tested: random forest, boosted decision trees, logistic regression, support vector machines, and neural networks. Performance was evaluated by analyzing Receiver operating characteristic (ROC) curves. The importance of each feature in the determination of the outcome predictability was also studied and a nomogram was created based on the most important features selected by the exclusion test. Results: Among the different sets of features, clinical variables age, lymphocyte number and weight were the most valuable features for prognosis prediction. However, we observed that skeletal muscle radiodensity and presence of pleural effusion were also important for outcome determination. Integrating these independent predictors was successfully developed to accurately predict mortality in COVID-19 in hospital patients. A nomogram based on these five features was created to predict COVID-19 mortality in hospitalized patients. The area under the ROC curve was 0.86 ± 0.04. Conclusion: ML algorithms can be reliable for the prediction of COVID-19-related in-hospital mortality, even when using a relatively small dataset. The success of ML techniques in smaller datasets broadens the applicability of these methods in several problems in the medical area. In addition, feature importance analysis allowed us to determine the most important variables for the prediction tasks resulting in a nomogram with good accuracy and clinical utility in predicting COVID-19 in-hospital mortality.

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19.

Inflammatory states and body composition changes are associated with a poor prognosis in many diseases, but their role in coronavirus disease 2019 (COVID-19) is not fully understood. To assess the impact of low skeletal muscle radiodensity (SMD), high neutrophil-to-lymphocyte ratio (NLR) and a composite score based on both variables, on complications, use of ventilatory support, and survival in patients with COVID-19. Medical records of patients hospitalized between May 1, 2020, and July 31, 2020, with a laboratory diagnosis of COVID-19 who underwent computed tomography (CT) were retrospectively reviewed. CT-derived body composition measurements assessed at the first lumbar vertebra level, and laboratory tests performed at diagnosis, were used to calculate SMD and NLR. Prognostic values were estimated via univariate and multivariate logistic regression analyses and the Kaplan-Meier curve. The study was approved by the local Institutional Review Board (CAAE 36276620.2.0000.5404). A total of 200 patients were included. Among the patients assessed, median age was 59 years, 58% were men and 45% required ICU care. A total of 45 (22.5%) patients died. Multivariate logistic analysis demonstrated that a low SMD (OR 2.94; 95% CI 1.13-7.66, P = 0.027), high NLR (OR 3.96; 95% CI 1.24-12.69, P = 0.021) and both low SMD and high NLR (OR 25.58; 95% CI 2.37-276.71, P = 0.008) combined, were associated with an increased risk of death. Patients who had both low SMD and high NLR required more mechanical ventilation (P < 0.001) and were hospitalized for a longer period (P < 0.001). Low SMD, high NLR and the composite score can predict poor prognosis in patients with COVID-19, and can be used as a tool for early identification of patients at risk. Systemic inflammation and low muscle radiodensity are useful predictors of poor prognosis, and the assessment of these factors in clinical practice should be considered.

Mothers as Teachers: The New Role of Mothers in the New Normal

The COVID-19 pandemic brought havoc to everyone but much more to child-rearing mothers. This qualitative study explored the new roles of mothers in the new normal specifically as being teachers to their children. Six mothers, who had public and private elementary grade children were purposely chosen. Information was gathered through a researcher-made validated interview questionnaire. Collection of information was done online through Facebook messenger and emails. Data analysis produced six themes, namely, complication in becoming mother-teachers, benefits in teaching one’s own children, supervision of children’s studies, impression of children of the modular schooling, considerations on children’s learning and reflection on mothers’ learning. Each theme was discussed thoroughly. To address the situation of these mothers, the Department of Education might consider giving support through home-visit tutorials. Teachers could introduce strategies to mothers on how to manage the studies with their children. Moreover, the Local Government Unit (LGU) may initiate alternative solutions led by the Department of Social Welfare and Development (DSWD) to unburden the mothers of their situations. © 2022, Commonwealth of Learning. All rights reserved.

Clinical and sociodemographic characterization of pregnant women hospitalized with COVID-19.

INTRODUCTION: In pregnant women, a higher risk for developing viral respiratory infections is identified. OBJECTIVE: To analyze sociodemographic characteristics, evolution, clinical manifestations, and complications of pregnant women hospitalized with COVID-19. METHODS: Study conducted at 11 public hospitals; sociodemographic variables, comorbidities, signs and symptoms, laboratory and imaging findings, pregnancy characteristics, treatment and pregnancy outcome were included for analysis. RESULTS: Age ranged between 15 and 40 years; 85.1% were at third trimester of pregnancy, 11.9% at second and 3% at first; 27% had any comorbidity such as obesity, hypertension or asthma; 89.5% had fever, 73.1% cough, 44.8% dyspnea, 43.3% headache and 35.8% myalgia. Diagnoses were mild disease (55.2%), mild pneumonia (26.9%), severe pneumonia (10.4%), severe pneumonia with acute respiratory distress syndrome (4.5%), and severe pneumonia with septic shock (3%); 76.2% had noninvasive oxygen support, and 9%, mechanical ventilation. Pregnancy was interrupted in 53.8%; 95.5% were discharged due to improvement of their condition and 4.5% died. CONCLUSIONS: Age range and symptoms are consistent with those previously reported. Evidence was found of an increase in cesarean section without a clear indication in women with COVID-19.

INTRODUCCIÓN: En las mujeres embarazadas se identifica mayor riesgo de desarrollar infecciones respiratorias virales. OBJETIVO: Analizar características sociodemográficas, evolución, manifestaciones clínicas y complicaciones en mujeres embarazadas con COVID-19 que fueron hospitalizadas. MÉTODOS: Estudio en 11 hospitales públicos; se incluyeron variables sociodemográficas, comorbilidades, síntomas y signos, hallazgos de laboratorio y gabinete, características del embarazo, tratamiento y desenlace de la gestación. RESULTADOS: La edad osciló entre 15 y 40 años; 85.1 % cursaba el tercer trimestre del embarazo, 11.9 % el segundo y 3 % el primero; 27 % presentó alguna comorbilidad como obesidad, hipertensión o asma; 89.5 % presentó fiebre, 73.1 % tos, 44.8 % disnea, 43.3 % cefalea y 35.8 % mialgias. Los diagnósticos fueron enfermedad leve (55.2 %), neumonía leve (26.9 %), neumonía severa (10.4 %), neumonía severa con síndrome de distrés respiratorio agudo (4.5 %) y neumonía severa con choque séptico (3 %); 76.2 % recibió soporte de oxígeno no invasivo y 9 %, ventilación mecánica. Se interrumpió el embarazo en 53.8 %; 95.5 % egresó por mejoría y 4.5 % falleció. CONCLUSIONES: El rango de edad y los síntomas coinciden con los señalados en la literatura especializada. En mujeres con COVID-19 se evidenció el incremento de la operación cesárea sin una indicación clara.

Coronavirus disease 2019 and the cardiologist.

PURPOSE OF REVIEW: There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS: Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY: Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.

Adherence to infection prevention and control practices among health care workers and its outcome in non-COVID areas in a tertiary care hospital

Aim and Objective: 1. To study the adherence to Infection Prevention and Control (IPC) practices by health care workers in Non-COVID areas. 2. To compare the proportion of COVID affected health care workers among those adhering to proper IPC and those with non-adherence. Background: Hospitals serve as frontline health care institutions caring for the increased number of COVID-19 patients. The health care personnel working in hospitals are at increased risk of acquiring the disease during the pandemic. It is the prime responsibility of the Hospital Infection Control Committee to protect the health care workers (HCW) and prevent nosocomial transmission. Materials and Methods: In the cross sectional study, all health care workers from non-COVID areas of the hospital who were exposed to COVID-19 patient during the study period were assessed according to the risk assessment criteria.

High throughput detection and genetic epidemiology of SARS-CoV-2 using COVIDSeq next-generation sequencing

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2.

New requirements of outpatients in the COVID-19 era: Adapting pharmaceutical care

Background and importance Adapt the outpatients care activity to the scenario arising out of the COVID-19 pandemic. Aim and objectives Reorganisation of the area, non in-person consultation, medication home delivery (MHD) and reduce patient attendance at day hospitals. Material and methods Phase 1 (P1): reinforcement of human resources, increase and easy the presential and telepharmacy schedule, adaptation of the facilities. Phase 2 (P2): advanced preparation of the medication, MHD, substitution of intravenous treatments by subcutaneous treatments. The telepharmacy and MHD were conducted at patients' request. Delivery routes and alternative urgent delivery systems were established. P1 activities began 2 weeks prior to the announcement of the State of Alarm (SoA, 16 March 2020) and P2 began and continues for vulnerable patients. Our project is currently underway in a proactive, selective and continuous way. Results Activities were analysed during 2020, weeks 12-19 (16 March to 10 May 2020) and compared with theoretical activity during the same period in 2019, with an increase in activity (+21%). The difference between the sum of in-person and telematic consultations and the theoretical consultations for the period was named after omitted consultations. Overall activity in weeks 12-19 was 5550 consultations, of which 4414 (79.5%) were in-person and 1136 (20.5%) telematic. The estimated activity would have been 7030 consultations, and 1480 (21% of the theoretical ones) have been omitted. In-person activity decreased from 5973 patients between weeks 12 and 19 in 2019 to 4414 in 2020 (-23.3%). Distribution of the 1136 MHD: week 12 (30), week 13 (131), week 14 (232), week 15 (190), week 16 (168), week 17 (155), week 18 (115) and week 19 (115). Waiting times for in-person consultation were reduced from an average of 5.2 min/patient in the pre-alarm period to 3 min during the alarm (-42.3%). Conclusion and relevance Our data may be used to detect areas for improvement;consultations should be made proactively and tools are needed to qualitatively analyse omitted activity. A system is needed to account for tele-assistance that has not resulted in dispensing medication or MHD.

A pivotal restructuring of modelling the control of COVID-19 during and after massive vaccination for the next few years (preprint)

This paper presents a new mathematical feedback model to demonstrate how direct observations of the epidemiological compartments of population could be mapped to inputs, such that the social spread of the disease is asymptotically subdued. Details of the stabilization and robustness are included.  This is a pivotal restructuring of modelling the control of corona virus from the current models in use world-wide which do not utilize feedback of functions of epidemiological compartments of population to construct the inputs. Although several vaccines have received Emergency Use Authorization (EUA) massive vaccination would take several years to reach herd immunity in most countries. Furthermore, the period of efficacy of the vaccination may be approximately one year only resulting in an unending vaccination. Even during the vaccination, there would be an urgent need to control the spread of the virus. When herd immunity is reached and vaccination is discontinued, there would be new surges of the disease. These surges of disease are not possible in appropriately designed stable feedback models. However, extensive testing, contact tracing, and medical treatment of those found infected, must be maintained.

Covid-19 vaccine acceptance: Beliefs and barriers associated with vaccination among the general population in india

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel zoonotic coronavirus that emerged from Wuhan, China. Development of SARS-CoV-2 specific vaccine is considered as the only solution that could control this pandemic. However, the success of COVID-19 vaccination programme will be dependent on the development of effective and safer vaccines and also on the public acceptance which in turn reliant on the beliefs and perception towards the vaccine. Therefore, this study was aimed to analyse the beliefs and barriers associated with COVID-19 vaccination among the general population in India. The study conducted using an online self-administered questionnaire that was distributed among the general population of India during the month of October 2020. The online questionnaire addressed several variables including the socio-demographic parameters, beliefs toward COVID-19 vaccine/vaccination, COVID-19 vaccine acceptance, potential barriers that may prevent from being vaccinated and factors that can improve COVID-19 vaccine acceptance. Among the 351 participants, 55% believed that the COVID-19 vaccination will be safe while only 46.2% believed that it will be effective. Majority of the participants (86.3%) were planning to get COVID-19 vaccination, whereas 13.7% admitted hesitancy. However, only 65.8% of the participants responded that they will receive vaccination as soon as possible whenever the vaccine is available. The study also identified that the. © 2020, Editorial board of Journal of Experimental Biology and Agricultural Sciences. All rights reserved.

The Safety and Security Measures of the Selected Universities in Nueva Ecija, Philippines: Its Combat to COVID–19 Pandemic (preprint)

To define and evaluate the areas of consideration concerning in identifying the critical factors that top universities in Nueva Ecija, Philippines can be used for triangulating the courses of actions that can be applied to improve the current practices of universities towards its combat to the COVID–19 disease is the primary objective of this study. The researchers used a descriptive design of methodology by using questionnaire–checklist to scientifically describe the situation, problems, phenomenon, or program, or provide information about certain issues related to the virus outbreak. The respondents of the study were faculty and staff of five established universities in Nueva Ecija, Philippines wherein the researchers employed a non–probability sampling technique to be logically assumed as the representative of the entire population. The results of the study shown that the top universities in Nueva Ecija have made efforts to ensure the safety of university workers by complying with the Inter–Agency Task Force (IATF) protocols. It can be inferred, in reality, that there are some areas that must be improved especially when it comes to ensuring the welfare of the personnel who are still reporting to work even in this time of the pandemic. The researchers suggested an enhancement plan that can be adapted by these universities to resolve the concerns of the faculty and staff especially in reducing the spread of the virus without sacrificing the day–to–day transactions of the academic institutions.

Modelo de Gestión de riesgos: el aporte del valor Phi en el plan de continuidad de negocios

La gestión de riesgos requiere análisis, contextualización y propuestas para responder a factores internos y externos que impactan la consecución de los objetivos y limitan el aprovechamiento de las oportunidades. Esta investigación tiene como propósito ofrecer a empresarios una recopilación de herramientas prácticas que podrán ser ejecutadas para implementar, gestionar y hacer seguimiento al análisis de los riesgos empresariales. Se realizó una revisión bibliográfica con base en el marco de referencia planteado por COSO ERM (2017), IIA (2013) y la ISO 31000:2018. Se realizó un estudio de caso en una empresa colombiana, dedicada a la producción y distribución de alimentos, donde se aplicó a los miembros de la alta dirección un instrumento que permitió conocer la severidad del riesgo, así como el valor Phi consultado a los miembros de la Junta Directiva. Se concluye que la gestión de riesgos pasa a ser una actividad de aplicación común en las empresas que se empeñan en el incremento de su valor organizacional, donde el plan de continuidad de negocios es una respuesta efectiva para hacer frente a situaciones de crisis como la generada por el COVID-19.Alternate abstract:Risk management requires analysis, contextualization and proposals to respond to internal and external factors that impact the achievement of objectives and limit the use of opportunities. The purpose of this research is to offer entrepreneurs a compilation of practical tools that can be executed to implement, manage and monitor the analysis of business risks. A bibliographic review was carried out based on the reference framework proposed by COSO ERM (2017), IIA (2013) and ISO 31000: 2018. A case study was carried out in a Colombian company, dedicated to food production and distribution, where an instrument was applied to members of senior management that allowed knowing the severity of the risk, as well as the Phi value consulted to the members of the Board of Directors. It is concluded that risk management becomes an activity of common application in companies that are committed to increasing their organizational value, where the business continuity plan is an effective response to deal with crisis situations such as the one generated by COVID-19.