Prevalence of respiratory infections during the 2018-2020 period in the paediatric population of primary care centres in Central Catalonia (preprint)

Following the COVID-19 pandemic, policies such as social distancing, hand washing and the use of masks were implemented which could play an important role in the reduction of infectious diseases. An observational, descriptive, cross-sectional study was conducted to observe the prevalence of respiratory infections in children under 15 years of age during the 2018-2020 period in Primary Care centres in Central Catalonia. In 2020, there was a 44.35 decrease in total consultations for respiratory infections compared to 2019. All respiratory infections exhibited a significant decrease except influenza, which increased by 41.76%. Children between the ages of 6 and 12 had the highest prevalence of influenza (87.68%), and the SARS-CoV-2-19 infection was most frequent (4.06%) among those between the ages of 12 and 15. Compared to urban centres, rural centres presented a higher prevalence of all infections except influenza and SARS-CoV-2. In conclusion, the COVID-19 pandemic caused a significant decrease in the number of consultations for respiratory infections in the paediatric population, except for influenza, which increased in cases in January and February 2020. No differences were found between sexes, although differences were found in the distribution of the different age groups.

Impact of COVID-19 on Diagnosis of Respiratory Diseases in the Northern Metropolitan Area in Barcelona (Spain) (preprint)

Objective: Several authors have analyzed the impact of the pandemic on the incidence rates of different conditions. Our aim was to analyze the impact of the COVID-19 pandemic on primary care new diagnoses of respiratory diseases. Methods: This was an observational retrospective study performed to describe the impact of COVID-19 pandemic on primary care new diagnosis of respiratory diseases other than lung cancer. Incidence rate ratio between pre-pandemic and pandemic period was calculated. Results: We found an decrease in the incidence of respiratory conditions (IRR 0.65) during the pandemic period. When we compared the different groups of diseases according to ICD-10, we found a significant decrease in the number of new cases during the pandemic period, except in the case of pulmonary tuberculosis, abscesses or necrosis of the lungs and other respiratory complications. Instead, we found increases in new diagnoses of flu and pneumonia (IRR 2.17) and respiratory interstitial diseases (IRR 1.41). Conclusion: There has been a decrease in new diagnosis of most respiratory diseases during the COVID-19 pandemic. The real clinical impact of this situation is still unknown. Large-scale real-life studies will make it possible to evaluate the long-term true impact of COVID-19 pandemic on the respiratory diseases management.

Social Network Analysis of Twitter Data Related to Blood Clots and Vaccines (preprint)

After the first weeks of vaccination against the SARS-CoV-2, several cases of acute thrombosis were reported. These news reports began to be shared frequently across social media platforms. The aim of this study was to conduct an analysis of Twitter data related to the overall discussion. Data was retrieved from 14th March to 14th April using the keyword ‘blood clots’. A dataset with n=266,677 tweets was retrieved, and a systematic random sample of 5% of tweets (n=13,334) were entered into NodeXL for further analysis. Social network analysis was used to analyse the data by drawing upon the Clauset-Newman-Moore algorithm. Influential users were identified by drawing upon the betweenness centrality metric. Text analysis was applied to identify the key hashtags and websites used at this time. More than half of the network was comprised of retweets and the largest groups within the network were broadcast clusters where a number of key users were retweeted. The most popular narratives were around highlighting the low risk of obtaining a blood clot from a vaccine and highlighting higher blood clot risks in medicines commonly consumed. A wide-variety of actors drove the discussion on Twitter ranging from writers, physicians, the general public academics, celebrities, and journalists. Twitter was used to highlight the low potential of obtaining a blood clot from a vaccine and encouraged vaccinations among the public.

COVID-19 First and Delta Waves in Relation to ACEI, ARB, Influenza Vaccination, and Comorbidity in a North Metropolitan Barcelona Health Consortium (preprint)

BACKGROUND Some authors have reported that angiotensin converter enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improve clinical outcomes in hypertensive COVID-19 patients, and others have proposed cross-protection for influenza vaccination. The impact of these variables on the evolution of hospitalized patients, focusing in the first wave and the Delta wave, is explored.METHODS COVID-19 hospitalizations (n = 1888) of the assigned population, from March 1, 2020, to July 31, 2021, in the Hospital of Terrassa, the referral center for the free access Terrassa Health Consortium in the North Metropolitan Barcelona Health Region (population = 167,386) were studied. The number of chronic treatments and conditions in a sample of patients from the first (n = 184) and Delta outbreak (n = 158) were recorded.RESULTS Of the non-survivors, 96.3% were aged > 60 years in the first wave and 100% were aged > 70 years in the Delta wave. In non-survival hospitalized patients aged > 60 years, the percentage treated with ACEI was similar to general population but was significantly different for ARB treatments or influenza vaccination, although associated to a higher comorbidity and age. In July 2021, the number of hospitalizations for patients aged < 50 years was higher than March 2020 and 22% of hospitalized patients without chronic treatments and conditions needed admission to the intensive care unit. Mortality was reduced in the groups with most comorbidities who received influenza and SARS-CoV2 vaccination.CONCLUSIONS In COVID-19 infection, age and comorbidity are related to survival, ACEI use is safe. A high proportion of patients without comorbidity require hospitalization and intensive care.

Analysing Discussions Around Rural Health on Twitter During the COVID-19 Pandemic (preprint)

Individuals from rural areas are increasingly using social media as a means of communication, receiving information, or actively complaining of inequalities and injustices. This study captured 57 days’ worth of Twitter data from June to August 2021 related to rural health using English language keywords. The study utilised social network analysis and natural language processing to analyse the data. It was found that Twitter served as a fruitful platform to raise awareness of problems faced by those living in rural areas. Overall, Twitter was utilised in rural areas to express complaints, to debate, and share information. Twitter could be leveraged as a powerful social listening tool for individuals and organisations who want to gain insight into popular narratives around rural health.

COVID-19 first and delta waves in relation to ACEI, ARB, Influenza vaccination, and comorbidity in a North Metropolitan Barcelona Health Consortium (preprint)

BACKGROUND: Some authors have reported that angiotensin converter enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improve clinical outcomes in hypertensive COVID-19 patients, and others have proposed cross-protection for influenza vaccination. This study explores the impact of these variables on the evolution of hospitalized patients, focusing in the first wave and the Delta wave. METHODS: Hospitalizations (n=1888) from March 1, 2020, to July 31, 2021, in the Hospital of Terrassa, the referral center for the free access Terrassa Health Consortium in the North Metropolitan Barcelona Health Region (population=167,386) were studied. The number of chronic treatments and conditions of patients from the initial outbreak (n=184) and the Delta outbreak (n=158) were recorded. RESULTS: Of the non-survivors, 96.3% were aged >60 years in the first wave and 100% were aged >70 years in the Delta wave. In non-survival hospitalized patients aged >60 years, the percentage treated with ACEI was similar to general population but was significantly different for ARB treatments of influenza vaccination, although associated to a higher comorbidity and age. In July 2021, the number of hospitalizations for patients aged <50 years was higher than March 2020 and 22% of hospitalized patients without chronic treatments and conditions needed admission to the intensive care unit. Mortality was reduced in the groups with most comorbidities who received influenza and SARS-CoV2 vaccination. CONCLUSIONS: In COVID-19 infection, age and comorbidity are related to survival, ACEI use is safe. A high proportion of patients without comorbidity require hospitalization and intensive care.

Influenza Vaccination in Coronavirus Times: Intention to Be Vaccinated by Primary Care Professionals in Central Catalonia (VAGCOVID) (preprint)

BackgroundInfluenza vaccination is the main measure of prevention against the epidemic flu, which annually produces a significant increase in the pressure on healthcare systems, in addition to influencing the absenteeism of health workers. Although it is recommended that health professionals be vaccinated, their vaccination coverage is low. The lack of knowledge about the evolution of influenza in the context of the SARS-CoV-2 coronavirus pandemic led to the continued recommendation of influenza vaccination to people at risk and to professionals. The aim of the study is to determine the intention to vaccinate against seasonal flu of health professionals in the 2020-21 campaign in the context of the SARS-CoV-2 pandemic, and to analyse the factors that influence it.MethodsCross-sectional study through a structured online survey aimed at Primary Care professionals in the region of central Catalonia.ResultsA total of 610 participants responded to the survey, 65.7% of whom intended to be vaccinated against the flu in this campaign and 11.1% did not yet know or did not answer. The intention to be vaccinated against flu is associated with the professional category, the years of professional practice, the fact of making face-to-face guards, and the perception of the risk of suffering from flu. It is also related to a history of influenza vaccination in the previous year and to having been vaccinated on another occasion. The profile of professionals who intend to be vaccinated against flu includes professionals with a history of vaccination, who were on duty and perceived that their staff were at risk of becoming ill with flu.ConclusionsDuring the SARS-CoV-2 pandemic, many professionals show a clear intention to get vaccinated against the flu, but there are still some who doubt it. In order to improve influenza vaccination coverage among health professionals, it is necessary to design strategies aimed at professionals who are hesitant or reluctant to vaccination.

Impact of Mass Workplace COVID-19 Rapid Testing on Health and Healthcare Resource Savings (preprint)

Background: The epidemiological situation generated by COVID-19 has cast into sharp relief the delicate balance between public health priorities and the economy, with businesses obliged to toe a line between employee health and continued production. In an effort to detect as many cases as possible, isolate contacts, cut transmission chains and limit the spread of the virus in the workplace, mass testing strategies have been implemented in both public health and industrial contexts to minimize the risk of disruption in activity. Objective: To evaluate the economic impact of mass workplace testing strategy as carried out by a large automotive company in Catalonia in terms of health and healthcare resource savings. Methodology: Analysis of health costs and impacts based on the estimation of mortality and morbidity avoided because of screening and the resulting savings in healthcare costs. Results: The economic impact of the mass workplace testing strategies (using both PCR and RAT tests) was approximately €10.44 per test performed or €5,575.49 per positive detected. 38% of this figure corresponds to savings derived from better use of health resources (hospital beds, ICU beds and follow-up of infected cases), while the remaining 62% corresponds to improved health rates due to avoided morbidity and mortality. In scenarios with higher positivity rates and a greater impact of the infection on health and the use of health resources, these results could be up to ten times higher (€130.24 per test performed or €69,565.59 per positive detected). Conclusion: In the context of COVID-19, preventive actions carried out by the private sector to safeguard industrial production also have concomitant public benefits in the form of savings in healthcare costs. Thus, governmental bodies need to recognize the value of implementing such strategies in private settings and facilitate them through, for example, subsidies.

Influenza Vaccination During the Coronavirus Epidemic: Intention to Vaccinate among the at-risk Population in the Central Catalonia Health Region (VAGCOVID). (preprint)

BackgroundInfluenza is a major public health issue, with the primary preventive measure being an annual influenza vaccination. Nevertheless, vaccination coverage among the at-risk population is low. Our understanding of the behaviour of the influenza virus during the SARS-CoV-2 coronavirus pandemic is limited, meaning the influenza vaccination is still recommended for individuals in high-risk groups. The aim of the study is to determine the intention to vaccinate against seasonal influenza among the at-risk population in the 2020-21 campaign during the SARS-CoV-2 pandemic and to analyse the factors which influence said intention.MethodsCross-sectional telephone survey of adults (aged over 18) with risk factors in central Catalonia where the need for the Seasonal Influenza Vaccine (SIV) was recommended.ResultsA total of 434 participants responded to the survey, 43.3% of whom intended to have the vaccination against influenza this year and 15.9% did not know or did not express an opinion. The intention to get vaccinated against influenza is associated with having dependents, the individual’s perception of the risk of them catching influenza and the perceived risk for dependents. It is also associated with age, whether the individual had received an influenza vaccination the year before and whether they had been vaccinated on another occasion. The best predictors of the intention to vaccinate are the individual’s perception of the risk of catching influenza and whether the individual had been vaccinated in the previous year.ConclusionsVaccination intention can be a good predictor of behaviour in relation to vaccination. During the current SARS-CoV-2 pandemic many individuals are undecided. In order to improve vaccination coverage in people at risk, it is necessary to promote educational actions, especially in those people who express doubts.

Persistence and baseline determinants of seropositivity and reinfection rates in health care workers up to 12.5 months after COVID-19 (preprint)

We assessed the duration and baseline determinants of antibody responses to SARS-CoV-2 spike antigens and the occurrence of reinfections in a prospective cohort of 173 Spanish primary health care worker patients followed up initially for nine months and subsequently up to 12.5 months after COVID-19 symptoms onset. Seropositivity to SARS-CoV-2 spike and receptor binding domain antigens up to 149-270 days was 92.49% (90.17% IgG, 76.3% IgA, 60.69% IgM). In a subset of 64 health care workers who had not yet been vaccinated by April 2021, seropositivity was 96.88% (95.31% IgG, 82.81% IgA) up to 322-379 days post symptoms onset. There were four suspected reinfections detected by passive case detection, two among seronegative individuals (five and seven months after the first episode), and one low antibody responder. Antibody levels significantly correlated with fever, hospitalization, anosmia/hypogeusia, allergies, smoking and occupation. Stable sustainment of IgG responses raises hope for long-lasting COVID-19 vaccine immunity.