The asymptomatic proportion of SARS-CoV-2 Omicron-variant infections in households: A systematic review (preprint)

Background Understanding the clinical spectrum of SARS-CoV-2 infection, including the asymptomatic fraction, is important as asymptomatic individuals are still able to infect other individuals and contribute to ongoing transmission. The WHO Unity Household transmission investigation (HHTI) protocol provides a platform for the prospective and systematic collection of high-quality clinical, epidemiological, serological, and virological data from SARS-CoV-2 confirmed cases and their household contacts. These data can be used to understand key severity and transmissibility parameters - including the asymptomatic proportion - in relation to local epidemic context and help inform public health response. Methods We aimed to estimate the asymptomatic proportion of SARS-CoV-2 Omicron-variant infections in Unity-aligned HHTIs. We conducted a systematic review and meta-analysis in alignment with the PRISMA 2020 guidelines and registered our systematic review on PROSPERO (CRD42022378648). We searched EMBASE, Web of Science, MEDLINE, and bioRxiv and medRxiv from 1 November 2021 to 22 August 2023. Results We identified 8,368 records, of which 98 underwent full text review. We identified only three studies for data extraction, with substantial variation in study design and corresponding estimates of the asymptomatic proportion. As a result, we did not generate a pooled estimate or I2 metric. Conclusions The limited number of quality studies that we identified highlights the need for improved preparedness and response capabilities to facilitate robust HHTI implementation, analysis and reporting, to better inform national, regional and global risk assessments and policy making.

Prevalence of Burnout in Health Professionals during the COVID-19 Pandemic: A Review of Reviews (preprint)

(1) Background: Burnout syndrome results from chronic stress in the work-place. The COVID-19 pandemic has imposed a heavy workload on health professionals, doctors and nurses to respond to first-line health care during the first two years of an emergency caused by this virus. The aim of this study was to evaluate the prevalence of burnout in healthcare personnel, doctors and nurses during the COVID-19 pandemic. (2) Methods: This was a review of reviews on the prevalence of professional burnout syndrome in healthcare personnel, doctors and nurses before or during the COVID-19 pandemic, without language restrictions or missing data from the Cochrane Library electronic databases. In total, 48,657 articles were obtained from Pub-Med/MEDLINE and the Web of Science. (3) Results: After completing the examination, 20 articles were included in the review. Of these articles, 7% included nurses in their study population, 72% interviewed doctors from different specialties, and the remaining 21% reported personnel data. Healthcare as a whole: In total, 624 articles with 233,087 participants were included. Regarding the prevalence by subscale, a PD of 33% (95% CI; 33%- 34%), an AE of 37% (95% CI; 37%- 37%) and a PR of 29% (95% CI) were found. %; 29% and 29%). ; (4) Conclusions: The incidences of DP and AE are high, and that of RP is low. These findings demonstrate the high prevalence of burnout according to subscale. Burnout is a problem of great magnitude, and as such, interventions must be implemented immediately at the individual and group levels by institutions and health systems.

Grief and Depression in Relatives of Deceased Individuals during Social Isolation. Risk and Protective Factors (preprint)

The COVID-19 pandemic resulted in the loss of thousands of lives, leading to a global phenomenon where numerous families are undergoing a grieving process. Simultaneously, health restrictions to prevent the disease´s transmission have prevented individuals from bidding farewell to their loved ones and conducting cultural farewell rituals. Through a cross-sectional study, we investigated, via social media surveys, the Mexican population that experienced the death of a close family member from November 2020, regardless of the cause. The aim was to determine whether those who did not have the opportunity to say goodbye to their loved one prior to their death and/or those who could not perform farewell rituals according to their culture were at a different risk of developing depressive disorders and/or complicated grief compared to those who did have the opportunity to bid farewell and practice their rituals. Contrary to our initial hypothesis, we found no statistically significant difference in the likelihood of developing major depressive disorders or complicated grief based on whether individuals said their goodbyes or not. However, we did identify risk and protective factors by analyzing other variables such as the initiation or increase in substance consumption following the loss, religious attachment, and age.

Why did people not get vaccinated against COVID-19? Results from a nationwide survey among Mexican adults (preprint)

ObjectiveTo explore the reasons for not getting vaccinated against COVID-19. Material and methodsIn October 2021, a nationwide structured telephone survey (disproportionate stratified sampling) was conducted regarding COVID-19 pandemics, including vaccination experience. To examine associations between inoculation and other characteristics, the chi-square test and logistic regression analysis were applied. ResultsOut of 3 126 adults, 68% reported complete vaccination and 21% only the first dose, while 11% remained unvaccinated. Non-vaccination was associated with being younger, male, without a partner, low socioeconomic level, and no previous diagnosis of hypertension, obesity or diabetes. Furthermore, the non-vaccinated were less likely to have tested for COVID-19, and more likely to consider COVID-19 as low severe and not real compared with the vaccinated. Using logistic regression models: place of residence, marital status, educational level, age, BMI, testing for COVID-19, and the perception of COVID-19 (severe and real) were significant predictors of non-vaccination. The predominant reasons for not getting vaccinated were: 63% "external barriers" (e.g., not being able to attend an appointment), and 37% "internal motives" (e.g., "vaccine does not work"). ConclusionsThe causes of non-vaccination against COVID-19 are related to both social and geographical determinants. Addressing external barriers is necessary in order to promote equity in vaccination. Reviewing the results in the context of earlier studies on the willingness to vaccinate, the gap between intention and vaccination is notable.

Social determinants of adult COVID-19 vaccine acceptance and uptake in a Brazilian urban informal community: a longitudinal time-to-event study (preprint)

Residents of informal urban settlements have a high risk of COVID-19 exposure and have less access to medical care, making vaccine-driven prevention critical in this vulnerable population. Despite robust vaccination campaigns in Brazil, vaccine uptake and timing continue to be influenced by social factors and contribute to health disparities. To address this, we conducted a sequential survey in a cohort of 717 adults in an urban favela in Salvador, Brazil where participants were interviewed in 2020, before vaccines were rolled out, and in 2022, after primary and booster dose distribution. We collected data on demographics, social characteristics, and COVID-19 vaccination status and intent. Primary series uptake was high (91.10% for 1st dose and 94.74% for 2nd dose among eligible); however, booster uptake was lower (63.51% of eligible population) at the time of the second interview, suggesting a decreasing interest in vaccination. To account for both vaccine refusal and delays, we conducted a Cox time-to-event analysis of dose uptake using sequential independent outcomes. Exposure times were determined by dose eligibility date to account for age and comorbidities. Intent to vaccinate in 2020 (hazard ratio [HR]: 1.54, CI: [1.05, 1.98]) and age (HR: 1.27, CI: [1.01, 2.08]) were associated with higher vaccination rates for the 1st dose. Males were less likely to receive the 1st dose (HR: 0.61, CI: [0.35, 0.83]), and, compared to catholics, 2nd dose uptake was lower for those identifying with Pentecostalism (HR: 0.49, CI: [0.37, 0.66]) and without a religion (HR: 0.49, CI: [0.37, 0.66]), with the latter association disappearing after controlling by age. Risk perception was associated with 2nd dose uptake (HR: 1.15, CI: [1.08, 1.26]). The role of sex and religion in vaccination behavior highlights the need for targeted outreach and interfacing with local organizations. The data offers lessons to build a long-term COVID-19 vaccination strategy beyond availability.

Relevance of social capital in preserving subjective well‐being in the face of the COVID‐19 pandemic

This paper analyzes the changes in subjective well‐being (SWB) in 11 Latin American cities at the end of the acceleration phase of the COVID‐19 pandemic, the variables that influenced these changes, and the role of the public support policies and the social capital on SWB recovery. This study, the second of a two‐phase research project, is a survey‐based comparative analysis. The 5604 survey responses obtained included 3279 observations from the research project's preceding phase, and 2325 observations conducted as part of the second project phase and current study. A multivariate linear regression model was used to evaluate the impact of the different variables related to COVID‐19 on people's SWB. Results show that the most significant positive impacts on SWB, are attributed to social capital, particularly family and social cohesion. The study confirms that the level of SWB is strongly associated with personality traits, health, and key variables such as age, marital status, and income. The different measures established to control the pandemic have not remedied the negative impacts of COVID‐19 on people's SWB. However, an increase in different degrees of SWB was observed in 10 out of the 11 cities between the initial survey and the follow‐up survey.Alternate :本文分析了11个拉丁美洲城市在2019冠状病毒病（COVID‐19）大流行加速阶段结束时的主观幸福感（SWB）变化、影响SWB变化的变量、以及公共支持政策和社会资本对SWB恢复发挥的作用。本研究是一项由两阶段组成的研究课题的第二阶段——一项基于调查的比较分析。获得的5,604份调查回复包括来自研究课题第一阶段的3,279次观察，以及课题第二阶段（本研究）进行的2,325次观察。使用多元线性回归模型评价与COVID‐19相关的不同变量对人民SWB产生的影响。结果表明，对SWB产生最显著积极影响的变量为社会资本，特别是家庭和社会凝聚力。本研究证实，SWB水平与人格特征、健康状况、以及年龄、婚姻状况和收入等关键变量强烈相关。为控制大流行而制定的不同措施并没有弥补COVID‐19对人民SWB产生的负面影响。不过，从初次调查到后续调查的期间，11个城市中有10个城市的SWB出现了不同程度的上升。Alternate :RESUMENEste artículo analiza los cambios en el bienestar subjetivo en 11 ciudades de América Latina al final de la fase de aceleración de la pandemia de COVID‐19, las variables que influyeron en estos cambios y el papel de las políticas públicas de apoyo y el capital social en la recuperación del bienestar subjetivo.Este estudio, el segundo de un proyecto de investigación de dos fases, es un análisis comparativo basado en encuestas. Las 5605 encuestas respondidas incluyeron 3279 observaciones de la fase anterior del proyecto de investigación y 2325 observaciones realizadas como parte de la segunda fase del proyecto y el estudio actual. Se utilizó un modelo de regresión lineal multivariado para evaluar el impacto de las diferentes variables relacionadas con COVID‐19 en el bienestar subjetivo de las personas.Los resultados muestran que los impactos positivos más significativos en el bienestar subjetivo se atribuyen al capital social, particularmente a la cohesión familiar y social. El estudio confirma que el nivel de bienestar subjetivo está fuertemente asociado con los rasgos de personalidad, la salud y variables clave como la edad, el estado civil y los ingresos. Las diferentes medidas establecidas para el control de la pandemia no han subsanado los impactos negativos del COVID‐19 en el bienestar subjetivo de las personas. Sin embargo, se observó un aumento en diferentes grados de bienestar subjetivo en 10 de las 11 ciudades entre la encuesta inicial y la encuesta de seguimiento.

Impact of allocation concealment and blinding in trials addressing treatments for COVID-19: A methods study.

OBJECTIVE: Assess the impact of allocation concealment and blinding on the results of COVID-19 trials. DATA SOURCES: World Health Organization (WHO) COVID-19 database (up to February 2022) Methods: We included randomized trials that compared drug therapeutics with placebo or standard care in patients with COVID-19. We performed random-effects meta-regressions comparing the results of trials with and without allocation concealment and blinding of healthcare providers and patients. RESULTS: We identified 488 trials. We found that, compared to trials with allocation concealment, trials without allocation concealment may estimate treatments to be more beneficial for mortality, mechanical ventilation, hospital admission, duration of hospitalization, and duration of mechanical ventilation, but results were imprecise. We did not find compelling evidence that, compared to trials with blinding, trials without blinding produce consistently different results for mortality, mechanical ventilation, and duration of hospitalization. We found that trials without blinding may estimate treatments to be more beneficial for hospitalizations and duration of mechanical ventilation. CONCLUSION: We did not find compelling evidence that COVID-19 trials in which healthcare providers and patients are blinded produce different results from trials without blinding but trials without allocation concealment estimate treatments to be more beneficial compared to trials with allocation concealment. What's new? Additional information: For decades, allocation concealment (the concealment of the randomization sequence from personnel enrolling participants) and blinding (the concealment of the arm to which participants have been randomized from one or more individuals involved in a trial) have been important considerations in the assessment of risk of bias of trials. Previous studies have produced conflicting results with regards to the associations of blinding and allocation concealment and none have investigated the associations of allocation concealment and blinding in the context of COVID-19. IMPLICATIONS: Our study suggests that lack of blinding may not always bias results but that evidence users should remain skeptical of trials without allocation concealment.

Monoclonal antibodies for prophylaxis and therapy of respiratory syncytial virus, SARS-CoV-2, human immunodeficiency virus, rabies and bacterial infections: an update from the World Association of Infectious Diseases and Immunological Disorders and the Italian Society of Antinfective Therapy.

Monoclonal antibodies (mABs) are safe and effective proteins produced in laboratory that may be used to target a single epitope of a highly conserved protein of a virus or a bacterial pathogen. For this purpose, the epitope is selected among those that play the major role as targets for prevention of infection or tissue damage. In this paper, characteristics of the most important mABs that have been licensed and used or are in advanced stages of development for use in prophylaxis and therapy of infectious diseases are discussed. We showed that a great number of mABs effective against virus or bacterial infections have been developed, although only in a small number of cases these are licensed for use in clinical practice and have reached the market. Although some examples of therapeutic efficacy have been shown, not unlike more traditional antiviral or antibacterial treatments, their efficacy is significantly greater in prophylaxis or early post-exposure treatment. Although in many cases the use of vaccines is more effective and cost-effective than that of mABs, for many infectious diseases no vaccines have yet been developed and licensed. Furthermore, in emergency situations, like in epidemics or pandemics, the availability of mABs can be an attractive adjunct to our armament to reduce the impact. Finally, the availability of mABs against bacteria can be an important alternative, when multidrug-resistant strains are involved.

Mesenchymal Stem Cells: Case Report of an Adjuvant Ambulatory Therapy for a COVID-19 High-Risk and steroid-hypersensitive Patient.

INTRODUCTION: Due to the rapid progression of COVID-19 to severe and critical stages, thousands of patients have required the use of intensive care unit (ICU) treatment, placing an excessive strain on health systems. Immunomodulatory effects of Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) have shown promising results on the treatment of patients with COVID-19. However, the effect of promptly applied cell therapy on ambulatory patient prognosis has not been described. This case report presents the clinical outcome of a multimorbid, steroid-hypersensitive, COVID-19 patient treated with WJ-MSCs transplantation. CASE PRESENTATION: A 67-year-old woman with Type 2 diabetes, overweight (82 kg, 168 cm, BMI = 29.053), hypertension (60/190 mmHg) and steroid-hypersensitivity, tested positive for COVID-19 after presenting typical symptoms such as fatigue, chest pain, myalgia, nasal congestion, dysgeusia, anosmia and oxygen saturation (SpO2) 94% - 96%, with normal body temperature (36°C). The patient received pharmacologic treatment but, when symptoms worsened, WJ-MSCs were transplanted to modulate the suspected onset of the cytokine release syndrome. Significant improvement of symptoms and clinical parameters (inflammatory markers and CT score) were observed, and the patient fully recovered within a short period of time. CONCLUSION: The present case report exhibits the favorable outcome of using Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) as an ambulatory and adjuvant therapy for COVID-19. Prompt WJ-MSCs infusion can be a safe ambulatory adjuvant therapy in COVID-19 infection care, preventing disease progression to critical stages and avoiding hospital overcrowding.

Changes in the epidemiological profile of SARS-CoV-2-positive individuals in Mexico across pandemic waves as an explanation of fatality reduction: a retrospective observational study.

OBJECTIVES: We aim to quantify shifts in hospitalisation and mortality and how those were related to the first three phases of the epidemic and individuals' demographics and health profile among those with a positive test for SARS-CoV-2 treated at the Mexican Social Security Institute's facilities from March 2020 to October 2021. DESIGN: Retrospective observational study using interrupted time series analysis to identify changes in hospitalisation rate and case fatality rate (CFR) by epidemic wave. SETTING: Data from the Mexican Institute of Social Security's (IMSS) Online Influenza Epidemiological Surveillance System (SINOLAVE) that include all individuals that sought care at IMSS facilities all over Mexico. PARTICIPANTS: All individuals included in the SINOLAVE with a positive PCR or rapid test for SARS-CoV-2. PRIMARY AND SECONDARY OUTCOME MEASURES: Monthly test positivity rates, hospitalisation rates, CFRs and prevalence of relevant comorbidities by age group. RESULTS: From March 2020 to October 2021, the CFR declined between 1% and 3.5%; the declines were significant for those 0-9, 20-29, 30-39, 40-49 and 70 and older. The decline was steep during the first wave and was less steep or was temporarily reversed at the beginning of the second and third waves (changes in the trend of about 0.3% and 3.8%, and between 0.7% and 3.8%, respectively, for some age groups), but then continued to the end of the analytical period. Prevalence of diabetes, hypertension and obesity among patients testing positive also declined-two for most age groups (reductions of up to 10 percentage points for diabetes, 12 percentage points for hypertension and 19 percentage points for obesity). CONCLUSION: Data suggest that the decrease in COVID-19 fatality rate is at least partially explained by a change in the profile of those contracting the disease, that is, a falling proportion of individuals with comorbidities across all age groups.

Acontecimiento y COVID-19. Elementos para comprender la pandemia desde el campo filosófico

Resumen. El presente artículo se propone plantar y brindar elementos para reflexionar sobre la siguiente pregunta: La pandemia del COVID-19, ¿es un acontecimiento? Entonces este artículo persigue dos objetivos: por un lado, hacer un recuento de las posiciones teóricas que algunos pensadores han hecho sobre esta cuestión. En segundo lugar, enmarcar estas posiciones respecto al planteo y problematización del acontecimiento con anclaje en la filosofía de Deleuze.Alternate :. This article aims to plant and provide elements to reflect on the following question: Is the COVID-19 pandemic an event? So this article pursues two objectives: on the one hand, to make a recount of the theoretical positions that some thinkers have made on this question. Secondly, to frame these positions with respect to the presentation and problematization of the event anchored in Deleuze's philosophy.

Socioeconomic disparities in the reopening of schools during the pandemic in Chile.

The COVID-19 pandemic produced the most significant disruption in education in history. More than 190 countries suspended in-person instruction, affecting an estimated 1.6 billion students. The reopening of schools has been unequal. Schools in more affluent areas reopened sooner than poorer ones, exacerbating preexisting inequalities. There is limited research about the reopening processes in Latin America, where schools were closed for extended periods. Using a rich administrative dataset, we investigate the gaps in the resumption of in-person instruction in Chilean schools across socioeconomic groups in the fall of 2021. Schools with lower socioeconomic status were significantly less likely to offer in-person instruction. Disparities in reopening decisions were associated with administrative factors rather than economic or local epidemiological conditions.

PANDEMIA COVID-19: IMPACTO ECONOMICO Y POLITICAS ANTICICLICAS. SIMULACIONES BASADAS EN UN MODELO DE EQUILIBRIO GENERAL COMPUTADO DE ARGENTINA

Se ha adaptado un modelo de equilibrio general computado de Argentina para analizar el impacto de la pandemia Covid-19 en la economía y el rol de las políticas anticíclicas para mitigar dicho impacto. Las simulaciones del modelo arrojan resultados consistentes con lo observado en 2020 mostrando un fuerte impacto negativo en el PBI, el desempleo y el bienestar de los hogares. El paquete de políticas anticíclicas logra mitigar en el corto plazo el impacto adverso acerca de algunas variables macroeconómicas y, en particular, respecto del bienestar. Pero a mediano y largo plazo, la menor acumulación de capital y creciente endeudamiento implican menor crecimiento y bienestar. Una política fiscal sostenible -que estabilice la relación deuda-productopermite mediante mayor inversión y empleo que la economía y el bienestar recuperen los niveles del escenario base (recién) al cabo de 10 años.Alternate :A computable general equilibrium model of Argentina was adapted to analyze the impact of the Covid-19 pandemia on the economy and to assess the mitigating effects of anticyclicalpolicies. The simulations are consistent with the observed performance of GDP, unemployment and social welfare. The anticyclical program is effective in reducing the short term adverse impact on several economic and social indicators, particularly, on social welfare. But over the medium and long term, smaller capital accumulation and sovereign indebtment imply lower growth and welfare. A sustainable fiscal policy -that stabilizes the debt-GDP ratio- allows the economy to, through higher investment and employment creation recover the base scenario levels (only) after 10 years.

Discharge Disposition and Loss of Independence Among Survivors of COVID-19 Admitted to Intensive Care: Results From the SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS).

OBJECTIVES: To describe incidence and risk factors of loss of previous independent living through nonhome discharge or discharge home with health assistance in survivors of intensive care unit (ICU) admission for coronavirus disease 2019 (COVID-19). DESIGN: Multicenter observational study including patients admitted to the ICU from January 2020 till June 30, 2021. HYPOTHESIS: We hypothesized that there is a high risk of nonhome discharge in patients surviving ICU admission due to COVID-19. SETTING: Data were included from 306 hospitals in 28 countries participating in the SCCM Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 registry. PATIENTS: Previously independently living adult ICU survivors of COVID-19. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was nonhome discharge. Secondary outcome was the requirement of health assistance among patients who were discharged home. Out of 10 820 patients, 7101 (66%) were discharged alive; 3791 (53%) of these survivors lost their previous independent living status, out of those 2071 (29%) through nonhome discharge, and 1720 (24%) through discharge home requiring health assistance. In adjusted analyses, loss of independence on discharge among survivors was predicted by patient age ≥ 65 years (adjusted odds ratio [aOR] 2.78, 95% confidence interval [CI] 2.47-3.14, P < .0001), former and current smoking status (aOR 1.25, 95% CI 1.08-1.46, P = .003 and 1.60 (95% CI 1.18-2.16), P = .003, respectively), substance use disorder (aOR 1.52, 95% CI 1.12-2.06, P = .007), requirement for mechanical ventilation (aOR 4.17, 95% CI 3.69-4.71, P < .0001), prone positioning (aOR 1.19, 95% CI 1.03-1.38, P = .02), and requirement for extracorporeal membrane oxygenation (aOR 2.28, 95% CI 1.55-3.34, P < .0001). CONCLUSIONS: More than half of ICU survivors hospitalized for COVID-19 are unable to return to independent living status, thereby imposing a significant secondary strain on health care systems worldwide.

[Pneumococcal conjugate vaccines in pediatrics, its impact on Public Health]. / Vacunas conjugadas contra neumococo en pediatría, su impacto en la Salud Pública.

Streptococcus pneumoniae (also known as pneumococcus) is part of the natural bacterial flora of the nasal and pharyngeal mucosa, colonizes mainly the nasopharynx, and causes this carriage to precede pneumococcal disease, thus becoming the main source of propagation among people, especially in children. Since 1983, when the first 23-component anti-pneumococcal vaccine was authorized, different conjugated vaccines have been developed according to the circulating serotypes that cause invasive pneumococcal diseases (IPD), reducing the incidence and mortality of these diseases considerably. In November 2021, a group of experts held a virtual meeting to update and analyze the impact that pneumococcal vaccines have generated on the countries' public health, especially during the COVID-19 pandemic. The recommendations that emerged included the need to look for alternatives in serotype-independent vaccines after the introduction of pneumococcal conjugate vaccines (PCV) in the national immunization schedules, as well as to strengthen the surveillance of serotypes, focusing on those not included in the current vaccines. The objective of this report is to communicate the conclusions of the group of experts that in November 2021 analyzed the impact of pneumococcal vaccines on public health in the countries, in order to generate recommendations applicable in Latin America.

Socioeconomic disparities associated with mortality in patients hospitalized for COVID-19 in Colombia.

Socioeconomic disparities play an important role in the development of severe clinical outcomes including deaths from COVID-19. However, the current scientific evidence in regard the association between measures of poverty and COVID-19 mortality in hospitalized patients is scant. The objective of this study was to investigate whether there is an association between the Colombian Multidimensional Poverty Index (CMPI) and mortality from COVID-19 in hospitalized patients in Colombia from May 1, 2020 to August 15, 2021. This was an ecological study using individual data on hospitalized patients from the National Institute of Health of Colombia (INS), and municipal level data from the High-Cost Account and the National Administrative Department of Statistics. The main outcome variable was mortality due to COVID-19. The main exposure variable was the CMPI that ranges from 0 to 100% and was categorized into five levels: (i) level I (0%-20%), (ii) level II (20%-40%), (iii) level III (40%-60%), (iv) level IV (60%-80%); and (v) level V (80%-100%). The higher the level, the higher the level of multidimensional poverty. A Bayesian multilevel logistic regression model was applied to estimate Odds Ratio (OR) and their corresponding 95% credible intervals (CI). In addition, a subgroup analysis was performed according to the epidemiological COVID-19 waves using the same model. The odds for dying from COVID-19 was 1.46 (95% CI 1.4-1.53) for level II, 1.41 (95% CI 1.33-1.49) for level III and 1.70 (95% CI 1.54-1.89) for level IV hospitalized COVID-19 patients compared with the least poor patients (CMPI level I). In addition, age and male sex also increased mortality in COVID-19 hospitalized patients. Patients between 26 and 50 years-of-age had 4.17-fold increased odds (95% CI 4.07-4.3) of death compared with younger than 26-years-old patients. The corresponding for 51-75 years-old patients and those above the age of 75 years were 9.17 (95% CI 8.93-9.41) and 17.1 (95% CI 16.63-17.56), respectively. Finally, the odds of death from COVID-19 in hospitalized patients gradually decreased as the pandemic evolved. In conclusion, socioeconomic disparities were a major risk factor for mortality in patients hospitalized for COVID-19 in Colombia.

Inflammasome signaling proteins as biomarkers of COVID-19.

Introduction: One of the main characteristics of COVID-19 is an exacerbated inflammatory response that results in cardiometabolic complications and dysfunction in the nervous system. Moreover, these complications may extend beyond the period of active SARS-CoV2 infection and even extend over a year. Thus, it is important to better understand the contribution of the inflammatory responses in COVID-19 patients, not just in the acute phase but also after the infection has subsided. Methods: We measured the protein levels of inflammasome signaling proteins using Simple Plex microfluidics technology in patients with an active SARS-CoV2 infection and in recovered patients to determine their potential use as biomarkers of COVID-19. We carried out statistical analyses to identify which proteins were increased in COVID-19 patients with active infection and in recovered patients. The receiver operating characteristics (ROC) were calculated for each analyte to determine their potential fit as biomarkers. Results: The inflammasome proteins caspase-1, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), interleukin (IL)-1ß and IL-18 were elevated in the plasma of patients with active infection and remained elevated after the infection was resolved for approximately 2 months after. Levels of caspase-1 and ASC continued to increase long after patients had recovered from the infection. Furthermore, when measuring biomarkers of inflammation during active infection, analyses with area under the curve (AUC) values above 0.75 indicated that caspase-1, ASC, IL-1ß and IL-18 are reliable biomarkers of the inflammatory response during active COVID-19 infection. Moreover, when measuring biomarkers of inflammation after recovery from active infection, caspase-1 and ASC presented AUC values above 0.9. Discussion: These findings indicate that inflammasome signaling proteins can be used to reliably monitor the inflammatory innate immune response in COVID-19 patients.

[Deliberative dialogue with Ibero-American universities on interventions in student mental health during the COVID-19 pandemicDiálogo deliberativo com universidades ibero-americanas sobre intervenções em saúde mental dos estudantes na pandemia de COVID-19]. / Diálogo deliberativo con universidades iberoamericanas sobre intervenciones en salud mental estudiantil durante la pandemia de COVID-19.

Objective: To contextualize a synthesis of evidence on interventions in student mental health during the COVID-19 pandemic through a deliberative dialogue with Ibero-American universities. Methods: An evidence synthesis and synchronous dialogues were previously conducted, consisting of subgroup discussions about the design and implementation of mental health interventions. An analysis of dialogic data was conducted, then organized by topic. Results: Fifty-seven representatives of 17 public and private Ibero-American universities participated in the meeting. In terms of the design of interventions, mental health is perceived as neglected, although its profile was raised by the pandemic. Interventions are guided by detection of needs; scientific evidence is rarely used to design them. Importance was given to forming an interdisciplinary team with continuous training in order to design a specific program that also covers families and teaching/administrative staff. In terms of implementation, problems include saturation of services due to high demand and lack of basic resources among students. Regarding the provision of resources, the influence of the broader context, including the institutional context, is undeniable. The dialogues were perceived as an opportunity to build a new set of interventions. Conclusions: These dialogues enriched the description of interventions already described in the literature on student mental health during the COVID-19 pandemic. However, implementing such interventions in the region means addressing previous neglect and a high level of unmet basic needs.

Objetivo: Contextualizar uma síntese de evidências sobre intervenções em saúde mental de estudantes universitários na pandemia de COVID-19, por meio do diálogo deliberativo com universidades ibero-americanas. Métodos: A partir de uma síntese de evidências previamente elaborada, o diálogo síncrono foi conduzido por meio de discussões em subgrupos sobre o planejamento e a implementação de intervenções em saúde mental. Os dados obtidos foram analisados e resumidos por área temática. Resultados: Cinquenta e sete integrantes de 17 universidades ibero-americanas públicas e privadas participaram do encontro. Os participantes indicaram que a saúde mental é negligenciada no planejamento das intervenções, mas ganhou visibilidade na pandemia. As intervenções são direcionadas às necessidades identificadas e raramente planejadas com base em evidências científicas. Disseram considerar importante formar uma equipe interdisciplinar com capacitação contínua para planejar um programa específico que englobe também familiares e o corpo docente e administrativo. Implementar intervenções é complicado porque os serviços estão sobrecarregados devido à grande demanda e à falta de recursos básicos para os estudantes. O contexto macro e institucional claramente influencia a disponibilização de recursos. O diálogo foi visto como uma oportunidade para consolidar um novo conjunto de intervenções. Conclusões: O presente diálogo contribuiu para enriquecer a literatura de intervenções de saúde mental para estudantes universitários na pandemia de COVID-19. Implementar intervenções no nosso contexto requer sanar as falhas por negligência passada e as enormes necessidades básicas não atendidas.