Estructura urbana y movilidad como factores de vulnerabilidad. Lima y Bogotá en tiempos de cuarentena

The COVID-19 pandemic and the preventive measures that were adopted have had a wide range of consequences that went beyond health problems for the inhabitants of many cities around the world. In order to understand why the impacts on the dwellers' lives were so different within the city, we looked at pre-existing socio-spatial vulnerabilities, taking as an example the metropolises of Lima and Bogota. We investigated the relationship between urban structure, daily mobility patterns and the effects of COVID-19 during the 2020 quarantines. We adopted a multidimensional approach using census data, the latest available origin-destination surveys, and the levels of contagion in both cities during 2020. Based on a factor analysis and a cluster analysis, we devised a typology and a synthetic map of pre-existing vulnerability factors. The results allow us to understand the role of these factors in the difficulties that the populations had to face during the quarantine, and why people living in the low-income outskirts suffered the worst disruptions in their daily lives. © 2022 Universidad Nacional de Colombia. All rights reserved.

Urban structure and mobility as vulnerability factors. Lima and Bogota in times of quarantine

The COVID-19 pandemic and the preventive measures that were adopted have had a wide range of consequences that went beyond health problems for the inhabitants of many cities around the world. In order to understand why the impacts on the dwellers' lives were so different within the city, we looked at pre-existing socio-spatial vulnerabilities, taking as an example the metropolises of Lima and Bogo-ta. We investigated the relationship between urban struc-ture, daily mobility patterns and the effects of COVID-19 during the 2020 quarantines. We adopted a multidimen-sional approach using census data, the latest available ori-gin-destination surveys, and the levels of contagion in both cities during 2020. Based on a factor analysis and a clus-ter analysis, we devised a typology and a synthetic map of pre-existing vulnerability factors. The results allow us to understand the role of these factors in the difficulties that the populations had to face during the quarantine, and why people living in the low-income outskirts suffered the worst disruptions in their daily lives.

Impact of vaccination on the epidemiology and prognosis of pneumonia.

Adults with lung diseases, comorbidities, smokers, and elderly are at risk of lung infections and their consequences. Community-acquired pneumonia happen in more than 1% of people each year. Possible pathogens of community-acquired pneumonia include viruses, pneumococcus and atypicals. The CDC recommend vaccination throughout life to provide immunity, but vaccination rates in adults are poor. Tetravalent and trivalent influenza vaccine is designed annually during the previous summer for the next season. The available vaccines include inactivated, adjuvant, double dose, and attenuated vaccines. Their efficacy depends on the variant of viruses effectively responsible for the outbreak each year, and other reasons. Regarding the pneumococcal vaccine, there coexist the old polysaccharide 23-valent vaccine with the new conjugate 10-valent and 13-valent conjugate vaccines. Conjugate vaccines demonstrate their usefulness to reduce the incidence of pneumococcal pneumonia due to the serotypes present in the vaccine. Whooping cough is still present, with high morbidity and mortality rates in young infants. Adult's pertussis vaccine is available, it could contribute to the control of whooping cough in the most susceptible, but it is not present yet in the calendar of adults around the world. About 10 vaccines against SARS-CoV-2 have been developed in a short time, requiring emergency use authorization. A high rate of vaccination was observed in most of the countries. Booster doses became frequent after the loss of effectiveness against new variants. The future of this vaccine is yet to be written.

An appraisal of respiratory system compliance in mechanically ventilated COVID-19 patients

Rationale Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous smallcase series or studies conducted at a national level.Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe the impact of CRS on the ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.Results We enrolled 318 COVID-19 patients enrolled into the study from January 14th through September 31th, 2020 in 19 countries and stratified into two CRS groups. CRS was calculated as: tidal volume/[airway plateau pressure-positive endexpiratory pressure (PEEP)] and available within 48h from commencement of MV in 318 patients. Patients were mean±SD of 58.0±12.2, predominantly from Europe (54%) and males (68%). Median CRS (IQR) was 34.1 mL/cmH2O (26.5-45.5) and PaO2/FiO2 was 119 mmHg (87.1-164) and was not correlated with CRS. Female sex presented lower CRS than in males (95% CI:-13.8 to-8.5 P<0.001) and higher body mass index (34.7±10.9 vs 29.1±6.0, p<0.001). Median (IQR) PEEP was 12 cmH2O (10-15), throughout the range of CRS, while median (IQR) driving pressure was 12.3 (10-15) cmH2O and significantly decreased as CRS improved (p<0.001). No differences were found in comorbidities and clinical management between CRS strata. In addition, 28-day ICU mortality and hospital mortality did not differ between CRSgroups.Conclusions This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV-predominantly males or overweight females, in their late 50s-admitted to ICU during the first international outbreaks. Phenotypes associated with different CRS upon commencement of MV could not be identified.