ABSTRACT
Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
ABSTRACT
Objectives: To estimate the public health impact of COVID-19 booster vaccination in the UK during Omicron predominance, and to explore the impact in counterfactual scenarios with different booster eligibility or uptake. Method(s): A dynamic transmission model was developed to compare public health outcomes for actual and hypothetical UK Spring and Autumn 2022 booster programs. Outcomes were projected over an extended time horizon from April 2022-April 2023, assuming continued Omicron predominance as in Jan-Mar 2022. Health outcomes included averted cases, hospitalizations, long COVID cases, and deaths. NHS resource use outcomes were averted general ward and intensive care unit bed days and general practitioner visits. Patient productivity loss outcomes considered productive days lost for those in and outside the paid work force. Analyses used publicly available data. Result(s): Model output suggested that actual Spring and Autumn 2022 programs, which offered boosters to older adults and vulnerable populations, would avert approximately 716,000 hospitalizations, 1.9M long COVID cases and 125,000 deaths compared to not offering boosters in Spring and Autumn 2022. In a scenario that broadened eligibility to individuals aged >=5 years, an estimated 1.6M hospitalizations, 8.3M long COVID cases, and 222,000 deaths were averted. A scenario assuming broadened eligibility and increased uptake produced the greatest benefit among scenarios analyzed: 1.6M hospitalizations, 9.2M long COVID cases, and 228,000 deaths averted;and 953M productive days saved. Scenarios offering boosters only to high-risk individuals (aged >=5 years) were also estimated to improve benefit relative to actual programs. High-risk-only programs assuming increased uptake provided about half to two-thirds of the benefit estimated for programs assuming broadened eligibility and increased uptake. Conclusion(s): UK booster vaccination programs were estimated to provide substantial benefit to public health during Omicron predominance. Public health benefits could be maximized by broadening booster eligibility to younger age groups and increasing uptake.Copyright © 2023
ABSTRACT
Objectives: Clinical Practice Research Datalink (CPRD) Aurum contains primary care electronic health records, including vaccinations and nearly complete capture of SARS-CoV-2 PCR test results between August 2020-March 2022. Our objective was to build code lists to define a cohort of persons diagnosed with COVID in England using routinely collected health data. Method(s): Persons aged 1 year or older were indexed on first COVID diagnosis from August 1, 2020 - January 31, 2022. We developed SNOMED code lists to define high risk of severe disease: 1) National Health Service's (NHS) list of highest risk conditions;2) PANORAMIC trial inclusion criteria;3) UK Health Security Agency (UKHSA) clinical risk groups. COVID vaccinations were defined as of December 1, 2021 using medical and product codes. Code lists were developed using wildcard search terms which were reviewed by multiple independent reviewers, and inclusion/exclusion was determined by consensus. All lists for diagnoses were reviewed by a UK physician. Result(s): We identified 2,257,907 people diagnosed in primary care with COVID;46% were male and mean age was 34 years, comparable to governmental data for the same period reporting 47% of cases in England were male and mean age was 34 years. We identified 12% at high risk of severe disease using the NHS definition, 31% using the PANORAMIC trial criteria, and 10% using the UKHSA clinical risk groups. Among adults, 86.1% had >=1 and 80.2% had >=2 COVID vaccine doses (2% and 0.2% lower than official reports, respectively). Conclusion(s): This cohort represented the age and sex distribution of COVID cases, and the COVID vaccination coverage, in England through January 2022. Definitions were built using reproducible methods that can be leveraged for future work. The high capture of COVID vaccinations supports the use of this cohort to examine clinical and societal benefits of COVID vaccination in England.Copyright © 2023
ABSTRACT
Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023
ABSTRACT
Introduction: The Portuguese government put into practice a vaccination plan soon after the approval of the first COVID-19 vaccine, prioritizing healthcare professionals (HCPs) and other population groups at risk. Objective(s): To characterize the case reports of adverse drug reactions (ADRs) associated with the administration of Comirnaty to HCPs in a Portuguese oncology hospital (IPO Coimbra). Method(s): This study was a nine-month prospective, observational study following a cohort event monitoring approach focused on signalling ADRs associated with the administration of Comirnaty to HCP in IPO Coimbra. The case reports of ADRs were sent to the Pharmacovigilance Unit of Coimbra (UFC) between 14/01/2021 and 13/10/2021. The population of HCP was characterized according to gender and age distribution. The seriousness of ADRs was assessed for each individual case in accordance with WHO criteria [1]. ADRs were coded with MedDRA version 24.0 (System Organ Classification [SOC] and Preferred Term [PT]). ADRs were classified as ''expected'' or ''unexpected'' according to their description in the Summary of Product Characteristics (SmPC) of Comirnaty [2]. Result(s): A total of 816 HCPs were inoculated with at least one dose of Comirnaty-. The case reports of ADRs concerned 469 (57.5%) HCPs: 386 (82.3%) females;642 (78.7%) aged 30-59 years old. Of the 469 case reports, 24 (5%) were assessed as serious, 44 (9.4%) as unexpected, and 11 (2.3%) as both serious and unexpected. The 469 case reports contained a total of 1,955 ADRs. ''General disorders and administration site condition'' (n = 1,075;54,9%), such as vaccination site pain, chills and vaccination site swelling;''Musculoskeletal and connective tissue disorders'' (n = 373;19.1%), including myalgia and arthralgia;and ''Nervous system disorders'' (n = 250;12.8%), including headache, were the most frequently reported ADRs, which is in line with the SmPC of Comirnaty-. The 11 case reports classified as both serious and unexpected contained a total of 17 ADRs, including hyperhidrosis and paraesthesia. Conclusion(s): The results of this study bring value to the characterization of the safety profile of Comirnaty since the use of a cohort of individuals allows to estimate frequencies of ADRs in the real-world. Further, serious, and unexpected ADRs were identified. Importantly, this type of safety data was further included in the SmPC of the vaccine. In conclusion, the results are in favour of the positive benefitrisk ratio of Comirnaty-, and reinforce the importance of post-marketing pharmacovigilance to increase knowledge on drug safety.
ABSTRACT
Introduction: The COVID-19 pandemic has had an impact on several sectors of the society. Whether it has disrupted drug safety monitoring is yet to be determined. Objective(s): To investigate whether the COVID-19 pandemic has had an impact on the proportions of spontaneous reports (SRs) of serious and unexpected adverse drug reactions (ADRs). Method(s): SRs received by the Coimbra Pharmacovigilance Unit (UFC) between January 2017 and December 2021 were included, except for those containing COVID-19 vaccines as suspected medicines. The SRs were categorized into two groups: pre-pandemic (2017-2019);and post-pandemic (2020-2021). The SRs were classified as serious or non-serious, and expected or unexpected, depending on the seriousness and expectedness of the suspected ADRs, according to the WHO criteria and the Summary of Product Characteristics [SmPC] of each suspected medicine, respectively [1,2]. To study the impact of the COVID-19 pandemic on the patterns of spontaneous reporting of suspected ADRs, two null hypotheses were proposed to test whether (i) the seriousness, and (ii) the expectedness were independent of the pandemic (i.e., if the pandemic has had no impact, then the proportions of SRs containing (i) serious and (ii) unexpected ADRs were expected to be the same in both periods). The qui-square test was used to test the hypotheses;p-values <0.001 were considered statistically significant. Microsoft Excel was used for the statistical analyses. Result(s): A total of 1,311 and 657 SRs were received in the prepandemic and post-pandemic periods, respectively. Of the 1,311 SRs received in the three pre-pandemic years, 1,012 (77%) were serious and 657 (13%) contained unexpected ADRs;of the 657 SR received during the two post-pandemic years, 434 (66%) were serious and 133 (20%) contained unexpected ADRs. The changes from pre- to postpandemic on both proportions of SRs containing serious (an absolute decrease of 11%;p = 0.01) or unexpected ADRs (an absolute increase of 7%;p = 0.01) were not statistically significant. Conclusion(s): The COVID-19 pandemic has had not a significant impact on the proportions of SRs of serious or unexpected ADRs in the Central Region of Portugal. Further research should be carried out in other pharmacovigilance databases to understand if the present conclusions are applicable to other geographic regions.
ABSTRACT
Introduction: The Portuguese government put into practice a vaccination plan soon after the approval of the first COVID-19 vaccine, prioritizing healthcare professionals (HCPs) and other population groups at risk. Objective: To characterize the case reports of adverse drug reactions (ADRs) associated with the administration of Comirnaty to HCPs in a Portuguese oncology hospital (IPO Coimbra). Methods: This study was a nine-month prospective, observational study following a cohort event monitoring approach focused on signalling ADRs associated with the administration of Comirnaty to HCP in IPO Coimbra. The case reports of ADRs were sent to the Pharmacovigilance Unit of Coimbra (UFC) between 14/01/2021 and 13/10/2021. The population of HCP was characterized according to gender and age distribution. The seriousness of ADRs was assessed for each individual case in accordance with WHO criteria [1]. ADRs were coded with MedDRA version 24.0 (System Organ Classification [SOC] and Preferred Term [PT]). ADRs were classified as expected or unexpected according to their description in the Summary of Product Characteristics (SmPC) of Comirnaty [2]. Results: A total of 816 HCPs were inoculated with at least one dose of Comirnaty. The case reports of ADRs concerned 469 (57.5%) HCPs: 386 (82.3%) females;642 (78.7%) aged 30-59 years old. Of the 469 case reports, 24 (5%) were assessed as serious, 44 (9.4%) as unexpected, and 11 (2.3%) as both serious and unexpected. The 469 case reports contained a total of 1,955 ADRs. "General disorders and administration site condition" (n = 1,075;54,9%), such as vaccination site pain, chills and vaccination site swelling;"Musculoskeletal and connective tissue disorders" (n = 373;19.1%), including myalgia and arthralgia;and "Nervous system disorders" (n = 250;12.8%), including headache, were the most frequently reported ADRs, which is in line with the SmPC of Comirnaty®. The 11 case reports classified as both serious and unexpected contained a total of 17 ADRs, including hyperhidrosis and paraesthesia. Conclusion: The results of this study bring value to the characterization of the safety profile of Comirnaty® since the use of a cohort of individuals allows to estimate frequencies of ADRs in the real-world. Further, serious, and unexpected ADRs were identified. Importantly, this type of safety data was further included in the SmPC of the vaccine. In conclusion, the results are in favour of the positive benefitrisk ratio of Comirnaty®, and reinforce the importance of post-marketing pharmacovigilance to increase knowledge on drug safety.
ABSTRACT
Introduction: The COVID-19 pandemic has had an impact on several sectors of the society. Whether it has disrupted drug safety monitoring is yet to be determined. Objective: To investigate whether the COVID-19 pandemic has had an impact on the proportions of spontaneous reports (SRs) of serious and unexpected adverse drug reactions (ADRs). Methods: SRs received by the Coimbra Pharmacovigilance Unit (UFC) between January 2017 and December 2021 were included, except for those containing COVID-19 vaccines as suspected medicines. The SRs were categorized into two groups: pre-pandemic (2017-2019);and post-pandemic (2020-2021). The SRs were classified as serious or non-serious, and expected or unexpected, depending on the seriousness and expectedness of the suspected ADRs, according to the WHO criteria and the Summary of Product Characteristics [SmPC] of each suspected medicine, respectively [1,2]. To study the impact of the COVID-19 pandemic on the patterns of spontaneous reporting of suspected ADRs, two null hypotheses were proposed to test whether (i) the seriousness, and (ii) the expectedness were independent of the pandemic (i.e., if the pandemic has had no impact, then the proportions of SRs containing (i) serious and (ii) unexpected ADRs were expected to be the same in both periods). The qui-square test was used to test the hypotheses;p-values < 0.001 were considered statistically significant. Microsoft Excel® was used for the statistical analyses. Results: A total of 1,311 and 657 SRs were received in the prepandemic and post-pandemic periods, respectively. Of the 1,311 SRs received in the three pre-pandemic years, 1,012 (77%) were serious and 657 (13%) contained unexpected ADRs;of the 657 SR received during the two post-pandemic years, 434 (66%) were serious and 133 (20%) contained unexpected ADRs. The changes from pre- to postpandemic on both proportions of SRs containing serious (an absolute decrease of 11%;p = 0.01) or unexpected ADRs (an absolute increase of 7%;p = 0.01) were not statistically significant. Conclusion: The COVID-19 pandemic has had not a significant impact on the proportions of SRs of serious or unexpected ADRs in the Central Region of Portugal. Further research should be carried out in other pharmacovigilance databases to understand if the present conclusions are applicable to other geographic regions.
ABSTRACT
Background and importanceThe COVID-19 vaccines have shown excellent safety and efficacy profiles. Healthcare workers (HCW), a priority group for vaccination in Portugal, were probably the first to receive mixed vaccines for COVID-19. A previous study reported more adverse events (AE) after using two different COVID-19 vaccines in adults aged 50 years and older. To our knowledge, there are no data for younger individuals.Aim and objectivesTo identify and compare self-reported AE after a second dose of Pfizer or AstraZeneca vaccines in HCW who received a first dose of AstraZeneca vaccine.Material and methodsProspective, cohort study, including hospital HCW who received a first dose of AstraZeneca vaccine, and a second dose of AstraZeneca (group A) or Pfizer (group B) and completed a pharmacovigilance monitoring plan. Specific local reactions and systemic events were assessed until 10 days after each dose of the vaccine by means of a questionnaire. The data were processed using SPSS 26.0.ResultsThe study included 247 HCW, mean age 41.7±10.8 years, with 75% being female. Of them, 127 were included in group A and 120 in group B. In group A, 76.4% reported at least 1 AE, with a total of 423 AE and a median of 3 (0–15). In group B, 87.5% reported at least 1 AE, with a total of 594 AE and a median of 5 (0–17). The systemic AE with higher incidence were fatigue, malaise and headache in both groups, and chills for group A and somnolence for group B. We found a statistically significant difference in the occurrence of AE (p<0.05;OR 0.462 (0.234;0.910)) and in the number of AE in both groups (p<0.05).Conclusion and relevanceThe reported AE frequency in this study is in agreement with that described by other authors. In this study, HCW receiving a second dose of Pfizer were more likely to have an AE and higher number of AE. There are some limitations, namely, post-vaccination symptom data were self-reported and not verified. Active surveillance should continue to check the vaccines’ risk/benefit ratio over time. This safety profile knowledge in younger individuals may contribute to boosting trust in vaccines.References and/or acknowledgements1. Shaw RH, Stuart A, Greenland M, Liu X, Van-Tam JSN, Snape MD. Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data. Lancet 2021;397(10289):2043–6.Conflict of interestNo conflict of interest
ABSTRACT
Background/Introduction: The approval of COVID-19 vaccines has been based on fast clinical development programs leading to limited knowledge on safety data [1]. Unexpected adverse drug reactions (ADRs), including rare ADRs or delayed ADRs from long-term exposure, may occur [2]. Moreover pre-marketing clinical trials do not have power to detect all ADRs, thereby highlighting the need to analyse post-marketing spontaneous reports (SRs). Objective/Aim: To identify unexpected ADRs associated with COVID-19 vaccines spontaneously reported to the Regional Pharmacovigilance Unit of Coimbra in Portugal (UFC). Methods: SRs of ADRs associated with COVID-19 vaccines received by UFC between 30/12/2020 and 30/04/2021 were included. ADRs were coded with MedDRA®, v.24 (System Organ Classification [SOC] and Preferred Term [PT]). ADRs were classified as "expected" or "unexpected" according to their description on the vaccines Summary of Product Characteristics (SmPC). Further, each unexpected ADR was classified as an important medical event (IME) according to the list from the European Medicines Agency (EMA). Results: A total of 771 SRs, of which 262 SRs (34%) contained a total of 420 unexpected ADRs were received. For Comirnaty®, out of 287 unexpected ADRs, 26 (9.1%) were IME. The most frequently reported IMEs were angioedema (n = 2;7.7%), bradycardia (n = 2;7.7%), death (n = 2;7.7%), deep vein thrombosis (n = 2;7.7%), ischaemic stroke (n = 2;7.7%), and seizure (n = 2;7.7%). The remaining ADRs (acute kidney injury, cardio-respiratory arrest, cerebrovascular accident, corneal opacity, haemorrhagic stroke, hypertensive crisis, laryngeal oedema, loss of consciousness, pneumonia, pulmonary oedema, sepsis, status epilepticus, tongue paralysis and upper gastrointestinal haemorrhage), had one report each (n=14;53.8%). Of the 121 unexpected ADRs reported for Vaxzevria®, 20 were IME (16.5%). The most frequently reported IMEs were ischaemic stroke (n = 5;25.0%), and conjunctival haemorrhage (n = 3;15.0%). The remaining ADRs (acute myocardial infarction, altered state of consciousness, angina pectoris, arrhythmia, death, guillain-Barre syndrome, hypothermia, mesenteric vein thrombosis, monoplegia, pericarditis, syncope and truncus coeliacus thrombosis), had one report each (n = 12;60.0%). Twelve unexpected ADRs were reported for the Moderna COVID-19 vaccine®, of which 4 IMEs (33.3%), corresponding to cerebrovascular accident (n = 1;25.0%), conjunctival haemorrhage (n = 1;25.0%), death (n = 1;25.0%) and retinal artery occlusion (n = 1;25.0%). Conclusion: A considerable proportion of SRs received by UFC contained unexpected ADRs, among which 11.9% were IMEs. These results highlight the value of post-marketing spontaneous reporting to identify unknown ADrs and to better characterize the safety profiles of newly approved COVID-19 vaccines, as well as their benefit/risk ratios.
ABSTRACT
Background: The surge of the COVID-19 pandemic in Portugal and the implemented public health measures were accompanied with a noticeable decrease in patients' attendance to the Emergency Department (ED). Objectives: This study aims to evaluate the impact of COVID-19 pandemic on Vascular Surgery ED admissions, by comparing clinical and demographic characteristics of patients visiting the ED during the pandemic and the homologous period of 2019. Methods: We retrospectively collected data from patients admitted to the ED of a Portuguese tertiary hospital centre between March 4th and April 1st, 2020 - two weeks before and two weeks after the governmental implementation of the state of emergency in our country due to the COVID-19 pandemic - and the homologous period of 2019. Individual medical records were revised to obtain patients demographics and characteristics, clinical severity under the Manchester Triage System (MTS), final diagnosis, need for hospitalization or emergent/urgent surgery, in-hospital length of stay and mortality within 30 days of hospital discharge. Results: A total of 119 and 210 patients visited the Vascular Surgery ED during the pandemic and the homologous period of 2019, respectively. Males comprised the majority of patients in both years and the proportion of women visiting the ED was lower in 2020 compared to 2019 (P=0.015). The MTS attributed a lower number of high-priority levels (yellow and orange) to patients visiting the ED in 2020 (P=0.048). A higher proportion of patients required in-hospital treatment or emergent/urgent surgery (P<0.001 and P=0.002, respectively) during the pandemic. No differences were observed in in-hospital length of stay and early mortality. The most prevalent diagnosis during this critical period were chronic limb threatening ischemia (CLTI), deep vein thrombosis, and acute limb ischemia;in 2019, CLTI, non-vascular limb pain and post-operative pain were the dominating diagnosis. Conclusion: We found a 43.3% decrease in the number of visits to the Vascular Surgery ED in the first month after the inaugural diagnosis of COVID-19 in Portugal. There was a significant reduction of patients with high-priority complaints, but those who presented to the ED had more severe and advanced disease, refiected by the increased proportion on hospitalization and emergent/urgent surgery requirements. Fear of infection and mobility limitations imposed by the quarantine may deter patients from attending the ED and delay proper healthcare. Mid to long-term impact of such behaviour on morbimortality should be determined to evaluate the quality of response of healthcare services to the pandemic.
ABSTRACT
In parallel with the technological revolution there was a decrease in industrial activities, diminishing the necessity for labor in the sector, on the other hand, the demand for service providing professionals grew. Besides, the Sars-coV-19 pandemic brought a new set of concerns for society in all dimensions of sustainability: economic, social, and environmental. Further this scenario of growth in the importance of the third sector for World GDP, and the necessary changes concerning to the social, environmental and economical questions, a concern for capacitating specified labor for the resolution of problems in services is overlooked. Therefore, this article has the objective investigate the capacity of engineers to act in the service sector. To accomplish this goal a methodological procedure was structured and an investigation that can be characterized as a descriptive, a survey type design research was launched. Quantitative data regarding the existence of undergraduate and graduate degrees in the field of Service Engineering was collected. Although, it is considered that even though a few initiatives in this direction, they are still incipient. It was found, as final considerations, the importance of a service engineering professional, justified by the global demand for labor capable of solving the daily problems faced in the third sector, as well as the relevance in a graduation specific to the services sector. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Covid-19 pandemic forced, at the final rounds of 2019-2020 season, in many different sport leagues worldwide, teams to play without an audience. Therefore, the present paper aims to compare the home advantage score in the last ten rounds in 2019-2020 season with the first 24 rounds in same season using Pollard's (1986) and Matos et al.'s (2020) methods. In addition, comparisons across different seasons (2016-2017;2017-2018;2018-2019 and 2019-2020) using the same methods were also analyzed. Results showed no differences (p > 0.05) between first 24 rounds and the last 10 in 2019-2020 season as well as in the 3 previous seasons. With Pollard's method, no differences (p > 0.05) were also found among those four seasons on global (all 34 rounds) home advantage. However, a significance difference between 2017-2018 and 2019-2020 (p < 0.05) was founded using Matos et al.'s (2020) method, which is an indicator of the importance of using complementary methods when analyzing the same realities. Overall, despite what might be expectable from recent findings, the lack of an audience in the last 10 rounds of Portuguese Football League 2019-2020 season, due to COVID-19 pandemic, did not affect home advantage. Therefore, future studies could try to analyze other different variables in Portuguese Football League, such as referees' behaviors, rules changing (e.g., the possibility of making five substitutions, instead of three), crowd dimension and density as well as include variables about odds as forecasts in football being played without crowds.