ABSTRACT
The measure of school closures in the context of the pandemic caused by the SARS COV2 virus did not take into account the diversity of socioeconomic and geographic situations of families living in rural areas. Most of these families do not have a stable and quality Internet connection as a resource for continuing their children's schooling through virtuality. The objective to this article is to demonstrate that, despite the difficulties mentioned above, the pedagogical tools of alternation have allowed to support the pedagogical continuity of the students, since there was a previous experience linked to self-management and accompaniment of the families. Methodologically, we analyzed the results of a survey applied to rural alternation schools in the province of Buenos Aires to learn about what happened during the pandemic. We complemented this analysis with the coding of interviews conducted with actors linked to these schools. We conclude that it is important to consider self-management and accompaniment of families not only as a circumstantial solution for a specific moment but as part of an educational and political project for rural communities.
ABSTRACT
Background: Data on SARS-CoV-2 infection in Hemoglobinopathies are still scarce and controversial. Since March 2020, we, as Italian Society for Thalassemia and Hemoglobinopathies (SITE), recommended close monitoring and set up an Italian survey to verify the impact of SARSCoV- 2 infection on patients with Hemoglobinopathies (EMO AER COVID-19 NCT04746066) among Italian Centers. Aims: To explore the hypothesis of an increased vulnerability of Hemoglobinopathies to SARS-COV2 infection. Methods: After SITE proposal and Ethics Committee approval, each participating Center entered data on a specific electronic Case Report Form (eCRF) (https://covid19.site-italia.org). Inclusion criteria included positive swab or serology and at least 15 days of follow-up from either the onset of symptoms or SARS-CoV2 positivity. This cut-off is updated to February 15, 2021. Results: Twenty-seven Centers that provide care to 6121 patients with Hemoglobinopathy (65% of the Italian population) recorded a total of 275 SARS-CoV2 infections (overall, prevalence 4.5%), in 191 transfusion- dependent thalassemia cases (TDT, prevalence 5.8%), 36 non-transfusion- dependent thalassemia (NTDT, prevalence 2.3%) and 48 sickle cell disease patients (SCD, prevalence 3.7%). Median age was 41 years (IQR: 30-48, range: 9 months-85 year). Twenty-eight patients (10 %) were pediatrics (median age: 6.5 years, IQR: 4-11). Most patients (72%) had comorbidities;134 (49%) had splenectomy or functional asplenia. We observed a broad spectrum of disease severity, ranging from no symptoms in 65 patients (24%) to multisystem organ failure and death in 5 patients: 2 TDT (age: 49 and 56 years), 1 NTDT (age: 45 years), 2 SCD (age: 57 years both). Overall, 56 (20%) patients required hospitalization, 12 in high-intensity care unit;10 required support by oxygen, 11 needed more intensive ventilation support with continuous positive airway pressure (CPAP), and 7 required intubation. Nine patients required ad hoc transfusion or more than scheduled. Two SCD patients of 9 and 20 months of age, respectively, recovered after a long and life-treating disease. One TDT patient experienced reinfection after 3 months from the first;one 30w-pregnant SCD woman developed COVID-19 without consequences for herself and the fetus. Overall clinical severity has been higher in SCD than in thalassemia patients. Summary/Conclusion: The prevalence of COVID-19 in Hemoglobinopathies apparently overlaps the general population (4.5% vs 4.6%), however, these patients are more strictly observed and we could postulate that the precautions suggested or self-applied by the patients were effective. The overall mortality is 1.8% vs 3.4% and the difference may be due to the younger age of patients with Hemoglobinopathies. Our data confirm the higher risk of severe disease and death in SCD.
ABSTRACT
Objectives: As of December 2020, COVID19 has infected over 13 million Americans and killed over 275,000. Each infection surge leads to increased emergency department (ED) utilization and subsequent critical care admission for patients with acute respiratory distress syndrome (ARDS). Not all COVID19 patients necessitate a ventilator and therefore can remain at home to minimize infection spread and manage hospital capacity concerns. Remote Bluetooth-enabled pulse-oximeter monitoring of moderate-to-severely ill COVID19 patients can be used to closely monitor symptoms and trigger necessary visits to the hospital. Our objective was to analyze remote pulse-oximeter monitoring cost-effectiveness to reduce facility burden and health expenditures. Methods: We analyzed home-monitoring with pulse-oximetry cost-utility using a Markov model over a 3-week time horizon in daily cycles from a US health sector perspective. Cost and outcome measures were derived from real-world evidence from University Hospitals. Pulse-oximetry monitoring was implemented for patients presenting at the ED with ARDS-like symptoms but not necessitating immediate care;patients were then remotely monitored by experts for up to 4-days until recovery or a second ED visit. Additional parameters were extracted from literature. Costs (2020 U.S. dollars) and quality-adjusted life years (QALYs) were used to determine the incremental cost-effectiveness ratio (ICER) at a $100,000/QALY cost-effectiveness threshold. Model uncertainty was assessed using one-way and probabilistic sensitivity analysis. Results: Results demonstrated that pulse-oximetry monitoring dominated current standard care for COVID19 patients based on reduced costs and increased QALYs. Individuals with access to remote pulse-oximetry monitoring averaged $49,176 and 0.03 QALYs, whereas standard care increased costs to $113,792 and 0.02 QALYs. Resulting ICER was not sensitive to uncertainty ranges. Conclusions: Remote pulse-oximetry monitoring of symptomatic COVID19 patients increases the specificity of those requiring immediate follow-up. We recommend adoption of this technology across health systems to cost-effectively manage COVID19 volume surges, maintain patients’ comfort, reduce infection spread, and simultaneously monitor multiple patients.