Multisystem Inflammatory Syndrome in Children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain. (preprint)

Purpose Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical and laboratory findings of all the MIS-C cases diagnosed in children < 18 years-old in Catalonia (Spain) to study their trend throughout the pandemic.Methods Multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all the hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR).Results Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. Monthly MIS-C incidence was 4.1 (95%CI: 3.4–4.8) per 1,000,000 people, and 273 (95%CI: 230–316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, MIS-C RR was 8.2 (95%CI: 5.7–11.7) per 1,000,000 SARS-CoV-2 infections, significantly lower (p < 0.001) than for previous variant periods, in all age groups. Median [IQR] age of MIS-C was 8 [4–11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39oC (81.6%), nearly 40% had an abnormal echocardiography and 7% coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).Conclusions The rate ratio between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all the age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic.

Late Reinfection With a Different SARS-CoV-2 Clade in a Patient With Refractory Arterial Hypertension: a Case Report. (preprint)

Background: Differentiating between persistent infection with intermittent viral shedding and reinfection with SARS-CoV-2 remains challenging. Although a small number of cases with genomic evidence of second infection have been reported, limited information exists on frequency and determinants of reinfection, time between infections, and duration of immunity after the primary infection. Case presentation: We report a reinfection with SARS-CoV-2 in a 52-year old male whose primary infection was diagnosed in May 2020, during the first wave of the pandemic in Spain, and the second occurred eight months later, in January 2021. We present a complete data set including results from real-time polymerase chain reaction, serology and genome sequencing confirming reinfection with a different clade. Noteworthy was that the patient was immunocompetent but had multiple cardiometabolic comorbidities, including refractory arterial hypertension, that might increase the individual risk in COVID-19. Conclusions: This case of reinfection with SARS CoV-2 occurring several months after the primary infection reports the longest time interval between reinfection and initial infection described to date. It raises concerns on the duration of protective immunity, suggesting that it may begin to wane in patients who acquired the initial infection during the first wave of the pandemic. The potential contributing role of arterial hypertension and cardiometabolic comorbidities as risk factors for reinfection deserves investigation.

University Student’s Lifestyle Changes During COVID-19 Lockdown: A Spanish Cross-Sectional Survey. (preprint)

Background Coronavirus disease 2019 (COVID-19) pandemic has an impact on the university student’s lifestyles. The present study aims to investigate the perceived changes in lifestyles among Spanish university students during the confinement.Method: An observational, descriptive, cross-sectional study with a 2-time cut was conducted during the month of April in 2020. Sociodemographic and anthropometric data was then obtained. The FANTASTIC questionnaire was used to assess lifestyles of the 488 participants who took part in the study. The STROBE cross-sectional reporting guidelines were followed on this study.Results 76.3% of the participants were female. Overall, the lifestyles of university students had significantly deteriorated during the period of confinement caused by the COVID-19 pandemic in Spain. University female students have been especially affected compared to their male fellows (p = .010). For women, social and family relationships (p < .001), personality (p < .001), interior (p < .001) and career (p < .001) were the aspects that worsened during confinement. For men, lack of physical exercise practice (p < .001), social and family relationships (p < .001) and career (p = .002) were affected to a greater extent. In both cases confinement was a protective factor against the consumption of tobacco, toxins (p < .001) and alcohol (p < .001). Gender (p = .008) and obesity (p = .044) are the two factors that most affected the change in the score of the FANTASTIC questionnaire.Conclusions The Spanish university students’ lifestyles have worsened during the lockdown caused by the COVID-19 pandemic, especially women who were the most affected. Some aspects such as those related to social and emotional behaviors have been deeply affected, while confinement could be a protective factor against previous toxic habits.

Performance of saliva specimens for the molecular detection of SARS-CoV-2 in the community setting: does sample collection method matter? (preprint)

BackgroundData on the performance of saliva specimens for diagnosing COVID-19 in ambulatory patients are scarce and inconsistent. We assessed saliva-based specimens for detecting SARS-CoV-2 by RT-PCR in the community setting and compared three different collection methods. MethodProspective study conducted in three primary care centres. RT-PCR was performed in paired nasopharyngeal swabs (NPS) and saliva samples collected from outpatients with a broad clinical spectrum of illness. To assess differences in collection methods, saliva specimens were obtained in a different way in each of the participating centres: supervised collection (SVC), oropharyngeal washing (OPW) and self-collection (SC). ResultsNPS and saliva pairs of samples from 577 patients (median age 39 years, 44% men, 42% asymptomatic) were collected and tested, and 120 (20.8%) gave positive results. The overall agreement with NPS and kappa coefficients (K) for SVC, OPW and SC were 95% (=0.85), 93.4% (=0.76), and 93.3% (=0.76), respectively. The sensitivity (95% CI) of the saliva specimens varied from 86% (72.6-93.7) for SVC to 66.7% (50.4-80) for SC samples. The sensitivity was higher in samples with lower cycle threshold (Ct) values. The best performance of RT-PCR was observed for SVC, with sensitivity (95% CI) for Ct values [≤]32 of 97% (82.5-99.8) in symptomatic, and 88.9% (50.7-99.4) in asymptomatic individuals. ConclusionsSaliva is an acceptable specimen for the detection of SARS-CoV-2 in the community setting. Specimens collected under supervision perform comparably to NPS and can effectively identify individuals with higher risk of transmission in real life conditions.