[Factors associated with the duration of SARS-CoV-2 infection in healthcare professionals at a second-level public hospital in the Community of Madrid (Spain) during the sixth wave.]

OBJECTIVE: The incidence of COVID-19 infections among health professionals during the sixth wave has suffered an exponential increase, mainly due to the rapid community transmission caused by the Omicron variant. The main objective of the study was to evaluate the time to negativization in COVID-positive health professionals during the sixth wave, according to the PDIA result;and secondarily, to evaluate the possible influence of other factors (previous infection, vaccination, sex, age, job position) on the time to get negative status. METHODS: A descriptive, longitudinal, observational and retrospective study was carried out at Infanta Sofia University Hospital (Madrid, Spain). Made from the registry of the Occupational Risk Prevention Service of suspected or confirmed cases of SARS-COV-2 infection in health professionals, during the period between November 1, 2021 and February 28, 2022. Bivariate comparisons were made using Mann Whitney, Kruskal Wallis or Chi-square test (or exact test) according to variables. Subsequently, logistic regression (explanatory model) was performed. RESULTS: The cumulative incidence of SARS-COV-2 infection in health professionals was 23.07%. The mean time to become negative was 9.94 days. Only the history of previous SARS-COV-2 infection had a statistically significant influence on the time to negativization of PDIA. The variables vaccination, sex and age had no effect on the time to negativization of PDIA. CONCLUSIONS: Professionals with a history of COVID-19 infection present lower times of negativization than those who had not have the disease. The results of our study confirm the immune escape of the vaccine against COVID-19, since more than 95% of those infected had received a complete vaccination schedule.

Active medical recommendation is the best tool for increasing influenza vaccine coverage in healthy adult workers

Introduction: In Spain, influenza vaccination is available in companies free of charge for their workers. Despite this, vaccination coverage against influenza is very low in these groups. Objective(s): The aim of this work is to know the reasons for acceptance of influenza vaccination in a working population. Method(s): During the 2021-2022 influenza vaccination campaign, we conducted a survey of two groups of workers at the automobile factories of RENAULT ESPANA S.A. in the cities of Valladolid and Palencia (Spain). The first group (NV) was formed by 304 (33.5%) workers who did not receive the influenza vaccine in the previous season. The second (V) was formed by 604 workers (66.5%) who had been vaccinated against influenza at least the previous season. In the NV group, they were asked the reasons why they did not get vaccinated the previous season and if they did so in 2021-2022. In group V, only the reasons for continuing to be vaccinated were asked. Result(s): In NV, the main reason for avoiding vaccination in the previous season was the lack of perception of the severity of the influenza infection (74.7%), and 31.6% and 29.0% of them decided to get vaccinated during the 2021-2022 season due to the fear of co-infection of SARS-CoV-2 and influenza and medical recommendations respectively. The 83.5% of group V responded that the reason for getting vaccinated in 2021-2022 was their adherence to vaccination. Conclusion(s): The results show that medical recommendation is the best tool to vaccinate workers against influenza and make them adhere to it. Also, the fear to co-infection of COVID-19 and flu was a frequent reason for getting vaccinated, above all in NV.Copyright © 2023

Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare area in Andalusia, Spain

Introduction: The COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. Methods: We present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥ 14 years. The reasons for consultation were pre-established: "primary headache” (PH), "new-onset cognitive impairment” (CI), "complications of dementia” (DEM), and "epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. Results: A total of 1,806 e-consultations were received (approximately 6/1,000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: "refer for in-person consultation” (47.12%), "resolved” (39.98%), "criteria not met” (12.57%), or "follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%);the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of "resolved” e-consultations reached 52.61%. Conclusions: Asynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, "one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments. © 2023

Evaluation of COVID mortality during hospital admission in patients receiving oncological treatment

Background and importanceCOVID-19 mortality changes depending on patients’ characteristics. The literature describes similar mortality in general COVID-19 patients and those receiving cancer therapies. However, cancer treatments represent a heterogeneous group.Aim and objectivesTo evaluate how different cancer treatments can affect COVID-19 mortality in patients requiring hospital admission.Material and methodsRetrospective observational analysis conducted from March 2020 to February 2021 in a tertiary hospital.Bio-demographic data (sex, age) and clinical data (type of cancer, ECOG, comorbidities) were obtained from the hospital records.All adult oncological patients admitted for COVID-19, who had received anticancer drugs at least 6 weeks prior to hospital admission, were included.Patients were classified according to type of treatment: chemotherapy, immunotherapy, hormonal therapies, or targeted-treatment.ResultsOf 5633 cancer patients treated at our centre, 108 (1.9%) met the inclusion criteria and were included.59 (54.6%) were men, median age 64 (21–96) years, 50 (46.3%) had ECOG 0 or 1.Treatment received: chemotherapy (62, 57.4%), immunotherapy (32, 29.5%), targeted-therapy (23, 21.2%), hormone therapy (3, 2.7%) or another antineoplastic agent (6, 5.55%). The most frequent comorbidities were: hypertension (50, 46.3%), dyslipidaemia (33, 30.6%) and diabetes (24, 22.2%).Half of the patients with lymphoid neoplasms (22, 20.3%) received chemotherapy (13;59.1%) or immunotherapy (11;50%).Of 20 (18.5%) patients with gastrointestinal, 13 (12.0%) with lung and 12 (11.1%) with head and neck cancer, respectively, 14 (70%), 9 (69.2%) and 10 (83.3%) had received chemotherapy.Mortality rate for all patients admitted to hospital with moderate-severe COVID was 10.4%, while patients included in our study had a higher mortality (n=38;35.1%).Higher mortality was associated with immunotherapy (40.6%) and targeted-therapy (43.4%). Chemotherapy was less related with mortality (28.5%). Anti-CD20 was the mechanism of action most related with mortality (n=10;mortality: 60%).Conclusion and relevanceAlthough some evidence suggests that recent exposure to systemic anticancer therapy does not increase COVID-19 mortality, our results show that in a subgroup of moderate-severe hospitalised patients, cancer treatment does increase COVID-19 mortality.Immunotherapy and targeted-therapy could be more related to higher mortality rates than chemotherapy. Specifically, anti-CD20 have significantly higher mortality than other drugs.References and/or acknowledgementsConflict of interestNo conflict of interest

Flexibility, Occupation and Gender: Insights from a Panel Study of Online Freelancers

We report findings and discuss implications from a panel study of 68 U.S.-based online freelancers. These findings emerge from analysis of two rounds of data collection: The first round straddled the arrival of COVID in 2020 and the ensuing pandemic-inspired economic downturn. The second round, from early 2021, provides insight into how online work changed in the following months. We see online freelancing as a window into one future of work, one where the market, not the organization, is the primary structure of the worker-employer interaction, mediated by digital platforms and relying on both algorithms and interaction between parties. Our purposive sampling framework, multiple sources of data, and longitudinal design provides for both empirical and conceptual insights into the occupational differences and arrangements of freelance workers. Findings make clear: 1) these workers value job flexibility even as workers experience diminishing flexibility;2) occupation mediates worker’s experiences;and 3) gender differences impact the outcomes of this form of work. These findings also highlight the precarity of online freelance work, raising questions about both online freelancing, and market-based labor structures more generally, as a sustainable source of work or viable career path. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

[Coinfections by SARS-CoV-2 and other respiratory viruses and their clinical outcome]

Background: SARS-CoV-2 is a coronavirus described for the first time in China, in December 2019. This virus can cause a disease with a very variable spectrum that ranges from asymptomatic cases to deaths. The most severe cases are normally associated with comorbidities and with the age of the patient. However, there are patients who are not part of these risk groups and develop severe cases. Objetive: To determine the association between coinfections by SARS-CoV-2 and other respiratory viruses and their clincal outcome. Material and methods: RT-qPCR was performed to determine the presence of 16 respiratory viruses in 103 confirmed COVID-19 cases. Demographic and comorbid data were collected, and statistical analyzes were performed to determine associations with severity. Results: Of the 103 analyzed cases, 14 (13.6%) presented a coinfection, of these, 92% did not require hospitalization, even in those cases in which the patient presented advanced age and some comorbidities. Conclusions: These results suggest that coinfection of SARS-CoV-2 and other respiratory viruses is not related to a more severe form of COVID-19 and, in some cases, depending on the virus involved, it could even lead to a better prognosis. These findings lay the foundations for the development of new studies that could determine the biological mechanism of this phenomenon.

Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive women. METHODS: Pregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab 24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the study population. RESULTS: Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our results also showed that 40-60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested. CONCLUSION: This study contributes evidence to reinforce the potential for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

ORAL ABSTRACTS: O4 IMPACT OF THE COVID-19 PANDEMIC ON PREGNANCY PREFERENCES: A LONGITUDINAL INTERRUPTED TIME-SERIES STUDY

Objectives: Research on how major disruptive events – pandemics, wars, and economic recessions – influence people's pregnancy intentions and fertility yields mixed findings. Experts have speculated about the impact of the COVID-19 pandemic on pregnancy desires, but existing research has major limitations, including being cross-sectional, relying on people's perceptions of their preference changes (rather than documenting actual changes), and lacking valid measures. Methods: Using longitudinal data collected from March 2019 to March 2021, we assessed changes in trajectories of pregnancy preferences among women aged 15-34 in Arizona, New Mexico, and Texas (N=630, n=2,860). At baseline and quarterly for one year, participants responded to a validated measure of feelings and desires around pregnancy within 3 months (Desire to Avoid Pregnancy [DAP] scale, range 0-4, 4=higher preference to avoid pregnancy). We used multivariable mixed effects segmented regression to examine changes in pregnancy preferences before and during the pandemic. Results: Over the 12-months prior to the first shelter-in-place order (April 2020), marginal DAP scores decreased steadily over time (coefficient.=-0.24/year [95% CI: -0.31- -0.17], p<0.001). When shelter-in-place went into effect, DAP scores stopped declining and became flat (coefficient.=0/year, change in slope: p<0.001). Scores remained flat until the resurgence in COVID-19 cases in November 2020, when DAP scores started to increase, but insignificantly (coefficient.=0.25/year). Time-by-socioeconomic status interactions were insignificant. Conclusions: Pandemic onset was associated with changes in people's preference to avoid pregnancy, stalling a general trend toward greater openness to pregnancy over time. Understanding how COVID-19 affected people's pregnancy preferences is essential for evaluating pandemic effects on contraception and abortion.

SARS-CoV-2 contact tracing among disadvantaged populations during epidemic intervals should be a priority strategy: results from a pilot experiment in Barcelona.

OBJECTIVES: The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas. STUDY DESIGN: Longitudinal analysis of contacts identified from index cases. METHODS: A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts. RESULTS: In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval {CI} = 27.3-38.0]), with a secondary infection rate of 48.3% (95% CI = 40.8-55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P < 0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI = 41.0-60.9] vs 22.3% [95% CI = 16.8-28.8]; P < 0.001). CONCLUSIONS: Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.

Early impact of COVID on the activity of a clinical research oncology pharmacy unit at a tertiary care hospital

Background and importance The COVID-19 pandemic has impacted notably on clinical care and led to numerous challenges in the conduct of clinical trials (CT). Hospital pharmacies have had to develop new procedures and strategies to ensure pharmaceutical care, availability of treatment and patient safety. Aim and objectives To analyse the activity in a clinical research oncology pharmacy unit during the COVID-19 period. Material and methods We retrospectively collected the number of site initiation visits (SIV) and pharmaceutical care visits (screening visits, cycle 1 day 1 (C1D1) visits, follow-up visits, medical queries or patient's queries) performed in our unit from January to September 2020. Three phases were differentiated: 'pre-state of emergency' from 1 January to 13 March;'state of emergency' from 14 March to 21 June;and 'post-state of emergency' from 22 June to 30 September. Results During the 'pre-state of emergency' phase, 31 SIV and 273 pharmaceutical care visits were performed. Of these 273, 75 were screenings, 67 C1D1 visits, 26 follow-up visits, 28 medical queries and 77 patient queries. In the 'state of emergency' phase, 47 SIV and 206 pharmaceutical care visits were performed. Of these 206, 69 were screenings, 55 C1D1 visits, 10 follow-up visits, 35 medical queries and 37 patient queries. During the first 90 days of this emergency state, citizens were confined, so remote pharmaceutical care and remote SIV were implemented. 34 screenings were performed and 33 queries about interactions or drug instructions for patients were resolved. Medication was delivered to 139 patients. Four chemotherapy regimens were modified, extending in time administrations of pembrolizumab and cetuximab in four patients. 28 SIV were performed remotely (10 phase I CT, 7 phase II CT and 11 phase III CT). During the last phase, 60 SIV and 365 pharmaceutical care visits were performed. Of these 365, 83 were screenings, 79 C1D1 visits, 42 follow-up visits, 95 medical queries and 66 patient queries. Conclusion and relevance The oncohaematological CT pharmacy unit managed to maintain pharmaceutical activity and care during the state of emergency period due to COVID-19, highlighting a considerable increase in activity in the months after the state of emergency.

Pseudotumor Cerebri Caused by SARS-CoV-2 Infection in a Boy

We present the case of a 7-year-old boy who started with diplopia and paralysis of the sixth unilateral cranial nerve after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The cranial resonance was normal and the cerebrospinal pressure was 32 cm H 2O detected by lumbar puncture. The treatment with corticosteroids and acetazolamide was effective. This is the first case of idiopathic intracranial hypertension associated to SARS-CoV-2 probably due to immune-mediated process.