A Novel Approach to Obtain Vaccine Effectiveness Continuous Profiles. Example Case: COVID-19 in Elderly Mexicans.

Population-wide vaccination is the most promising long-term COVID-19 disease management strategy. However, the protection offered by the currently available COVID-19 vaccines wanes over time, requiring boosters to be periodically given, which represents an unattainable challenge, especially if it is necessary to apply several doses per year. Therefore, it is essential to design strategies that contribute to maximizing the control of the pandemic with the available vaccines. Achieving this objective requires knowing, as precisely and accurately as possible, the changes in vaccine effectiveness over time in each population group, considering the eventual dependence on age, sex, etc. Thus, the present work proposes a novel approach to calculating realistic effectiveness profiles against symptomatic disease. In addition, this strategy can be adapted to estimate realistic effectiveness profiles against hospitalizations or deaths. All such time-dependent profiles allow the design of improved vaccination schedules, where each dose can be administrated to the population groups so that the fulfillment of the containment objectives is maximized. As a practical example for this analysis, vaccination against COVID-19 in Mexico was considered. However, this methodology can be applied to other countries' data or to characterize future vaccines with time-dependent effectiveness values. Since this strategy uses aggregated observational data collected from massive databases, assumptions about the data validity and the course of the studied epidemic could eventually be necessary.

Psychogeriatric care in times of COVID. Lessons learned and proposals for similar situations.

The objective is to describe the problems related to outpatient psychogeriatric care in the context of the SARS-CoV-2 pandemic, as well as the proposed and implemented solutions for optimizing care for elderly people with mental disorders during the pandemic, that can also be applied in emerging similar situations in the future.

High prevalence of SARS-CoV-2 detection and prolonged viral shedding in stools: A systematic review and cohort study Elevada detección de SARS-CoV-2 y prolongada excreción viral en deposiciones: Estudio de cohorte y revisión sistemática

Objectives To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. Methods We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan–Meier curves. Results We included 32 patients;mean age was 43.7 ± 17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10–15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients;95%CI:25.4–45.1);heterogeneity was high (I2:91.2%, Q:208.6;p ≤ 0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p = 0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients;95%CI:19–25). After 34 days, 19.9% (95%CI:11.3–29.7) of patients have a persistent detection in stools. Conclusions Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.

Buildout and integration of an automated high-throughput CLIA laboratory for SARS-CoV-2 testing on a large urban campus.

In 2019, the first cases of SARS-CoV-2 were detected in Wuhan, China, and by early 2020 the first cases were identified in the United States. SARS-CoV-2 infections increased in the US causing many states to implement stay-at-home orders and additional safety precautions to mitigate potential outbreaks. As policies changed throughout the pandemic and restrictions lifted, there was an increase in demand for COVID-19 testing which was costly, difficult to obtain, or had long turn-around times. Some academic institutions, including Boston University (BU), created an on-campus COVID-19 screening protocol as part of a plan for the safe return of students, faculty, and staff to campus with the option for in-person classes. At BU, we put together an automated high-throughput clinical testing laboratory with the capacity to run 45,000 individual tests weekly by Fall of 2020, with a purpose-built clinical testing laboratory, a multiplexed reverse transcription PCR (RT-qPCR) test, robotic instrumentation, and trained staff. There were many challenges including supply chain issues for personal protective equipment and testing materials in addition to equipment that were in high demand. The BU Clinical Testing Laboratory (CTL) was operational at the start of Fall 2020 and performed over 1 million SARS-CoV-2 PCR tests during the 2020-2021 academic year.

Radiology Education and Clinical Service during the COVID-19 Pandemic - the Puerto Rico Medical Center Experience.

Residency training programs have faced the dual challenge of providing continuous and effective clinical services and graduate medical education during the Coronavirus Disease 2019 (COVID-19) pandemic. This article outlines the changes incorporated by the University of Puerto Rico School of Medicine Diagnostic Radiology Program during the COVID-19 pandemic, including incorporating a virtual approach for read-out sessions, didactic conferences and additional learning experiences for the radiology residents. By means of collaboration and unity in the noble goal of public service, the faculty and residents of the Diagnostic Radiology Program at UPR-SOM have shown resilience throughout the many challenges faced during the current COVID-19 pandemic.

High prevalence of SARS-CoV-2 detection and prolonged viral shedding in stools: A systematic review and cohort study.

OBJECTIVES: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. METHODS: We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan-Meier curves. RESULTS: We included 32 patients; mean age was 43.7±17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10-15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.4-45.1); heterogeneity was high (I2:91.2%, Q:208.6; p≤0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p=0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients; 95%CI:19-25). After 34 days, 19.9% (95%CI:11.3-29.7) of patients have a persistent detection in stools. CONCLUSIONS: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.

A host transcriptomic signature for identification of respiratory viral infections in the community.

BACKGROUND: Fever-7 is a test evaluating host mRNA expression levels of IFI27, JUP, LAX, HK3, TNIP1, GPAA1 and CTSB in blood able to detect viral infections. This test has been validated mostly in hospital settings. Here we have evaluated Fever-7 to identify the presence of respiratory viral infections in a Community Health Center. METHODS: A prospective study was conducted in the "Servicio de Urgencias de Atención Primaria" in Salamanca, Spain. Patients with clinical signs of respiratory infection and at least one point in the National Early Warning Score were recruited. Fever-7 mRNAs were profiled on a Nanostring nCounter® SPRINT instrument from blood collected upon patient enrolment. Viral diagnosis was performed on nasopharyngeal aspirates (NPAs) using the Biofire-RP2 panel. RESULTS: A respiratory virus was detected in the NPAs of 66 of the 100 patients enrolled. Median National Early Warning Score was 7 in the group with no virus detected and 6.5 in the group with a respiratory viral infection (P > .05). The Fever-7 score yielded an overall AUC of 0.81 to predict a positive viral syndromic test. The optimal operating point for the Fever-7 score yielded a sensitivity of 82% with a specificity of 71%. Multivariate analysis showed that Fever-7 was a robust marker of viral infection independently of age, sex, major comorbidities and disease severity at presentation (OR [CI95%], 3.73 [2.14-6.51], P < .001). CONCLUSIONS: Fever-7 is a promising host immune mRNA signature for the early identification of a respiratory viral infection in the community.

Pandemic Injustice: Spatial and Social Distributions of COVID-19 in the US Epicenter

We examine the uneven social and spatial distributions of COVID-19 and their relationships with indicators of social vulnerability in the U.S. epicenter, New York City (NYC). As of July 17th, 2020, NYC, despite having only 2.5% of the U.S. population, has ∼6% of all confirmed cases, and ∼16% of all deaths, making it a key learning ground for the social dynamics of the disease. Our analysis focuses on the multiple potential social, economic, and demographic drivers of disproportionate impacts in COVID-19 cases and deaths, as well as population rates of testing. Findings show that immediate impacts of COVID-19 largely fall along lines of race and class. Indicators of poverty, race, disability, language isolation, rent burden, unemployment, lack of health insurance, and housing crowding all significantly drive spatial patterns in prevalence of COVID-19 testing, confirmed cases, death rates, and severity. Income in particular has a consistent negative relationship with rates of death and disease severity. The largest differences in social vulnerability indicators are also driven by populations of people of color, poverty, housing crowding, and rates of disability. Results highlight the need for targeted responses to address injustice of COVID-19 cases and deaths, importance of recovery strategies that account for differential vulnerability, and provide an analytical approach for advancing research to examine potential similar injustice of COVID-19 in other U.S. cities.Significance Statement Communities around the world have variable success in mitigating the social impacts of COVID-19, with many urban areas being hit particularly hard. Analysis of social vulnerability to COVID-19 in the NYC, the U.S. national epicenter, shows strongly disproportionate impacts of the pandemic on low income populations and communities of color. Results highlight the class and racial inequities of the coronavirus pandemic in NYC, and the need to unpack the drivers of social vulnerability. To that aim, we provide a replicable framework for examining patterns of uneven social vulnerability to COVID-19- using publicly available data which can be readily applied in other study regions, especially within the U.S.A. This study is important to inform public and policy debate over strategies for short- and long-term responses that address the injustice of disproportionate impacts of COVID-19. Although similar studies examining social vulnerability and equity dimensions of the COVID-19 outbreak in cities across the U.S. have been conducted (Cordes and Castro 2020,Kim and Bostwick 2002,Gaynor and Wilson 2020;Wang et al. 2020;Choi and Unwin 2020), this study provides a more comprehensive analysis in NYC that extends previous contributions to use the highest resolution spatial units for data aggregation (ZCTAs). We also include mortality and severity rates as key indicators and provide a replicable framework that draws from the Centers for Disease Control and Prevention’s Social Vulnerability indicators for communities in NYC.

Recomendaciones SEPAR sobre la vacuna COVID-19 en las enfermedades respiratorias◊

Resumen La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna COVID-19 en las enfermedades respiratorias con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación por COVID-19 de estos pacientes. Las recomendaciones han sido elaboradas por un grupo de expertos en la materia tras la revisión de la literatura recopilada hasta el 7 de marzo de 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha. Podemos concluir que las vacunas para la COVID-19 no sólo son seguras y eficaces, sino que en aquellos pacientes vulnerables con enfermedades respiratorias crónicas es prioritaria. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas. The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients. The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date. We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.

International Society for Extracellular Vesicles and International Society for Cell and Gene Therapy statement on extracellular vesicles from mesenchymal stromal cells and other cells: considerations for potential therapeutic agents to suppress coronavirus disease-19

STATEMENT: The International Society for Cellular and Gene Therapies (ISCT) and the International Society for Extracellular Vesicles (ISEV) recognize the potential of extracellular vesicles (EVs, including exosomes) from mesenchymal stromal cells (MSCs) and possibly other cell sources as treatments for COVID-19. Research and trials in this area are encouraged. However, ISEV and ISCT do not currently endorse the use of EVs or exosomes for any purpose in COVID-19, including but not limited to reducing cytokine storm, exerting regenerative effects or delivering drugs, pending the generation of appropriate manufacturing and quality control provisions, pre-clinical safety and efficacy data, rational clinical trial design and proper regulatory oversight.