The Impact of COVID-19 on Living Standards: Addressing the Challenges of Nowcasting Unprecedented Macroeconomic Shocks with Scant Data and Uncharted Economic Behavior

We present a methodological approach with relatively low information requirements to quantify the impact of large, unprecedented macroeconomic shocks like the COVID-19 pandemic on living standards across the income distribution. The approach can be produced quickly and, contrary to other "fast-delivery" exercises, does not assume that income losses are proportional across the income distribution, a feature that is critical to understanding the impact on poverty and inequality. Our method is sufficiently flexible to refine the projected effects of the shock as more information becomes available. We illustrate with data from the four largest countries in Latin America: Argentina, Brazil, Colombia, and Mexico, and discuss the estimated effect of COVID-19 on inequality and poverty. We also present the guidelines for adapting our framework to different countries and economic shocks © 2023, Lustig et al

[Ischaemic stroke due to basilar artery occlusion in a puerperal patient with SARS-CoV-2 infection]. / Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2.

INTRODUCTION: Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant. CASE REPORT: We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem. CONCLUSION: Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.

TITLE: Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2.Introducción. La infección por coronavirus de tipo 2 (SARS-CoV-2), causante del síndrome respiratorio agudo grave (COVID-19), produce complicaciones tromboembólicas, incluyendo casos de enfermedad cerebrovascular aguda. Debido al estado de hipercoagulabilidad que acompaña al embarazo, el riesgo trombótico en estas pacientes puede ser especialmente relevante. Caso clínico. Presentamos el caso de una mujer de 41 años, gestante de 34 + 1 semanas, diagnosticada de neumonía intersticial bilateral, SARS-CoV-2. La paciente presentó insuficiencia respiratoria grave, por lo que se decidió la realización de una cesárea urgente y se trasladó a la unidad de cuidados intensivos. Durante su estancia en ésta, la paciente presentó un episodio brusco de disminución del nivel de consciencia, y se evidenció por angiorresonancia magnética una trombosis en la arteria vertebral izquierda y en la arteria basilar, con presencia de infarto isquémico agudo en ambos hemisferios cerebelosos y afectación bilateral del tronco del encéfalo. Conclusión. La enfermedad grave por el SARS-CoV-2 produce un estado protrombótico que se correlaciona con el pronóstico de la enfermedad. El último trimestre del embarazo y el puerperio son factores de riesgo protrombóticos conocidos. Las recomendaciones del manejo de anticoagulación en pacientes embarazadas con COVID-19 se basan en una evidencia limitada. Éste es el primer caso publicado en España de trombosis arterial cerebral en una paciente embarazada con infección por el SARS-CoV-2.

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Risk models for predicting in-hospital mortality from COVID-19 pneumonia in the elderly

Objective. To compare the prognostic value of 3 severity scales: the Pneumonia Severity Index (PSI), the CURB-65 pneumonia severity score, and the Severity Community-Acquired Pneumonia (SCAP) score. To build a new predictive model for in-hospital mortality in patients over the age of 75 years admitted with pneumonia due to the coronavirus disease 2019 (COVID-19). Methods. Retrospective study of patients older than 75 years admitted from the emergency department for COVID-19 pneumonia between March 12 and April 27, 2020. We recorded demographic (age, sex, living in a care facility or not), clinical (symptoms, comorbidities, Charlson Comorbidity Index [CCI]), and analytical (serum biochemistry, blood gases, blood count, and coagulation factors) variables. A risk model was constructed, and the ability of the 3 scales to predict all-cause in-hospital mortality was compared. Results. We included 186 patients with a median age of 85 years (interquartile range, 80-89 years);44.1% were men. Mortality was 47.3%. The areas under the receiver operating characteristic curves (AUCs) were as follows for each tool: PSI, 0.74 (95% CI, 0.64-0.82);CURB-65 score, 0.71 (95% CI, 0.62-0.79);and SCAP score, 0.72 (95% CI, 0.63-0.81). Risk factors included in the model were the presence or absence of symptoms (cough, dyspnea), the CCI, and analytical findings (aspartate aminotransferase, potassium, urea, and lactate dehydrogenase. The AUC for the model was 0.81 (95% CI, 0.73-0.88). Conclusions. This study shows that the predictive power of the PSI for mortality is moderate and perceptibly higher than the CURB-65 and SCAP scores. We propose a new predictive model for mortality that offers significantly better performance than any of the 3 scales compared. However, our model must undergo external validation.

Influence of hypoxemia on lymphocytes subpopulations in sars-cov-2 pneumonia

BACKGROUND The role of lymphocytes in the response to SARS-CoV-2 infection is crucial and lymphopenia is a well-known poor prognostic factor in COVID-19. However, the influence of a hypoxemic environment on lymphocytes and their populations is not known.We aim to evaluate the influence of hypoxemia on lymphocyte populations in patients with SARS-CoV-2 pneumonia who present with lymphopenia. METHODSWe analyzed the clinical and analytical data of a prospective cohort of 338 patients with diagnosis of SARS-CoV-2 pneumonia. The microbiological diagnosis was made by RT-PCR. Hypoxemia was defined a PaO2/FiO2 value <300 and lymphopenia for the total lymphocyte count less than 1000 109/L. Statistical analysis was made using X2 and Student's t tests. RESULTSFrom an initial cohort of 338 patients with analyzed those with ABG resulting in 118 patients. 48.3% (57 cases) presented PaO2/FiO2<300 at admission. Lymphopenia was present in 75 cases (63.6%) and it was significantly associated with the presence of hypoxemia [PaO2/FiO2 280.5 (104.5) vs 328.3 (82.7);p=0.011] and high levels of ferritine [1108.4 (1530.5) vs 539 (488.9);p=0.020]. Patients with lymphopenia who presented hypoxemia showed low levels of CD4+ T lymphocytes compared to non-hypoxemic patients [339.7 (260.7) vs. 468.8 (319.5);p=0.019], however the CD8+ T lymphocyte values were not affected by the presence of hypoxemia [247.4 (339.8) vs. 239.7 (172.1);p=0.875].The presence of lymphopenia was associated with ICU admission (44% vs. 16.7%;p=0.003) and the need of mechanical ventilation (40% vs. 14.3%;p=0.004). Survival was similar between groups (29.3% vs. 16.3%;p=0.113). CONCLUSIONS In our series, the different lymphocyte subpopulations exhibit a different behavior in patients with acute hypoxemic respiratory failure: CD4+ T lymphocytes seem to be especially susceptible to hypoxemia in patients with SARSCoV- 2 pneumonia.

The impact of COVID-19 lockdowns and expanded social assistance on inequality, poverty and mobility in Argentina, Brazil, Colombia and Mexico

Based on the economic sector in which household members work, we use microsimulation to estimate the distributional consequences of COVID-19-induced lockdown policies in Argentina, Brazil, Colombia and Mexico. Our estimates of the poverty consequences are worse than many others' projections because we do not assume that the income losses are proportionally equal across the income distribution. We also simulate the effects of most of the expanded social assistance governments have introduced in response to the crisis. This has a large offsetting effect in Brazil and Argentina, much less in Colombia. In Mexico, there has been no such expansion. Contrary to prior expectations, we find that the worst effects are not on the poorest, but those (roughly) in the middle of the ex ante income distribution. In Brazil, we find that poverty among the afrodescendants and indigenous populations increases by more than for whites, but the offsetting effects of expanded social assistance also are larger for the former. In Mexico, the crisis induces significantly less poverty among the indigenous population than it does for the nonindigenous one. In all countries the increase in poverty induced by the lockdown is similar for male- and female-headed households but the offsetting effect of expanded social assistance is greater for female-headed households.