Epidemiology: global spread, risk factors for disease incidence, severity and mortality

There are many unknowns surrounding COVID-19 and the ongoing pandemic. Standard epidemiological methods helped to determine the initial and ongoing distribution of COVID-19 in time and space, with unprecedented global coverage in almost real-time, and the forecasting methods used already had a reasonable predictive ability. Cumulative incidence and other complex epidemiological estimators have been widely disseminated via the media and are becoming lay terms thanks to persistent use, but their thresholds to determine public health interventions are yet to achieve consensus. The natural history of SARS-CoV-2, the interplay of risk factors and the effectiveness of mitigating factors in subpopulations remain unmet challenges. Establishing standard definitions of COVID-19 and its consequences is essential to the implementation of research. Pending widespread vaccine coverage, the world is experiencing unleashed community transmission in many countries, and the COVID-19 endgame is a distant goal. Several characteristics differentiate the transmissibility of SARS-CoV-2 from other viruses, making COVID-19 much more difficult to control with universal hygiene interventions. Epidemiology remains a necessary discipline to help end the COVID-19 pandemic;economic, social and health policy decision-making analysis are also needed.Copyright © ERS 2021.

Towards skill-based evaluation in a hybrid learning context: an experience in Aircraft Maintenance

COVID-19 forced Higher Education to take place virtually. The evaluation process was particularly sensitive, mainly if it involved written tests. Still, it posed an opportunity to revise learning activities and evaluations. The Aircraft Maintenance course at UPV was driven from a content-based evaluation toward a skill-based one, replacing an open-answer test with a thorough assignment. Student grades and surveys motivated the perpetuation of the activity once students were back in a classroom.

Associations of pre-existing comorbidities and COVID-19 in-hospital mortality: an unCoVer analyses : Elly Mertens

Background Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors. Methods Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex. Results Patients were on average 60.1 (± 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68;1.40, 2.01), followed by hypertension (1.40;1.19, 1.64) and diabetes (1.27;1.07, 1.50), and the lowest for obesity (1.13;0.94, 1.37). Conclusions By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact. Key messages Federated analyses, capable of streamlining ethical and legal aspects, provide unique opportunities for robust results to inform public health. Higher COVID-19 in-hospital mortality risk with increasing number of comorbidities.

Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic.

OBJECTIVE: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. MATERIAL AND METHODS: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). RESULTS: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). CONCLUSION: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

[Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic]. / Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2.

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

Incidence, typology and measures of prevention and treatment of skin lesions associated with the use of personal protective equipment in health care professionals during the COVID-19 pandemic in Spain Collaborative study GNEAUPP-Cátedra de estudios avanzados en heridas GNEAUPP - FSJJ - Universidad de Jaén

Introduction: The recent COVID-19 pandemic has represented the use by health care professionals (HCP) of different personal protective equipment (PPE), resulting in the appearance of skin injuries associated with PPE (PPE-SI). Knowing the epidemiology, characteristics and factors related to the use of different types of PPE and the prevention and treatment of PPE-SI can be very useful to understand the scope of the problem and to define strategies for its prevention and treatment in possible future pandemics. Methods: To this end, the GNEAUPP proposed the performance of a cross-sectional study, in the geographical area of the Spanish state, by means of a self-administered survey using a Google forms questionnaire. The study universe was HCP, from any discipline and from any level of care or type of institution with patients who have been in contact with COVID-19 patients or COVID-19 suspects and have used PPE during the first wave of the COVID-19 pandemic in Spain. Main results: We obtained 2078 questionnaires, 75.5% from nurses, 10.79% from nurse aids, and 6.6% from physicians. Of these, 84.7% were women and 15.3% were men with an average age of 43.7 years. In 18.2% of the cases the institution of the professional had a protocol for the prevention of PPE-SI, in 10.2% the professional did not know if it existed or not and in the remaining 71.3% the institution did not have such a protocol. 29.9% of the professionals always used some prevention product and 25.3% sometimes. 52.4% of respondents reported having submitted at least one PPE-SI, of which 39% had submitted one, 35.8% two, 14.3% three, 2.2% four and 8.6% more than four. In relation to PPE-SI, 74.3% were defined as pressure injuries (PI), 11% were friction injuries (FI), 8.5% were combined or multicausal injuries (CMCI) and 6.1% were skin injuries associated with moisture (MASI). The mean duration of incident injuries was 11.6 days (9.7 days for PI, 10.2 days for FI, 19.9 days for CMCI and 19.4 days for MASI). More detailed Information is presented in the paper by type of device causing, typology and severity of injuries per device as well as preventive measures used.

Angiographic and Clinical Profile of Patients With COVID-19 Referred for Coronary Angiography During SARS-CoV-2 Outbreak: Results From a Collaborative, European, Multicenter Registry.

Data regarding angiographic characteristics, clinical profile, and inhospital outcomes of patients with coronavirus disease 2019 (COVID-19) referred for coronary angiography (CAG) are scarce. This is an observational study analyzing confirmed patients with COVID-19 referred for CAG from 10 European centers. We included 57 patients (mean age: 66 ± 15 years, 82% male) , of whom 18% had previous myocardial infarction (MI) and 29% had renal insufficiency and chronic pulmonary disease. ST-segment elevation myocardial infarction (STEMI) was the most frequent indication for CAG (58%). Coronavirus disease 2019 was confirmed after CAG in 86% and classified as mild in 49%, with 21% fully asymptomatic. A culprit lesion was identified in 79% and high thrombus burden in 42%; 7% had stent thrombosis. At 40 days follow-up, 16 (28%) patients experienced a major adverse cardiovascular event (MACE): 12 deaths (92% noncardiac), 1 MI, 2 stent thrombosis, and 1 stroke. In an European multicenter registry, patients with confirmed COVID-19 infection referred for CAG during the first wave of the severe acute respiratory syndrome coronavirus 2 pandemic presented mostly with STEMI and were predominantly males with comorbidities. Severity of COVID-19 was in general noncritical and 21% were asymptomatic at the time of CAG. Culprit coronary lesions with high thrombus burden were frequently identified, with a rate of stent thrombosis of 7%. The incidence of MACE at 40 days was high (28%), mostly due to noncardiac death.

Reliability of home spirometry compared to traditional clinic spirometry in an adult cystic fibrosis population

RATIONALE: The potential risk of acquiring COVID-19 has presented a particular challenge to delivering in-person outpatient care, especially to patients with chronic respiratory diseases who may be hesitant to come to clinic. Though much of an interdisciplinary visit for cystic fibrosis can be performed via telehealth, in-clinic spirometry is an important part of disease monitoring. Home spirometry has been proposed as a way to improve telehealth in cystic fibrosis care. Here we examine the reliability of home spirometers in an adult cystic fibrosis clinic. METHODS: Patients received home spirometers (Mir Spirobank Smart, n = 38) from the Cystic Fibrosis Foundation or obtained their own Microlife home spirometers (n = 2). They were instructed to bring their home spirometer to clinic for teaching and comparison with the calibrated clinical spirometer. Initial patient demographics, exacerbations in the last year, current symptoms, home airway clearance and inhaler regimen were recorded. After the initial visit, patients were emailed links to report symptoms and record home spirometry weekly or with worsening of their symptoms. Data was recorded in REDCap and analyzed in RStudio version 1.3.1056. RESULTS: A total of 40 patients have completed the initial clinic visit and teaching for their home spirometers. The clinic and home spirometers were very highly correlated when measuring forced expiratory volume in one second (FEV1) with a Pearson correlation coefficient 0.993 (P < 0.001) with the clinic spirometer recording a higher value, on average, of 0.072 ± 0.11 L (mean ± standard deviation). Of the 36 patients that had a home spirometer forced vital capacity (FVC) recorded, the correlation coefficient was 0.946 (P < 0.001) with the clinic spirometer recording a higher value of 0.134 ± 0.31 L on average. Measurements of percent predicted of FEV1 and FVC had Pearson correlation coefficients of 0.987 (P<0.001) and 0.953 (P<0.001), respectively, with clinic spirometers showing higher values, on average, of 0.806 ± 3.54 % and 1.31 ± 1.12 %, respectively. Peak expiratory flow (L/s), on the contrary, tended to be higher on the home devices by 0.542 ± 1.12 L/s on average, with a Pearson correlation coefficient of 0.857 between devices. Home spirometry measurements are ongoing. CONCLUSIONS: Home spirometry provide similar estimates of lung function compared to standard in-clinic devices and could play a useful role in the longitudinal telehealth care of cystic fibrosis patients. The reliability of their measurements in the home environment is currently ongoing.

Selection of the best of 2020 in congenital heart disease

This paper shows a selection of the most relevant articles in congenital heart diseases published since the end of the last year. The COVID-19 pandemic represents a significant challenge for the care of patients with congenital heart diseases. Multiple guidelines and consensus have been published (pulmonary hypertension, multimodality imaging during follow-up, ultrasound examination of the fetal heart and management of arrhythmias) and will be very useful for the standardization of the management of these complex patients. We highlight contributions related to risk stratification for sudden cardiac death and advanced heart failure therapies for patients with congenital heart disease. In this regard, the long waiting lists for pediatric heart transplantation are being reduced due to the progress in the management of potential donors. Finally, percutaneous interventions at any age and surgical techniques, with a particular focus on aortic valve leaflet reconstruction techniques in children and young adults, continue to develop and explore new paths previously unexpected.