Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper.

We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.

Comparative tolerability profile of mRNA vaccines during mass vaccination of healthcare professionals at a tertiary hospital. An active pharmacovigilance study

Background: Further understanding on the safety profile of vaccines in a real-world still need to be elucidated, such as the comparative tolerability and reactogenicity of mRNA vaccines (BNT162b2 and MRNA- 1273) beyond the controlled context of clinical trials. An active pharmacovigilance study was designed to capture a complete short-term safety profile of two mRNA vaccines BNT162b2 and mRNA- 1273, targeting incidence rates of adverse reactions within a pre-defined denominator of vaccinated healthcare professionals. Methods: A prospective active surveillance study was implemented during the vaccination campaign at Hospital Clínic by a multidisciplinary team, involving the Pharmacovigilance Technical Committee, the Department of Preventive Medicine and Epidemiology and the Department of Occupational Health Care of the Hospital. Target population of the program included vaccinated professionals from Hospital Clínic and affiliated institutions, who were vaccinated with BNT162b2 and mRNA-1273. The program was based on the delivery of a structured questionnaire by telephonic interview after each vaccine dose. A total of 64% of vaccinated professionals completed the questionnaire (n=5088). Results: A total of 85% subjects suffered at least 1 AR reaction with the vaccine. The proportion of professionals developing any AR was 2878 (81.2%) after vaccination with BNT162b2 and 1463 (92.9%) after vaccination with mRNA-1273. Severe ARs (VAS scoring ≥ 7) were reported in 1184 (33.7%) professionals after vaccination with BNT162b2 and 886 (56.4%) after mRNA-1273. In the multivariate analysis, mRNA-1273 showed a greater reactogenicity than BNT162b2 (OR=3.04 (95% CI 2.48 - 3.73;p-value: <0.0001)). Conclusions: Our study shows that mRNA-1273 has greater reactogenicity than BNT162b2. Overall, both mRNA vaccines had a reasonable tolerability profile, compared in a real-world scenario. This can be understood as a reassuring message for the medical and scientific community.

Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors' clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

[Management of elective surgical activity in a tertiary hospital during the SARS-CoV-2 pandemic]. / Gestión de la actividad quirúrgica electiva de un hospital terciario durante la pandemia por SARS-CoV-2.

INTRODUCTION: During the SARS-CoV-2 pandemic, elective surgical activity was reduced to a minimum. As both the number of cases and the hospitalization needs for this pathology decreased, we thought it appropriate to progressively recover scheduled surgical activity. This work describes how, even with the current alarm state, we were able to practically normalize this activity in a few weeks. METHODS: Two weeks before the intervention, the patients included in the waiting lists were contacted by telephone. After checking their health status and expressing their desire to undergo surgery, they were provided with recommendations to decrease the risk of coronavirus infection. Likewise, an exclusive circuit was established to carry out, 48 hours before the intervention, the detection of SARS-CoV-2 by means of exudates nasopharyngeal PCR. The results were evaluated by each surgical service and the anesthesiology service. In addition, asymptomatic Surgical Area professionals could undergo weekly screening for the early detection of coronavirus according to the recommendations of Occupational Health. RESULTS: In the midst of a pandemic, scheduled surgical activity was reduced by 85%. From the week of April 13, the operating rooms available were recovered, which allowed practically all surgical activity to be recovered the week of May 25. CONCLUSIONS: The creation of circuits and procedures to streamline surgical activity, still in full force of the state of alarm, has allowed us, in a few weeks, to recover almost all of it.