Employment and Teleworking in the Argentine Tourism Sector: a Case Study Based on the COVID-19 Pandemic

We analyze the viability of teleworking in the tourism sector in Argentina by using the COVID-19 shock on employment as a case study. We pay special attention to the tourism sector and its sub-sectors because they comprise activities with low teleworking potential and high informality rates, which could further condition the effective implementation of new work arrangements, such as remote work. By using estimates of teleworking potential at the sectoral level, we study its relationship with the evolution of employment during the quarantines implemented in the face of the COVID-19 pandemic in Argentina. We find a positive effect of teleworking potential on employment in the tourism subsectors, such as food and accommodation and travel agencies activities, but more pronounced in the other services subsectors (sports, cultural, and entertainment service activities). This suggests that, despite having a low telework potential, certain tourism activities could be performed remotely. Surprisingly, we find that teleworking potential had a positive effect on employment in some tourism subsectors only for informal workers. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

COVID-19 in donation and transplant.

SARS-CoV-2 infection has had a major impact on donation and transplantation. Since the cessation of activity two years ago, the international medical community has rapidly generated evidence capable of sustaining and increasing this neccesary activity. This paper analyses the epidemiology and burden of COVID-19 in donation and transplantation, the pathogenesis of the infection and its relationship with graft-mediated transmission, the impact of vaccination on donation and transplantation, the evolution of donation in Spain throughout the pandemic, some lessons learned in SARS-CoV-2 infected donor recipients with positive PCR and the applicability of the main therapeutic tools recently approved for treatment among transplant recipients.

INTERDISCIPLINARY STUDENT LEAD CALL CENTER TO SUPPORT SOCIAL NEEDS OF PATIENTS DIAGNOSED WITH COVID19

STATEMENT OF PROBLEM/QUESTION: Social risk factors (SRF), such as food insecurity, represent adverse social circumstances associated with poor health outcomes. The COVID-19 pandemic impacted impoverished communities by exacerbating existing SRF. Students and faculty at Boston University Medical Center (BUMC), an academic safety net hospital, and Boston University School of Social Work (BUSSW) partnered to develop an outreach call center (CC) to explore SRF of patients with COVID-19 and connect them with available social need resources. In this , the development and operations of the CC and descriptive data on the volume and type of outreach efforts will be presented. DESCRIPTION OF PROGRAM/INTERVENTION: Call Center (CC) Operation: An ambulatory RN performed SRF screening in patients diagnosed with COVID-19 and sent referrals to the CC. Then, students called patients and screened for SRF using the THRIVE screening tool, and used the THRIVE Directory, an online repository of resources, to provide information about organizations to support their social needs. Two weeks later, students called the patients to assess whether they received help and provided additional support as needed. MEASURES OF SUCCESS: Volume of outreach calls and type of outreach efforts were evaluated. Number of patients reached through the CC were tracked using Epic reports. Types of referrals were tracked using automated reports from the THRIVE Directory database. Finally, students completed surveys to reflect on their experiences and to evaluate the impact on skills to address social needs. FINDINGS TO DATE: Between 10/2020 and 03/2021, the CC served 312 patients and 478 referrals were made, with a mean of 1.53 referrals per patient. Patients were most often referred to the City of Boston Food Delivery (148 referrals). Patients were most often referred to Government programs (188), followed by BMC programs (133) and Local Non-Profits (70). The most common primary support area was Food. Preliminary results from students' surveys showed a positive impact in their skills to collaboratively address social needs. KEY LESSONS FOR DISSEMINATION: It was feasible to develop and implement an interdisciplinary social needs outreach workforce to support patients with COVID-19. Food was the most important driver of social need among BUMC patients. Our partnership with the City of Boston was key to effective assistance with food delivery, showing the importance of collaborative partnerships when developing outreach efforts to support patients with social needs. Finally, interdisciplinary outreach opportunities like the CC can be used to teach health professional students about the different scopes of practice and how to effectively collaborate with other disciplines when addressing patient health related social needs.

COVID-19: DIARRHEA, INFLAMMATION AND INTESTINAL MICROBIOTA

Introduction: Increased inflammatory cytokines has been observed in COVID-19 patients and there is evidence showing an alteration in gut-microbiota composition. SARS-CoV-2 can cause gastrointestinal symptoms, such as diarrhea. Evidence of an altered gut-microbiota composition and cytokines levels in COVID-19 diarrhea patients is lacking. Objectives: To compare serum cytokine levels and gut microbiota between COVID-19 diarrhea (D-COVID- 19) and non-diarrhea (NonD-COVID-19) patients and non- COVID-19 controls (HC). Material and methods: We included 143 hospitalized COVID-19 patients (positive quantitative reverse transcription PCR) in a single University Hospital, and 53 ambulatory HC (negative rapid serological test) were included. Blood and stool samples were collected at hospital admission in COVID-19 patients and at the time of HC recruitment. 27- pro and anti-inflammatory cytokines (Bio-Plex Pro™, Bio- Rad) were measured. Gut microbiota composition and diversity profiles were characterized by sequencing the 16S rRNA gene V3-V4 region amplified using DNA extracted from stool samples. Bioinformatics analysis was performed with QIIME2 software. First, we compare cytokine levels between COVID- 19 and HC and then COVID-19 with and without diarrhea. All comparisons were adjusted for age, sex, and BMI with linear regression. Results: The mean age in COVID-19 patients was 54 +/- 15 years (F=50%) and 52 +/- 8 (F=62%) for HC. Diarrhea was present in 19 (13.29%) of COVID-19 patients. COVID-19 patients had significative higher levels of: IL- 1ra, IL-2, IL-6, IL-7, IL-8, IL-13, IP-10 and PDGF-bb. Significant lower values of: IL-9, FGF -basic, MIP-1β, TNF-α were observed in D-COVID-19 compared to NonD-COVID-19. COVID-19 patients had a significant reduction of bacterial species (p=0.0001), and diversity and complexity of the bacterial community (Shannon's index) (p=0.0001) compared to the HC. There was no difference between D-COVID-19 and NonD-COVID-19. There were also changes in the composition of the microbiota associated with COVID-19. At the phylum level, COVID-19 patients showed a significant decrease in Actinobacteria and Firmicutes, and an increase in Bacteroidetes. At species level, an increase of 4 species of the genus Bacteroides was observed in COVID-19 patients. 31 very diverse bacterial species were found, all decreased in D-COVID-19. Conclusions: An alteration in serum cytokine levels was observed between COVID-19 and HC. D-COVID-19 had a decrease in some proinflammatory cytokines. A significant decrease in richness and species diversity of gutmicrobiota was observed in COVID-19 patients compared to HC, but no significant differences were observed between D-COVID-19 and NonD-COVID-19. However, in D-COVID- 19, a decrease in some bacterial species was observed.(Table Presented)(Figure Presented)

Social Determinants of Health Screening During COVID-19: A Comparison Between an Urban Academic Emergency Department Fast Track and Adult Primary Care Clinic

Study Objectives: Social determinants of health (SDOH) impact patients’ health outcomes, yet screening methods in emergency departments (EDs) are inconsistent. Patients who seek care in EDs may be at greater risk for adverse SDOH than those seen by their primary care physician (PCP), but little comparable data is available. The authors sought to identify SDOH among ED Fast Track patients during the COVID-19 pandemic at an urban, safety-net hospital, measure preferred methods of resource referrals and barriers to accessing resources, and compare the prevalence of adverse SDOH among of ED Fast Track patients to that of adult PCP clinic patients. Methods: ED Fast Track patients were screened using a validated SDOH screener, and asked about the impact of COVID-19 on their SDOH. This was a convenience sample conducted from 1/15/21 to 4/13/21 and determined to be exempt by the IRB. Trained study staff completed screening and provided a printed resource guide. A two-week follow-up telephone survey assessed for barriers to resource connection. ED Fast Track patient data was then compared to concurrent SDOH data for adult PCP clinic patients, which collected the same validated SDOH screening data but was self-reported. Results: Among 414 adult ED Fast Track patients, 296 (71.5%) screened positive for at least one adverse SDOH, most commonly education (38.41%), food (35.0%), and housing insecurity (20.5%). Most (56.8%) endorsed COVID-19 affecting their SDOH. Fewer patients (36/156, 23.1%) reported attempting to connect with a resource. Barriers to accessing resources included having no time to call or visit the resource (59%), not recalling being given the resource guide (41%) or having lost it (28%). When compared to adult PCP clinic patients (Table 1), ED Fast Track patients were 10 times more likely to report at least one adverse SDOH (OR 10.0, 95% CI 6.9-14.4), 13 times more likely to report housing needs (OR 13.1, 95% CI 5.2-32.7), 8 times more likely to have food insecurity (OR 8.2, 95% CI 4.7-14.1) and 11 times more likely to have employment difficulty (OR 11.1, 95% CI 5.7-21.6). Conclusion: Most ED Fast Track patients reported at least one adverse SDOH negatively impacted by the COVID-19 pandemic. Providing printed resource guides at ED discharge may be insufficient for linking patients to resources. ED Fast Track patients were far more likely to report adverse SDOH than adult PCP clinic patients based on the unadjusted odds ratio analyses. This finding, however, is limited by the negative impact of COVID-19 on ambulatory SDOH screening rate, and a potential selection bias as patients with adverse SDOH may have experienced difficulty accessing their PCP clinics. This finding further emphasizes the need to standardize and expand SDOH screening and strengthen further resources from EDs. [Formula presented]

The pandemic knocks on the occupational health acute accent s door

The pandemic caused by SARS-CoV-2 has tested our current National Occupational Safety and Health System. The pandemic, managed from the public health Administration sector, has directly affected the world of work. Therefore, the management of this contingency has demanded a joint and agile response from two areas, public health and occupational health, and has proved its indissoluble nature. This article analyzes the main activities carried out in the labor context to fight against COVID-19 in order to identify the best tools to integrate the measures defined by the competent public health authorities in the occupational safety and health management. Likewise, this article shows the vision of the main international organizations about the relationship between the pandemic and the safety and health at work.

ORAL TANNINS REDUCE PROINFLAMMATORY CYTOKINES ASSOCIATED WITH DIARRHEA AND PNEUMONIA IN HOSPITALIZED COVID-19 PATIENTS

INTRODUCTION: There is evidence that the gut microbiota and its relationship with the immune system could be involved in the pathogenesis of COVID-19. SARS-CoV-2 can cause gastrointestinal symptoms during the early phases of the disease. Intestinal dysfunction induces changes in intestinal microbes, and an increase in inflammatory cytokines. Therefore, microbiota modulation could play a role in COVID-19 treatment. Tannins have been shown to work as prebiotics on the gastrointestinal microbiota. In particular, quebracho and chestnut tannins have shown to regulate the immune response and decrease in vitro-cytokines production, through microbiota fermentation-secondary metabolites, such as quercetin and SCFAs. OBJECTIVE: To evaluate the efficacy and the effect on cytokine levels of a tannin specific natural extract in COVID-19 patients. MATERIAL AND METHODS: This prospective, doubleblind, and randomized study was approved by the Hospital de Clínicas, José de San Martín (Buenos Aires, Argentina). Blood and stool samples were collected at baseline (Day 0) and after treatment (Day 14) during July-October 2020, with final follow-up in November 2020. We randomly assigned 124 RT-PCR confirmed COVID-19 cases (>18 years) to receive oral dry extracts of quebracho and chestnut tannins (240 mg) and B12 vitamin (0.72 μg) or placebo, twice daily for 14 days as adjunct treatment to their standard of care management. 27-pro and anti-inflammatory cytokines were measured on day 0 and 14 (Bio-Plex Pro™, Bio-Rad). Final enrollment of 140 patients with matched fecal microbiome characterization (16S, WGS and metabolites) is expected. RESULTS. Of 124 patients who were randomized (mean age 55+/-15, 63 [50.81%] male), 121 (97.58%) completed the trial. No adverse events were observed in the tannin group. Patients presenting with diarrhea (13%) had a trend to have elevated blood MIP-1α levels, which were significantly reduced by tannin treatment (Table 1). At baseline, higher levels of MIP-1α were also associated with diagnosis of pneumonia (Fig. 1), which was maintained after adjusting for confounders (age, sex, diabetes;p=0.04). Moreover, at baseline there was a positive correlation between MIP-1 α and IL-1ra, IL-2, MIP-1b and TNF-α, with all of these cytokines decreasing mostly with tannin treatment. CONCLUSION: To our knowledge, this clinical trial represents the first study to target the gut microbiome in hospitalized COVID-19 patients. Oral tannins as adjunct treatment with standard-of-care management of these patients significantly reduced proinflammatory cytokine levels that are generally associated with poor predictive outcomes, i.e. pneumonia and diarrhea. Further, our prospective studies will determine which microbiome-mediated mechanisms may attenuate the cytokine storm that is evident in COVID-19 disease pathogenesis. (Table presented) (Figure presented)

Inflammatory bowel disease (IBD) and immunosuppression do not worsen the prognosis of COVID-19. Results from the eneida project of Geteccu

Introduction: The exhaustive registry of COVID-19 cases in patients with IBD is a unique opportunity to learn how to deal with this infection, especially in reference to the management of immunosuppressive treatment, isolation measures or if the disease is more severe in IBD patients due to immunosuppression. Aims & Methods: Aims: The aims of this study were to know the incidence and characteristics of COVID-19 in the ENEIDA cohort during the first wave of the pandemic;the outcomes among those under immunosuppressants/ biologics for IBD;the risk factors for contracting the infection and poor outcomes;and the impact of the infection after three-month followup. Methods: Prospective observational cohort study of all IBD patients with COVID-19 included in the ENEIDA registry (with 60.512 patients in that period) between March and July 2020, with at least 3 months of follow-up. Any patient with a confirmed (by PCR or SARS-CoV-2 serology) or probable (suggestive clinical picture) infection was considered as a case. Results: A total of 482 patients with COVID-19 from 63 centres were included: 247 Crohn's disease, 221 ulcerative colitis and 14 unclassified colitis;median age 52 years (IQR: 42-61), 48% women and 44% 1 comorbidity. Diagnosis was made by PCR: 62% and serology: 35%. The most frequent symptoms: fever (69%), followed by cough (63%) and asthenia (38%). During lockdown 78% followed strict isolation. 35% required hospital admission (ICU: 2.7%) and 12% fulfilled criteria for SIRS upon admission. 18 patients died from COVID-19 (mortality:3.7%). 12% stop IBD medication during COVID-19. At 3 months, taken into account all included cases, 76% were in remission of IBD. Age 50 years (OR 2.09;95% CI:1.27-3.4;p=0.004), 1 comorbidities (OR 2.28;95% CI:1.4-3.6;p=0.001), and systemic steroids <3 months before infection (OR 1.3;95%CI:1-1.6;p= 0.003), were risk factors for hospitalisation due to COVID-19. A Charlson score 2 (OR 5.4;95%CI:1.5-20.1;p=0.01) was associated with ICU admission. Age 60 years (OR 7.1;95%CI:1.8-27.4;p=0.004) and having 2 comorbidities (OR 3.9;95% CI:1.3-11.6;p=0.01) were risk factors for COVID- 19 related death. Conclusion: IBD does not seem to worsen the prognosis of COVID-19, even when immunosuppressants and biological drugs are used. Age and comorbidity are the most important prognostic factors for more severe COVID-19 in IBD patients.

Comorbidities and epidemiological risk factor but not immunosuppressive therapies increase the risk of COVID-19 in inflammatory bowel disease (IBD): An ENEIDA-based, casecontrol study

Introduction: The information regarding IBD patients with COVID-19 suggests that the factors related to bad outcome are older age and comorbidity whereas immunosuppressants do not have a significant impact worsening the disease evolution. Aims & Methods: Aims: To assess if there are differences in epidemiological, demographical, and clinical characteristics between infected and non-infected IBD patients. Methods: Case-control study in IBD patients with COVID-19 (cases) compared to IBD without COVID-19 (controls) in the period March-July/2020 within the ENEIDA registry (promoted by GETECCU and with more than 60.000 IBD patients included). Cases were matched 1:2 by age (±5y), type of disease (CD/UC), gender, and centre. All controls were selected from only one investigator blind to other clinical characteristics of the patients to avoid selection bias. Results: 482 cases and 964 controls from 63 Spanish centres were included. No differences were found within the basal characteristics including CD location, CD behaviour, extraintestinal manifestations, family history of IBD or smoking habits. Cases had ≥ 1 comorbidities (cases:43%vs. controls: 35%, p=0.01) and occupational risk (cases:27% vs. controls:10.6%, p<0.0001) in a higher proportion. Strict lock-down was the only measure demonstrating protection against COVID-19 (cases:49% vs. controls:70%, p<0.0001). There were no differences in the use of systemic steroids (p=0.19), immunosuppressants (p=0.39) or biologics (p=0.28) between cases and controls. Cases were more often treated with aminosalycilates (42% vs.34%, p=0.003). Having ≥ 1 comorbidities (OR:1.6, 95%CI: 1.2-2.1), occupational risk (OR:1.95, 95%CI:1.39-2.7) and the use of aminosalycilates (OR:1.4, 95%CI: 1-1.8) were risk factors for COVID-19. On the other hand, strict lockdown was a protective factor (OR:0.38, CI:0.29-0.49). Conclusion: Comorbidities and epidemiological risk factors are the most relevant aspects for the risk of COVID-19 in IBD patients. This risk of COVID- 19 seems to be increased by aminosalycilates but not by immunosuppressants or biologics. The attitude regarding treating IBD patients with aminosalicylates during COVID-19 pandemic deserves a deeper analysis. (Table Presented).

The pandemic knocks on the occupational health's door

The pandemic caused by SARS-CoV-2 has tested our current National Occupational Safety and Health System. The pandemic, managed from the public health Administration sector, has directly affected the world of work. Therefore, the management of this contingency has demanded a joint and agile response from two areas, public health and occupational health, and has proved its indissoluble nature. This article analyzes the main activities carried out in the labor context to fight against COVID-19 in order to identify the best tools to integrate the measures defined by the competent public health authorities in the occupational safety and health management. Likewise, this article shows the vision of the main international organizations about the relationship between the pandemic and the safety and health at work.