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1.
Revista Cubana de Salud Publica ; 48(2), 2022.
Article in Spanish | EMBASE | ID: covidwho-1965341

ABSTRACT

Introduction: Although there is ample scientific evidence on the pandemic, the impact of COVID-19 on health services from the perspective of healthcare personnel has been little explored. Objective: To explore the experiences in health services of epidemiologists in training during the COVID-19 pandemic. Methods: Exploratory, qualitative-descriptive study, with ethnographic research tools for data collection such as observation, field diary and group interview;as well as grounded theory for the construction of categories that allowed to understand the studied phenomenon. For the formation of the focus group, seven epidemiologists in training from a Colombian university participated, with prior informed consent. The topic was introduced, with the subsequent application of the focus group guide tools, consensus posters, response sheets and an observation guide. Results: Hospital collapse and emerging restructuring of health services were generated, promoting other care strategies such as telemedicine. Study participants experienced fear attending patients on stressful days, with shortages of supplies and medicines;they were stigmatized, which generated "anxiety and work stress." However, they learned "to better classify cases" and with the increase in patients they were able to perceive inequities that represented a professional and human challenge. Conclusions: The COVID-19 pandemic has been valid as a learning process with new training perspectives to be able to act in the face of health events of global interest, with the necessary application and management of protocols, which can change the focus of health care and allow epidemiology to move towards education, promotion and prevention.

2.
34th International Conference on Advanced Information Systems Engineering, CAiSE 2022 ; 13295 LNCS:304-318, 2022.
Article in English | Scopus | ID: covidwho-1919707

ABSTRACT

Predictive monitoring is a key activity in some Process-Aware Information Systems (PAIS) such as information systems for operational management support. Unforeseen circumstances like COVID can introduce changes in human behaviour, processes, or computing resources, which lead the owner of the process or information system to consider whether the quality of the predictions made by the system (e.g., mean time to solution) is still good enough, and if not, which amount of data and how often the system should be trained to maintain the quality of the predictions. To answer these questions, we propose, compare, and evaluate different strategies for selecting the amount of information required to update the predictive model in a context of offline learning. We performed an empirical evaluation using three real-world datasets that span between 2 and 13 years to validate the different strategies which show a significant enhancement in the prediction accuracy with respect to a non-update strategy. © 2022, Springer Nature Switzerland AG.

3.
Topics in Antiviral Medicine ; 30(1 SUPPL):101-102, 2022.
Article in English | EMBASE | ID: covidwho-1880960

ABSTRACT

Background: Understanding the determinants of long-term immune responses to SARS-CoV-2 and the concurrent impact of vaccination and emerging variants of concern will guide optimal strategies to achieve global protection against the COVID-19 pandemic. Methods: A prospective cohort of 332 COVID 19 patients was followed beyond one year. Plasma neutralizing activity was evaluated using HIV-based reporter pseudoviruses expressing different SARS-CoV-2 spikes and was longitudinally analyzed using mixed-effects models. Results: Long-term neutralizing activity was stable beyond one year after infection in mild/asymptomatic and hospitalized participants. However, longitudinal models suggest that hospitalized individuals generate both short-and long-lived memory B cells, while responses of non-hospitalized were dominated by long-lived B cells. In both groups, vaccination boosted responses to natural infection. In unvaccinated participants, viral variants, mainly beta, reduced the efficacy of long-term (>300 days from infection) neutralization. Importantly, despite showing higher neutralization titers, hospitalized patients showed lower cross-neutralization of beta variant compared to non-hospitalized. Multivariate analysis identified severity of primary infection as the factor that independently determines both the magnitude and the inferior cross-neutralization activity of long-term neutralizing responses. Conclusion: Neutralizing response induced by SARS-CoV-2 is heterogeneous in magnitude but stable beyond one year after infection. Vaccination boosts these long-lasting natural neutralizing responses and should help counteract the resistance to neutralization of variants of concern such as the beta variant. Severity of primary infection determines higher magnitude but poorer quality of long-term neutralizing responses.

4.
Revista Espanola de Salud Publica ; 95(e202110144), 2021.
Article in English | GIM | ID: covidwho-1870956

ABSTRACT

Background: The COVID-19 pandemic has generated a high demand for hospital resources taking the national health system to its limit. In order to reduce this over burden and to avoid a potential system collapse, it would be beneficial to generate scientific evidence for the prognosis of the disease and to count with models that are able to forecast the mortality and progression of the disease. Identify mortality risk factors in COVID-19 patients from analytic data obtained from the Emergency Service at our hospital and to elaborate a prognostic score for predicting 30-day mortality (PMCovid Score) that will be included in the report submitted by the Emergency Clinic Laboratory.

5.
Revista Espanola de Salud Publica ; 95:28, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1489616

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has generated a high demand for hospital resources taking the national health system to its limit. In order to reduce this over burden and to avoid a potential system collapse, it would be beneficial to generate scientific evidence for the prognosis of the disease and to count with models that are able to forecast the mortality and progression of the disease. Identify mortality risk factors in COVID-19 patients from analytic data obtained from the Emergency Service at our hospital and to elaborate a prognostic score for predicting 30-day mortality (PMCovid Score) that will be included in the report submitted by the Emergency Clinic Laboratory. METHODS: Transversal descriptive study in a population that came to the Emergency Service at the University Hospital of Jaen between March 8th and April 7th 2020. We obtained the variables for the prognosis by a univariate data analysis. On this basis, we applied a multivariate analysis of the logistical regression of the mortality after 30 days in order to generate a prognostic score which was validated subsequently by the TRIPOD method. RESULTS: 298 patients were included. PMCovid Score assigns 1 point to patients age >=77 years old;1 point to patients with a urea level >=49 mg/dL, 1 point to erythrocyte values <4.6x106/microL, 2 points to platelet values <165x103/microL;1 point to patients with a percentage of lymphocytes below 18.1%;1 point to those with a % of monocytes <6.8% and 2 points if the % of eosinophils is <0.4%.Our score had a predictive accuracy of 88.6% (AUC 0.886 IC at 95%;0.842-0.931), with a sensibility of 91.7% (IC at 95% 82.810-100) and a specificity of 69.7% (IC at 95% 63.840-75.680). CONCLUSIONS: PMCovid Score provides the doctor with information on the prognosis of the positive COVID-19 patient along with the usual first analysis data, the necessary parameters for the calculations are available at all Emergency Laboratory Clinics. This information can be very useful for the management of this kind of patients and their classification based on the risk supplied by the PMCovid Score.

6.
European Stroke Journal ; 6(1 SUPPL):77-78, 2021.
Article in English | EMBASE | ID: covidwho-1468036

ABSTRACT

Background and Aims: The effect of the COVID pandemic on stroke networks performance are unclear, particularly with consideration of drip & ship versus mothership models. We systematically reviewed and metaanalyzed variations in stroke admissions, rate and timing of reperfusion treatments during the COVID pandemic versus the prepandemic timeframe. Methods: The systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We searched MEDLINE, EMBASE and Cochrane CENTRAL until 9/10/ 2020, for studies reporting variations in ischemic stroke admissions, treatment rates and timing in COVID vs control-period. Primary outcome was the weekly admission incidence rate ratio (IRR=admissions during COVID-period/admissions during control-period). Secondary outcomes were (i) changes in rate of patients undergoing reperfusion treatment and (ii) time metrics for pre-and in-hospital phase. Results: Twenty-nine studies were included in qualitative synthesis, with 212960 patients observed for 532 cumulative weeks (325 control-period, 207 COVID-period). COVID-period was associated with a significant reduction in stroke admission rates (IRR=0.69, 95%CI, 0.61-0.79) and a higher relative presentation with large vessel occlusion stroke (RR=1.62, 95%CI, 1.24-2.12). Proportions of patients treated with intravenous thrombolysis remained unchanged, while endovascular treatment increased (RR=1.14, 95%CI, 1.02-1.28). Onset-to-door time was longer for drip&ship compared to mothership model (+32 minutes vs-12 minutes, pmeta-regression =.03). Conclusions: Despite a 35% drop in stroke admissions during the pandemic, proportions of patients receiving reperfusion and time-metrics were not inferior to control-period, justifying allocation of resources to keep stroke networks up and running.

7.
Topics in Antiviral Medicine ; 29(1):88, 2021.
Article in English | EMBASE | ID: covidwho-1250606

ABSTRACT

Background: One of the fundamental pillars of SARS-CoV-2 pandemic control and vaccine development is understanding mid-and long-term immunity. Early humoral response has been extensively studied, however data on what recovered individuals are still scarce and the most recent studies are based on few time points over time, which limits the comprehension of the longitudinal pattern of the potential changes. In this study we have evaluated the neutralizing activity and IgG antibody titer against SARS-CoV-2 in mild/ asymptomatic and hospitalized COVID-19 individuals, over a 6-month period. Methods: We have evaluated the kinetics of the humoral immune response in 210 individuals infected by SARS-CoV-2 covering the first and second waves of COVID-19 outbreak in Catalonia (Spain). IgG antibody titer was evaluated with an in-house sandwich ELISA against the S2 subunit, the binding domain receptor (RBD) and the nucleoprotein (NP) and the neutralizing activity was evaluated by a neutralization assay with HIV reporter pseudoviruses expressing SARS-CoV-2 S protein. Statistical analyses were carried out using mixed-effects non-linear and linear models. Results: Most study participants developed a neutralizing humoral response against SARS-CoV-2, however the maximum neutralization titer was 10-fold lower in mild/asymptomatic individuals compared to those with a more severe illness. We observed a slow and progressive decay of neutralizing activity in individuals with mild or asymptomatic disease throughout the 6-month period. In hospitalized individuals, half maximal neutralization activity was achieved on day 10 and showed an initial rapid decline that significantly slowed and remained nearly flat after day 80. Despite this, activity at six months remained higher in hospitalized individuals compared to mild symptomatic participants. On the other hand, we observed that IgG antibody titers against S2, RBD and NP had a more marked fall without showing differences in the decay pattern between individuals with different degree of severity of the disease. Conclusion: Our data suggest that the neutralizing activity remains relatively stable for more than 6 months despite the decline in IgG antibodies, suggesting that the quality of immune response evolves and allows maintaining the neutralizing activity despite the decay in antibody titers. Our results provide a more detailed picture of the behavior of the natural humoral immune response over time that complements the current evidence on mid-term immunity.

8.
Topics in Antiviral Medicine ; 29(1):90, 2021.
Article in English | EMBASE | ID: covidwho-1250361

ABSTRACT

Background: Many immune studies of SARS-CoV-2 (CoV-2) infection have focused on the generation of virus-specific as a means of protection. However, a small group of CoV-2 infected individuals called Non-seroconverters (NSC), do not generate antibodies but experience a mild or moderate disease course. Identifying mechanism of CoV-2 control in NSC may inform the development of novel therapeutics and vaccines approaches. Methods: We identified eleven CoV-2 NSC (3.6%) from the King-cohort study (PI-20-217). NSC were defined by a positive CoV-2 PCR at the time of diagnosis in the absence of IgG, IgA and IgM in serum and plasma measured by two independent ELISA techniques. For comparison, we identify groups of CoV-2 convalescent (n=15) and low-neutralizers (n=15). We measured T-cell responses to the CoV-2 Spike (S) and Nucleocapsid (NP) recombinant proteins in PBMCs by ELISPOT and flow cytometry. We combined T-cell surface and lineage markers together with PD-1, functional (TNF, IFN-y, and IL-2) and activation induced markers (AIM: CD25, CD137 and OX40). Results: We identified CoV-2 specific CD4+ and CD8+ T-cells against the S and the NP in NSC individuals. All NSC responded to S by production of one or more cytokine in either CD4+ or CD8+ T-cells, and 57% responded to NP. Specific-CD8+ T cells against S in NSC were characterized by IFN-y, and TNF production, and we observed higher levels of TNF production as compared to low neutralizers (p=0.02). No differences were found in IFN-y, IL-2 and TNF production in S-specific CD4+ T cells between groups, nor in NP CD8+ or CD4+ T-cell responses. The levels of CD137/OX40 in CD8+ and CD4+ T cells were significantly lower in NSC in response to S (p=0.006, and p=0.012). Also, lower levels of PD-1 were observed in CD8+ T cells in response to NP in NSC (p=0.017). Conclusion: We provide evidence of SARS-CoV2 cellular immunity in NSC individuals despite the absence of humoral neutralizing responses. CD8+ and CD4+ T cells against the S and NP were present in NSC and characterized by TNF production in CD8+ T-cells in responses to S when compared to low neutralizers. Decreased levels of activation markers were observed in NSCs following S and NP stimulation. We propose a protective role of cellular immunity in NSC potentially driven by preexisting cellular responses.

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