Asymptomatic or mildly symptomatic COVID-19 patients with craniomaxillofacial injuries have an increased risk of surgical site infection.

The aim of this paper was to evaluate the association between 'asymptomatic or mildly symptomatic' severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (AS/MS-COVID) and surgical site infection (SSI) after repair of craniomaxillofacial injury (CMFI). Using a case-control study design with a match ratio of 1:4, we enrolled a cohort of AS/MS-COVID cases with immediately treated CMFI during a one-year period. The main predictor variable was SARS-CoV-2 infection (yes/no), and the outcome of interest was SSI (yes/no). The other variables were demographic, clinical, and operative. Appropriate statistics were computed, and p<0.05 was considered statistically significant. The study group comprised 257 cases (28.8% female; 13.2% aged ≥ 60 years; 10.5% with fractures; 39.7% with involvement of nasal/oral/orbital tissue [viral reservoir organs, VROs]; 81.3% with blunt trauma; 19.1% developed an SSI [vs 6.8% in the control group]) with a mean (SD) age of 39.8 (16.6) years (range 19-87). There was a significant relation between SARS-CoV-2 infection and SSI events (p<0.0001; odds ratio 3.22; 95% confidence interval 2.17 to 4.78). On subgroup analysis, SSIs significantly increased with age ≥ 60 years, presence and treatment of fracture, contact with VROs, and prolonged antibiotic use (PAU). However, multivariate logistic regression analysis confirmed a positive effect only from old age, contact with VROs, and PAU (relative risk = 1.56, 2.52, and 2.03, respectively; r = 0.49; p = 0.0001). There was a significant 2.8-fold increase in SSIs among AS/MS-COVID cases, especially in those aged ≥ 60 years, or those with injuries to VROs, or both, who therefore required PAU.

Daily communication of corrected mortality estimates in Spain during the second wave of the COVID-19 pandemic

Introduction: MoMo monitors and communicates daily mortality in Spain, however, the delay in the notifi- cation of deaths biases downwards the estimates from MoMo. Objective: this study evaluates five methods that correct for the effect of notification delays on daily excess mortality estimates during the second wave of the COVID-19 pandemic. Methods: 1) estimates for the excess mortality in Spain were published daily and gathered within 01/09/2020-25/12/2020. 2) adjusted excess mortality estimates were computed by applying five different models that correct for the delay in the notification of deaths. 3) these corrections were evaluated using the mean absolute error (MAE) and the root mean square error (RMSE). Results: the delay in the notification implied that the cumulative excess mortality estimates from MoMo during the second wave were, on average, 87% of their definitive values. The quadratic and cubic regression models raised them to 98%, on average. Using quadratic regressions reduced the RMSE and the MAE of MoMo's estimates in 6 and 13%, respectively. Conclusion: to improve the daily estimates from MoMo for the cumulative excess of deaths, it is recommended to use quadratic regressions to correct the effect of the notification delay.