[Socioeconomic inequalities and COVID-19 in Spain. SESPAS Report 2022]. / Desigualdades socioeconómicas y COVID-19 en España. Informe SESPAS 2022.

The COVID-19 pandemic has shown its syndemic nature where the contagion by coronavirus joins the high prevalence of chronic diseases in a context of great social inequality and a clear gradient of those pathologies. The objectives of this article are: 1) to show a conceptual framework of the determinants of social inequality in the COVID-19; 2) to review the available literature on socioeconomic inequalities in various aspects related to COVID-19 in Spain; and 3) propose recommendations to monitor, intervene with policies and communication guides to reduce social inequalities in COVID-19, showing examples developed in Spain. The conceptual framework includes structural and intermediate determinants reflecting the different axes of inequality that characterize the syndemic nature of COVID-19. The literature review published up to July 2021 in Spain describes a socioeconomic gradient of COVID-19, not always consistent among studies, as well as an uneven impact of many measures to control the pandemic. Finally, the proposals for reducing social inequalities in COVID-19 include: 1) to guarantee information systems and research with an equity perspective; 2) to reduce inequalities in COVID-19 through its intermediate, and economic and political determinants; and 3) to design communication models and understanding frameworks that break with hegemonies that hide the relevance of social inequality in the pandemic. Given the syndemic nature of COVID-19 and accumulated knowledge, surveillance systems, interventions and communication must include a clear perspective of health equity.

El séptimo sello (1957), entre pestes y sindemias

Tal que, a otros muchos, sin duda, con el inicio de los confinamientos decretados para intentar contener la actual pandemia, nos vino a la cabeza El séptimo sello (1957) de Bergman, relacionando los acontecimientos del tiempo en que se desarrolla la película con los que vivíamos y vivimos actualmente: la epidemia de Peste Negra que asolaba Suecia en el siglo XIV de un lado y la pandemia por Covid-19 de otro, sindemias ambas como algunos prefieren llamarlas. Tomando como disculpa la obra de Ingmar Bergman nuestra pretensión es hacer algunas comparaciones entre la peste medieval y la pandemia actual aportando algunas reflexiones y opiniones personales surgidas muchas de ellas de nuestra propia experiencia durante estos largos meses.

SOCIODEMOGRAPHIC INDICATORS APPLIED TO THE COVID-19 SYNDEMIC

The pandemic nature of the new SARS-CoV-2 coronavirus requires extraordinary efforts in all areas of management and the formulation of public health policies to contain the number of contagion cases and deaths inflicted on the world population. However, it is possible to develop and encourage follow-up practices that can help reduce the number of contagion cases. This work aims to collect sociodemographic indicators associated by the scientific literature with the spatial distribution of COVID-19. Methodologically, it is a case study that aims to build a knowledge management model based on sociodemographic data collection. Their comparison with the viral RNA measurements in wastewater obtained at different points would allow managers to predict the possibility of an early warning of the onset of the disease, the future increase or decrease in the number of cases or the end of the pandemic in location. Regarding government action, associating the information related to the virus with the sociodemographic indicators of the region where the wastewater is collected, its managers can design preventive measures with greater precision and accuracy.

HIV and SARS-CoV-2 Co-infection: Epidemiological, Clinical Features, and Future Implications for Clinical Care and Public Health for People Living with HIV (PLWH) and HIV Most-at-Risk Groups.

PURPOSE OF REVIEW: The purpose of this review is to use the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health response to SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH). RECENT FINDINGS: While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV co-infection, prevented a clear picture of the synergies between them, currently available data strongly support the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, comorbidities, and detectable HIV viral load as associated worse prognostic factors among PLWH. Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, a syndemic approach to prevent SARS-CoV-2 among HIV high-risk groups and PLWH, targeting these populations for SARS-CoV-2 vaccines and protocolizing early identification of PLWH with worse COVID-19 prognosis factors, is crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV co-infection.

HIV and SARS-CoV-2 Co-infection: Epidemiological, Clinical Features, and Future Implications for Clinical Care and Public Health for People Living with HIV (PLWH) and HIV Most-at-Risk Groups.

PURPOSE OF REVIEW: The purpose of this review is using the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health response with regard SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH). RECENT FINDINGS: While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV coinfection prevented to have a clear picture of the synergies between them, currently available data strongly supports the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, co-morbidities, and HIV viral load as associated worse prognosis factors among PLWH. Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, in the meanwhile, syndemic approaches to prevent SARS-CoV-2 among HIV higher risk groups and PLWH, targeting these population for SARS-CoV-2 vaccines and protocolizing early identification of HIV + patients with worse COVID-19 prognosis factors, are crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV coinfection.

Risk of a syndemic between COVID-19 and dengue fever in southern Mexico / Riesgo de sindemia de COVID-19 y fiebre del dengue en el sur de México

Resumen Una sindemia es la convergencia de dos o más enfermedades en un mismo espacio y tiempo. En México, la epidemia de dengue está activa y predomina en zonas del Pacífico y Golfo de México; por su parte, la epidemia de COVID-19 afecta severamente las mismas zonas que el dengue. Dado que estas enfermedades comparten numerosas manifestaciones clínicas, en zonas endémicas de enfermedades tropicales es importante la evaluación minuciosa del paciente que consulta por fiebre, para establecer oportunamente un diagnóstico correcto. Las pruebas de laboratorio son necesarias para llevar a cabo las medidas pertinentes en cada paciente. En México, el riesgo de sindemia de COVID-19 y dengue es alto, por lo que puede colapsar los sistemas de salud. Los estados del sureste y los colindantes con el Pacífico requieren especial atención ya que presentan condiciones geográficas, ambientales y climáticas que favorecen la rápida propagación del dengue y COVID-19. La infección simultánea empeorará la situación epidemiológica, complicará el diagnóstico, control y tratamiento de ambas enfermedades.

Abstract A syndemic is the convergence of two or more diseases in the same space and time. In Mexico, the dengue epidemic is active and predominates in areas of the Pacific and the Gulf of Mexico; in turn, the COVID-19 epidemic severely affects the same areas as dengue fever. Given that both these diseases share many clinical manifestations, in areas where tropical diseases are endemic, it is important to make careful evaluations of the patient who consults for fever in order to establish a timely diagnosis. Laboratory diagnostic tests are necessary to take the pertinent measures for each patient. In Mexico, the risk of a syndemic between COVID-19 and dengue fever is high, and thus it that can collapse health systems. The states of southeastern Mexico and the Pacific region require special attention, since they have geographic, environmental and climatic conditions that favor the rapid spread of dengue and COVID-19. Simultaneous infection will worsen the epidemiological situation, and complicate the diagnosis, control and treatment of both diseases.

Risk of a syndemic between COVID-19 and dengue fever in southern Mexico.

A syndemic is the convergence of two or more diseases in the same space and time. In Mexico, the dengue epidemic is active and predominates in areas of the Pacific and the Gulf of Mexico; in turn, the COVID-19 epidemic severely affects the same areas as dengue fever. Given that both these diseases share many clinical manifestations, in areas where tropical diseases are endemic, it is important to make careful evaluations of the patient who consults for fever in order to establish a timely diagnosis. Laboratory diagnostic tests are necessary to take the pertinent measures for each patient. In Mexico, the risk of a syndemic between COVID-19 and dengue fever is high, and thus it that can collapse health systems. The states of southeastern Mexico and the Pacific region require special attention, since they have geographic, environmental and climatic conditions that favor the rapid spread of dengue and COVID-19. Simultaneous infection will worsen the epidemiological situation, and complicate the diagnosis, control and treatment of both diseases.

Una sindemia es la convergencia de dos o más enfermedades en un mismo espacio y tiempo. En México, la epidemia de dengue está activa y predomina en zonas del Pacífico y Golfo de México; por su parte, la epidemia de COVID-19 afecta severamente las mismas zonas que el dengue. Dado que estas enfermedades comparten numerosas manifestaciones clínicas, en zonas endémicas de enfermedades tropicales es importante la evaluación minuciosa del paciente que consulta por fiebre, para establecer oportunamente un diagnóstico correcto. Las pruebas de laboratorio son necesarias para llevar a cabo las medidas pertinentes en cada paciente. En México, el riesgo de sindemia de COVID-19 y dengue es alto, por lo que puede colapsar los sistemas de salud. Los estados del sureste y los colindantes con el Pacífico requieren especial atención ya que presentan condiciones geográficas, ambientales y climáticas que favorecen la rápida propagación del dengue y COVID-19. La infección simultánea empeorará la situación epidemiológica, complicará el diagnóstico, control y tratamiento de ambas enfermedades.