Mental health in the Mexican population due to COVID-19 / Salud mental en población mexicana por COVID-19

Este artículo analiza el estado de salud mental de población adulta de México en el contexto de pandemia ocasionada por el virus SARS-CoV-2 (COVID-19). Participaron 899 participantes de diferentes regiones de México Medad = 34. 8, DE= 11.38, mujeres= 641, hombres=258, durante el contexto de pandemia por COVID-19. Los instrumentos aplicados fueron la Escala de Miedo al COVID-19 (FCV-19S), la Escala para el Trastorno de Ansiedad Generalizada (GAD-7), el Test de Propósito de Vida (PIL), el Cuestionario de Salud del Paciente (PHQ-9) y el Cuestionario Medical Outcomes Study (MOS) para el apoyo social. La aplicación se realizó de manera individual, durante el período del 12 de junio al 14 de septiembre de 2020. Los resultados indicaron que los participantes no presentaron síntomas agudos de miedo hacia la COVID-19. No obstante, se encontró presencia considerable de ansiedad generalizada y de depresión en diferentes niveles. El apoyo social y propósito de vida se encuentran presentes, contrarrestando la ansiedad y la depresión, mientras que el miedo y la cantidad de horas de exposición a pensamientos sobre COVID-19 contribuyeron de forma positiva a estas variables psicológicas. Se concluye que la crisis sanitaria ocasionada por COVID-19 ha impactado fuertemente en la salud mental de los participantes, no obstante, existen fortalezas como el apoyo social y el propósito de vida que ayudan a sobrellevar los efectos de la pandemia y se debería trabajar en ellas para promover la salud mental durante los momentos de la crisis sanitaria(AU)

This paper analyzes the status of mental health of the adult population of Mexico in the context of the pandemic caused by the SARS-CoV-2 virus (COVID-19). This article analyzes the mental health status of the adult population of Mexico in the context of the pandemic caused by the SARS-CoV-2 virus (COVID-19). A total of 899 participants from different regions of Mexico participated, M age = 34.8, SD= 11.38, women= 641, men=258, during the context of the COVID-19 pandemic. The instruments applied were the COVID-19 Fear Scale (FCV-19S), the Generalized Anxiety Disorder Scale (GAD-7), the Purpose I Life Test (PIL), the Patient Health Questionnaire (PHQ -9) and the Medical Outcomes Study (MOS) Questionnaire for social support. The application was carried out individually, during the period from June 12 to September 14, 2020. The results indicated that the participants did not present acute symptoms of fear towards COVID-19. However, a considerable presence of generalized anxiety and depression was found at different levels. Social support and life purpose are present, counteracting anxiety and depression, while fear and the number of hours of exposure to thoughts about COVID-19 contributed positively to these psychological variables. It is concluded that the health crisis caused by COVID-19 has strongly impacted on the mental health of the participants; however, there are strengths such as social support and life purpose that help to cope with the effects of the pandemic. Therefore, these two strengths should be worked on to promote mental health during times of health crisis(AU)

Lifestyle Habits during the Coronavirus Disease 2019 Quarantine in a Colombian Population Sample / Hábitos de vida durante la cuarentena por covid-19 en una muestra de la población colombiana / Hábitos de vida duram a quarentena por covid-19 em uma amostra de indivíduos colombianos

Introducción: la cuarentena mundial decretada produjo cambios en los hábitos de la población. La investigación tuvo como objetivo identificar el efecto de la cuarentena en los hábitos de una muestra de sujetos colombianos. Materiales y métodos: se realizó un estudio transversal, observacional en 1928 sujetos mayores de edad, a través de una encuesta de Google Forms entre las semanas 9 y 10 de con-finamiento en Colombia. Se preguntó por: ejercicio físico, estado nutricional, estrés, ansiedad, miedo, consumo de tabaco y alcohol, y hábitos de sueño. Resultados: se reunieron datos de hombres y mujeres de 128 ciudades del país y todos los estratos socioeconómicos. La mayoría de los participantes tomaba clases virtuales (53.8 %) o estaba en teletrabajo (39.7 %). El 51.6 % de los sujetos reportaron no hacer o hacer menos de 150 minutos de ejercicio semanal; el 27.0 % de las personas estaban en sobrepeso u obesidad; el 37.5 % comió más saludable; el 56.1 % usaba más redes sociales, y el 72.6 % refirieron depresión, ansiedad y estrés. El antecedente patológico familiar predominante es la hipertensión arterial (53.2 %). Conclusión: aunque muchos de los sujetos encuestados han buscado mantenerse activos físicamente a través de ejercicio en casa, es importante generar de forma continua recomendaciones para mejorar su adherencia; además, se deben realizar campañas más agresivas usando las redes sociales, para compartir información sobre alimentación, descanso y salud mental. Es importante reducir el impacto de la cuarentena en el desarrollo de enfermedades crónicas no transmisibles más adelante.

Introduction: The worldwide quarantine led to several changes in the habits of the population. This research aimed to identify the effect of quarantine on the habits of a sample Colombian population. Materials and methods: A cross-sectional, observational study was conducted on 1928 participants through a Google survey form between weeks 9 and 10 of the quarantine in Colombia. Questions related to the following topics were included: physical exercise, nutritional status, stress, anxiety, fear, tobacco and alcohol consumption, and sleeping habits. Results: Data were collected from men and women from 128 Colombian cities belonging to all socio-economic strata. Most of the participants took virtual classes (53.8%) or teleworking (39.7%), 51.6% reported did not do or did <150 min of weekly activity; 27.0% were overweight or obese, 37.5% ate healthier, 56.1% used more social networks, and 72.6% reported depression, anxiety, and stress. The predominant familial pathological condition reported was arterial hypertension (53.2%). Conclusion: Although several participants sought to remain physically active through exercise at home, it is important to continuously generate recommendations to improve their adherence; further, more aggressive campaigns need to be performed using social media to share infor-mation about the importance of nutrition, rest, and mental health. It is crucial to reduce the effects of quarantine that may lead to chronic non-communicable diseases in future.

Introdução: a quarentena decretada mundialmente produziu mudanças nos hábitos da população. Esta pesquisa visa identificar o efeito da quarentena nos hábitos de uma amostra de sujeitos colombianos. Materiais e métodos: um estudo transversal e observacional foi realizado com 1928 indivíduos maiores de idade por meio de uma pesquisa usando o Google Forms entre as semanas 9-10 de confinamento na Colômbia. Foram feitas perguntas sobre: prática de exercícios físicos, estado nutricional, estresse, ansiedade, medo, consumo de tabaco e álcool e hábitos de sono. Resultados: foram coletados dados de homens e mulheres de 128 cidades do país e de todos os estratos socioeconômicos. A maioria dos parti-cipantes fez aulas virtuais (53,8%) ou teletrabalho (39,7%), 51,6% dos sujeitos relatam não fazer ou fazer menos de 150 minutos de exercício por semana, 27,0% das pessoas estão com sobrepeso ou obesidade, 37,5% se alimentam de forma mais saudável, 56,1% usam mais redes sociais e 72,6% relataram depres-são, ansiedade e estresse. O histórico patológico familiar predominante é a hipertensão arterial (53,2%). Conclusão: embora muitos dos sujeitos pesquisados tenham buscado se manter fisicamente ativos por meio da prática de exercícios em casa, é importante gerar continuamente recomendações para melhorar sua adesão, além disso, campanhas mais agressivas devem ser realizadas utilizando as redes sociais para compartilhar informações sobre alimentação, descanso e saúde mental. É importante reduzir o impacto da quarentena no desenvolvimento de doenças crônicas não transmissíveis posteriormente

Thinking about the Spanish Flu in Bogotá in the Era of covid-19 / Pensar la Gripa Española en Bogotá en tiempos de la covid-19 / Pensando na gripe espanhola em Bogotá em tempos de covid-19

Introducción: como ocurrió en 1918, cuando la epidemia de gripa llegó a la capital colombiana, la actual pandemia de la covid-19 demostró que si bien la enfermedad ataca indiscriminadamente a la población, las clases populares se ven particularmente expuestas teniendo en cuenta sus condiciones de vida. Desarrollo: en el artículo se analizan los discursos que, con motivo de la epidemia de gripa de 1918, se construyeron alrededor de las clases populares capitalinas. La aproximación a las fuentes primarias, en especial a la prensa gráfica de la época, permite dar cuenta de la precariedad con la que los pobres, ubicados en un sector periférico y deprimido de la ciudad, debieron enfrentar una enfermedad letal que causó gran desconcierto y que avanzó rápidamente a lo largo y ancho de una ciudad que carecía de un servicio médico público. Por su parte, las élites bogotanas que, bajo el discurso de la caridad cristiana pretendieron atenuar la crisis, responsabilizaron a los pobres de su suerte por su falta de higiene, su imprevisión y su desorden. Conclusiones: hoy, un siglo después de la epidemia de gripa en Bogotá y en medio de la pandemia de la covid-19, se ha evidenciado, ante una serie de medidas ordenadas por el Gobierno nacional y por el Gobierno local, que incluyen cuarentenas obligatorias, la permanencia de visiones y discursos en los que los enfermos pobres, lejos de ser comprendidos en su realidad social, siguen viéndose como un peligro para el resto de la sociedad

Introduction: The current covid-19 pandemic demonstrated that although the disease indiscriminately attacks the population, the popular classes are particularly more exposed due to their conditions of life, which is similar to the Spanish flu epidemic that reached the Colombian capital in 1918. Development: In this study, we analyzed discourses that were built around the capital's popular classes during the Spanish flu epidemic in 1918. The approach to primary sources, especially the graphic press of the time, accounts for the precari-ousness with which the poor, located in a peripheral depressed sector of the city, had to face a lethal disease that caused great confusion as it advanced rapidly through a city that lacked public health services. Whereas, the Bogotá elites, who tried to mitigate the crisis under the discourse of Christian charity, blamed the poor for their fate, which resulted in their lack of hygiene and foresight and their disorder. Conclusions: Today, a century after the flu epidemic in Bogotá and in the midst of the covid-19 pandemic, it has been evidenced in the face of a series of measures ordered by the national and local governments that include mandatory quarantines, the permanence of visions and discourses in which poor patients, far from being understood in their social reality, continue to be seen as a danger to the rest of society

Introdução: tal qual ocorreu em 1918, quando a epidemia de gripe chegou à capital colombiana, a atual pandemia de covid-19 mostrou que, embora a doença ataque a população indiscriminadamente, as classes populares estão particularmente expostas levando em consideração suas condições de vida. Desenvolvimento: este artigo analisa os discursos que, em função da epidemia de gripe de 1918, se construíram em torno das classes populares da capital. A abordagem das fontes primárias, especialmente da imprensa gráfica da época, permite notar a precariedade com que os pobres, localizados em um setor periférico e deprimido da cidade, tiveram que enfrentar uma doença letal que causou grande confusão e avançou rapidamente em toda a extensão de uma cidade que carecia de um serviço médico público. Por sua vez, as elites de Bogotá que, sob o discurso da caridade cristã, tentaram mitigar a crise, culpam os pobres por seu próprio destino, por sua falta de higiene, falta de visão e desordem. Conclusões: hoje, um século após a epidemia de gripe em Bogotá e em meio à pandemia de covid-19, está comprovado, diante de uma série de medidas ordenadas pelo governo nacional e pelo governo local que incluem quarentenas obrigatórias, a permanência de visões e discursos nos quais os doentes pobres, longe de serem compreen-didos em sua realidade social, continuam sendo vistos como um perigo para o resto da sociedade.

Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study.

BACKGROUND: Bell's palsy is a rare adverse event reported in clinical trials of COVID-19 vaccines. However, to our knowledge no population-based study has assessed the association between the inactivated SARS-CoV-2 vaccines and Bell's palsy. The aim of this study was to evaluate the risk of Bell's palsy after BNT162b2 and CoronaVac vaccination. METHODS: In this case series and nested case-control study done in Hong Kong, we assessed the risk of Bell's palsy within 42 days following vaccination with BNT162b2 (Fosun-BioNTech [equivalent to Pfizer-BioNTech]) or CoronaVac (from Sinovac Biotech, Hong Kong) using data from voluntary surveillance reporting with the Hospital Authority, the COVID-19 Vaccine Adverse Event Online Reporting system for all health-care professionals, and the Hospital Authority's territory-wide electronic health records from the Clinical Data Analysis and Reporting System. We described reported cases of Bell's palsy among vaccine recipients (aged 18-110 years for CoronaVac and aged 16-110 years for BNT162b2). We compared the estimated age-standardised incidence of clinically confirmed cases among individuals who had received the CoronaVac or BNT162b2 vaccination (up to 42 days before presentation) with the background incidence in the population. A nested case-control study was also done using conditional logistic regression to estimate the odds ratio (OR) for risk of Bell's palsy and vaccination. Cases and controls were matched (1:4) by age, sex, admission setting, and admission date. FINDINGS: Between February 23 and May 4, 2021, 451 939 individuals received the first dose of CoronaVac and 537 205 individuals received the first dose of BNT162b2. 28 clinically confirmed cases of Bell's palsy were reported following CoronaVac and 16 cases were reported following BNT162b2. The age-standardised incidence of clinically confirmed Bell's palsy was 66·9 cases per 100 000 person-years (95% CI 37·2 to 96·6) following CoronaVac vaccination and 42·8 per 100 000 person-years (19·4 to 66·1) for BNT162b2 vaccination. The age-standardised difference for the incidence compared with the background population was 41·5 (95% CI 11·7 to 71·4) for CoronaVac and 17·0 (-6·6 to 40·6) for BNT162b2, equivalent to an additional 4·8 cases per 100 000 people vaccinated for CoronaVac and 2·0 cases per 100 000 people vaccinated for BNT162b2. In the nested case-control analysis, 298 cases were matched to 1181 controls, and the adjusted ORs were 2·385 (95% CI 1·415 to 4·022) for CoronaVac and 1·755 (0·886 to 3·477) for BNT162b2. INTERPRETATION: Our findings suggest an overall increased risk of Bell's palsy after CoronaVac vaccination. However, the beneficial and protective effects of the inactivated COVID-19 vaccine far outweigh the risk of this generally self-limiting adverse event. Additional studies are needed in other regions to confirm our findings. FUNDING: The Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

High SARS-CoV-2 Seroprevalence in Rural Peru, 2021: a Cross-Sectional Population-Based Study.

Latin America has been severely affected by the COVID-19 pandemic. The COVID-19 burden in rural settings in Latin America is unclear. We performed a cross-sectional, population-based, random-selection SARS-CoV-2 serologic study during March 2021 in the rural population of San Martin region, northern Peru. In total, 563 persons from 288 houses across 10 provinces were enrolled, reaching 0.2% of the total rural population of San Martin. Screening for SARS-CoV-2 IgG antibodies was done using a chemiluminescence immunoassay (CLIA), and reactive sera were confirmed using a SARS-CoV-2 surrogate virus neutralization test (sVNT). Validation of the testing algorithm using prepandemic sera from two regions of Peru showed false-positive results in the CLIA (23/84 sera; 27%) but not in the sVNT, highlighting the pitfalls of SARS-CoV-2 antibody testing in tropical regions and the high specificity of the two-step algorithm used in this study. An overall 59.0% seroprevalence (95% confidence interval [CI], 55 to 63%) corroborated intense SARS-CoV-2 spread in San Martin. Seroprevalence rates between the 10 provinces varied from 41.3 to 74.0% (95% CI, 30 to 84%). Higher seroprevalence was not associated with population size, population density, surface area, mean altitude, or poverty index in Spearman correlations. Seroprevalence and reported incidence diverged substantially between provinces, suggesting regional biases of COVID-19 surveillance data. Potentially, limited health care access due to environmental, economic, and cultural factors might lead to undetected infections in rural populations. Additionally, test avoidance to evade mandatory quarantine might affect rural regions more than urban regions. Serologic diagnostics should be pursued in resource-limited settings to inform country-level surveillance and vaccination strategies and to support control measures for COVID-19. IMPORTANCE Latin America is a global hot spot of the COVID-19 pandemic. Serologic studies in Latin America have been mostly performed in urban settings. Rural populations comprise 20% of the total Latin American population. Nevertheless, information on COVID-19 spread in rural settings is scarce. Using a representative population-based seroprevalence study, we detected a high seroprevalence in rural populations in San Martin, northern Peru, in 2021, reaching 41 to 74%. However, seroprevalence and reported incidence diverged substantially between regions, potentially due to limited health care access or test avoidance due to mandatory quarantine. Our results suggest that rural populations are highly affected by SARS-CoV-2 even though they are sociodemographically distinct from urban populations and that highly specific serological diagnostics should be performed in resource-limited settings to support public health strategies of COVID-19 control.

Epidemiological features and spatial-temporal distribution of visceral leishmaniasis in mainland China: a population-based surveillance study from 2004 to 2019.

BACKGROUND: Although visceral leishmaniasis (VL) was largely brought under control in most regions of China during the previous century, VL cases have rebounded in western and central China in recent decades. The aim of this study was to investigate the epidemiological features and spatial-temporal distribution of VL in mainland China from 2004 to 2019. METHODS: Incidence and mortality data for VL during the period 2004-2019 were collected from the Public Health Sciences Data Center of China and annual national epidemic reports of VL, whose data source was the National Diseases Reporting Information System. Joinpoint regression analysis was performed to explore the trends of VL. Spatial autocorrelation and spatial-temporal clustering analysis were conducted to identify the distribution and risk areas of VL transmission. RESULTS: A total of 4877 VL cases were reported in mainland China during 2004-2019, with mean annual incidence of 0.0228/100,000. VL incidence showed a decreasing trend in general during our study period (annual percentage change [APC] = -4.2564, 95% confidence interval [CI]: -8.0856 to -0.2677). Among mainly endemic provinces, VL was initially heavily epidemic in Gansu, Sichuan, and especially Xinjiang, but subsequently decreased considerably. In contrast, Shaanxi and Shanxi witnessed significantly increasing trends, especially in 2017-2019. The first-level spatial-temporal aggregation area covered two endemic provinces in northwestern China, including Gansu and Xinjiang, with the gathering time from 2004 to 2011 (relative risk [RR] = 13.91, log-likelihood ratio [LLR] = 3308.87, P < 0.001). The secondary aggregation area was detected in Shanxi province of central China, with the gathering time of 2019 (RR = 1.61, LLR = 4.88, P = 0.041). The epidemic peak of October to November disappeared in 2018-2019, leaving only one peak in March to May. CONCLUSIONS: Our findings suggest that VL is still an important endemic infectious disease in China. Epidemic trends in different provinces changed significantly and spatial-temporal aggregation areas shifted from northwestern to central China during our study period. Mitigation strategies, including large-scale screening, insecticide spraying, and health education encouraging behavioral change, in combination with other integrated approaches, are needed to decrease transmission risk in areas at risk, especially in Shanxi, Shaanxi, and Gansu provinces.

Association of Sickle Cell Trait with Risk and Mortality of COVID-19: Results from the United Kingdom Biobank.

Sickle cell trait (SCT) carriers inherit one copy of the Glu6Val mutation in the hemoglobin gene and is particularly common in Black individuals (5-10%). Considering the roles of hemoglobin in immune responses and the higher risk for coronavirus disease (COVID-19) among Black individuals, we tested whether Black SCT carriers were at increased risk for COVID-19 infection and mortality according to the United Kingdom Biobank. Among Black individuals who were tested for COVID-19, we found similar infection rates among SCT carriers (14/72; 19.7%) and noncarriers (167/791; 21.1%), but higher COVID-19 mortality rates among SCT carriers (4/14; 28.6%) than among noncarriers (21/167; 12.6%) (odds ratio [OR], 3.04; 95% confidence interval [CI], 0.69-11.82; P = 0.12). Notably, SCT carriers with preexisting diabetes had significantly higher COVID-19 mortality (4/4; 100%) than those without diabetes (0/10; 0%; (OR, 90.71; 95% CI, 5.66-infinite; P = 0.0005). These findings suggest that Black SCT carriers with preexisting diabetes are at disproportionally higher risk for COVID-19 mortality. Confirmation by larger studies is warranted.

Mortality and Excess Mortality: Improving FluMOMO.

FluMOMO is a universal formula to forecast mortality in 27 European countries and was developed on EuroMOMO context, http://www.euromomo.eu. The model has a trigonometric baseline and considers any upwards deviation from that to come from flu or extreme temperatures. To measure it, the model considers two variables: influenza activity and extreme temperatures. With the former, the model gives the number of deaths because of flu and with the latter the number of deaths because of extreme temperatures. In this article, we show that FluMOMO lacks important variables to be an accurate measure of all-cause mortality and flu mortality. Indeed, we found, as expected, that population ageing and exposure to the risk of death cannot be excluded from the linear predictor. We model weekly deaths as an autoregressive process (lag of one together with a lead of one week). This step allowed us to avoid FluMOMO trigonometric baseline and have a fit to weekly deaths through demographic variables. Our model uses data from Portugal between 2009 and 2020, on ISO-week basis. We use negative binomial-generalized linear models to estimate the weekly number of deaths as an alternative to traditional overdispersion Poisson. As explanatory variables were found to be statistically significant, we registered the number of deaths from the previous week, the influenza activity index, the population average age, the heat waves, the flu season, the number of deaths with COVID-19, and the population exposed to the risk of dying. Considering as excess mortality the number of deaths above the best estimate of deaths from our model, we conclude that excess mortality in 2020 (net of COVID-19 deaths, heat wave of July, and ageing) is low or inexistent. The model also allows us to have the number of deaths arising from flu and we conclude that FluMOMO is overestimating deaths from flu by 78%. Averages from the probability of dying are obtained as well as the probability of dying from flu. The latter is shown to be decreasing over time, probably due to the increase of flu vaccination. Higher mortality detected with the start of COVID-19, in March-April 2020, was probably due to COVID-19 deaths not recognized as COVID-19 deaths.

Population pharmacokinetics of lopinavir/ritonavir in Covid-19 patients.

OBJECTIVE: To develop a population pharmacokinetic model for lopinavir boosted by ritonavir in coronavirus disease 2019 (Covid-19) patients. METHODS: Concentrations of lopinavir/ritonavir were assayed by an accredited LC-MS/MS method. The population pharmacokinetics of lopinavir was described using non-linear mixed-effects modeling (NONMEM version 7.4). After determination of the base model that better described the data set, the influence of covariates (age, body weight, height, body mass index (BMI), gender, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C reactive protein (CRP), and trough ritonavir concentrations) was tested on the model. RESULTS: From 13 hospitalized patients (4 females, 9 males, age = 64 ± 16 years), 70 lopinavir/ritonavir plasma concentrations were available for analysis. The data were best described by a one-compartment model with a first-order input (KA). Among the covariates tested on the PK parameters, only the ritonavir trough concentrations had a significant effect on CL/F and improved the fit. Model-based simulations with the final parameter estimates under a regimen lopinavir/ritonavir 400/100 mg b.i.d. showed a high variability with median concentration between 20 and 30 mg/L (Cmin/Cmax) and the 90% prediction intervals within the range 1-100 mg/L. CONCLUSION: According to the estimated 50% effective concentration of lopinavir against SARS-CoV-2 virus in Vero E6 cells (16.7 mg/L), our model showed that at steady state, a dose of 400 mg b.i.d. led to 40% of patients below the minimum effective concentration while a dose of 1200 mg b.i.d. will reduce this proportion to 22%.

Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK.

OBJECTIVES: To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES: Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study.

BACKGROUND: School closures have occurred globally during the COVID-19 pandemic. However, empiric data on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children and in educational settings are scarce. In Australia, most schools have remained open during the first epidemic wave, albeit with reduced student physical attendance at the epidemic peak. We examined SARS-CoV-2 transmission among children and staff in schools and early childhood education and care (ECEC) settings in the Australian state of New South Wales (NSW). METHODS: Laboratory-confirmed paediatric (aged ≤18 years) and adult COVID-19 cases who attended a school or ECEC setting while considered infectious (defined as 24 h before symptom onset based on national guidelines during the study period) in NSW from Jan 25 to April 10, 2020, were investigated for onward transmission. All identified school and ECEC settings close contacts were required to home quarantine for 14 days, and were monitored and offered SARS-CoV-2 nucleic acid testing if symptomatic. Enhanced investigations in selected educational settings included nucleic acid testing and SARS-CoV-2 antibody testing in symptomatic and asymptomatic contacts. Secondary attack rates were calculated and compared with state-wide COVID-19 rates. FINDINGS: 15 schools and ten ECEC settings had children (n=12) or adults (n=15) attend while infectious, with 1448 contacts monitored. Of these, 633 (43·7%) of 1448 had nucleic acid testing, or antibody testing, or both, with 18 secondary cases identified (attack rate 1·2%). Five secondary cases (three children; two adults) were identified (attack rate 0·5%; 5/914) in three schools. No secondary transmission occurred in nine of ten ECEC settings among 497 contacts. However, one outbreak in an ECEC setting involved transmission to six adults and seven children (attack rate 35·1%; 13/37). Across all settings, five (28·0%) of 18 secondary infections were asymptomatic (three infants [all aged 1 year], one adolescent [age 15 years], and one adult). INTERPRETATION: SARS-CoV-2 transmission rates were low in NSW educational settings during the first COVID-19 epidemic wave, consistent with mild infrequent disease in the 1·8 million child population. With effective case-contact testing and epidemic management strategies and associated small numbers of attendances while infected, children and teachers did not contribute significantly to COVID-19 transmission via attendance in educational settings. These findings could be used to inform modelling and public health policy regarding school closures during the COVID-19 pandemic. FUNDING: NSW Government Department of Health.

Internet-Related Behaviors and Psychological Distress Among Schoolchildren During COVID-19 School Suspension.

The novel coronavirus disease 2019 (COVID-19) infection has rapidly grown worldwide,1 and many governments have implemented policies to control the infection rate. For example, school suspension, self-quarantine, requirement of citizens to stay at home,2 travel and border controls, and discouragement of outdoor activities3 have been used. Although these actions emphasizing the importance of "spatial distancing" are based on the perspective of public health, they may result in health problems other than COVID-19 infection, such as psychological distress and fear.4 Therefore, the present authors examined the potential predictors for psychological distress among schoolchildren during COVID-19 school suspension.

COVID-19 Waves: Importance of Accumulative Mortality per Million Inhabitants.

The reported number of new cases underestimates the real spread of COVID-19 pandemic because of non-tested asymptomatic people and limited global access to reliable diagnostic tests. In this context, COVID-19 mortality with confirmed diagnosis becomes an attractive source of information to be included in the analysis of perspectives and proposals. Objective data are required to calculate the capacity of resources provided by health systems. New strategies are needed to stabilize or minimize the mortality surge. However, we will not afford this goal until more alternatives were available. We still need an effective treatment, an affordable vaccine, or a collective achievement of sufficient immunity (reaching up to 70% of the whole population). At any time, the arriving waves of the pandemic are testing the capacity of governments. The health services struggle to keep the plateau in a steady-state below 100 deaths per million inhabitants. Therefore, it is necessary to increase the alternatives and supplies based on the current and near-future expected demands imposed by the number of deaths by COVID-19. Estimating COVID-19 mortality in various scenarios with the gradual release of social constraints will help predict the magnitude of those arriving waves.