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1.
PLoS One ; 16(3): e0248029, 2021.
Article in English | MEDLINE | ID: covidwho-1167077

ABSTRACT

Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.


Subject(s)
/epidemiology , Hospitalization/statistics & numerical data , Aged , Comorbidity , Female , Humans , Male , Middle Aged , Pandemics , Spain/epidemiology , Treatment Outcome
2.
BMC Pregnancy Childbirth ; 21(1): 273, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1166895

ABSTRACT

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.


Subject(s)
/epidemiology , Fetal Membranes, Premature Rupture/epidemiology , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Adolescent , Adult , Case-Control Studies , Cesarean Section/statistics & numerical data , Female , Gestational Age , Humans , Infant, Extremely Premature , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal/statistics & numerical data , Labor, Induced/statistics & numerical data , Logistic Models , Middle Aged , Multivariate Analysis , Odds Ratio , Pregnancy , Prospective Studies , Spain/epidemiology , Young Adult
3.
BMJ Open ; 11(4): e049066, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1166515

ABSTRACT

OBJECTIVES: To investigate which were the most relevant sociodemographic and clinical variables associated with COVID-19 severity, and uncover how their inter-relations may have affected such severity. DESIGN: A retrospective observational study based on electronic health record data. PARTICIPANTS: Individuals ≥14 years old with a positive PCR or serology test, between 28 February and 31 May 2020, belonging to the Basque Country (Spain) public health system. Institutionalised and individuals admitted to a hospital at home unit were excluded from the study. MAIN OUTCOME MEASURE: Three severity categories were established: primary care, hospital/intensive care unit admission and death. RESULTS: A total of n=14 197 cases fulfilled the inclusion criteria. Most variables presented statistically significant associations with the outcome (p<0.0001). The Classification and Regression Trees recursive partitioning methodology (based on n=13 792) suggested that among all associations, those with, age, sex, stratification of patient healthcare complexity, chronic consumption of blood and blood-forming organ, and nervous system drugs, as well as the total number of chronic Anatomical Therapeutic Chemical types were the most relevant. Psychosis also emerged as a potential factor. CONCLUSIONS: Older cases are more likely to experience more severe outcomes. However, the sex, underlying health status and chronic drug consumption may interfere and alter the ageing effect. Understanding the factors related to the outcome severity is of key importance when designing and promoting public health intervention plans for the COVID-19 pandemic.


Subject(s)
/epidemiology , Pandemics , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Spain/epidemiology , Treatment Outcome
5.
Aging Clin Exp Res ; 32(7): 1195-1198, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1152155

ABSTRACT

WHO declared SARS-CoV-2 a global pandemic. The present aim was to propose an hypothesis that there is a potential association between mean levels of vitamin D in various countries with cases and mortality caused by COVID-19. The mean levels of vitamin D for 20 European countries and morbidity and mortality caused by COVID-19 were acquired. Negative correlations between mean levels of vitamin D (average 56 mmol/L, STDEV 10.61) in each country and the number of COVID-19 cases/1 M (mean 295.95, STDEV 298.7, and mortality/1 M (mean 5.96, STDEV 15.13) were observed. Vitamin D levels are severely low in the aging population especially in Spain, Italy and Switzerland. This is also the most vulnerable group of the population in relation to COVID-19. It should be advisable to perform dedicated studies about vitamin D levels in COVID-19 patients with different degrees of disease severity.


Subject(s)
Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Vitamin D Deficiency/epidemiology , Betacoronavirus , Coronavirus Infections/etiology , Coronavirus Infections/prevention & control , Humans , Italy/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/etiology , Pneumonia, Viral/prevention & control , Spain/epidemiology , Vitamin D/blood , Vitamin D Deficiency/complications
6.
Int J Environ Res Public Health ; 18(7)2021 03 27.
Article in English | MEDLINE | ID: covidwho-1154412

ABSTRACT

Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (-11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March-10 May). The reduction in the consumption of RBCs was significant in the period from 1-15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs.


Subject(s)
Pandemics , Blood Donors , Hospitals , Humans , Prospective Studies , Retrospective Studies , Spain/epidemiology
7.
Int J Environ Res Public Health ; 18(7)2021 03 25.
Article in English | MEDLINE | ID: covidwho-1154401

ABSTRACT

The lockdown measures in Spain due to the SARS-CoV-2 or COVID-19 (Coronavirus disease 2019) pandemic from 13 March to 21 June 2020 had extensive social and environmental implications. This study aims to understand how the measures of lockdown have influenced noise levels, as well as people's perception of sound quality before and after lockdown, including de-escalation. For this purpose, an online survey was carried out. Moreover, the noise linked to the Global Positioning System (GPS) position of each individual respondent was recorded aiming to correlate the noise level with the result of the survey. An average reduction of over 30 dB was observed compared with the sound pressure level before lockdown. Furthermore, it was found that the loudness parameter, together with the overall level, increased as the country started relaxing restrictions. Additionally, results showed that the perception of noise quality changed depending on the phase of de-escalation (p < 0.01), the type of property (p < 0.05), and the outside noise (p < 0.01). Moreover, noise annoyance was determined considering age (p < 0.01), gender (p < 0.05), type of property (p < 0.001), and home refurbishment (p < 0.05). It may be concluded that the most important measure to decrease noise levels is the reduction of traffic noise, through using eco-friendly public transportation or bicycles and limiting nightlife hours.


Subject(s)
Pandemics , Communicable Disease Control , Humans , Perception , Spain/epidemiology
8.
Euro Surveill ; 26(9)2021 03.
Article in English | MEDLINE | ID: covidwho-1154190

ABSTRACT

BackgroundSeveral clinical trials have assessed the protective potential of chloroquine and hydroxychloroquine. Chronic exposure to such drugs might lower the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or severe coronavirus disease (COVID-19).AimTo assess COVID-19 incidence and risk of hospitalisation in a cohort of patients chronically taking chloroquine/hydroxychloroquine.MethodsWe used linked health administration databases to follow a cohort of patients with chronic prescription of hydroxychloroquine/chloroquine and a control cohort matched by age, sex and primary care service area, between 1 January and 30 April 2020. COVID-19 cases were identified using International Classification of Diseases 10 codes.ResultsWe analysed a cohort of 6,746 patients (80% female) with active prescriptions for hydroxychloroquine/chloroquine, and 13,492 controls. During follow-up, there were 97 (1.4%) COVID-19 cases in the exposed cohort and 183 (1.4%) among controls. The incidence rate was very similar between the two groups (12.05 vs 11.35 cases/100,000 person-days). The exposed cohort was not at lower risk of infection compared with controls (hazard ratio (HR): 1.08; 95% confidence interval (CI): 0.83-1.44; p = 0.50). Forty cases (0.6%) were admitted to hospital in the exposed cohort and 50 (0.4%) in the control cohort, suggesting a higher hospitalisation rate in the former, though differences were not confirmed after adjustment (HR: 1·46; 95% CI: 0.91-2.34; p = 0.10).ConclusionsPatients chronically exposed to chloroquine/hydroxychloroquine did not differ in risk of COVID-19 nor hospitalisation, compared with controls. As controls were mainly female, findings might not be generalisable to a male population.


Subject(s)
Antiviral Agents/therapeutic use , /epidemiology , Chloroquine/adverse effects , Female , Humans , Hydroxychloroquine/adverse effects , Incidence , Male , Prospective Studies , Spain/epidemiology
9.
PLoS One ; 16(3): e0249037, 2021.
Article in English | MEDLINE | ID: covidwho-1150553

ABSTRACT

The novel coronavirus (COVID-19) that was first reported at the end of 2019 has impacted almost every aspect of life as we know it. This paper focuses on the incidence of the disease in Italy and Spain-two of the first and most affected European countries. Using two simple mathematical epidemiological models-the Susceptible-Infectious-Recovered model and the log-linear regression model, we model the daily and cumulative incidence of COVID-19 in the two countries during the early stage of the outbreak, and compute estimates for basic measures of the infectiousness of the disease including the basic reproduction number, growth rate, and doubling time. Estimates of the basic reproduction number were found to be larger than 1 in both countries, with values being between 2 and 3 for Italy, and 2.5 and 4 for Spain. Estimates were also computed for the more dynamic effective reproduction number, which showed that since the first cases were confirmed in the respective countries the severity has generally been decreasing. The predictive ability of the log-linear regression model was found to give a better fit and simple estimates of the daily incidence for both countries were computed.


Subject(s)
/epidemiology , Models, Statistical , Basic Reproduction Number , /virology , Humans , Incidence , Italy/epidemiology , Spain/epidemiology
10.
Cardiovasc Diabetol ; 20(1): 69, 2021 03 23.
Article in English | MEDLINE | ID: covidwho-1148218

ABSTRACT

BACKGROUND: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. OBJECTIVES: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. METHODS: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. RESULTS: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. CONCLUSION: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.


Subject(s)
Coronary Angiography , Diabetes Mellitus , Heart Diseases/diagnostic imaging , Heart Diseases/therapy , Percutaneous Coronary Intervention , Time-to-Treatment , Waiting Lists , Age Factors , Aged , Aged, 80 and over , Comorbidity , Databases, Factual , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Female , Heart Diseases/mortality , Humans , Male , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Spain/epidemiology , Time Factors , Waiting Lists/mortality
12.
Int J Environ Res Public Health ; 18(6)2021 03 18.
Article in English | MEDLINE | ID: covidwho-1145615

ABSTRACT

The concept of neighborhood contagion focus is defined and justified as a basic spatial unit for epidemiological diagnosis and action, and a specific methodological procedure is provided to detect and map focuses and micro-focuses of contagion without using regular or artificial spatial units. The starting hypothesis is that the contagion in urban spaces manifests unevenly in the form of clusters of cases that are generated and developed by neighborhood contagion. Methodologically, the spatial distribution of those infected in the study area, the city of Málaga (Spain), is firstly analyzed from the disaggregated and anonymous address information. After defining the concept of neighborhood contagion focus and justifying its morphological parameters, a method to detect and map neighborhood contagion focus in urban settings is proposed and applied to the study case. As the main results, the existence of focuses and micro-focuses in the spatial pattern of contagion is verified. Focuses are considered as an ideal spatial analysis unit, and the advantages and potentialities of the use of mapping focus as a useful tool for health and territorial management in different phases of the epidemic are shown.


Subject(s)
Cities , Humans , Residence Characteristics , Spain/epidemiology
13.
BMC Infect Dis ; 21(1): 283, 2021 Mar 20.
Article in English | MEDLINE | ID: covidwho-1143186

ABSTRACT

BACKGROUND: Pneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system. We therefore analyse the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity. METHODS: Time series analysis of pneumonia cases, from January 2014 to December 2020. We collected pneumonia diagnoses from primary care EHR, a software system covering > 6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019-2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics. RESULTS: Between 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9909 to 13,498) were identified. Previously, we identified an excess from January to March 2020 in the population older than 15 years of 20%. We observed another excess pneumonia period from 22 october to 15 november of 1377 excess cases (95% CI: 665 to 2089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3534 less pneumonia cases (95% CI, 1005 to 6064) from March to July; and 54 days and 1960 less pneumonia cases (95% CI 917 to 3002) from October to December. CONCLUSIONS: Diagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19.


Subject(s)
Electronic Health Records , Pandemics , Pneumonia/epidemiology , Adolescent , Adult , Aged , Child , Humans , Influenza, Human/epidemiology , Male , Middle Aged , Primary Health Care , Seasons , Spain/epidemiology , Young Adult
14.
Int J Environ Res Public Health ; 18(5)2021 03 08.
Article in English | MEDLINE | ID: covidwho-1134152

ABSTRACT

Physical activity and a healthy diet are key factors for avoiding major noncommunicable diseases. The aim of the present study was to analyze how physical activity (PA) and adherence to the Mediterranean diet among employees participating in the Healthy Cities program have been affected during confinement due to the COVID-19 pandemic. The sample was composed of 297 employees from 40 leading companies based in Spain, who participated in the 5th edition of the Sanitas "Healthy Cities" challenge. The participants (148 women and 149 men), aged between 24 and 63 years old (M = 42.76; SD = 7.79) completed the short form of the International Physical Activity Questionnaire (IPAQ) and the PREDIMED (Prevención con Dieta Mediterránea) questionnaire to measure adherence to the Mediterranean diet before and during the pandemic. Pearson χ2 tests revealed that workers were more likely to show sedentary behaviors during the pandemic than before (83.5% vs. 66.7%). Additionally, they were more likely to reach high levels of PA (51.2% vs. 64%), and Wilcoxon tests revealed that energy expenditure measured in Metabolic Equivalent of Task (MET) was higher during the pandemic (4199.03 METs) than before (3735.32 METs), due to an increase in moderate PA. Lastly, a higher adherence to a Mediterranean diet during the pandemic (76.4%) than before (54.5%) was reported. The findings of this investigation suggest a positive effect of working from home for employees involved in a health-promotion program, and highlight the relevance of this kind of action among this population.


Subject(s)
Diet, Mediterranean , Adult , Cities , Exercise , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Spain/epidemiology , Young Adult
15.
Int J Environ Res Public Health ; 18(5)2021 03 08.
Article in English | MEDLINE | ID: covidwho-1134150

ABSTRACT

COVID-19-induced quarantine may lead to deleterious effects on health status as well as to impaired performance and increased injury risk when re-starting training after lockdown. We investigated the physical activity (PA) habits of recreational runners in Spain during a 48-day home quarantine during the COVID-19 pandemic and the characteristics of the first outdoor running session after confinement. A cross-sectional study, including a self-reported running questionnaire completed after the first outdoor running session after quarantine, was performed. Three hundred recreational runners (74% males; 60% 18-40 years old; most typical running experience >3 years, 10-30 km weekly running distance distributed in 3-4 sessions) were considered for analysis. Advanced runners ran, at least, 4 days/week and participated in running events. They performed significantly longer and more non-supervised weekly training sessions during confinement (p < 0.01 for both) than novice and amateur runners. Most runners performed their first outdoor running session on asphalt (65.3%) and ran 5 to 10 km (61%) at a pace above 5 min/km (60%), reporting no pain before (77%), during (64%), and 24 h after (76%) the session. Advanced runners performed a significantly longer running session, at a higher pace, and covered a greater distance (p < 0.01 for all) than novice and amateur runners, while enjoyment and motivation tended to be significantly higher when runners' level increased (p < 0.05). Higher training levels prior to and during confinement may lower the collateral effects (e.g., detraining, injury risk) of home quarantine when runners return to previous PA levels.


Subject(s)
Running , Adolescent , Adult , Communicable Disease Control , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Quarantine , Spain/epidemiology , Young Adult
16.
PLoS One ; 16(3): e0248243, 2021.
Article in English | MEDLINE | ID: covidwho-1133690

ABSTRACT

In this work, a SEIR-type mathematical model of the COVID-19 outbreak was developed that describes individuals in compartments by infection stage and age group. The model assumes a close well-mixed community with no migrations. Infection rates and clinical and epidemiological information govern the transitions between stages of the disease. The impact of specific interventions (including the availability of critical care) on the outbreak time course, the number of cases and the outcome of fatalities were evaluated. Data available from the COVID-19 outbreak from Spain as of mid-May 2020 was used. Key findings in our model simulation results indicate that (i) universal social isolation measures appear effective in reducing total fatalities only if they are strict and the number of daily interpersonal contacts is reduced to very low numbers; (ii) selective isolation of only the elderly (at higher fatality risk) appears almost as effective as universal isolation in reducing total fatalities but at a possible lower economic and social impact; (iii) an increase in the number of critical care capacity directly avoids fatalities; (iv) the use of personal protective equipment (PPE) appears to be effective to dramatically reduce total fatalities when adopted extensively and to a high degree; (v) extensive random testing of the population for more complete infection recognition (accompanied by subsequent self-isolation of infected aware individuals) can dramatically reduce the total fatalities only above a high percentage threshold that may not be practically feasible.


Subject(s)
/pathology , Models, Theoretical , Age Factors , Awareness , /virology , Disease Outbreaks , Humans , Quarantine , Spain/epidemiology
17.
Appl Environ Microbiol ; 87(7)2021 03 11.
Article in English | MEDLINE | ID: covidwho-1133127

ABSTRACT

Two large wastewater treatment plants (WWTP), covering around 2.7 million inhabitants, which represents around 85% of the metropolitan area of Barcelona, were sampled before, during, and after the implementation of a complete lockdown. Five one-step reverse transcriptase quantitative PCR (RT-qPCR) assays, targeting the polymerase (IP2 and IP4), the envelope (E), and the nucleoprotein (N1 and N2) genome regions, were employed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection in 24-h composite wastewater samples concentrated by polyethylene glycol (PEG) precipitation. SARS-CoV-2 was detected in a sewage sample collected 41 days ahead of the declaration of the first COVID-19 case. The evolution of SARS-CoV-2 genome copies in wastewater evidenced the validity of water-based epidemiology (WBE) to anticipate COVID-19 outbreaks, to evaluate the impact of control measures, and even to estimate the burden of shedders, including presymptomatic, asymptomatic, symptomatic, and undiagnosed cases. For the latter objective, a model was applied for the estimation of the total number of shedders, evidencing a high proportion of asymptomatic infected individuals. In this way, an infection prevalence of 2.0 to 6.5% was figured. On the other hand, proportions of around 0.12% and 0.09% of the total population were determined to be required for positive detection in the two WWTPs. At the end of the lockdown, SARS-CoV-2 RNA apparently disappeared in the WWTPs but could still be detected in grab samples from four urban sewers. Sewer monitoring allowed for location of specific hot spots of COVID-19, enabling the rapid adoption of appropriate mitigation measures.IMPORTANCE Water-based epidemiology (WBE) is a valuable early warning tool for tracking the circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among the population, including not only symptomatic patients but also asymptomatic, presymptomatic, and misdiagnosed carriers, which represent a high proportion of the infected population. In the specific case of Barcelona, wastewater surveillance anticipated by several weeks not only the original COVID-19 pandemic wave but also the onset of the second wave. In addition, SARS-CoV-2 occurrence in wastewater evidenced the efficacy of the adopted lockdown measures on the circulation of the virus. Health authorities profited from WBE to complement other inputs and adopt rapid and adequate measures to mitigate the effects of the pandemic. For example, sentinel surveillance of specific sewers helped to locate COVID-19 hot spots and to conduct massive numbers of RT-PCR tests among the population.


Subject(s)
/virology , Evolution, Molecular , Sentinel Surveillance , Waste Water/virology , Asymptomatic Infections/epidemiology , Cities , Genome, Viral , Humans , Prevalence , Spain/epidemiology , Virus Shedding , Waste Disposal Facilities
18.
Int J Environ Res Public Health ; 18(5)2021 03 04.
Article in English | MEDLINE | ID: covidwho-1129709

ABSTRACT

After the first pandemic wave, a nationwide survey assessed the seroprevalence of SARS-CoV-2 antibodies in Spain and found notable differences among provinces whose causes remained unclear. This ecological study aimed to analyze the association between environmental and demographic factors and SARS-CoV-2 infection by province. The seroprevalence of SARS-CoV-2 antibodies by province was obtained from a nationwide representative survey performed in June 2020, after the first pandemic wave in Spain. Linear regression was used in the analysis. The seroprevalence of SARS-CoV-2 antibodies of the 50 provinces ranged from 0.2% to 13.6%. The altitude, which ranged from 5 to 1131 m, explained nearly half of differences in seroprevalence (R2 = 0.47, p < 0.001). The seroprevalence in people residing in provinces above the median altitude (215 m) was three-fold higher (6.5% vs. 2.1%, p < 0.001). In the multivariate linear regression, the addition of population density significantly improved the predictive value of the altitude (R2 = 0.55, p < 0.001). Every 100 m of altitude increase and 100 inhabitants/km2 of increase in population density, the seroprevalence rose 0.84 and 0.63 percentage points, respectively. Environmental conditions related to higher altitude in winter-spring, such as lower temperatures and absolute humidity, may be relevant to SARS-CoV-2 transmission. Places with such adverse conditions may require additional efforts for pandemic control.


Subject(s)
Altitude , Antibodies, Viral , Humans , Immunoglobulin G , Pandemics , Seroepidemiologic Studies , Spain/epidemiology
19.
Nutr Hosp ; 37(5): 1039-1042, 2020 Oct 21.
Article in English | MEDLINE | ID: covidwho-1128242

ABSTRACT

Introduction: Background: coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection. Methods: patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes. Results: we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages. Conclusions: in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.


Subject(s)
Age Factors , Betacoronavirus , Coronavirus Infections/etiology , Pneumonia, Viral/etiology , Vitamin D Deficiency/complications , Vitamin D/analogs & derivatives , Adult , Aged , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Female , Heart Diseases/complications , Humans , Kidney Diseases/complications , Male , Middle Aged , Obesity/complications , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Retrospective Studies , Sex Factors , Spain/epidemiology , Vitamin D/blood
20.
BMJ Open ; 11(3): e042934, 2021 03 10.
Article in English | MEDLINE | ID: covidwho-1127582

ABSTRACT

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths. RESULTS: To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation: while parts of Italy, Spain and the USA have the highest unstandardised rates, parts of Mexico and Peru have the highest standardised rates. For several populations with the necessary data by age and sex for direct standardisation, we show that direct and indirect standardisation yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst 3 years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding 2 years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardisation, indirect standardisation is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.


Subject(s)
/mortality , Brazil/epidemiology , China/epidemiology , Humans , Italy/epidemiology , Mexico/epidemiology , New York/epidemiology , Panama/epidemiology , Peru/epidemiology , Spain/epidemiology , United States/epidemiology
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