Hybrid Immunization In COVID-19: Time Matters (preprint)

Purpose: SARS-CoV-2 reinfections have been frequent, even among those vaccinated. The aim of this study is to know if hybrid immunity (infection+vaccination) is affected by the moment of vaccination and the number of doses received. Methods: We conducted a retrospective study in 745 patients with a history of COVID-19 reinfection and recovered the dates of infection and reinfection and vaccination status (date and number of doses). To assess differences in the time to reinfection(tRI) between unvaccinated, vaccinated before 6 months and later, and comparing one, two or three doses(incomplete, complete and booster regime) we performed  the log-rank test of the cumulative incidence calculated as 1 minus the Kaplan-Meier estimator. Results: The tRI was significantly higher in those vaccinated vs. non-vaccinated (q<0.001). However, an early incomplete regime(1 dose) protects similar time than not receiving a vaccine. Vaccination before 6 months after infection showed a lower tRI compared to those vaccinated later with the same regime(q<0.001). Actually, early vaccination with complete(2 doses) and booster regimes(3 doses) provided lower length of protection compared to vaccinating later with incomplete(1 dose) and complete regime(2 doses), respectively.  Vaccination with complete and booster regimes significantly increases the tRI(q<0.001). Conclusion: Vaccination increases the time it takes for a person to become reinfected with SARS-CoV-2. Increasing the time from infection to vaccination increases the time in which a person could be reinfected. Booster doses increase the time to reinfection. Those results emphasize the role of vaccines and boosters during the pandemic and can guide strategies on future vaccination policy.

Efectos de la pandemia COVID-19 en la actividad asistencial de los laboratorios clínicos españoles, evolución 2019–2021

Cuantificar el impacto de la pandemia en la actividad asistencial de los laboratorios clínicos españoles. Estudio descriptivo, observacional, retrospectivo y multicéntrico. De marzo a diciembre de 2020 hubo un descenso estadísticamente significativo en el número de solicitudes (−17.7%, p=<0,001) y análisis totales (−18,3%, p<0,001) respecto al mismo periodo de 2019. Se redujo el número de solicitudes de Atención Primaria en un 37,4% (p<0,001) y el número de mediciones de sangre oculta en heces (−45,8%), análisis cualitativo de orina (−30,1%), antígeno prostático específico (PSA) (−28,5%), tirotropina (TSH) (−27,8%), colesterol total (−27,2%) y hemoglobina glicosilada (HbA1c) (−24,7%), p<0,001. Se observó un aumento significativo del número de solicitudes de UCI (76,6%, p<0,001) y del número de mediciones de IL-6 (+22,350,9), dímero-D (+617,2%), troponina (+46,8%) y gasometría arterial (+35,9%), p<0,001. Durante los seis primeros meses de 2021, existieron diferencias significativas para análisis cualitativo de orina (−8,7%, p<0,001), PSA (−6,3%, p=0,009), IL-6 (+66.269,2, p<0,001), dímero-D (+603,6%, p<0,001), troponina (+28,7%, p<0,001), gasometría arterial (+26,2%, p=0,014) y ferritina (+16,0%, p=0,002). Los laboratorios clínicos españoles han sufrido un cambio en el origen de sus solicitudes y en la demanda de pruebas. Se han incrementado aquellas utilizadas en la evaluación y seguimiento de los pacientes COVID-19, y han disminuido las dirigidas al control de los pacientes no-COVID y a cribados poblacionales. El análisis a más largo plazo refleja una recuperación en las pruebas dirigidas al control de las enfermedades crónicas y se mantiene el aumento del número de mediciones de los biomarcadores utilizados en el manejo de los pacientes COVID-19.

Innovation during the COVID-19 crisis: Why it was more critical for official statistics than ever1

During the COVID-19 pandemic, quantitative evidence was desperately needed in order to understand and manage an unprecedented situation, and to make important national, European and international decisions. Eurostat and the national statistical institutes (NSIs) played a key role in managing the pandemic, providing society with a high quality statistical information service. In particular, the crisis accelerated innovation in statistical production, steered complex processes of change towards the use of new data sources and privately held data for official statistics, enhanced the adoption of new statistical methods, and consequently the production of experimental statistics and dashboards.While the new data ecosystem provided opportunities for the production of official statistics, the importance of privacy preservation, data security and the development of adequate data quality frameworks remained a priority. Important strands of work for the future would be: satisfying the increased needs of users, as well as supporting decision-making and the delivery of government services in emergencies. NSIs would also do well to invest in innovation, collaborate and establish partnerships with the data providers and research communities that have worked closely with them since the beginning of the pandemic. This article is based on the experiences of six NSIs in the Netherlands, Spain, France, Italy, Germany and Finland during the pandemic. [ FROM AUTHOR] Copyright of Statistical Journal of the IAOS is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant

Background Antibody response against SARS-CoV-2 after mRNA or adenoviral vector based vaccines is weak in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines in KT. Here, we compare antibody response following vaccination with inactivated virus (Coronavacࣨ) and BNT162b2 mRNA. Methods A national multicenter cross-sectional study was conducted. The study group was composed of patients from all KT centers in Uruguay, vaccinated between May 1st-May 31st (Coronavacࣨ n = 245 and BNT162b2 n = 39). Control group was constituted by 82 healthy individuals. Participants had no prior confirmed COVID-19 test. Blood samples were collected between 30 and 40 days after second dose. Serum specific IgG antibodies against Receptor Binding Domain (RBD) of SARS-CoV-2 Spike protein were determined using COVID-19 IgG QUANT ELISA Kit. Results Only 29% of KT recipients showed seroconversion [36.5% BNT162b2, 27.8% inactivated virus, p = 0.248] in comparison to 100% in healthy control with either vaccine. Antibody levels against RBD were higher with BNT162b mRNA than with inactivated virus [173 (73–554) and 29 (11–70) BAU/mL, p < 0.034] in KT and 10 times lower than healthy control [inactivated virus: 308 (209–335) and BNT162b2: 2638 (2608–3808) BAU/mL, p < 0.034]. In multivariate analysis, variables associated with negative humoral response were age, triple immunosuppression, eGFR and time post-KT. Conclusion Seroconversion was low in KT patients after vaccination with both platforms. Antibody levels against SARS-CoV-2 were lower with inactivated virus than BNT162b mRNA. These findings support the need of strategies to improve immunogenicity in KT recipients after two doses of either vaccine. Graphical Graphical

Emergence and spread of a B.1.1.28-derived lineage with Q675H and Q677H Spike mutations in Uruguay (preprint)

Uruguay was able to control the viral dissemination during the first nine months of the SARS-CoV-2 pandemic. Unfortunately, towards the end of 2020, the number of daily new cases exponentially increased. We previously identified a B.1.1.28 sublineage carrying mutations Q675H+Q677H in the viral Spike, with local transmission in Rocha, a department bordering Brazil. To understand whether these B.1.1.28+Q675H+Q677H sequences were part of an emergent SARS-CoV-2 lineage broadly disseminated in Uruguay, herein we analyzed the country-wide genetic diversity of viruses between November, 2020 and April, 2021. Our findings support that B.1.1.28+Q675H+Q677H probably arose around November 2020, in Montevideo, Uruguay's capital department. This clade spread to other Uruguayan departments, with evidence of further local transmission clusters. It also spread to the USA and Spain. The Q675H and Q677H mutations are in the proximity of the polybasic cleavage site at the S1/S2 boundary and also arose independently in many SARS-CoV-2 lineages circulating worldwide. Although in Uruguay the B.1.1.28+Q675H+Q677H lineage was dominated by the VOC P.1 since April 2021, the monitoring of the concurrent emergence of Q675H+Q677H in VOIs and/or VOCs should be of worldwide interest.

Spatiotemporal dissemination pattern of SARS-CoV-2 B1.1.28-derived lineages introduced into Uruguay across its southeastern border with Brazil. (preprint)

During the first nine months of the SARS-CoV-2 pandemic, Uruguay successfully kept it under control, even when our previous studies support a recurrent viral flux across the Uruguayan-Brazilian border that sourced several local outbreaks in Uruguay. However, towards the end of 2020, a remarkable exponential growth was observed and the TETRIS strategy was lost. Here, we aimed to understand the factors that fueled SARS-CoV-2 viral dynamics during the first epidemic wave in the country. We recovered 84 whole viral genomes from patients diagnosed between November, 2020 and February, 2021 in Rocha, a sentinel eastern Uruguayan department bordering Brazil. The lineage B.1.1.28 was the most prevalent in Rocha during November-December 2020, P.2 became the dominant one during January-February 2021, while the first P.1 sequences corresponds to February, 2021. The lineage replacement process agrees with that observed in several Brazilian states, including Rio Grande do Sul (RS). We observed a one to three month delay between the appearance of P.2 and P.1 in RS and their subsequent detection in Rocha. The phylogenetic analysis detected two B.1.1.28 and one P.2 main Uruguayan SARS-CoV-2 clades, introduced from the southern and southeastern Brazilian regions into Rocha between early November and mid December, 2020. One synonymous mutation distinguishes the sequences of the main B.1.1.28 clade in Rocha from those widely distributed in RS. The minor B.1.1.28 cluster, distinguished by several mutations, harbours non-synonymous changes in the Spike protein: Q675H and Q677H, so far not concurrently reported. The convergent appearance of S:Q677H in different viral lineages and its proximity to the S1/S2 cleavage site raise concerns about its functional relevance. The observed S:E484K-VOI P.2 partial replacement of previously circulating lineages in Rocha might have increased transmissibility as suggested by the significant decrease in Ct values. Our study emphasizes the impact of Brazilian SARS-CoV-2 epidemics in Uruguay and the need of reinforcing real-time genomic surveillance on specific Uruguayan border locations, as one of the key elements for achieving long-term COVID-19 epidemic control.

Implementation of a qPCR assay coupled with genomic surveillance for real-time monitoring of SARS-CoV-2 variants of concern. (preprint)

We developed a genomic surveillance program for real-time monitoring of SARS-CoV-2 variants of concern in Uruguay. Here, we present the first results, including the proposed qPCR-VOC method, the general workflow and the report of the introduction and community transmission of the VOC P.1 in Uruguay in multiple independent events.

Actividad y asistencia a la parada cardiorrespiratoria en un servicio extrahospitalario de emergencias durante la pandemia COVID-19

Objective. To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on the initiation of cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiopulmonary arrest. To compare the cardiopulmonary arrest caseload during the pandemic to the caseloads in other periods. Methods. Observational, prospective study based on the registry of out-of-hospital cardiopulmonary arrest emergencies the SUMMA112 ambulance service responded to between March 1 and April 30, 2020, in the Spanish autonomous community of Madrid. The registry is a Utstein-style database. The period of March--April 2019 was the control period for direct comparison with the 2020 study period and with the January--February periods of 2019 and 2020. Results. The responders undertook advanced CPR in 146 of the 313 cardiopulmonary arrest cases registered during March-April, 2020. Of the 87 patients with COVID-19--positive tests, 33 reached the hospital alive. Advanced CPR was not applied in 167 cases;the most frequent reason was prolonged circulatory collapse. Most cases (92.7%) occurred in the home. The emergency dispatchers received more calls in March and April of 2020, but they sent out a similar number of ambulances. Conclusions. Mortality was higher in cases of cardiopulmonary arrest during the COVID-19 pandemic. The percentage of cases with no application of advanced CPR rose;the main reason was the amount of time between collapse and first response. Even though the number of emergency calls increased significantly, the SUMMA112 service did not dispatch more ambulances. Objetivos. Conocer las consecuencias de la pandemia COVID-19 en la atención a la parada cardiorrespiratoria (PCR) extrahospitalaria con relación al inicio de las maniobras de resucitación cardiopulmonar (RCP) y su supervivencia. Valorar el impacto de la pandemia por COVID-19 en la actividad asistencial de un servicio de urgencias y emergencias extrahospitalarias en comparación con otros periodos sin enfermedad. Método. Estudio observacional prospectivo, basado en un registro continuo de PCR extrahospitalaria del SUMMA 112 de Madrid, durante el periodo del 1 de marzo al 30 de abril del 2020. Las variables se recogieron siguiendo las recomendaciones Utstein. Se utilizó el periodo de marzo-abril 2019 como control de comparación directa con el periodo de estudio y los periodos de enero-febrero de 2019 y de 2020 para conocer la variabilidad entre dichos años. Resultados. De las 313 PCR atendidas en marzo-abril de 2020, en 146 casos se realizó RCP avanzada. De los 87 pacientes catalogados COVID positivo, llegaron vivos al hospital 33. No se aplicaron maniobras de RCP avanzada en 167 ocasiones, identificando como causa más frecuente el tiempo de colapso excesivo. El 92,7% de las PCR sucedieron en domicilio. Comparado con otros periodos, hubo más llamadas al centro coordinador de urgencias en marzo-abril de 2020, si bien la movilización de recursos fue similar. Conclusiones. Durante la pandemia de COVID-19 hubo más mortalidad en la PCR extrahospitalaria, aumentando el porcentaje de PCR sin RCP avanzada, destacando como principal causa el tiempo de colapso excesivo. Sin embargo, aunque se incrementó significativamente la demanda telefónica, este servicio de emergencias extrahospitalarias no tuvo aumento en la movilización de los recursos móviles asistenciales.