Lifting COVID-19 mitigation measures in Spain (May-June 2020)

GESTACOVID Project: Psychological and Perinatal Effects in Spanish Pregnant Women Subjected to Strict Confinement Due to the COVID-19 Pandemic and Their Evolution during De-Escalation

The lockdown and de-escalation process following the COVID-19 pandemic led to a period of new normality. This study aimed to assess the confinement impact on the mental health of peripartum women, as their psychological well-being may be particularly vulnerable and thus affect their offspring's development. A cross-sectional epidemiological study was conducted among women who gave birth during strict confinement (G0) and the new normality period (G1), in which a self-administered paper-based questionnaire assessed 15 contextual factors and the General Health Questionnaire-12 (GHQ-12). For each item, it was verified whether the positive screening rate differed in each confinement phase, and a risk factor study was conducted. For G0, significantly higher positive screening and preterm birth rates were observed in the positive screening group. In the case of G1, maternal age (>35 years), decreased physical activity, and normal weight were found to be protective factors against distress. This study underscores the heightened mental health risk for postpartum women during major psychosocial upheavals (war, economic crisis, natural disasters, or pandemics), along with their resilience as the positive screening rate decreases with the new normality. Findings encourage adopting strategies to identify high-risk women and promote effective measures, such as promoting physical activity.

Effectiveness of non-pharmaceutical interventions in nine fields of activity to decrease SARS-CoV-2 transmission (Spain, September 2020-May 2021)

Background

We estimated the association between the level of restriction in nine different fields of activity and SARS-CoV-2 transmissibility in Spain, from 15 September 2020 to 9 May 2021.

Methods

A stringency index (0-1) was created for each Spanish province (n = 50) daily. A hierarchical multiplicative model was fitted. The median of coefficients across provinces (95% bootstrap confidence intervals) quantified the effect of increasing one standard deviation in the stringency index over the logarithmic return of the weekly percentage variation of the 7-days SARS-CoV-2 cumulative incidence, lagged 12 days.

Results

Overall, increasing restrictions reduced SARS-CoV-2 transmission by 22% (RR = 0.78; one-sided 95%CI: 0, 0.82) in 1 week, with highest effects for culture and leisure 14% (0.86; 0, 0.98), social distancing 13% (0.87; 0, 0.95), indoor restaurants 10% (0.90; 0, 0.95) and indoor sports 6% (0.94; 0, 0.98). In a reduced model with seven fields, culture and leisure no longer had a significant effect while ceremonies decreased transmission by 5% (0.95; 0, 0.96). Models R ² was around 70%.

Conclusion

Increased restrictions decreased COVID-19 transmission. Limitations include remaining collinearity between fields, and somewhat artificial quantification of qualitative restrictions, so the exact attribution of the effect to specific areas must be done with caution.

Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia

Background: Currently, there are few studies that have analyzed the benefits of using lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.

[Lessons learnt from COVID-19 surveillance. Urgent need for a new public health surveillance. SESPAS Report 2022]

Este artículo recoge los aspectos epidemiológicos más destacados en las primeras fases de la pandemia y unas primeras reflexiones desde una unidad, el Centro de Coordinación de Alertas y Emergencias Sanitarias, que ha coordinado la vigilancia en el ámbito nacional. La COVID-19 ha puesto de manifiesto las carencias de la vigilancia y la dificultad para gestionar una crisis sanitaria sin un modelo robusto de salud pública. El compromiso de los profesionales durante la epidemia ha suplido en muchas ocasiones la falta de recursos y se ha evidenciado la necesidad de incorporar nuevas profesiones a los equipos de vigilancia. Es urgente contar con herramientas para automatizar los procesos y realizar una recogida oportuna de información. Para ello, la salud pública y la vigilancia deben participar en el proceso de desarrollo digital del Sistema Nacional de Salud. Es importante también reforzar la capacidad de análisis promoviendo alianzas y acciones conjuntas. La necesidad de adaptación rápida ha supuesto una mejora en los sistemas existentes y el desarrollo de nuevas herramientas, que deben convertirse en cambios estructurales que mejoren la calidad de la vigilancia, disminuyendo brechas territoriales y asegurando una respuesta coordinada ante futuras crisis. Son necesarios cambios profundos en la vigilancia en salud pública, que debe estar integrada en todos los niveles asistenciales. Se ha visto también durante esta alerta la importancia de la coordinación en materia de salud pública en un Estado descentralizado, en especial cuando nos enfrentamos a situaciones de crisis. En el contexto internacional es preciso revisar las herramientas para compartir datos desde etapas tempranas en una alerta.

Temporal trends in within-city inequities in COVID-19 incidence rate by area-level deprivation in Madrid, Spain

Patterns of exposure and policies aiming at reducing physical contact might have changed the social distribution of COVID-19 incidence over the course of the pandemic. Thus, we studied the temporal trends in the association between area-level deprivation and COVID-19 incidence rate by Basic Health Zone (minimum administration division for health service provision) in Madrid, Spain, from March 2020 to September 2021. We found an overall association between deprivation and COVID-19 incidence. This association varied over time; areas with higher deprivation showed higher COVID-19 incidence rates from July to November 2020 and August-September 2021, while, by contrast, higher deprivation areas showed lower COVID-19 incidence rates in December 2020 and July 2021.