Search

The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain. The level of analysis is the local government managing the health care system response, which corresponds to regions for Italy. The one-week-ahead forecasts are validated with out-of-sample data over successive weeks; they are found to provide timely and robust prediction of ICU capacity needs in Lombardy, the most-affected Italian region, starting from the sample of the first 2 weeks of data. The same methodology is successfully validated on other Italian regions, Switzerland and Spain. This approach may be used in other countries/regions/provinces to help adapt the health care system response to COVID-19 (or other similar disease); for this purpose, the open-source software code to produce the forecasts is provided with the paper. [ABSTRACT FROM AUTHOR]

The COVID-19 lockdown in Spain caused abrupt changes for students following the Bachelor's Degree in Civil Engineering at the University of Burgos when face-to-face classes switched to online teaching. The recovery of face-to-face teaching after lockdown meant that classes were taught with obligatory social distancing and the use of masks. Teachers were therefore unable to interact with students closely, to perceive their facial expressions during class, or to conduct group work. The changes to civil-engineering teaching linked to the COVID-19 pandemic and the lessons that civil-engineering teachers learnt from the new teaching scenarios are studied in this paper. The reflections of teachers throughout all three stages of the pandemic (pre-pandemic and lockdown, during lockdown, and post-lockdown), and the qualitative and mixed analysis of their responses to a survey of open-ended questions contributed to the identification of six major lessons: (1) asking questions and using real-time quiz tools enliven classes and help to determine which concepts to emphasize for proper student understanding; (2) autonomous student learning can be promoted through the provision of supplementary documentation and the digitalization of solutions to classroom exercises; (3) virtual site visits and real visual examples interspersed with explanations bring concepts closer to their real applications; (4) the delivery of projects in the form of audio-recorded presentations enable their distribution, so that other students can also learn from them as well as the students who created them; (5) online videoconferences, adapted to the concepts that are addressed, facilitate fast and flexible communication with students; and (6) online continuous-assessment exams can promote better student learning patterns and final-exam preparation. Nevertheless, these six lessons were drawn from the experience of teachers at a small Spanish university where the period of solely online teaching during the COVID-19 pandemic lasted only four months. Thus, it would be interesting to analyze the experience of civil-engineering teachers at larger universities and universities that had longer periods of solely online teaching. A study of the level of implementation of the six aspects when the pandemic is declared over might also be worthwhile., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Revilla-Cuesta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In most big cities, public transports are enclosed and crowded spaces. Therefore, they are considered as one of the most important triggers of COVID-19 spread. Most of the existing research related to the mobility of people and COVID-19 spread is focused on investigating highly frequented paths by analyzing data collected from mobile devices, which mainly refer to geo-positioning records. In contrast, this paper tackles the problem by studying mass mobility. The relations between daily mobility on public transport (subway or metro) in three big cities and mortality due to COVID-19 are investigated. Data collected for these purposes come from official sources, such as the web pages of the cities' local governments. To provide a systematic framework, we applied the IBM Foundational Methodology for Data Science to the epidemiological domain of this paper. Our analysis consists of moving averages with a moving window equal to seven days so as to avoid bias due to weekly tendencies. Among the main findings of this work are: a) New York City and Madrid show similar distribution on studied variables, which resemble a Gauss bell, in contrast to Mexico City, and b) Non-pharmaceutical interventions don't bring immediate results, and reductions to the number of deaths due to COVID are observed after a certain number of days. This paper yields partial evidence for assessing the effectiveness of public policies in mitigating the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist.

Objective: The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA., Material and Methods: Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo., Results: Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo., Conclusions: The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA., Competing Interests: The authors have declared that no competing interests exist.

This paper analyses COVID-19 patients' dynamics during the first wave in the region of Castilla y León (Spain) with around 2.4 million inhabitants using multi-state competing risk survival models. From the date registered as the start of the clinical process, it is assumed that a patient can progress through three intermediate states until reaching an absorbing state of recovery or death. Demographic characteristics, epidemiological factors such as the time of infection and previous vaccinations, clinical history, complications during the course of the disease and drug therapy for hospitalised patients are considered as candidate predictors. Regarding risk factors associated with mortality and severity, consistent results with many other studies have been found, such as older age, being male, and chronic diseases. Specifically, the hospitalisation (death) rate for those over 69 is 27.2% (19.8%) versus 5.3% (0.7%) for those under 70, and for males is 14.5%(7%) versus 8.3%(4.6%)for females. Among patients with chronic diseases the highest rates of hospitalisation are 26.1% for diabetes and 26.3% for kidney disease, while the highest death rate is 21.9% for cerebrovascular disease. Moreover, specific predictors for different transitions are given, and estimates of the probability of recovery and death for each patient are provided by the model. Some interesting results obtained are that for patients infected at the end of the period the hazard of transition from hospitalisation to ICU is significatively lower (p < 0.001) and the hazard of transition from hospitalisation to recovery is higher (p < 0.001). For patients previously vaccinated against pneumococcus the hazard of transition to recovery is higher (p < 0.001). Finally, internal validation and calibration of the model are also performed., Competing Interests: No authors have competing interests.

Since the first case reported of SARS-CoV-2 the end of December 2019 in China, the number of cases quickly climbed following an exponential growth trend, demonstrating that a global pandemic is possible. As of December 3, 2020, the total number of cases reported are around 65,527,000 contagions worldwide, and 1,524,000 deaths affecting 218 countries and territories. In this scenario, Spain is one of the countries that has suffered in a hard way, the ongoing epidemic caused by the novel coronavirus SARS-CoV-2, namely COVID-19 disease. In this paper, we present the utilization of phenomenological epidemic models to characterize the two first outbreak waves of COVID-19 in Spain. The study is driven using a two-step phenomenological epidemic approach. First, we use a simple generalized growth model to fit the main parameters at the early epidemic phase; later, we apply our previous finding over a logistic growth model to that characterize both waves completely. The results show that even in the absence of accurate data series, it is possible to characterize the curves of case incidence, and construct a short-term forecast of 60 days in the near time horizon, in relation to the expected total duration of the pandemic., Competing Interests: The authors have declared that no competing interests exist.

This paper examines the perceptions of firms in April 2020, one month after the Spanish Government declared the state of alarm, about how the COVID-19 pandemic will affect their business activity in the following months, and what employment decisions they expect to make in response. The data for the study was collected by the Government of the region of Aragon (Spain) through a survey of a non-randomly selected sample of firms located in the region. In addition to prospects and intended actions, firms were asked whether or not they had applied for ERTE aid (the Spanish job retention scheme to contain the pandemic crisis). We find that firms participating (voluntarily and anonymously) in the survey anticipated rather well the severity of the effects of the pandemic in the following months. The ERTE aid helped firms to maintain the jobs of their inactive employees, while firms that did not ask for aid responded by laying off employees. Further, the ERTE aid helped to maintain the jobs of furloughed employees, but the firms receiving ERTE aid expected to lay off the same proportion of employees as firms without that aid, controlling for the different anticipated effects of the pandemic in the two groups of firms., Competing Interests: The authors have declared that no competing interests exist.

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., Competing Interests: The authors have declared that no competing interests exist.

The aim of this study was to examine aspects of children's health literacy; the information sources they were accessing, their information preferences, their perceived understanding of and their reported information needs in relation to COVID-19. An online survey for children aged 7-12 years of age and parent/caregivers from the UK, Sweden, Brazil, Spain, Canada and Australia was conducted between 6th of April and the 1st of June 2020. The surveys included demographic questions and both closed and open questions focussing on access to and understanding of COVID-19 information. Descriptive statistics and qualitative content analysis procedures were conducted. The findings show that parents are the main source of information for children during the pandemic in most countries (89%, n = 347), except in Sweden where school was the main source of information. However, in many cases parents chose to shield, filter or adapt their child's access to information about COVID-19, especially in relation to the death rates within each country. Despite this, children in this study reported knowing that COVID-19 was deadly and spreads quickly. This paper argues for a community rather than individual approach to addressing children's health literacy needs during a pandemic., Competing Interests: The authors have declared that no competing interests exist.

With the spread of COVID-19, more countries now recommend their citizens to wear facemasks in public. The uptake of facemasks, however, remains far from universal in countries where this practice lacks cultural roots. In this paper, we aim to identify the barriers to mask-wearing in Spain, a country with no mask-wearing culture. We conduct one of the first nationally representative surveys (n = 4,000) about this unprecedented public health emergency and identify the profile of citizens who are more resistant to face-masking: young, educated, unconcerned with being infected, and with an introverted personality. Our results further indicate a positive correlation between a social norm of mask-wearing and mask uptake and demonstrate that uptake of facemasks is especially high among the elderly living in localities where mask-wearing behavior is popular. These results are robust when controlling for respondents' demographics, time spent at home, and occupation fixed effects. Our findings can be useful for policymakers to devise effective programs for improving public compliance., Competing Interests: The authors have declared that no competing interests exist.

The COVID–19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the presence of specific mental health conditions and the risk of death and hospitalization. This is a retrospective cohort study including all individuals with confirmed infection by SARS-CoV-2 from the PRECOVID (Prediction in COVID–19) Study (Aragon, Spain). Mental health illness was defined as the presence of schizophrenia and other psychotic disorders, anxiety, cognitive disorders, depression and mood disorders, substance abuse, and personality and eating disorders. Multivariable logistic regression models were used to examine the likelihood of 30-day all-cause mortality and COVID–19 related hospitalization based on baseline demographic and clinical variables, including the presence of specific mental conditions, by gender. We included 144,957 individuals with confirmed COVID–19 from the PRECOVID Study (Aragon, Spain). The most frequent diagnosis in this cohort was anxiety. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID–19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID–19 based on their mental health status will be crucial to improve their access to the healthcare system and the establishment of public health prevention measures for future outbreaks. [ABSTRACT FROM AUTHOR]

There is an increasing awareness of the magnitude of different forms of sexual violence (SV), especially in relation to youth. The COVID-19 pandemic has also had a negative impact on different forms of violence against women. In this study, we aim to analyse SV in the COVID-19 lockdown among young people and SV-related services from the perspective of professionals and young people from different sectors in Spain with responsibilities in attending SV and other forms of violence against women-related. A qualitative content analysis was performed on semi-structured interviews with 23 women and men aged 18 to 24 and 15 professionals working with youth and/or in violence against women or sexual violence related services. The sample was from northern, eastern and central regions of Spain. According to the professionals' experience, the COVID-19 lockdown lessened their ability to work on violence prevention. Both informants perceived that sexual violence had decreased in public spaces whereas it increased in digital ones and noticed the silence surrounding violent situations had deepened. However, they differed regarding its impact on sexual violence within intimate partners, mainly due to the lack of awareness of this problem among young men. In regard to violence against women and sexual violence, our results highlight the need to develop protocols for action and improve resource accessibility in crisis contexts. [ABSTRACT FROM AUTHOR]

Background: Pressure Injuries (PIs) are major worldwide public health threats within the different health-care settings. Objective: To describe and compare epidemiological and clinical features of PIs in COVID-19 patients and patients admitted for other causes in Internal Medicine Units during the first wave of COVID-19 pandemic. Design: A descriptive longitudinal retrospective study. Setting: This study was conducted in Internal Medicine Units in Salamanca University Hospital Complex, a tertiary hospital in the Salamanca province, Spain. Participants: All inpatients ≥18-year-old admitted from March 1, 2020 to June 1, 2020 for more than 24 hours in the Internal Medicine Units with one or more episodes of PIs. Results: A total of 101 inpatients and 171 episodes were studied. The prevalence of PI episodes was 6% and the cumulative incidence was 2.9% during the first-wave of COVID-19. Risk of acute wounds was four times higher in the COVID-19 patient group (p<0.001). Most common locations were sacrum and heels. Among hospital acquired pressure injuries a significant association was observed between arterial hypertension and diabetes mellitus in patients with COVID-19 diagnosis. Conclusion: During the first wave of COVID-19, COVID-19 patients tend to present a higher number of acute wounds, mainly of hospital origin, compared to the profile of the non-COVID group. Diabetes mellitus and arterial hypertension were identified as main associated comorbidities in patients with COVID-19 diagnosis. [ABSTRACT FROM AUTHOR]

Several studies in different countries have reported that part of the population does not fully comply with the measures recommended to prevent COVID-19, and therefore poses a risk to public health. For this reason, several measures have been developed to assess the level of compliance, although many of them have methodological limitations or do not include a comprehensive set of items. The main goal of the current study was to develop a new instrument with suitable psychometric properties, which includes a more complete set of items and controls the impact of acquiescence bias. The participants were 1410 individuals (59.2% women) from Spain, who answered the new questionnaire and several items on sociodemographic and attitudinal issues. Exploratory and confirmatory factor analyses were carried out, and the results suggested that only one content factor was underlying the data. This solution was replicated in a different subsample, which shows the stability of the solution. Furthermore, the relationships between the scores of the new questionnaire and the sociodemographic and attitudinal variables are similar to those obtained in previous studies, which can be regarded as evidence of the validity of the new questionnaire. [ABSTRACT FROM AUTHOR]

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020—April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV. [ABSTRACT FROM AUTHOR]

Evidence suggests that non-binary people have poorer mental and physical health outcomes, compared with people who identify within the gender binomial (man/woman). Research on the impact of the COVID-19 pandemic on mental health has been conducted worldwide in the last few months. It has however overlooked gender diversity. The aim of our study was to explore social and health-related factors associated with mental health (anxiety and depression) among people who do not identify with the man/woman binomial during COVID-19 lockdown in Spain. A cross-sectional study with online survey, aimed at the population residing in Spain during lockdown, was conducted. Data were collected between the 8th of April until the 28th of May 2020, the time period when lockdown was implemented in Spain. Mental health was measured using the Generalised Anxiety Disorder 7-item (GAD-7) scale for anxiety, and the Patient Health Questionnaire (PHQ-9) for depression. The survey included the question: Which sex do you identify with? The options "Man", "Woman", "Non-binary" and "I do not identify" were given. People who answered one of the last two options were selected for this study. Multivariate regression logistic models were constructed to evaluate the associations between sociodemographic, social and health-related factors, anxiety and depression. Out of the 7125 people who participated in the survey, 72 (1%) identified as non-binary or to not identify with another category. People who do not identify with the man/woman binomial (non-binary/I do not identify) presented high proportions of anxiety (41.7%) and depression (30.6%). Poorer mental health was associated with social-employment variables (e.g., not working before the pandemic) and health-related variables (e.g., poor or regular self-rated health). These findings suggest that social inequities, already experienced by non-binary communities before the pandemic, may deepen due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods: Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results: In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974–0.978), and 1.030 (1.023–1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144–1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007–1.011) and 1.083 (1.076–1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion: In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (CoViD-19), with the fatality rate in elder (60 years old or more) being much higher than young (60 years old or less) patients, was declared a pandemic by the World Health Organization on March 11, 2020. A mathematical model considering young and elder subpopulations under different fatality rates was formulated based on the natural history of CoViD-19 to study the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The model considered susceptible, exposed, asymptomatic, pre-symptomatic, mild CoViD-19, severe CoViD-19, and recovered compartments, besides compartments of isolated individuals and those who were caught by test. This model was applied to study the epidemiological scenario resulting from the adoption of quarantine (isolation or lockdown) in many countries to control the rapid propagation of CoViD-19. We chose as examples the isolation adopted in São Paulo State (Brazil) in the early phase but not at the beginning of the epidemic, and the lockdown implemented in Spain when the number of severe CoViD-19 cases was increasing rapidly. Based on the data collected from São Paulo State and Spain, the model parameters were evaluated, and we obtained a higher estimation for the basic reproduction number R0 (9.24 for São Paulo State, and 8 for Spain) compared to the currently accepted estimation of R0 around 2 using the SEIR (susceptible, exposed, infectious, and recovered compartments) model. In comparison with the lockdown in Spain, the relatively early adoption of the isolation in São Paulo State resulted in enlarging the period of the first wave of the epidemic and delaying its peak. The model allowed to explain the flattening of the epidemic curves by quarantine when associated with the protective measures (face mask, washing hands with alcohol and gel, and social distancing) adopted by the population. The description of the epidemic under quarantine and protections can be a background to foreseen the epidemiological scenarios from the release strategies, which can help guide public health policies by decision-makers. [ABSTRACT FROM AUTHOR]

Background: COVID-19 may predispose to both venous and arterial thromboembolism event (TEE). Reports on the prevalence and prognosis of thrombotic complications are still emerging. Objective: To describe the rate of TEE complications and its influence in the prognosis of hospitalized patients with COVID-19 after a cross-sectional study. Methods: We evaluated the prevalence of TEE and its relationship with in-hospital death among hospitalized patients with COVID-19 who were admitted between 1st March to 20th April 2020 in a multicentric network of sixteen Hospitals in Spain. TEE was defined by the occurrence of venous thromboembolism (VTE), acute ischemic stroke (AIS), systemic arterial embolism or myocardial infarction (MI). Results: We studied 1737 patients with proven COVID-19 infection of whom 276 died (15.9%). TEE were presented in 64 (3.7%) patients: 49 (76.6%) patients had a VTE, 8 (12.5%) patients had MI, 6 (9.4%%) patients had AIS, and one (1.5%) patient a thrombosis of portal vein. TEE patients exhibited a diffuse profile: older, high levels of D-dimer protein and a tendency of lower levels of prothrombin. The multivariate regression models, confirmed the association between in-hospital death and age (odds ratio [OR] 1.12 [95% CI 1.10–1.14], p<0.001), diabetes (OR 1.49 [95% CI 1.04–2.13], p = 0.029), chronic obstructive pulmonary disease (OR 1.61 [95% CI 1.03–2.53], p = 0.039), ICU care (OR 9.39 [95% CI 5.69–15.51], p<0.001), and TTE (OR 2.24 [95% CI 1.17–4.29], p = 0.015). Conclusions: Special attention is needed among hospitalized COVID-19 patients with TTE and other comorbidities as they have an increased risk of in-hospital death. [ABSTRACT FROM AUTHOR]

ABO blood groups have recently been related to COVID19 infection. In the present work, we performed this analysis using data from 412 COVID19 patients and 17796 blood donors, all of them from Gipuzkoa, a region in Northern Spain. The results obtained confirmed this relation, in addition to showing a clear importance of group O as a protective factor in COVID19 disease, with an OR = 0.59 (CI95% 0.481–0.7177, p<0.0001) while A, B and AB are risk factors. ABO blood groups are slightly differently distributed in the populations and therefore these results should be replicated in the specific areas with a proper control population. [ABSTRACT FROM AUTHOR]

During COVID-19 emergency the majority of health structures in Europe saturated or nearly saturated their availabilities already in the first weeks of the epidemic period especially in some regions of Italy and Spain. The aim of this study is to analyse the efficiency in the management of hospital beds before the COVID-19 outbreak at regional level in France, Germany, Italy and Spain. This analysis can indicate a reference point for future analysis on resource management in emergency periods and help hospital managers, emergency planners as well as policy makers to put in place a rapid and effective response to an emergency situation. The results of this study clearly underline that France and Germany could rely on the robust structural components of the hospital system, compared to Italy and Spain. Presumably, this might have had an impact on the efficacy in the management of the COVID-19 diffusion. In particular, the high availability of beds in the majority of the France regions paired with the low occupancy rate and high turnover interval led these regions to have a high number of available beds. Consider also that this country generally manages complex cases. A similar structural component is present in the German regions where the number of available beds is significantly higher than in the other countries. The impact of the COVID-19 was completely different in Italy and Spain that had to deal with a relevant large number of patients relying on a reduced number of both hospital beds and professionals. A further critical factor compared to France and Germany concerns the dissimilar distribution of cases across regions. Even if in these countries the hospital beds were efficiently managed, the concentration of hospitalized patients and the scarcity of beds have put pressure on the hospital systems. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 has disrupted the life of billions of people around the world since the first outbreak was officially declared in China at the beginning of 2020. Yet, important questions such as how deadly it is or its degree of spread within different countries remain unanswered. In this work, we exploit the 'universal' increase of the mortality rate with age observed in different countries since the beginning of their respective outbreaks, combined with the results of the antibody prevalence tests in the population of Spain, to unveil both unknowns. We test these results with an analogous antibody rate survey in the canton of Geneva, Switzerland, showing a good agreement. We also argue that the official number of deaths over 70 years old might be importantly underestimated in most of the countries, and we use the comparison between the official records with the number of deaths mentioning COVID-19 in the death certificates to quantify by how much. Using this information, we estimate the infection fatality ratio (IFR) for the different age segments and the fraction of the population infected in different countries assuming a uniform exposure to the virus in all age segments. We also give estimations for the non-uniform IFR using the sero-epidemiological results of Spain, showing a very similar increase of the fatality ratio with age. Only for Spain, we estimate the probability (if infected) of being identified as a case, being hospitalized or admitted in the intensive care units as function of age. In general, we observe a nearly exponential increase of the fatality ratio with age, which anticipates large differences in total IFR in countries with different demographic distributions, with numbers that range from 1.82% in Italy, to 0.62% in China or even 0.14% in middle Africa. [ABSTRACT FROM AUTHOR]

Policymakers need clear, fast assessment of the real spread of the COVID-19 epidemic in each of their respective countries. Standard measures of the situation provided by the governments include reported positive cases and total deaths. While total deaths indicate immediately that countries like Italy and Spain had the worst situation as of mid-April, 2020, reported cases alone do not provide a complete picture of the situation. Different countries diagnose differently and present very distinctive reported case fatality ratios. Similar levels of reported incidence and mortality might hide a very different underlying pictures. Here we present a straightforward and robust estimation of the diagnostic rate in each European country. From that estimation we obtain a uniform, unbiased incidence of the epidemic. The method to obtain the diagnostic rate is transparent and empirical. The key assumption of the method is that the infection fatality ratio of COVID-19 in Europe is not strongly country-dependent. We show that this number is not expected to be biased due to demography nor to the way total deaths are reported. The estimation protocol is dynamic, and it has been yielding converging numbers for diagnostic rates in all European countries as from mid-April, 2020. Using this diagnostic rate, policy makers can obtain Effective Potential Growth updated every day, providing an unbiased assessment of the countries at greater risk of experiencing an uncontrolled situation. The method developed has been and will be used to track possible improvements in the diagnostic rate in European countries as the epidemic evolves. [ABSTRACT FROM AUTHOR]

During the state of alarm declared in Spain by COVID-19 due to the pandemic, the country's authorities declared Social Services and their workers to be essential, considering that the activity of these professionals with the vulnerable population was crucial and that services should continue to be provided to guarantee the well-being of users in this exceptionally serious situation. This article analyzes the impact that the COVID-19 and the state of alarm has had on Spanish social service professionals. An ad hoc questionnaire was used, administered on-line, individually, voluntarily and anonymously to 560 professionals working in social services, both in the public and private sectors, based throughout Spain. This questionnaire has five different parts: socio-demographic profiling, impact that the health crisis has had on the practice of professional functions, degree of knowledge of the measures imposed to guarantee the protection and safety of professionals and users, impact that it has had on the professional and personal development of social services professionals and, the fifth and last part, degree of adaptation of the measures aimed at the care of the vulnerable population. These results are discussed based on the situation in which professionals working in this sector find themselves in the face of the changes they are experiencing in the development of their work, and we are able to determine the profile of the workers who have felt most affected by the situation, with the consequent and foreseeable mental and emotional affectation that this implies. These professionals tend to value more negatively the set of measures developed to mitigate the impact of COVID-19 on Spanish social services. [ABSTRACT FROM AUTHOR]

Many different countries have been under lockdown or extreme social distancing measures to control the spread of COVID-19. The potentially far-reaching side effects of these measures have not yet been fully understood. In this study we analyse the results of a multi-country survey conducted in Italy (N = 3,504), Spain (N = 3,524) and the United Kingdom (N = 3,523), with two separate analyses. In the first analysis, we examine the elicitation of citizens' concerns over the downplaying of the economic consequences of the lockdown during the COVID-19 pandemic. We control for Social Desirability Bias through a list experiment included in the survey. In the second analysis, we examine the data from the same survey to predict the level of stress, anxiety and depression associated with being economically vulnerable and having been affected by a negative economic shock. To accomplish this, we have used a prediction algorithm based on machine learning techniques. To quantify the size of this affected population, we compare its magnitude with the number of people affected by COVID-19 using measures of susceptibility, vulnerability and behavioural change collected in the same questionnaire. We find that the concern for the economy and for "the way out" of the lockdown is diffuse and there is evidence of minor underreporting. Additionally, we estimate that around 42.8% of the populations in the three countries are at high risk of stress, anxiety, and depression, based on their level of economic vulnerability and their exposure to a negative economic shock. [ABSTRACT FROM AUTHOR]

Background/Objectives: To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. Design: Epidemiological study. Setting: Six open LTCFs in Albacete (Spain). Participants: 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. Measurements: Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. Results: The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. Conclusion: The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high. [ABSTRACT FROM AUTHOR]

It is paramount to expand the knowledge base and minimize the consequences of the pandemic caused by the new Coronavirus (SARS-Cov2). Spain is among the most affected countries that declared a countrywide lockdown. An ecological study is presented herein, assessing the trends for incidence, mortality, hospitalizations, Intensive Care Unit admissions, and recoveries per autonomous community in Spain. Trends were evaluated by the Joinpoint software. The timeframe employed was when the lockdown was declared on March 14, 2020. Daily percentage changes were also calculated, with CI = 95% and p<0.05. An increase was detected, followed by reduction, for the evaluated indicators in most of the communities. Approximately 18.33 days were required for the mortality rates to decrease. The highest mortality rate was verified in Madrid (118.89 per 100,000 inhabitants) and the lowest in Melilla (2.31). The highest daily percentage increase in mortality occurred in Catalonia. Decreasing trends were identified after approximately two weeks of the institution of the lockdown by the government. Immediately the lockdown was declared, an increase of up to 33.96% deaths per day was verified in Catalonia. In contrast, Ceuta and Melilla presented significantly lower rates because they were still at the early stages of the pandemic at the moment of lockdown. The findings presented herein emphasize the importance of early and assertive decision-making to contain the pandemic. [ABSTRACT FROM AUTHOR]