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Importance Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. Objective To describe the local spread of SARS-CoV-2 in Valencia, Spain. Design, Setting, and Participants This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. Exposures Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. Main Outcomes and Measures The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. Results In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (β2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (β1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. Conclusions and Relevance This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown., This study was supported by the Innovation, Universities, Science and Digital Society Council through the Valencia Innovation Agency (AVI); grant 851255 from the European Research Council under the European Union’s Horizon 2020 research and innovation program (Dr Zanin); grant MDM-2017-0711 from the Spanish State Research Agency through the Severo Ochoa and María de Maeztu Program for Centers and Units of Excellence in Research and Development (Dr Zanin); and from the Universitat de Valencia (Drs Iftimi and Lozano).

Dear Editor: Pericarditis is rarely reported in inflammatory bowel disease (IBD). The most frequent presentation is as acute pericarditis. It can arise as a true extraintestinal IBD event or as a secondary effect due to drug employment. We present a case of a recurrent pericarditis related to ulcerative colitis (UC) and induced with suppositories of mesalazine. A 54-year-old male was seen as an outpatient with scarce bloody diarrhea during the past 6 months. Clinical history reported hypertension, colecystectomy with adenocarcinoma in situ 7 years ago, upper gastrointestinal bleeding treated medically due to gastritis and a lupus-like reaction 20 years ago. Recently, diagnosed and treated with metformine due to diabetes type 2. The performance of a colonoscopy revealed a continuously inflamed mucosa up to the rectosigmoid junction and proven histology of UC without displastic lesions. Corticoid foamwas initiated for 2 weeks and then switched to mesalazine 1.5 g orally a day. After 3 weeks, he was admitted to hospital with chest pain, fatigue, and fever as high as 39oC. With the diagnosis of viral pericarditis, a chest X-ray was ordered and revealed an enlarged cardiac silhouette. Electrocardiogram was normal but echocardiogram detected pericardic effusion in the anterior and posterior space. Among the laboratory data of interest were hemoglobin 15.2 g, leucocytes 9.900 (51.6% neutrophils), eosinophils 0.9%, albumin 41.6 g/L globulin 32.2 g/L (albumin/globulin ratio=1.29), and ferritin 180.7 ng/ml. C-reactive protein 7.89 mg/L (slightly elevated) and erythrocyte sedimentation rate 10 mm. Treatment was commenced with 3 g daily for 7 days of acetilsalycilic acid. Oral mesalazine was stopped in the meanwhile. After the cardiac episode, the patient was managed with 500 mg mesalazine in suppository as maintenance therapy. After 3 weeks, he presented with a second episode of pericarditis. A chest CT revealed a thickened pericardium. Rheumatoid factor, antinuclear, anti-DNA, and antimitochondrial antibodies were negative or in normal range. Complement C3 143 mg/dl, complement C4 23.5 mg/dl, complement CH50 55.5U/mL was in normal ranges. Since the withdrawal of mesalazine no further pericarditis episode developed. Cardiac involvement can be associated with IBD especially with UC being pericarditis the most frequent cardiac feature, although it may affect the myocardium or even both structures. Both cutaneous test with mesalazine and test for linfoblastic proliferation were negative, but do not exclude the diagnosis of drug-induced pericarditis. The gold standard for the diagnosis of drug allergy is a provocation test with the potential agent. This method of course would not be ethical at all and implies a great risk for the patient. J. C. Bernal-Sprekelsen (*) European Board of Coloproctology, Department of General Surgery, Hospital General de Requena, Pasaje Casablanca s/n, 46340 Requena, Spain e-mail: jcbernal@comv.es