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A limited number of longitudinal studies have examined the symptoms associated with long-COVID-19. We conducted an assessment of symptom onset, severity and patient recovery, and determined the percentage of patients who experienced reinfection up to 2 years after the initial onset of the disease. Our cohort comprises 377 patients (≥18 years) with laboratory-confirmed COVID-19 in a secondary hospital (Madrid, Spain), throughout March 3–16, 2020. Disease outcomes and clinical data were followed-up until August 12, 2022. We reviewed the evolution of the 253 patients who had survived as of April 2020 (67.1%). Nine died between April 2020 and August 2022. A multivariate regression analysis performed to detect the risk factors associated with long-COVID-19 revealed that the increased likelihood was associated with chronic obstructive lung disease (OR 14.35, 95% CI 1.89–109.09; p = 0.010), dyspnea (5.02, 1.02–24.75; p = 0.048), higher LDH (3.23, 1.34–7.52; p = 0.006), and lower D-dimer levels (0.164, 0.04–0.678; p = 0.012). Reinfected patients (n = 45) (47.8 years; 39.7–67.2) were younger than non-reinfected patients (64.1 years; 48.6–74.4)) (p < 0.001). Patients who received a combination of vaccines exhibited fewer symptoms (44.4%) compared to those who received a single type of vaccine (77.8%) (p = 0.048). Long-COVID-19 was detected in 27.05% (66/244) of patients. The early detection of risk factors helps predict the clinical course of patients with COVID-19. Middle-aged adults could be susceptible to reinfection, highlighting the importance of prevention and control measures regardless of vaccination status.

BACKGROUNDThe coronavius disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reached Spain by 31 January 2020, in April 2020, the Comunidad de Madrid suffered one of the world’s highest crude mortality rate ratios. This study aimed to detect risk factors for mortality in patients with COVID-19.METHODSOur cohort were all consecutive adult patients (≥18 years) with laboratory-confirmed COVID-19 at a secondary hospital in Madrid, March 3-16, 2020. Clinical and laboratory data came from electronic clinical records and were compared between survivors and non-survivors, with outcomes followed up until April 4. Univariable and multivariable logistic regression methods allowed us to explore risk factors associated with in-hospital death.FINDINGSThe cohort comprised 562 patients with COVID-19. Clinical records were available for evaluation for 392 patients attended at the emergency department of our hospital, of whom 199 were discharged, 85 remained hospitalized and 108 died during hospitalization. Among 311 of the hospitalized patients, 34.7% died. Of the 392 patients with records, the median age was 71.5 years (50.6-80.7); 52.6% were men. 252 (64.3%) patients had a comorbidity, hypertension being the most common: 175 (44.6%), followed by other cardiovascular disease: 102 (26.0%) and diabetes: 97 (24.7%). Multivariable regression showed increasing odds of in-hospital death associated with age over 65 (odds ratio 8.32, 95% CI 3.01–22.96; pINTERPRETATIONCOVID-19 was associated in our hospital at the peak of the pandemic with a crude mortality ratio of 19.2% and a mortality ratio of 34.7% in admitted patients, considerably above most of the ratios described in the Chinese series. These results leave open the question as to which factors, epidemiological or intrinsically viral, apart from age and comorbidities, can explain this difference in excess mortality.FUNDINGNone.

In the recent decades it has been found the occurrence of a large number of hitherto unknown or undervalued pathogens, and they present a risk to health and human welfare. Almost all incidents caused by emerging pathogens have been attached to zoonotic agents, which expanded its host range and are capable of breaching the species barrier (Zeier et al., 2005). Besides the known diseases, new ones emerge or reemerge due to a variety of socioeconomic, health and environmental questions. This increase in communicable diseases has serious implications for public health and animal health (Chomel, 1998; Daszak et al., 2000, Cleaveland et al., 2001, Simpson, 2002; Daszak & Cunningham, 2003; Zeier et al., 2005; Cunningham, 2005; Blancou et al., 2005, Gibbs, 2005; Gortazar et al., 2007). Emerging zoonoses are also a public health problem, the biggest threat to animal welfare, environmental quality and conservation of biodiversity (Daszak et al., 2000; Cunningham, 2005, Briones et al., 2002). The expected increase contact between humans and wildlife, caused by anthropogenic interference in the ecosystem, increase the emergence of pathogens originating in wildlife cycles, which can cross-infect man and animals (Bengis et al., 2004). Thus, wildlife is a constant source of "zoonotic pool" that plays a fundamental role in human exposure to infectious agents against novel animal (Morse, 1995). In the recent past, the diseases of wild animals have been important only when they threatened livestock or human health (Daszak et al., 2000), but outbreaks in endangered species have led to them having more significant consideration. Currently, these diseases are booming, especially in the space where interaction occurs between wildlife and farm animals, including an increase in contact between them and the man (Simpson, 2002; Gortazar et al., 2007). Arthropod-borne diseases represent the most common zoonosis in relation to wildlife in the northern hemisphere, especially the Old World (Lindgren et al., 2000), so infectious agents are diverse and constantly growing, so their relationship would be endless (Bueno et al., 2009). Wild animals and arthropod vectors play also important roles in the exposure of humans and domestic animals to animal-borne pathogens (Morse, 1995). Contact between humans and wild animals may occur when people venture into the latter’s ecosystems, such contact in foreseen as a future generator of cross infestation, but the knowledge of ectoparasites, with special mention to ticks and their hosts’ reservoirs that are located in many areas of