the sad end of the forgotten heroine that gives its name to the new coronavirus hospital

Manuel P. VillatoroManuel P. Villatoro

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Isabel Zendal she was a forgotten heroine who gave her youth to Spain and science. Immersed in the eighteenth century, this nurse and single mother decided to leave her homeland to head to the The new World as part of the Vaccine Philanthropic Expedition. Easy to summarize along a few lines, but difficult to understand in an age where women were still struggling to make their way into society.

Along a journey I longed for eradicate smallpox in all the recesses of the limping Spanish Empire, the Galician was in charge of the care of the children inoculated with the virus; a task that earned him his love and a place in history

But, as often happens in our country, the story of this heroine (one who did not fight with the sword, but with hard work) had remained there until now, in the history books. Forgotten and almost lost. These days, however, it has once again been illuminated by the spotlights of the present day after the president of the Community of Madrid, Isabel Diaz Ayuso, has inaugurated the Isabel Zendal epidemic hospital. A center that, beyond the controversy that still generates between the different political parties, recalls the first woman to participate in an international health expedition.

To the New World

As explained by the doctor in History Susana María Ramírez Martín In an article about this nurse prepared for the Royal Academy of History, we know little about the childhood of Isabel Zendal Gómez. Just that he was born in Santa Marina de Parada, in La Coruña, back in 1773 and who had a somewhat turbulent childhood. “During the smallpox epidemic of 1786 he lost his mother and had to leave a family home with few resources to go to work, “explains the expert.

When he added a score of springs behind his back his son was born, Benito Velez, center of her life because she was a single mother.

Statue in honor of Isabel Zendal
Statue in honor of Isabel Zendal

The death of his parents, «quasi poor of solemnityAccording to their respective death certificates, they indicate that Isabel did not come from a wealthy family. But that condition did not end her illusion of becoming a nurse and, already in 1800, of entering to work as Rector in an inclusive destined to take care of abandoned children. That would be his fate in life, and he would carry it as a flag in the following years, as the “Isabel Zendal Association” recounts well in the many articles about the character that they host on their website.

This is how his life went when, in 1803, Carlos IV, who had lost a daughter to smallpox, ordered a convoy to leave the Peninsula to spread the vaccine against this disease throughout all overseas territories. The result was the Royal Vaccine Philanthropic Expedition, which can be considered as the first humanitarian mission in history. There was only one problem … how to move the sample? The answer came from the hand of the Spanish doctor Francisco Javier Balmis, at the forefront of this adventure, and consisted of transporting the serum into 22 living children. To be more specific, orphans from La Coruña.

This is how the «Gaceta de Madrid» narrated it:

“There are several doctors commissioned, and they have 22 children, who being successively inoculated arm by arm during the navigation, they will keep the bovine fluid alive and without alteration. For this reason, other means of driving it have not been omitted, thus for greater safety, as well as to experience which ones are to be preferred over long distances and in different climates.

Hard expedition and sad end

Although at first the participation of a woman in the expedition was not considered, she changed her mind shortly after. It was thought, and not without reason, that children would need a figura maternal to give them confidence during the journey.

«On October 14, 1803, a month and a half before the departure, Francisco Xavier Balmis, her director, hired her with a salary equal to that enjoyed by men in their training and duties, three thousand reales for their habilitation and a salary of five hundred pesos per year. He was the last expeditionary to join the humanitarian convoy, “adds the expert. This is how his adventure in the corvette began «Maria Pita», that left the port of La Coruña on November 30, 1803.

As a nurse, Isabel Zendal took care of the children both on land and at sea. She cared for them, cleaned them, helped them clean up, and ultimately made sure that their journey was as pleasant as possible. «The rector had specific and exclusive functions: take care, accompany, entertain Y serene to the children during the trip ”, adds Ramírez.

Among the smallest, by the way, was his son Benito, which served as “Living receptacle”, as the media of the time pointed out. The Coruñesa did her job well, as she received praise from some superiors who, in the documents, defined her as «selfless rector», «mother of the galleguitos” Y “woman of integrity».

After passing, among other regions, through Canary Islands, Puerto Rico, Caracas O Mexico, Isabel Zendal left in 1805 for the Pacific. Now, with twenty-six Mexican children.

After the last few trips, he decided to stay in Mexico to spend the rest of his days. There he worked in a hospice Puebla de los Angeles with your little one. «About the end of his life we ​​know little. The last we know of her is that in 1811 she continued to request a pension of 3 reales a month to which her son was entitled because he was one of the number children who came with the vaccine and the Royal Cajas de Puebla where it was not paid. he was living. The date and place of his death are unknown ”, concludes the doctor in History.

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Children can transmit the coronavirus just like adults, according to the latest studies

Zoë Hyde

Madrid

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The latest research shows that infections in children often go unnoticed and that they are just as susceptible to them as adults. Children are likely to transmit the virus at similar rates.

Although children are fortunately less likely to become seriously ill, the same is not true of the adults who care for them. Evidence suggests that schools have been a driver of the second wave in Europe and elsewhere. This means that school safety needs an urgent rethink.

Detecting covid-19 in children is difficult

Infections with SARS-CoV-2, the virus that causes covid-19, in children are generally much milder than in adults and easier to go unnoticed. A study from South Korea found that the majority of children had symptoms mild enough to go unnoticed, and only 9% were diagnosed at the time of onset of symptoms.

The researchers used an antibody test (which can detect whether a person previously had the virus and recovered) to analyze a sample, representative of the German population, of nearly 12,000 children. They found that the majority of cases in children had gone undetected. This is not surprising, because many cases in adults are also missed.

Do not consume news, understand it.

But what made this study important was that it showed that young and old children were similarly likely to be infected.

Official tests in Germany had suggested that young children were much less likely to become infected than adolescents, but this was not true. Younger children with infections just weren’t tested. The study also found that nearly half of the infected children were asymptomatic. This is about twice what is normally seen in adults.

Zoë Hyde
Zoë Hyde

But children transmit the virus

We have known for a long time that approximately the same amount of viral genetic material can be found in the nose and throat of children and adults.

But that does not necessarily mean that children transmit viruses in the same way as adults. Because children have smaller lung capacity and are less likely to have symptoms, they may release less virus into the environment.

However, a new study by the US Centers for Disease Control and Prevention (CDC) found that children and adults had a similar probability of transmitting the virus to their closest contacts.

Another study in India, carried out with more than 84,000 cases and their close contacts, found that children and young adults were especially prone to transmitting the virus.

Most of the children in these studies probably had symptoms. Therefore, it is not clear whether asymptomatic children transmit the virus in the same way.

But outbreaks in children’s centers have shown that transmission by children who show no symptoms occurs. During an outbreak in two daycare centers in Utah (United States), asymptomatic children transmitted the virus to their relatives, resulting in the hospitalization of one of the parents.

What we know about outbreaks in Australian schools

Schools did not appear to be a major source of transmission for the epidemic in the Australian state of Victoria (Australia), although most students switched to remote learning at the peak of the second wave.

However, to some extent the schools contributed to community transmission. This was made clear by the Al-Taqwa College group, which was linked to outbreaks in two Melbourne public housing towers.

When researchers analyzed the cases linked to Victoria schools between the start of the epidemic and the end of August 2020, they found that infections in schools reflected what was happening in the wider community. They also found that 66% of all infections in schools were limited to a single person.

This may seem encouraging, but we must remember that this virus is characterized by over-propagation events. We now know that around 10% of infected people are responsible for about 80% of secondary covid-19 cases.

Two relevant studies in Hong Kong and India revealed that approximately 70% of people did not transmit the virus to anyone. The problem is that the remaining 30% could potentially infect a lot of people. What happened in the Victorian schools is entirely consistent with this analysis.

The risk associated with schools increases with the level of community transmission. The international scene has made it clear.

What we know about outbreaks in schools, internationally

After the reopening of schools in Montreal, Canada, cases in school groups quickly outnumbered those in workplaces and healthcare settings combined. The president of the Quebec Infectious Diseases Microbiologists Association, Karl Weiss, said:

Schools were the engine of the second wave in Quebec, although the government does not recognize it.

A report from Israel’s Ministry of Health concluded that the reopening of schools played a significant role in accelerating the epidemic in the country, and that schools can contribute to the spread of the virus unless community transmission is low.

In the Czech Republic, a rapid increase in cases following the reopening of schools led the mayor of Prague to describe the schools as a ‘covid exchange market’.

The opposite pattern has been observed when schools have closed. England just witnessed from a drop in new cases, followed by a return to growth, coinciding with the mid-term school holidays. This happened before lockdown measures were introduced in the UK.

These observations are consistent with a study examining the effect of imposing and lifting different restrictions in 131 countries. The researchers found that school closings were associated with a reduction in R, the measure of how fast the virus spread, while the reopening of schools was associated with an increase in R.

The risk has been more clearly explained by the president of the Robert Koch Institute, the German equivalent of the Centers for Disease Control and Prevention. Last week, the institute reported that the virus is spreading in schools and also in the community.

What we need to do

It will not be possible to control the pandemic if we do not address transmission from children. This means that we must take a proactive approach in schools.

At a minimum, precautionary measures should include the use of masks by staff and students (including elementary students). Schools must also improve ventilation and indoor air quality, reduce class sizes, and ensure that children and staff practice hand hygiene.

School closures also have a role to play. But they must be carefully considered because of the associated harms. But these damages are probably less than those caused by the epidemic.

In regions with high levels of community transmission, the temporary closure of schools should be considered. While a lockdown without school closings is likely to reduce transmission, it is unlikely to be fully effective.

Epidemiologist, University of Western Australia.

Published in THECONVERSARION.ES

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your risk of death is 48% higher

Cristina GarridoCristina Garrido

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The obesity is a disease that increases the risk of hospitalization, admission to the ICU, the need for mechanical ventilation and deadlyd in patients with Covid-19, compared to those of normal weight. This has been detailed by specialists from the Spanish Society for the Study of Obesity (Seedo) and the Spanish Society of Endocrinology and Nutrition (Seen) during a press conference in which they have asked that, after the elderly and health workers, people with obesity are considered a priority in the strategy of vaccination against coronavirus.

«With a Body Mass Index (BMI) above 40, in those under 50 years of age, a very important relationship between obesity and a worse evolution of Covid-19. These patients have between 3 and 15 times more complications compared to a population of the same age without obesity, “explains Dr. Javier Escalada, president of the Seen and director of the Department of Endocrinology and Nutrition at the Clínica Universidad de Navarra. They also have a rate of thromboembolisms between two and three times higher than patients without excess weight and a higher risk of kidney failure acute during hospitalization. “It has been clearly demonstrated that obesity in its most severe grades, 2 and 3, is an independent risk factor for a worse evolution and higher mortality from Covid”, concludes Dr. Escalada.

Specifically, people who are overweight have 46% higher risk of catching coronavirus, a 113% higher risk of hospitalization for Covid-19, a 78% higher risk of admission to the ICU compared to the population with normal weight, and the risk of mortality is 48% higher.

An argument they consider important enough to suggest that “those people with a BMI over 35 they should be prioritized in vaccination against Covid-19», Said Dr. Albert Lecube, vice president of Seedo and head of the Endocrinology and Nutrition Service of the Arnau de Vilanova University Hospital (Lleida). This specialist has also asked that the message of social distance, mask and hand hygiene to prevent Covid be added “the need to maintain a healthy weight».

Higher risk also in young people

Experts have highlighted that, globally, severe obesity increases the risk of mortality from Covid-10 by almost 50%, but where it has the greatest impact is on young people. In patients under 50 years, with a BMI above 40 (obesity grade 3) mortality was 8%, while with obesity grade one (BMI between 30 and 35) mortality was 3%, that is, almost three times less .

People who are overweight have a increased risk of contagion, greater number of coronavirus receptors and worse clinical evolution of Covid for several reasons: «In obesity there is a constant state of inflammation, which is further enhanced by Covid, ”says Dr. Ana de Holanda, coordinator of the Seen obesity working group. Along the same lines, the expert has pointed out that the immune response in people with obesity is poor and that makes them unable to defend themselves properly against infections. In addition, he explained that adipose tissue is a reservoir for viruses. They also have more mechanical and respiratory problems because they have less space for the lungs to expand. And during treatment, it is more difficult to intubate and turn an obese patient face down.

Obesity is also behind most of the metabolic problems such as diabetes, hypertension, and dyslipidemia, which in turn are risk factors for severe Covid. “The obesity it is a disease not a condition that passes. 22% of the Spanish adult population is obese, and 18% of the infant and adolescent ”, warns Dr. Susana Monereo, secretary of Seedo.

Worst approach to being overweight

In addition, confinement has worsened the approach to excess weight. 98% of professionals who treat patients with obesity and who have been surveyed by Seedo and Seen, believe that the pandemic and confinement have had a negative impact on obesity and its complications.

Dr. Susana Monereo says that “only 2.4% of health professionals dedicated to obesity think that obese patients have been able to maintain the treatment they had prescribed (diet, exercise and / or drugs).” Further, only 12% of the professionals surveyed recognize that they have been able to preserve pbariatric surgery programs in their hospitals.

During the first two months of home confinement, it was confirmed that 49.8% of Spaniards had gained weight, the majority (86.6%) between 1 and 3 kilos. The combination of higher intake with less physical activity has taken its toll, but “the worst thing is that el 40.3% of respondents who gained weight did not take any action to manage this situation “, points out Dr. Diego Bellido, head of the Endocrinology and Nutrition Service of the Ferrol University Hospital Complex, who also highlights another risk factor in weight gain:” Among the people who responded to the survey, they gained more weight those who lived in the south of Spain.

Despite being a growing health problem, which has a very negative impact on morbidity and mortality and, even greater among people affected by Covid-19, attention to people with obesity is being relegated, “says Dr. Lecube.

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What is prolonged Covid-19 syndrome?

Vicente Soriano

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Infection by SARS-CoV-2 produces symptoms of Covid-19 in up to 80% of cases during the first two weeks, according to a recent meta-analysis that examined more than 21,000 infected. People with asymptomatic or mild symptoms may be less contagious, apparently because their viral load in the respiratory tract is lower.

In any case, with or without symptoms, all those infected can transmit the coronavirus for between 10 and 14 days. What is more important, can infect during the incubation period, that is, during the 2 to 3 days that precede the onset of cough, fever and the sensation of suffocation (dyspnea). In most patients, after two weeks, the immune system stops viral replication and eliminates the coronavirus.

The Centers for Disease Control and Prevention in the United States, better known by the acronym CDC, have recently proposed three stages in the natural history of SARS-CoV-2 infection, as shown in the following table:

In phase 1 (acute infection) there is viral replication and predominant respiratory manifestations (cough, dyspnea, etc.), although there may also be digestive manifestations such as diarrhea, nausea and vomiting, as well as fever and headache.

Although many patients recover after this stage, some progress to phase 2 after two weeks. This point coincides with the appearance of the immune response and antibodies, with a hyperinflammatory picture associated with a cytokine storm, which causes a clinical worsening. They develop bilateral pneumonia, bleeding disorders, and damage to other organs such as the heart, kidney, and brain. These patients require hospitalization and some require transfer to intensive care units.

To the two clinical phases of Covid-19 described above, a phase 3 has been added. This includes late complications and a residual condition known as postcovid syndrome after one month of suffering from the acute infection.

Late complications after Covid-19

Although SARS-CoV-2 infection, with or without symptoms, clears up naturally within a couple of weeks, some patients do not fully recover and have late complications. These occur because the damage that SARS-CoV-2 infection can cause is not only limited to the lungs, but the heart (myocarditis), blood vessels (embolisms), kidneys (kidney failure), the nervous system (neuropathies, stroke, etc.) and liver (hepatitis), among others. Similarly, some patients with severe bilateral pneumonia recover with significant residual pulmonary fibrosis.

It is convenient to collect a good medical history from these patients and differentiate at least three situations that explain their post-coronavirus pathology:

1. After prolonged stays in intensive care, with mechanical ventilation and bedridden for several weeks, with muscular atrophy due to little mobilization.

2. For permanent damage to affected organs in acute infection. It is the case of the pulmonary fibrosis after severe pneumonia, or heart failure secondary to myocarditis or pulmonary embolisms.

3. Due to persistence of viral replication for several months together with symptoms in patients with severe immunosuppression, well demonstrated in at least two patients.

The last situation, with sustained viral replication, is reminiscent of that described more than a decade ago with the hepatitis E virus, another RNA virus that typically produces a self-limited infection. However, unexpected cases of chronic hepatitis and cirrhosis due to the E virus began to be described in transplant patients, in direct relation to the use of immunosuppressive treatment.

Prolonged Covid-19 syndrome

Around 5% of patients suffering from Covid-19 report persistence of symptoms months after healing. The most frequent clinical manifestations in these patients are: fatigue, dyspnea, cough, changes in smell and taste, joint and muscle pain (arthralgias). It is the prolonged Covid-19 syndrome (long covid in the Anglo-Saxon medical literature).

They are patients with acute coronavirus infection in the previous months, who report not having recovered normality. They manifest sleep disorders, memory loss, disorientation, difficulty concentrating, fatigue, depression, muscle and joint pain, headache, palpitations, alopecia, and intermittent low-grade fever or fever. Many say they have experienced accelerated aging.

A recent pre-publication from King’s College London, pending peer review, examined 4,182 patients who had had a positive PCR for SARS-CoV-2. The results showed that 13.3% said they had not recovered after four weeks, 4.5% after eight weeks and 2.3% even after 12 weeks.

Chronic slice syndrome

The postviral fatigue picture of these patients with residual Covid-19 is reminiscent of chronic fatigue syndrome, also known as encephalomyelitis myalgia.

Myalgic encephalomyelitis is a poorly defined entity, like a mixed bag for a heterogeneous group of patients who report intense or strenuous fatigue, often after having suffered a viral infection.

It has occasionally been associated with infections by viruses of the herpes family, such as the Epstein-Barr virus, which can cause chronic infections and episodes of reactivation after being latent. It is more frequent in women in the middle age of life.

Of other viruses that cause chronic infections in humans, such as HIV, hepatitis B virus and hepatitis C virus, we know that processes of chronic inflammation and persistent immune activation have been associated with an increase in cellular metabolism and phenomena from early aging, both in certain organs and at the systemic level. It is difficult to accept this hypothesis for a coronavirus, which only produces self-limited infections that remit naturally, unlike HIV or hepatitis B or C viruses.

However, the cytokine storm that can be triggered after several days of SARS-CoV-2 infection could lead to immune dysregulation and lead to clinical worsening and complications throughout the body. This could lead to an activation of the expression of endogenous viruses and epigenetic changes that would increase cellular metabolism. This appears to be the pathogenesis of postcoronaviral syndrome.

Outpatient follow-up of patients who have had a confirmed SARS-CoV-2 infection will help to better understand the frequency and characteristics of prolonged Covid-19 syndrome. Identifying its causes will provide guidance on possible treatment strategies.

Vicente Soriano. Faculty of Health Sciences & Medical Center, UNIR – International University of La Rioja.

This article was originally published on The Conversation.

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Study: This Toothpaste Reduces COVID Viruses In The Mouth – Health

Colgate learned more about dental care in a study. The role of toothbrushing in the fight against the COVID-19 virus was examined.

Brushing your teeth keeps your teeth healthy! And apparently a lot more. Toothpastes and mouthwashes containing zinc or tin containing the active ingredient cetylpyridinium chloride (CPC) can potentially slow down the virus that causes COVID-19. At least that is what the results of a study suggest. Viruses could be neutralized to 99.9 percent.

Study with infected people

A clinical study with infected people examined the potential of oral care products to reduce the pathogen in the mouth. Lo and behold: “The results suggest that some toothpastes and mouthwashes can help reduce the spread of the SARS-CoV-2 virus, which causes COVID-19, by temporarily reducing the amount of pathogens in the mouth” According to the study authors.

Study authors: Brushing your teeth is not the ultimate protection!

“While brushing your teeth and using mouthwashes are not a therapy or a way to completely protect an individual from infection, they could help reduce the transmission of the virus,” said Dr. Maria Ryan.

Of course, the distance rules and the mask requirement must still be taken seriously. Viruses are ultimately also absorbed through the mucous membranes in the nose and eyes.

It depends on the ingredient

It is important that toothpastes containing tin or zinc are used. These substances are crucial and were also examined in the study. “We think oral care, along with other preventive measures, has a role to play in fighting the global pandemic,” said Dr. Ryan.

That means: If you want to protect yourself even better in the future, you can also use a toothbrush in between to wash your hands. It’s not just your teeth that will thank you!

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Suicide alarm returns in Japan. In October there are more than the dead from Covid

AGI – In just one month, in Japan the number of suicides has exceeded that of all deaths from Covid since the beginning of the pandemic. This is what emerges from a report by the US broadcaster CNN from Tokyo, which starts from the story about a 43-year-old woman who since she was 22 tried to get it over with 4 times, the last for fears of falling into poverty due to the consequences of the pandemic on his professional life.

In a country where historically there was a tradition of ritual suicide, the risk that the economic and psychological consequences of Covid lead to an extreme choice is particularly high. The statistics reported by the report show that in October there were 2,153 suicides, while the number of coronavirus deaths since the beginning of the pandemic is just over 2,000 (2,050 according to the latest data from Johns Hopkins University).

Japan, CNN points out, is one of the few countries that promptly disclose data on suicides, and these could be used to analyze the impact of the pandemic and measures to combat it on the mental health of the population, helping everyone to identify the most vulnerable categories.

Although Japan has a high suicide rate, in the last ten years there has been a decrease, and that of the last few months therefore appears as a turnaround, which affected women more than men: in October, suicides of women increased by 83% compared to the same month last year, while those of men increased by 22%.

According to CNN, this is due to the greater precariousness of female employment in sectors such as tourism and commerce, where there have been many layoffs as they are particularly affected by anti-covid measures. According to a study involving 10,000 women around the world, an increase in mental health problems linked to the consequences of the pandemic affected 27% of women and 10% of men.

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Covid-19, nearly one in two French people hostile to the vaccine

While the announcements of the development of vaccines against Covid-19 follow one another, skepticism reigns in the country of Pasteur. According to a survey carried out for the Jean Jaurès foundation, nearly one in two French people is against the vaccine. 24% answered that they probably would not agree and 19% that they would definitely not agree to receive the injection.

France has been the world champion in the mistrust of vaccines for years. The difficulties in combating Covid-19 and the dramatic economic repercussions of the crisis do not seem to change anything.

→ READ. Covid-19: what we know about this virus which is still intriguing

Countries like Brazil, South Korea, India and China approve the prospect of vaccination by more than 80%. Among our neighbors, we obtain scores of 64% in Spain, 65% in Italy, 69% in Germany and even 79% in Great Britain. France drops out of the group with a tiny 54% (1).

Suspected conflict of interest

How to explain such a state of mind? The H1N1 flu episode in 2009 would have “Lasting damage to the relationship between the French and vaccines”, analysis Antoine Bristielle, researcher at Sciences-Po Grenoble and expert at the Jean Jaurès foundation. The many controversies that took place at that time on the advisability of vaccinating and the suspicions of conflicts of interest have had a lasting impact on the confidence of the French in vaccines.

The Foundation’s study provides elements of analysis on the audiences most prone to mistrust, which are based on the results of the vast “French Fractures” survey carried out in early September (2). In this wave 8 of the survey conducted since 2013, respondents were asked about their confidence in the various institutions and the prospect of a vaccine.

It turns out that the first criterion for accepting vaccination against Covid-19 is age. All other things being equal, the older they are, the more the French say they agree to want to be vaccinated, which seems logical in the context of an epidemic that exposes them much more than the younger ones.

50% of women hostile to the vaccine

The refusal of vaccination concerns 50% of women against “only” 35% of men. While the socio-professional category and the level of education have no impact on opinion, the partisan positioning is divisive. The voters in 2017 of Jean-Luc Mélenchon, Marine Le Pen or Nicolas Dupont-Aignan “Are much more anti-vaccine than other voters”, emphasizes the study.

The arguments used by those who reject the vaccination against Covid-19 refer first to its effectiveness: 63% express a doubt in this direction and 46% say they are afraid of side effects. 14% think that barrier gestures and vigilance are enough to protect themselves. 10% do not feel at risk and 4% say that the probability of being infected is too low.

The charges of Professor Raoult

Finally, the study establishes a very strong correlation between the refusal of the vaccine and the lack of confidence in institutions. However, the “French Fractures” barometer shows a regular erosion of the confidence of the French in political bodies. Confidence in our scientists is higher, but it has dropped by more than 20 points between the start of the epidemic and October 2020.

→ ANALYSIS. Covid-19: how France is preparing its vaccination strategy?

“This figure is absolutely alarming, considers Antoine Bristielle. Scientists were the last bulwark of health policy. As the crisis evolved, the authority of scientists in the matter was widely questioned, in particular because of the public staging of a dissensus, presented
as deep, within the scientific community. “

The study recalls that Professor Raoult has increased the burden on the scientific world. Even though the evolution of the epidemic in the fall gave his predictions wrong, the Marseille doctor continued to benefit from wide media coverage. Over a million people were registered with support groups on Facebook. “It is therefore not surprising to see (…) how far the vaccine against Covid-19 is
consensus »,
explains the author who insists on the particular influence of social networks.

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What if working in a hospital was not relevant in the rate of infections in toilets?

R. Ibarra

Madrid

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It is possible that when Fernando Simon refers to the number of infections among health professionals stating that they had acquired a learning with respect to the first wave and that they had a better behavior avoiding being infected outside their workspace, they would not have read an investigation carried out at Hospital 12 de October in Madrid or maybe yes.

In this report, which is pre-published on medRxiv and has not been reviewed by peers, it is concluded that the infection rate for the SARS-CoV-2 coronavirus of the health personnel analyzed in the study could be an indicator of the dynamics of the epidemic in the community. Because, they say, «there appears to be a close connection between infection in healthcare workers and transmission in the community».

That is, although the researchers cannot exclude that working in a hospital setting is an additional risk factor for SARS-CoV-2 infection, “the similar proportions of positive cases across all areas of the hospital and the evolutionary wave of infection, compared to the community, are clear arguments and contrary to considering occupational risk as a determining factor ».

And they add: “Comprehensive tests, such as the one carried out in our institution, which covers more than a third of all workers, could serve as a reference for the infected population in the community.”

The similar proportions of positive cases among all areas of the hospital and the evolutionary wave of infection, compared to the community, are clear arguments against considering occupational risk as a determining factor

Does this mean that Simon was right when he said what he said and that it earned him the General Council of Official Medical Associations (CGCOM) will request his immediate cessation?

The lead author of the work, Rafael Delgado, has declined to speak with ABCSalud, but in their paper the authors write that the study found no statistically significant differences in the proportion of PCR-positive detection for SARS-CoV-2 among health workers in areas high-risk and with contact with covid-19 patients compared to office, administrative or laboratory personnel without direct contact with patients. “The evolution curves of accumulated cases between patients and healthcare personnel during March 2020 showed an almost parallel shape.”

And, although there were some cases of highly probable transmission from patients with covid-19 to health workers, mainly in the first phase of the epidemic, there were no significant differences in the infection rates of health and hospital personnel that could be related to work in areas of high incidence and higher risk of exposure. Furthermore, the evolution of cases during the same time period (March 2020) among patients who attended the emergency room and hospital staff suggests that both groups were driven by the same dynamics.

The first case of covid-19 at the 12 de Octubre University Hospital was confirmed on March 1. It is a large public hospital with 1,200 beds, for more than 400,000 inhabitants in the south of Madrid and which the pandemic attacked with all its might in the first wave.

Since the beginning of the epidemic, Occupational Health and Safety Service The aforementioned hospital organized the consultation and test of hospital personnel with confirmed exposure and also those who presented symptoms of viral respiratory infection. For the molecular diagnosis of the infection, PCR tests were carried out on suspected cases since February 25.

Thus, out of a total of 6,800 hospital employees, 2,085 (30.6%) were evaluated during the period between 1-29 March 2020, some of them repeatedly (2,286 samples in total).

The first infected healthcare worker was certified on March 9. And on the 29th of the same month it was confirmed that a total of 791 hospital workers, including non-healthcare personnel, were infected, representing 38% of those examined and 11.6% of all hospital workers.

The results have important implications for more accurately estimating the true number of cases in the community and developing public health policies for containment, treatment and recovery.

Likewise, the proportion of infected individuals among the different occupational exposure groups was estimated and the evolution of cases during the epidemic expansive wave was compared between health personnel and patients who attended the Emergency Department during the same period.

The authors conclude that the results contrast with the official figures that circulate nationally and internationally. And, furthermore, “they have important implications for more accurately estimating the true number of cases in the community and developing public health policies for containment, treatment and recovery.”

A total of 72 doctors have died in the care practice since March, a profession that also claims that the infection by the SARS-Cov-2 virus be recognized as an occupational disease

This experience is similar to that reported from Wuhan verified by the Joint Mission of the World Health Organization (WHO) and also to recent experiences in a hospital in the Netherlands, where the majority of health worker infections were related to household or community contacts.

The truth is that Spain is at the head of health personnel who died during the pandemic. According to the medical organization, there are 72 doctors who have died in the care practice since March, a profession that also insistently demands that the SARS-Cov-2 virus infection be recognized as an occupational disease

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use the covid-19 vaccination campaign

R. I.

Madrid

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A performance “bold but possible»Is why the experts are betting to recover the months lost in the elimination of the Hepatis C virus (HCV) in our country. It would try to take advantage of the massive tests and the vaccination campaign against covid-19 to identify those who carry the virus.

Experts gathered at the virtual conference held by the Alliance for the Elimination of Viral Hepatitis in Spain, AEHVE, on the occasion of the European Testing Week and within the framework of its program #HepCityFree, Hepatitis Free Cities, consider that the experience and advances in diagnostic tests brought about by the pandemic may be useful and applicable to micro-elimination strategies.

Experts propose turning the negative impact of the pandemic into a positive opportunity for the macro-elimination strategy (in the general population). How? Taking advantage of the previous serological tests that will be necessary in the vaccination against covid-19 for the diagnosis of HIV and hepatitis B and C. A possibility that, despite the difficulties, they consider feasible and that would strengthen Spain’s leadership in the race of the great nations committed to the goal of eliminating hepatitis C.

The director of National Plan for HIV and hepatitis C, Julia del Amo, has pointed out that «the pandemic has taught us that it is possible to decentralize medical care and tests and that there has been a revolution in health care points and rapid tests, something that can be applicable to all diseases and especially infectious ones.

The pandemic has taught us that it is possible to decentralize medical care and testing and that there has been a revolution in health care points and rapid tests

The health crisis caused by covid-19 has severely impacted on the macro and micro-elimination strategies of hepatitis C in Spain, causing a delay that experts estimate to be around a year, but which they consider could be recovered in a few months . For this, the role of cities will be essential.

With Primary Care saturated and focused on the care of patients with covid-19, the request for diagnostic tests for hepatitis C has been reduced ostensibly, decreasing practically to a minimum in the months of the worst impact of the pandemic and preventing therefore, advance in the macroelimination strategy (in the general population) at the expected pace.

In addition, micro-elimination efforts (in vulnerable groups) have also been affected, causing a reduced ability to diagnose new cases and guarantee continuity of treatment until cure.

However, in this situation caused by the pandemic, experts coincide in finding opportunities and some reasons for optimism, to the point that they see it possible to move much faster in the coming months. For this, they consider, the social environment that has been generated, much more favorable to all programs and investments in Public Health.

And also the involvement of cities (municipalities) that do not have health competencies, but do manage social policies that can be key especially in the micro-elimination strategy, collaborating with NGOs to bring health resources closer to vulnerable groups such as homeless people or consumers drugs, usually far from Primary Care.

María Buti, from the Vall d’Hebron University Hospital, stressed that the majority of patients at risk for the transmission of the virus do not go through conventional health circuits, so “you have to look for them on the streets.”

He also stressed the importance of improving the notification of new cases. Del Amo indicated that “having a registry in Spain continues to be one of our great challenges.”

Most patients at risk for the transmission of the virus do not go through conventional health circuits, so they have to be looked for in the streets

Hepatitis C is a chronic viral disease for which there is no vaccine, but there is a treatment that cures it in more than 98% of cases. In Spain, since the appearance of direct-acting antivirals (ADDs) and thanks to the PEAHC (Plan for the Approach to Hepatitis C in the National Health System), more than 135,000 people have been treated and cured. Hepatitis C is a common cause of liver cirrhosis and liver cancer and is responsible for 20% of liver transplants in Spain.

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This is the most common Covid-19 symptom in patients admitted to hospital

C. Garrido

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The most common symptom in Covid-19 patients at the time of hospital admission is the fever (83.9%), followed by cough (73.1%), respiratory distress (57.5%), fatigue (43.2%), diarrhea (24%), anorexia (19.7%), and anosmia (7.4%). Regarding the profile of people hospitalized for this infection, more than half (57.2%) are mens and the average age is 69.4 years. These are some of the findings of the SEMI-COVID-19 Clinical Registry, in which more than 19,000 patients and 686 researchers from 150 hospitals participate.

After monitoring more than 17,000 patients included in this Registry, who were discharged or died, it has been possible to determine what symptoms they presented on admission, what were the most common findings in the physical examination, treatments used, as well as which were the main complications and their prognosis.

In the physical exploration, among patients hospitalized in Spain with Covid-19, it was common to find fever (52%), abnormal sounds on auscultation (53.8%), tachypnea (31.5%), tachycardia (24.8%), saturation oxygen levels less than 90% (17.9%), confusion (12%) and hypotension (6.3%).

Regarding main complications that occurred in people hospitalized with coronavirus, are Acute Respiratory Distress Syndrome (33.8% of patients), bacterial pneumonia associated with poor prognosis (10.9% of cases) or sepsis (6, 2%).

Likewise, the overall mortality rate stands at 20.9%, the ICU admission rate at 8.6% and the hospital readmission rate at 3.8%.

Data analysis has also allowed researchers to classify Covid-19 patients into four phenotypic groups according to the type of symptoms and the clinical characteristics they present at the time of their hospital admission. This can serve as a guide to predict a better or worse outcome. Patients with only the classic triad of fever, cough, and dyspnea; those who also have vomiting and diarrhea; or those who suffer from arthromyalgia – joint and / or muscle pain -, headache and sore throat have the worst prognosis a priori. On the other hand, those with symptoms such as those of a common cold or with a clear loss of smell and taste have the best prognosis.

Another of the striking findings of one of the investigations linked to the SEMI-Covid-19 Registry is that tget high blood sugar(hyperglycemia), even in non-diabetic people, is a risk factor strong and independent of mortality in Covid-19 patients. The study authors consider that the detection of hyperglycemia in people without diabetes and its early treatment should be “mandatory” in the management of hospitalized patients with Covid-19.

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