Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

Autopsias en casos sospechosos de SARS-CoV-2 / Autopsies of suspected SARS-CoV-2 cases

La medicina forense debe contemplar la posibilidad de que fallecidos por causas violentas o desconocidas puedan estar infectados por el virus SARS-CoV-2, o que el diagnóstico de la enfermedad tenga implicaciones legales, lo que exige un conocimiento adecuado de la epidemiología de la enfermedad, de las medidas de protección, de la toma de muestras y de las características anatomopatológicas. La práctica de autopsias en fallecidos por COVID-19 se ha visto limitada por las obligadas medidas preventivas frente al contagio y por la necesidad de disponer de instalaciones con nivel de protección frente a riesgos biológicos de nivel 3, de modo que las series publicadas hasta la fecha son escasas, y parciales, con abordajes limitados (autopsia mínimamente invasiva o biopsia con aguja gruesa). En este artículo se hace una revisión de los aspectos de la fisiopatología de la enfermedad que tienen repercusión en la infectividad de los tejidos y fluidos del cadáver, de las medidas de prevención del riesgo biológico, de la toma de muestras y de los hallazgos patológicos, tanto macroscópicos como microscópicos, asociados a la muerte provocada por la infección por el virus SARS-CoV-2

Forensic physicians should consider the possibility that people who have died from violent or unknown causes may be infected by the virus SARS-CoV-2, or that the diagnosis of the disease has legal implications, which requires adequate knowledge of the epidemiology of the disease, protective measures, adequate sampling and the pathological characteristics. The practice of autopsies on people who have died from COVID-19 has been limited by the mandatory preventive measures against contagion and by the need for facilities with a level of protection against level-3 biological risk, and therefore series published to date are scarce and partial,with limited approaches (minimally invasive autopsy or needle biopsy). This article reviews the aspects of the pathophysiology of the disease that have an impact on the infectivity of the body's tissues and fluids, measures for preventing biological risk, taking samples and pathological findings, both macroscopic and microscopic, associated with death caused by infection with the SARS-CoV-2 virus

La certificacion de la defuncion de casos de COVID-19 en España / Death certification in COVID-19 cases in Spain

La certificación de la defunción es un acto médico en el que el profesional debe poner el mismo esfuerzo y dedicación que en el resto de los informes elaborados en vida del paciente. Para su correcta cumplimentación el facultativo debe seguir las instrucciones básicas, poniendo especial cuidado en rellenar adecuadamente la secuencia de causas de muerte. En casos de pandemia, la cumplimentación del certificado de defunción corresponde a la medicina asistencial y para poder hacerlo, los organismos oficiales deben publicar instrucciones basadas en recomendaciones internacionales. Debe establecerse, cuanto antes, la posibilidad de comunicación telemática de las defunciones. Mientras eso no sea posible tienen que establecerse procedimientos que permitan en situación de pandemia, comunicar de forma inmediata la mortalidad a las autoridades sanitarias

Death certification requires the same effort and dedication as all reports by doctors during their patients' lifetimes. The physician must follow the basic instructions to complete a death certificate correctly, taking special care to fill in the sequence of causes of death. In the case of a pandemic, completion of the death certificate falls to the primary care physician and therefore the official bodies must publish instructions based on international recommendations. It should be established as soon as possible whether it is possible to report deaths telematically. While this is not possible, in a pandemic procedures should be put in place to enable the immediate reporting of deaths to the health authorities

Gestión de los cadáveres durante la pandemia por COVID-19 en España / Management of corpses during the COVID-19 pandemic in Spain

El brote por el Coronavirus/COVID-19, declarado Emergencia de Salud Pública de Importancia Internacional el 30 de enero de 2020 por la Organización Mundial de la Salud, ha sobrepasado en numerosos países la capacidad de respuesta del sistema sanitario por su alta contagiosidad, y la de gestión de las personas fallecidas por su elevado riesgo de letalidad. Se revisan las principales guías y protocolos promovidos por las instituciones y las principales sociedades científicas, orientados a la contención de la pandemia mediante la adopción de medidas de protección de los profesionales y a la adecuada gestión del alto número de cadáveres. Se analizan los centros especiales de recogida de cadáveres en situación de epidemias y las clasificaciones de los cadáveres en función del riesgo infecto-contagioso. Específicamente se resumen las resoluciones dictadas por las autoridades sanitarias y se describen los protocolos de actuación ante fallecidos durante la pandemia COVID-19, incluyendo las autopsias forenses

The Coronavirus/COVID-19 outbreak, declared a Public Health Emergency of International Importance on January 30, 2020 by the World Health Organization, has in many countries exceeded the capacity of health systems to respond, due to its high contagiousness and the capacity to manage the deceased, due to its high fatality risk. A review is necessary of the principal guidelines and protocols promoted by the institutions and the main scientific societies, aimed at containing the pandemic by adopting professional protection measures and appropriately managing the high number of cadavers. The temporary mortuaries in an epidemic crisis and the classification of bodies according to infectious risk are analysed. In particular the resolutions issued by the health authorities are summarised and the protocols for dealing with deaths during the COVID-19 pandemic are described, including forensic autopsies

Valoración medicolegal de la infección por COVID-19 en el ámbito laboral / Medico-legal assessment of the COVID-19 infection in workplace

España ha sido uno de los países con mayor afectación por la pandemia COVID-19. Hasta la fecha, un 22% de los casos notificados son personal sanitario, siendo significativamente mayor este porcentaje entre las mujeres (76% del personal sanitario contagiado). Ante la evidencia de que muchos profesionales sanitarios pueden haberse contagiado en su puesto de trabajo, hemos revisado la problemática en el ámbito de la salud laboral que produce la COVID-19. Se describen los decretos publicados por el Gobierno de España y las recomendaciones de la Organización Internacional del Trabajo. Concretamente se analiza la clasificación del SARS-CoV-2 como agente biológico del grupo 3, su calificación como accidente de trabajo o enfermedad profesional y sus repercusiones en las situaciones de incapacidades (temporales y permanentes), secuelas y muerte, así como el estudio de las posibles demandas de aquellos que lo han sufrido como consecuencia de falta de medidas preventivas

Spain is one of the countries most affected by the COVID-19 pandemic. To date, 22% of reported cases are healthcare professionals, and 76% of them are women. Given that many healthcare professionals may have been infected in their workplace, we have reviewed the occupational health challenges posed by COVID-19. The Spanish laws and the recommendations of the International Labor Organization are described. The review covers the classification of SARS-CoV-2 as a biological agent in group 3 and of COVID-19 as an occupational accident or disease, its repercussions in temporary and permanent disabilities, sequelae and death, and the possible claims of those who may have developed the disease due to the lack of preventive measures

Unmasked Behavior.

After initial assertions that the wearing of face masks was an unnecessary public health tool in the prevention of the spread of Covid-19, the advice coming out of the Centers for Disease Control (CDC) suddenly changed. In early April, the CDC issued new guidelines advising people to wear face coverings in public settings where social distancing is difficult.

How compliant are technicians with universal safety measures in medical laboratories in Croatia?--A pilot study.

INTRODUCTION: This pilot study aimed to investigate the use of personal protective equipment (PPE) and compliance to the code of conduct (rules defined in institutional, governmental and professional guidelines) among laboratory technicians in Croatian medical laboratories. In addition, we explored the differences in compliance between participants of different age groups, laboratory ownership and accreditation status. MATERIALS AND METHODS: An anonymous and voluntary survey with 15 questions was conducted among Croatian medical laboratory technicians (N=217). The questions were divided into two groups: demographic characteristics and the use of PPE. The questions of the second part were graded according to the Likert scale (1-4) and an overall score, shown as median and range (min-max), was calculated for each participant. Differences between the overall scores were tested for each group of participants. RESULTS: The majority of participants always wear protective clothes at work, 38.7% of them always wear gloves in daily routine, more than 30.0% consume food and almost half of them drink beverages at workplace. A significantly lower overall score was found for participants working in public compared to private laboratories (36 (16-40) vs. 40 (31-40), P<0.001). There were no statistically significant differences in overall scores for participants of different age groups (P=0.456) and laboratory accreditation status (P=0.081). CONCLUSION: A considerable percentage of laboratory technicians in Croatian medical laboratories do not comply with safety measures. Lack of compliance is observed in all personnel regardless laboratory accreditation and participants' age. However, those working in private laboratories adhere more to the code of conduct.

[Peculiarities of forensic medical expertise in a situation of massive salmonellosis morbidity in a military unit].

The authors propose to consider infectious diseases as mass clinical conditions in both normative-legal and medical contexts. Peculiarities of commission and comprehensive inspections carried out in situations of massive infectious morbidity among servicemen are illustrated by examples of the work of state forensic medical organizations and investigative authorities of the Russian Defense Ministry.

The precautionary principle: a double edged sword?

There is no doubt that the introduction of quality system principles and regulation to blood and tissue services in the 1990's has brought about significant improvements in the control of processes and the quality of products being released for patient care. But, as regulation extends into new areas of cellular and tissue therapy, it is perhaps time to review the regulatory paradigm within which we work, and the principles that underpin it. At what point do the costs of regulation exceed the benefits to be gained? At what point to regulations cease to yield measurable benefits to patient care and safety at all, but instead become simply a burden on service providers and businesses, and ultimately the community as a whole? And is there a point at which regulation actually compromises patient care and safety, or the development of new technologies? In the early stages of regulation, there is demonstrable cost-benefit as assessed by product quality and patient outcomes. However, there is inevitably a "law of diminishing returns", whereby the degree of improvement that can be achieved decreases and the cost of achieving that benefit increases. What has not yet been determined is whether, as regulations and regulators become more precise and more demanding, there remains a measurable net cost benefit over time, or whether there is a point at which the cost of further improvement matches, or even exceeds, the benefits to be gained. A key underpinning of the regulatory philosophy is the "Precautionary Principle". This paper will focus on the application of the Precautionary Principle in the area of blood and tissues, which encompasses the burgeoning field of cellular therapies.

¿Cuáles son los beneficios de REACH para los trabajadores? / How workers stand to benefit from REACH?

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The precautionary principle and emerging biologic risks: lessons from human immunodeficiency virus in blood products.

In times of crisis, such as during the early 1980s when acquired immune deficiency syndrome (AIDS) was first recognized as a threat to the blood supply, it can be difficult to find reliable evidence upon which to base appropriate public health policies. Unreliable evidence produces substantial scientific uncertainty. Yet despite ambiguity and unanswered questions, decisions must be made and policy established to protect people's health. The precautionary principle provides important guidelines for public health policy decision making that are of particular value in times of crisis, such as the emergence of a new pathogen: be open and honest about scientific uncertainty; communicate with the public; and consider immediate, adaptable policy decisions. Ongoing research into the important uncertainties and review of policies in light of the data that emerge are crucial to the development of good public policy.

Bloodborne infections: should they be disclosed? Is differential treatment necessary?

There are students and staff in many schools with hepatitis B, hepatitis C, or HIV infections. Should parents or guardians be expected to disclose students' bloodborne infections to school officials? Can infected students play contact sports given the increased risk of blood spills? What type of response plan should schools develop in the event of a blood spill to protect student health and privacy? This article summarizes the policies and approaches that the federal government and medical, school nursing, teacher, and parent organizations have taken on these issues. It suggests strategies school nurses can employ to protect the civil rights, privacy, and health of all students and school staff.

Have health conditions associated with latex increased since the issuance of universal precautions?

OBJECTIVES: This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987. METHODS: Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time. RESULTS: No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations. CONCLUSIONS: Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers.