Modelling the risk of hospital admission of lab confirmed SARS-CoV-2-infected patients in primary care: a population-based study.

The objectives of this study are to develop a predictive model of hospital admission for COVID-19 to help in the activation of emergency services, early referrals from primary care, and the improvement of clinical decision-making in emergency room services. The method is the retrospective cohort study of 49,750 patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%, respectively). Data collected for this study included sociodemographic data, baseline comorbidities, baseline treatments, and other background data. Multilevel analyses with generalized estimated equations were used to develop the predictive model. Male sex and the gradual effect of age were the main risk factors for hospital admission. Regarding baseline comorbidities, coagulopathies, cancer, cardiovascular diseases, diabetes with organ damage, and liver disease were among the five most notable. Flu vaccination was a risk factor for hospital admission. Drugs that increased risk were chronic systemic steroids, immunosuppressants, angiotensin-converting enzyme inhibitors, and NSAIDs. The AUC of the risk score was 0.821 and 0.828 in the derivation and validation samples, respectively. Based on the risk score, five risk groups were derived with hospital admission ranging from 2.94 to 51.87%. In conclusion, we propose a classification system for people with COVID-19 with a higher risk of hospitalization, and indirectly with it a greater severity of the disease, easy to be completed both in primary care, as well as in emergency services and in hospital emergency room to help in clinical decision-making.Registration: ClinicalTrials.gov Identifier: NCT04463706.

[Low transmission of SARS-CoV-2 at school settings: a population-based study in the Basque Country.] / Baja transmisión del SARS-CoV-2 en el ámbito escolar: estudio poblacional en Euskadi.

OBJECTIVE: Studies about SARS-CoV-2 transmission at school settings have been outbreaks or schools clusters. There are scarce population-based studies has been studied. We aimed at describing SARS-CoV-2 school-related transmission and its relationship with baseline community cumulative incidence rate in the Basque Country after school reopening in order to inform Public Health decision-making. METHODS: We conducted a scholar surveillance population-based study of SARS-CoV-2 transmission from 7 September to 31 October 2020. We calculated percentages of cases in school-age population, secondary attack rates by education level among close contacts and correlation between population´s and scholars´ incidence rates at municipal level. RESULTS: There were 35,477 SARS-CoV-2 laboratory confirmed cases. Among them, 7.65% happened at school settings. Secondary attack rate at schools ranged from 2.9%, in preschools to 7.1% in high schools; Scholars caused a household and social secondary attack rate from 13% (high scholars) to 23.2% (elementary scholars). We found a low correlation between population´s and scholars´ incidence rates at municipal level (R2=0.047). CONCLUSIONS: Secondary attack rate at school settings increased as educational level did; conversely, to social and family secondary attack rate, that decreased with higher educational level. School attendance, during a SARS-CoV-2 high transmission period showed feasible and did not rise transmission. These findings happened under strict non-pharmaceutical measures at school settings and proper epidemiological surveillance, including tracing of laboratory confirmed cases of SARS-CoV-2 looking for close contacts, isolation and testing of close contacts during isolation period. The different degree of transmission of the circulating variants in the different periods of the pandemic must also be taken into account.

OBJETIVO: La transmisión del SARS-CoV-2 en escolares se ha estudiado en brotes o en conjuntos de escuelas y apenas hay estudios poblacionales. El objetivo de este estudio fue describir la transmisión de SARS-CoV-2 relacionada con el ámbito escolar y su relación con la incidencia acumulada comunitaria en Euskadi tras la reapertura de las escuelas para contribuir a la toma de decisiones en salud pública. METODOS: Se trató de un estudio poblacional, basado en el sistema de vigilancia epidemiológica, que analizó la transmisión de SARS-CoV-2 en el ámbito escolar tras la reapertura escolar el 7 de septiembre de 2020 hasta el 31 octubre de 2020. Se calcularon porcentajes de casos en población escolar, tasas de ataque secundaria por nivel educativo entre contactos estrechos, así como la correlación entre tasas de incidencia acumulada municipal y tasa en escolares. RESULTADOS: Se diagnosticaron 35.477 casos confirmados de SARS-CoV-2. Entre ellos el 7,65% sucedieron en el ámbito escolar. La tasa de ataque secundaria en dicho ámbito osciló entre un 2,9%, en educación infantil y un 7,1% en bachiller; los alumnos causaron, en el ámbito familiar y social, tasas de ataque secundarias de entre un 13% (bachiller) y un 23,2% (educación primaria). Encontramos una baja correlación entre las tasas de incidencia acumulada a nivel municipal y la de los escolares (R2=0,047). CONCLUSIONES: La tasa de ataque secundaria en ámbito escolar aumentó según el grado escolar, al contrario que la del ámbito social y familiar que disminuyó. La educación presencial no condujo a un incremento de la transmisión de SARS-CoV-2. Estos hallazgos sucedieron bajo estrictas medidas no farmacológicas en el ámbito escolar y una vigilancia epidemiológica adecuada que incluyó la búsqueda de contactos estrechos de casos de SARS-CoV-2 confirmados por laboratorio, así como el aislamiento y testeo de los contactos estrechos durante el periodo de aislamiento. Ha de tenerse en cuenta también, el diferente grado de transmisión de las variantes circulantes en los diferentes periodos de la pandemia.