Response of the Spanish Early Intervention to the Lockdown Situation due to COVID-19

The extraordinary situation of the COVID-19 pandemic led to the lockdown and interruption of the usual Early Intervention (EI) services, although families and children still needed support. The Spanish professionals reacted quickly, reorganizing the intervention, experimenting with the possibilities of tele-intervention and sharing knowledge and experiences. This work reviews the resources generated, in relation to EI, during the first five weeks of lockdown (from March 13). This work also reviews opinions and feelings that were shared by professionals. 72 resources were identified, provided through social networks: documents (33), videoconferences and online seminars (32) and applications or web resources (8). Its characteristics, timing, orientation to families or professionals, and its alignment with a paradigm of intervention centered on the family or the child are analyzed. The opinions and feelings of the professionals are analyzed in reference to the resources provided, the needs observed in the families, the problems in tele-intervention and in the face of the approach to return to a "new normality". The results obtained complement the vision of families about the situation generated by the lockdown, which has been collected in other works. It concludes on the good health of EI in Spain and the need to deepen the proactive involvement of the family in the intervention team.La situación extraordinaria de pandemia COVID-19 llevó al confinamiento y a la interrupción de los servicios habituales de Atención Temprana (AT), aunque familias y niños seguían necesitando apoyo. Los profesionales españoles reaccionaron rápidamente, reorganizando la intervención, experimentando con las posibilidades de teleintervención y compartiendo conocimientos y experiencias. Este trabajo revisa los recursos generados, en relación con AT, durante las cinco primeras semanas de confinamiento (desde del 13 de marzo), así como opiniones y sentimientos compartidos por los profesionales. Se identificaron un total de 72 recursos, facilitados a través de redes sociales: documentos (33), videoconferencias y seminarios online (32) y aplicaciones o recursos web (8). Se analizan sus características, temporización, orientación hacia familias oprofesionales y su alineación con un paradigma de intervención centrado en la familia o en el niño. Las opiniones y sentimientos de los profesionales se analizan en referencia a los recursos facilitados, las necesidades observadas en las familias, los problemas en la teleintervención y ante el planteamiento de vuelta a una 'nueva normalidad'. Los resultados obtenidos complementan la visión de las familias sobre la situación generada por el confinamiento, que ha quedado recogida en otros trabajos. Se concluye sobre la buena salud de la AT en España y la necesidad de profundizar en la implicación proactiva de la familia en el equipo de intervención

Construct Validity and Test–Retest Reliability of a Free Mobile Application to Evaluate Aerobic Capacity and Endurance in Post-COVID-19 Syndrome Patients—A Pilot Study.

Introduction: Disability associated with the symptoms of post-COVID-19 syndrome is one of its main features and can have a considerable impact on care and rehabilitation units. This, linked to a decreased aerobic capacity and endurance in post-COVID-19 syndrome patients, increases interest in studying the potential of mobile applications to assess performance capacity. The purpose of this research was to study how a free mobile application assesses aerobic capacity and endurance and its relationship with aerobic capacity, test-retest reliability, and endurance evaluated by a conventional test, along with fatigue and health-related quality of life. Methods: An observational study was conducted. RUNZI®, a free mobile application, was used by mounting a Samsung Galaxy S8 smartphone using a strap on the right forearm while all participants simultaneously performed a 6-Minute Walking Test (6MWT). Construct validity between the 6MWT and the total distance performed evaluated by RUNZI® was explored. Additionally, evaluation scales to assess fatigue (MFIS) and health-related quality of life (SF-36) were used to analyze the construct validity of RUNZI®. For test−retest reliability of the app, the same instructions about the 6MWT and procedure with the app were given to all participants at two different time periods. Results: A total of 16 post-COVID-19 syndrome patients (15 females and 1 male) completed the procedure. Distance measured with the RUNZI® showed an excellent correlation with the 6MWT assessed conventionally (p < 0.0001; r = 0.851). No statistical correlations were found between the distance assessed by the RUNZI® app with MFIS and the SF-36. Test−retest reliability was found to be close to statistical significance (p = 0.058) for distance (m) measured by RUNZI® with an ICC of 0.482. Conclusions: Instrumental 6MWT assessed by the RUNZI® app for the Android® operating system showed an excellent correlation with conventional 6MWT, indicating its construct validity in post-COVID-19 syndrome patients. Further, values for the test−retest reliability for the free mobile application were close to statistical significance with a reliability considered poor in an indoor setting.post-print953 K

COVID-19: Some unresolved issues

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.post-print462 K

New variants of SARS-CoV-2

The emergence and spread of new variants of SARS-CoV-2 has produced enormous interest due to their possible implication in the improved transmissibility of the virus, their consequences in the individual evolution of the infection, as well as in the possible escape from the immunity generated by the current vaccines. The variants that attract most attention are those of public health concern, including B.1.1.7 (UK), P.1 (Brazilian) and B.1.351 (South African). This list is extended by the variants of interest that emerge and are expanding in certain countries but are found sporadically in others, such as B.1.427 and B.1.429 (Californians) or B.1.617 (Indian). Whole genome sequencing or strategies specifically targeting the spicule gene are used in the microbiology laboratories for characterization and detection. The number of infected individuals, the sanitary situation of each country, epidemiological measures and vaccination strategies influence its dispersion and new variants are expected to emerge. This emergence can only be avoided today by increasing the vaccinated population in all countries and by not relaxing epidemiological containment measures. It is not excluded that in the future it will be necessary to revaccinate against new variants.post-print186 K

Persistence and viability of SARS-CoV-2 in primary infection and reinfections

Since the beginning of the SARS-CoV-2 epidemic, virus isolation in the infected patient was only possible for a short period of time and it was striking that this occurred constantly and did not provide guidance on the clinical course. This fact led to confusion about the efficacy of some of the drugs initially used, which seemed to have a high efficiency in viral clearance and proved ineffective in modifying the course of the disease. The immune response also did not prove to be definitive in terms of evolution, although most of the patients with very mild disease had a weak or no antibody response, and the opposite was true for the most severe patients. With whatever the antibody response, few cases have been re-infected after a first infection and generally, those that have, have not reproduced a spectrum of disease similar to the first infection. Among those re-infected, a large number have been asymptomatic or with very few symptoms, others have had a moderate picture and very few have had a poor evolution. Despite this dynamic of rapid viral clearance, laboratory tests were still able to generate positive results in the recovery of genomic sequences and this occurred in patients who were already symptom-free, in others who were still ill and in those who were very seriously ill. There was also no good correlate. For this reason and with the perspective of this year and the half of pandemic, we compiled what the literature leaves us in these aspects and anticipating that, as always in biology, there are cases that jump the limits of the general behavior of the dynamics of infection in genera

Actions and attitudes on the immunized patients against SARS-CoV-2

The access to COVID vaccines by millions of human beings and their high level of protection against the disease, both in its mild and severe forms, together with a plausible decrease in the transmission of the infection from vaccinated patients, has prompted a series of questions from the members of the College of Physicians of Madrid (ICOMEM) and the society. The ICOMEM Scientific Committee on this subject has tried to answer these questions after discussion and consensus among its members. The main answers can be summarized as follows: The occurrence of new SARS-CoV-2 infections in both vaccinated and previously infected patients is very low, in the observation time we already have. When breakthrough infections do occur, they are usually asymptomatic or mild and, purportedly, should have a lower capacity for transmission to other persons. Vaccinated subjects who have contact with a SARS-CoV-2 infected patient can avoid quarantine as long as they are asymptomatic, although this decision depends on variables such as age, occupation, circulating variants, degree of contact and time since vaccination. In countries with a high proportion of the population vaccinated, it is already suggested that fully vaccinated persons could avoid the use of masks and social distancing in most circumstances. Systematic use of diagnostic tests to assess the immune response or the degree of protection against reinfection after natural infection or vaccination is discouraged, since their practical consequences are not known at this time. The existing information precludes any precision regarding a possible need for future revaccination. This Committee considers that when mass vaccination of health care workers and the general population is achieved, SARS-CoV-2 screening tests could be avoided at least in out-patient care and in the case of exploratory procedures that do not require hospitalizatio

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among ex-isting drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.La precocidad y la eficacia de las vacunas desarrolladas hasta ahora frente al COVID-19, ha sido el avance más significativo y salvador frente a la pandemia. El desarrollo vacunal no ha impedido, durante todo el periodo de la pandemia, la búsqueda constante de remedios terapéuticos, tanto entre los medicamentos ya existentes y con indicaciones diversas, como en el desarrollo de nuevos fármacos. Sobre estos nuevos fármacos, sobre las novedades en la inmunoterapia y sobre lo aprendido de los moduladores de la respuesta inmune ya conocidos y que se han mostrado eficaces frente al virus, el Comité Científico del COVID-19 del Ilustre Colegio de Médicos de Madrid ha querido ofrecer una aproximación precoz, simplificada y critica que pueda ayudar a comprender la situación actua

COVID in Pediatric Age: an opinion paper

The incidence of COVID in pediatrics was underestimat-ed during the first months of the pandemic due to the oligo-symptomatic nature of the infection in many children and the scarcity of diagnostic tests applied to this population. It is now accepted that children are infected and transmit the disease in the same way as adults. On the contrary, children have less severe and less lethal COVID, probably due to a lower maturity of the child’s immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this population group. The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rari-ty, is a very serious condition that frequently requires intensive care. Other less severe post-COVID manifestations have been described in children but are not yet well defined. COVID has had and continues to have a significant psychological impact on the children themselves, on their caregivers and on the exacerbation of pre-existing psychiatric conditions. We apply adult therapeutic principles to children but with very low levels of evidence. Information on the tolerability of the available medications in this population group is still scarce. The mortality of COVID in children is very low and gen-erally affects children with significant comorbidities. There are, at present, three vaccines licensed for pediatric use which are compatible with all other vaccines applicable to children. In these circumstances, there has been much speculation about the indication for vaccination in the pediatric age group, but given its good tolerance, there are clinical and ethical rea-sons that, in our opinion, justify it.La incidencia de COVID en pediatría ha estado infraestimada durante los primeros meses de la pandemia por el carácter oligosintomático de la infección en muchos niños y por la escasez de pruebas diagnósticas aplicadas a esta población. Hoy se admite que los niños se infectan y transmiten la enfermedad igual que los adultos. Por el contrario, los niños tienen cuadros clínicos menos graves y letales lo cuál parece relacionado con una menor madurez del sistema inmune del niño, una menor cantidad de receptores ACE2 y la menor presencia de comorbilidades en este grupo de población. El desarrollo de un síndrome inflamatorio multisistémico tras la infección por SARS-CoV-2 en niños, pese a su rareza, es un cuadro muy grave que frecuentemente requiere cuidados intensivos. Se han descrito otros cuadros post-COVID en niños, menos graves, pero todavía no muy bien definidos. La COVID-19 ha tenido y tiene un importante impacto psicológico en los propios niños, en sus cuidadores y en la exacerbación de cuadros psiquiátricos pre-existentes. Aplicamos a los niños los principios terapéuticos de los adultos pero con niveles muy bajos de evidencia y la tolerancia de los medicamentos disponibles en este grupo de población es todavía mal conocida. La mortalidad de la COVID en niños es muy baja e incide generalmente en niños con importantes comorbilidades. Hay, en el momento presente, tres vacunas autorizadas para el uso pediátrico y las vacunas frente a SARS-CoV-2 son compatibles con el resto de las vacunas aplicables a niños. En estas circunstancias se ha especulado mucho sobre la indicación de vacunación en la edad pediátrica pero dada su buena tolerancia, existen, en nuestra opinión, razones clínicas y éticas que la justifican

Booster or additional vaccination doses in patients vaccinated against COVID-19

Several health organizations, mainly in Western countries, have recently authorized the use of a booster dose of the COV-ID-19 vaccine for patients previously vaccinated with mRNA vaccines, with criteria that do not always coincide. The COVID Scientific Committee of the Illustrious College of Physicians of Madrid (ICOMEM) has received and asked several questions about this situation, to which the group has tried to give answers, after deliberation and consensus. The efficacy of the vaccines administered so far is beyond doubt and they have managed to reduce, fundamentally, the severe forms of the disease. The duration of this protection is not well known, is different in different individuals and for different variants of the virus and is not easily predictable with laboratory tests. Data on the real impact of a supplementary or “booster” dose in the scientific literature are scarce for the moment and its application in large populations such as those in the state of Israel may be associated with a decrease in the risk of new and severe episodes in the short observation period available. We also lack sufficient data on the safety and potential adverse effects of these supplementary doses and we do not know the ideal time to administer them in different situations. In this state of affairs, it seems prudent to administer supplemental doses to those exposed to a higher risk, such as immunocompromised individuals and the elderly. On the other hand, we consider that this is not the time to accelerate, on the spur of the moment, a massive administration of a third dose to other population groups that are less exposed and at lower risk, without waiting for adequate scientific information, which will undoubtedly arrive gradually. We do not believe that this position is incompatible with the practical and ethical warnings made by the World Health Organization in this respectVarias organizaciones sanitarias, fundamentalmente de países occidentales, han autorizado recientemente el uso de una dosis de refuerzo de la vacuna frente al COVID-19 para pacientes previamente vacunados con vacunas mRNA, con criterios no siempre coincidentes. El Comité Científico de COVID, del Ilustre Colegio de Médicos de Madrid (ICOMEM) ha recibido y se ha formulado diversas preguntas sobre esta situación, a la que el grupo ha tratado de dar respuestas, tras deliberación y consenso. La eficacia de las vacunas administradas hasta el momento está fuera de toda duda y han logrado disminuir, fundamentalmente, las formas graves de enfermedad. La duración de esa protección no se conoce bien, es diferente en distintos individuos y para distintas variantes del virus y no es fácilmente predecible con pruebas de laboratorio. Los datos sobre el impacto real de una dosis complementaria o “booster” en la literatura científica son escasos por el momento y su aplicación en grandes poblaciones como las del estado de Israel pueden asociarse a una disminución del riesgo de nuevos episodios y episodios graves en el corto periodo de observación disponible. Carecemos también de datos suficientes sobre la seguridad y potenciales efectos adversos de estas dosis complementarias e ignoramos el momento idóneo de administrarlas en distintas situaciones. En este estado de cosas, parece prudente administrar dosis complementarias a aquellos expuestos a un mayor riesgo, como pueden ser los individuos inmunodeprimidos y las personas mayores. Por el contrario, consideramos que no es este el momento de acelerar improvisadamente una administración masiva de una tercera dosis a otros grupos de población menos expuesta y de menor riesgo, sin esperar la adecuada información científica, que sin duda irá llegando paulatinamente. No creemos que esta posición, sea incompatible con las advertencias prácticas y éticas que realiza la Organización Mundial de la Salud a este respect

Vacunación anti-COVID-19: la realidad tras los ensayos clínicos.

Tras el comienzo de la vacunación frente a SARS-CoV-2, se está acumulando ya suficiente experiencia clínica, en el mundo real y fuera de los ensayos clínicos, para resolver algunas de las cuestiones que siguen pendientes sobre este problema. El Comité Científico sobre COVID-19 del Colegio de Médicos de Madrid ha discutido y revisado algunos de estos temas con una aproximación multidisciplinar. El documento que sigue es un intento de responder a algunas de dichas cuestiones con la información disponible hasta el momento. Este documento se ha estructurado en preguntas sobre distintos aspectos de las indicaciones, eficacia y tolerancia de la vacunación anti- COVID-19.post-print214 K