Excess cases of influenza and the coronavirus epidemic in Catalonia: a time-series analysis of primary-care electronic medical records covering over 6 million people

Coma, Ermengol; Mora, Núria; Prats‐Uribe, Albert; Avilés, Francesc Fina; Prieto-Alhambra, Daniel; Medina, Manuel

doi:10.1136/bmjopen-2020-039369

Cited by 16 publications

(24 citation statements)

References 22 publications

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“…Different from Italy, where infections were concentrated in the North [9], the combination of these repeated introductions with early, unnoticed community transmission resulted in consecutive outbreaks in distant, highly populated areas of the Basque Country and Navarra (North), Madrid (Centre), Catalonia (North East), Andalusia (South) and Valencia (East). This is supported by preliminary evidence for an excess of cases diagnosed as influenza during February and March in Catalonia, compared with the historical record, which probably masked early COVID-19 infections [11]. The spatial structure of the Spanish populations played a role in the rapid spread of the pandemic in some regions the country [see 12].…”

Section: Introductionmentioning

confidence: 82%

Chasing the ghost of infection past: identifying thresholds of change during the COVID-19 infection in Spain

Santamarı́a

Hortal

2020

Epidemiol. Infect.

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One of the largest nationwide bursts of the first COVID-19 outbreak occurred in Spain, where infection expanded in densely populated areas through March 2020. We analyse the cumulative growth curves of reported cases and deaths in all Spain and two highly populated regions, Madrid and Catalonia, identifying changes and sudden shifts in their exponential growth rate through segmented Poisson regressions. We associate these breakpoints with a timeline of key events and containment measures, and data on policy stringency and citizen mobility. Results were largely consistent for infections and deaths in all territories, showing four major shifts involving 19-71% reductions in growth rates originating from infections before 3 March and on 5-8, 10-12 and 14-18 March, but no identifiable effect of the strengthened lockdown of 29-30 March. Changes in stringency and mobility were only associated to the latter two shifts, evidencing an early deceleration in COVID-19 spread associated to personal hygiene and social distancing recommendations, followed by a stronger decrease when lockdown was enforced, leading to the contention of the outbreak by mid-April. This highlights the importance of combining public health communication strategies and hard confinement measures to contain epidemics.

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Section: Introductionmentioning

confidence: 82%

Chasing the ghost of infection past: identifying thresholds of change during the COVID-19 infection in Spain

Santamarı́a

Hortal

2020

Epidemiol. Infect.

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“…The first case in Europe was reported on 20 January 2020 in France and the first case in Catalonia (Spain) was on 25 February 2020. However, some studies have suggested a previous circulation of the virus [8, 9]. Due to the rapid spread of the disease, on March 14 Spain established a national lockdown, as many other countries [10].…”

Section: Introductionmentioning

confidence: 99%

Divergences on expected pneumonia cases during the COVID-19 epidemic in Catalonia: A time-series analysis of primary care electronic health records covering about 6 million people

Coma

Méndez-Boo

Mora

et al. 2021

Preprint

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BackgroundPneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system.AimTo analyze the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity.MethodsTime series analysis of pneumonia cases, January 2014-December 2020. We collected pneumonia diagnoses from primary care EHR, covering >6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019-2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics.ResultsBetween 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9,909 to 13,498) were identified. We observed a second excess pneumonia period from 22 october to 15 november of 1,377 excess cases (95% CI: 665 to 2,089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3,534 less pneumonia cases (95% CI: 1,005 to 6,064) from March to July; and 54 days and 1,960 less pneumonia cases (95% CI 917 to 3,002) from October to December.ConclusionsDiagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19.

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“…Because some symptoms of COVID-19 and influenza are similar, 12 it has been suggested that influenza could mask early COVID-19 cases during the 2019–2020 season. 24 …”

Section: Discussionmentioning

confidence: 99%

Trend of pneumonia diagnosis in emergency departments as a COVID-19 surveillance system: a time series study

2021

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ObjectiveIn Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. Given the rapid spread of the infection in the population, it was suggested that in Europe, and specifically in Italy, the virus had already been present in the last months of 2019. In this paper, we aim to evaluate the hypothesis on the early presence of the virus in Italy by analysing data on trends of access to emergency departments (EDs) of subjects with a diagnosis of pneumonia during the 2015–2020 period.DesignTime series cohort study.SettingWe collected data on visits due to pneumonia between 1 October 2015 and 31 May 2020 in all EDs of the Agency for Health Protection of Milan (ATS of Milan). Trend in the winter of 2019–2020 was compared with those in the previous 4 years in order to identify unexpected signals potentially associated with the occurrence of the pandemic. Aggregated data were analysed using a Poisson regression model adjusted for seasonality and influenza outbreaks.Primary outcome measures Daily pneumonia-related visits in EDs.Results In the studied period, we observed 105 651 pneumonia-related ED visits. Compared with the expected, a lower occurrence was observed in January 2020, while an excess of pneumonia visits started in the province of Lodi on 21 February 2020, and almost 10 days later was observed in the remaining territory of the ATS of Milan. Overall, the peak in excess was found on 17 March 2020 (369 excess visits compared with previous years, 95% CI 353 to 383) and ended in May 2020, the administrative end of the Italian lockdown.Conclusions An early warning system based on routinely collected administrative data could be a feasible and low-cost strategy to monitor the actual situation of the virus spread both at local and national levels.

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Excess cases of influenza and the coronavirus epidemic in Catalonia: a time-series analysis of primary-care electronic medical records covering over 6 million people

Cited by 16 publications

References 22 publications

Chasing the ghost of infection past: identifying thresholds of change during the COVID-19 infection in Spain

Chasing the ghost of infection past: identifying thresholds of change during the COVID-19 infection in Spain

Divergences on expected pneumonia cases during the COVID-19 epidemic in Catalonia: A time-series analysis of primary care electronic health records covering about 6 million people

Trend of pneumonia diagnosis in emergency departments as a COVID-19 surveillance system: a time series study

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