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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On February 15&#44; 2020&#44; we warned of the imminent pandemic expansion of the 2019-nCoV virus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Just one year later&#44; we have a better understanding of the antigenic characteristics&#44; replicative cycle and genome of SARS-CoV-2&#44; and candidate therapeutic targets have been identified&#46; The high transmissibility of this virus via aerosols has also been confirmed&#44; a factor that we know increases the risk of contagion in indoor environments&#44; even if safe distances are maintained&#46; This means that more stringent preventive measures are needed&#44; especially among health professionals&#44; given the risk to which they are exposed in their clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The rate of Covid-19 infection among health professionals has been as high as 21&#46;4&#37;&#46; It is essential that we understand the reasons for and consequences of this high infection rate&#44; as not only are health workers at risk from these transmission mechanisms&#44; their close and continuous contact with people affected by Covid-19 has also made them vectors of transmission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During this year&#44; changes made in procedures and interventions as knowledge developed have generated confusion among professionals and given them the impression that the correct measures were being introduced late&#46; The shortage of personal protective equipment and support systems for the most serious patients led the authorities to roll out plans for prioritizing and rationalizing the use of supplies&#44; while material that offered better protection was reserved for professionals exposed to aerosol-generating procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The SANICOVI&#174;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> study concludes by recommending measures that include the appropriate management of preventive&#44; protective&#44; educational&#44; and organizational resources&#44; both human and material&#46; This not only prevents infections among healthcare professionals&#44; but also ensures safer patient care&#46; Workloads must be adjusted according to the care setting&#44; and prevention procedures must be reinforced&#44; training improved&#44; and protocols disseminated and implemented to provide tailored protective measures&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Covid-19 diagnosis has increased with the incorporation of rapid tests that detect viral antigens or agglutinating antibodies&#44; thus improving detection in the acute or convalescent phases&#46; The sensitivity and specificity of each test depend on the stage of infection&#44; so each one has a maximum effective period beyond which its results may be erroneous&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Each test&#44; therefore&#44; must be selected according to time and circumstance&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The course of Covid-19&#44; characterized by an initial viral phase followed by a hyperinflammatory phase and a prothrombotic phase&#44; is better characterized&#46; All 3 phases impact on the various manifestations of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Several prognostic factors have also been identified that have significantly influenced the management of patients during the months of the pandemic&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> while the early&#44; unproven use of lopinavir&#47;ritonavir&#44; hydroxychloroquine&#44; and azithromycin has been stopped after they were shown to be ineffective in trials&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The current therapeutic gold standard is oxygen therapy&#59; high-flow oxygen therapy has emerged as an essential modality&#44; and the need to develop intermediate respiratory care units is clear&#46; In these units&#44; the need for orotracheal intubation &#40;OTI&#41;&#44; a procedure associated with complications and mortality &#40;OTI 54&#37; vs&#46; non-OTI 7&#37;&#41;&#44; is significantly lower thanks to non-invasive mechanical ventilation and high-dependence care &#40;e&#46;g&#46; proning&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In terms of medical treatment&#44; we continue to use remdesivir as an antiviral&#44; dexamethasone or other steroids as anti-inflammatories&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and anticoagulation to prevent or treat thromboembolic disease&#44; despite their obvious limitations&#46; Tocilizumab&#44; an IL-6 receptor blocker&#44; continues to be used&#44; despite conflicting results in clinical trials&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Promising new data are being obtained with convalescent plasma&#44; hyperimmune gammaglobulin&#44; and monoclonal antibodies that neutralize viral epitopes&#44; such as bamlanivimab or casirivimab plus imdevinab or etesevimab&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The FDA has authorized bamlanivinab alone or in combination with etesevinab for mild-to-moderate non-hospitalized patients&#46; Pending further evidence&#44; the antiparasitic ivermectin&#44; the JAK inhibitor baricitinib&#44; and IL-1 inhibitors are not yet recommended due to lack of data&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Two trials have shown that colchicine shortened recovery time and decreased hospitalizations and complications&#46; In preclinical studies&#44; plitidepsin&#44; approved for multiple myeloma&#44; has recently shown 27&#46;5 times higher anti-SARS-CoV-2 activity than remdesivir&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Fortunately&#44; in contrast to the scant progress made in therapy&#44; several vaccines have been authorized in just 10 months&#44; including novel mRNA vaccines &#40;Pfizer&#44; Moderna&#41;&#44; vector-based vaccines&#44; similar to those used for Ebola &#40;Astra-Zeneca&#41;&#44; and other vaccines in the pipeline&#44; such as mRNA &#40;CureVac&#41; and vector-based products &#40;Janssen and the Russian Gamaleya&#41; and adjuvanted subunit vaccines &#40;Novavax&#44; Sanofi-GSK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> All of them target the spike &#40;S&#41; protein&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The very high viral replication has led to the appearance of mutant variants&#44; including spike mutations&#44; which demand close surveillance&#46; Asian countries prioritized traditional techniques &#40;inactivated virus&#41; that are less potent but offer more viral targets&#46; Current vaccines are safe and very effective&#44; although the duration of immunity is not known&#46; Nor is it known whether they will avert disease or infection by preventing transmission from vaccinated individuals&#46; Some interesting projects are investigating apparently powerful mucosal vaccines that offer sterilizing immunity&#46; All the evidence suggests that we will need to receive more than one vaccine&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Covid-19 causes persistent symptoms in most patients &#40;fatigue&#44; muscle weakness&#44; difficulty sleeping&#44; anxiety&#44; or depression&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The long-term complications remain unknown&#46; In the acute phase&#44; this infection has put a stop to humanized healthcare and forced hospitals to restrict&#44; or even ban&#44; patient visiting&#46; Despite efforts to improve the response capacity of care homes&#44; health centers&#44; and hospitals&#44; the pandemic is generating delays in care<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and limiting active user participation&#46; Wherever possible&#44; the switch to telemedicine has accelerated&#44; but are we prepared&#63;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After one year&#44; we can say that activities associated with Covid-19 biosecurity and treatment&#44; if they are to be effective&#44; must be backed up by high-quality science and evidence&#46; &#8220;Evidence-based policy&#8221;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> must count from the outset on the collaboration of all actors involved in current and future challenges&#46; In addition to the impact on the general population&#44; the effects on health professionals are beginning to be make themselves felt&#44; given the generalized accumulation of working hours&#44; infections&#44; and&#44; not least&#44; moral distress&#46;</p></span>"
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Editorial
One year on: Are we ready for COVID?
Y un año después, ¿estamos preparados para la COVID?
David Peña-Oteroa, Salvador Bello Drondab,
Corresponding author
sbello@salud.aragon.es

Corresponding author.
, David Díaz-Pérezc, David de la Rosa Carrillod
a Enfermería, Hospital Sierrallana, Subdirección de Cuidados del Servicio Cántabro de Salud, Miembro IDIVAL e IiSGM, Área de Enfermería Respiratoria-SEPAR, Torrelavega, Cantabria, Spain
b Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain
c Enfermería, Hospital Universitario Nuestra Señora de Candelaria, Servicio Canario de Salud, Área de Enfermería Respiratoria-SEPAR, Santa Cruz de Tenerife, Spain
d Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Área TIR-SEPAR, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On February 15&#44; 2020&#44; we warned of the imminent pandemic expansion of the 2019-nCoV virus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Just one year later&#44; we have a better understanding of the antigenic characteristics&#44; replicative cycle and genome of SARS-CoV-2&#44; and candidate therapeutic targets have been identified&#46; The high transmissibility of this virus via aerosols has also been confirmed&#44; a factor that we know increases the risk of contagion in indoor environments&#44; even if safe distances are maintained&#46; This means that more stringent preventive measures are needed&#44; especially among health professionals&#44; given the risk to which they are exposed in their clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The rate of Covid-19 infection among health professionals has been as high as 21&#46;4&#37;&#46; It is essential that we understand the reasons for and consequences of this high infection rate&#44; as not only are health workers at risk from these transmission mechanisms&#44; their close and continuous contact with people affected by Covid-19 has also made them vectors of transmission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During this year&#44; changes made in procedures and interventions as knowledge developed have generated confusion among professionals and given them the impression that the correct measures were being introduced late&#46; The shortage of personal protective equipment and support systems for the most serious patients led the authorities to roll out plans for prioritizing and rationalizing the use of supplies&#44; while material that offered better protection was reserved for professionals exposed to aerosol-generating procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The SANICOVI&#174;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> study concludes by recommending measures that include the appropriate management of preventive&#44; protective&#44; educational&#44; and organizational resources&#44; both human and material&#46; This not only prevents infections among healthcare professionals&#44; but also ensures safer patient care&#46; Workloads must be adjusted according to the care setting&#44; and prevention procedures must be reinforced&#44; training improved&#44; and protocols disseminated and implemented to provide tailored protective measures&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Covid-19 diagnosis has increased with the incorporation of rapid tests that detect viral antigens or agglutinating antibodies&#44; thus improving detection in the acute or convalescent phases&#46; The sensitivity and specificity of each test depend on the stage of infection&#44; so each one has a maximum effective period beyond which its results may be erroneous&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Each test&#44; therefore&#44; must be selected according to time and circumstance&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The course of Covid-19&#44; characterized by an initial viral phase followed by a hyperinflammatory phase and a prothrombotic phase&#44; is better characterized&#46; All 3 phases impact on the various manifestations of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Several prognostic factors have also been identified that have significantly influenced the management of patients during the months of the pandemic&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> while the early&#44; unproven use of lopinavir&#47;ritonavir&#44; hydroxychloroquine&#44; and azithromycin has been stopped after they were shown to be ineffective in trials&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The current therapeutic gold standard is oxygen therapy&#59; high-flow oxygen therapy has emerged as an essential modality&#44; and the need to develop intermediate respiratory care units is clear&#46; In these units&#44; the need for orotracheal intubation &#40;OTI&#41;&#44; a procedure associated with complications and mortality &#40;OTI 54&#37; vs&#46; non-OTI 7&#37;&#41;&#44; is significantly lower thanks to non-invasive mechanical ventilation and high-dependence care &#40;e&#46;g&#46; proning&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In terms of medical treatment&#44; we continue to use remdesivir as an antiviral&#44; dexamethasone or other steroids as anti-inflammatories&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and anticoagulation to prevent or treat thromboembolic disease&#44; despite their obvious limitations&#46; Tocilizumab&#44; an IL-6 receptor blocker&#44; continues to be used&#44; despite conflicting results in clinical trials&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Promising new data are being obtained with convalescent plasma&#44; hyperimmune gammaglobulin&#44; and monoclonal antibodies that neutralize viral epitopes&#44; such as bamlanivimab or casirivimab plus imdevinab or etesevimab&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The FDA has authorized bamlanivinab alone or in combination with etesevinab for mild-to-moderate non-hospitalized patients&#46; Pending further evidence&#44; the antiparasitic ivermectin&#44; the JAK inhibitor baricitinib&#44; and IL-1 inhibitors are not yet recommended due to lack of data&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Two trials have shown that colchicine shortened recovery time and decreased hospitalizations and complications&#46; In preclinical studies&#44; plitidepsin&#44; approved for multiple myeloma&#44; has recently shown 27&#46;5 times higher anti-SARS-CoV-2 activity than remdesivir&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Fortunately&#44; in contrast to the scant progress made in therapy&#44; several vaccines have been authorized in just 10 months&#44; including novel mRNA vaccines &#40;Pfizer&#44; Moderna&#41;&#44; vector-based vaccines&#44; similar to those used for Ebola &#40;Astra-Zeneca&#41;&#44; and other vaccines in the pipeline&#44; such as mRNA &#40;CureVac&#41; and vector-based products &#40;Janssen and the Russian Gamaleya&#41; and adjuvanted subunit vaccines &#40;Novavax&#44; Sanofi-GSK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> All of them target the spike &#40;S&#41; protein&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The very high viral replication has led to the appearance of mutant variants&#44; including spike mutations&#44; which demand close surveillance&#46; Asian countries prioritized traditional techniques &#40;inactivated virus&#41; that are less potent but offer more viral targets&#46; Current vaccines are safe and very effective&#44; although the duration of immunity is not known&#46; Nor is it known whether they will avert disease or infection by preventing transmission from vaccinated individuals&#46; Some interesting projects are investigating apparently powerful mucosal vaccines that offer sterilizing immunity&#46; All the evidence suggests that we will need to receive more than one vaccine&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Covid-19 causes persistent symptoms in most patients &#40;fatigue&#44; muscle weakness&#44; difficulty sleeping&#44; anxiety&#44; or depression&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The long-term complications remain unknown&#46; In the acute phase&#44; this infection has put a stop to humanized healthcare and forced hospitals to restrict&#44; or even ban&#44; patient visiting&#46; Despite efforts to improve the response capacity of care homes&#44; health centers&#44; and hospitals&#44; the pandemic is generating delays in care<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and limiting active user participation&#46; Wherever possible&#44; the switch to telemedicine has accelerated&#44; but are we prepared&#63;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After one year&#44; we can say that activities associated with Covid-19 biosecurity and treatment&#44; if they are to be effective&#44; must be backed up by high-quality science and evidence&#46; &#8220;Evidence-based policy&#8221;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> must count from the outset on the collaboration of all actors involved in current and future challenges&#46; In addition to the impact on the general population&#44; the effects on health professionals are beginning to be make themselves felt&#44; given the generalized accumulation of working hours&#44; infections&#44; and&#44; not least&#44; moral distress&#46;</p></span>"
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ISSN: 15792129
Original language: English
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