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In the current COVID-19 landscape dominated by Omicron subvariants, understanding the timing and efficacy of vaccination against emergent lineages is crucial for planning future vaccination campaigns, yet detailed studies stratified by subvariant, vaccination timing, and age groups are scarce. This retrospective study analyzed COVID-19 cases from December 2021 to January 2023 in Catalonia, Spain, focusing on vulnerable populations affected by variants BA.1, BA.2, BA.5, and BQ.1 and including two national booster campaigns. Our database includes detailed information such as dates of diagnosis, hospitalization and death, last vaccination, and cause of death, among others. We evaluated the impact of vaccination on disease severity by age, variant, and vaccination status, finding that recent vaccination significantly mitigated severity across all Omicron subvariants, although efficacy waned six months post-vaccination, except for BQ.1, which showed more stable levels. Unvaccinated individuals had higher hospitalization and mortality rates. Our results highlight the importance of periodic vaccination to reduce severe outcomes, which are influenced by variant and vaccination timing. Although the seasonality of COVID-19 is uncertain, our analysis suggests the potential benefit of annual vaccination in populations >60 years old, probably in early fall, if COVID-19 eventually exhibits a major peak similar to other respiratory viruses., This research was supported by the Ayudas Fundación BBVA a proyectos investigación científica 2021 under the project BBVA: Epidemiological modelling of SARS-CoV-2 in a post-pandemic surveil- lance context: an open platform for mid-term scenarios and short-term predictions; the Agència de Gestió d’Ajuts Universitaris i de Recerca, Catalonia [grant number 2021 SGR 00582]; and PID-2022- 139216NB-I00 funded by Ministerio de Ciencia e Innovación (MCIN/ AEI/10.13039/501100011033) and by ‘ERDF: A way of making Europe’, by the European Union., Postprint (published version)

Purpose: To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people). Methods: We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z- scores using the Pearson correlation coefficient (R2). Results: During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3days and R2 =0.86, while between ILI and all-cause deaths was 22days and R2 =0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021. Conclusion: Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited., APe received funding from Fundació La Marató de TV3 through the grant 202134-31., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020– April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4–4.8) per 1,000,000 people, and 273 (95% CI: 230–316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7–11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4–11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05). Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic., This study has received funding for the data analysis from the “Fundació la Marató TV3” with file number 202134–30-31., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)

El Departament de Salut, arran d’un augment del nombre de defuncions detectat entorn dels mesos d’estiu de 2022, ha elaborat l’informe L’excés de mortalitat a Catalunya. Anàlisi de l’excés de mortalitat de l’1 de juny al 31 d’agost de 2022. Aquest document analitza la mortalitat esdevinguda durant els mesos de juny, juliol i agost a Catalunya, contextualitzada en els primers vuit mesos de l’any i comparant-la amb la d’anys precedents i amb la registrada a Europa, a l’Estat espanyol. Aquest informe ha estat fruit de d’un treball col·laboratiu entre la Direcció General de Planificació i Recerca en Salut i la Secretaria de Salut Pública del Departament de Salut, l’Àrea de Sistemes d’Informació del Servei Català de la Salut, el Sistema d’Informació dels Serveis d’Atenció Primària de l’Institut Català de la Salut i el Departament de Física de la Universitat Politècnica de Catalunya., Aquest informe és fruit d’un treball col·laboratiu entre la Direcció General de Planificació i Recerca en Salut i la Secretaria de Salut Pública del Departament de Salut, l’Àrea de Sistemes d’Informació del Servei Català de la Salut, el Sistema d’Informació dels Serveis d’Atenció Primària de l’Institut Català de la Salut i el Departament de Física de la Universitat Politècnica de Catalunya, i ha estat dut a terme la tardor de 2022 arran de diferents informacions que han sorgit sobre un increment de la mortalitat entorn dels mesos d’estiu. Aquesta col·laboració explicita la multiplicitat de fonts d’informació, de períodes de referència, d’indicadors i de format en les taules, les figures i els mapes, tot i el treball en comú realitzat a l’hora de seleccionar els continguts, interpretar la informació i redactar-ne les conclusions. Entre les setmanes 28 a 32 de 2022, de l’11 de juliol al 14 d’agost, segons el sistema de monitoratge de la mortalitat EuroMOMO, l’Estat espanyol té un excés de mortalitat extraordinàriament elevat, amb la contribució especialment rellevant de les defuncions entre la població de 75 anys i més., Postprint (published version)

Despite their clear lesser vulnerability to COVID-19, the extent by which children are susceptible to getting infected by SARS-CoV-2 and their capacity to transmit the infection to other people remains inadequately characterized. We aimed to evaluate the role of school reopening and the preventive strategies in place at schools in terms of overall risk for children and community transmission, by comparing transmission rates in children as detected by a COVID-19 surveillance platform in place in Catalonian Schools to the incidence at the community level., Funding The components of the analysis drawn from the different KIDS Corona platform have been funded by Stavros Niarchos Foundation (SNF), Banco Santander and other private donors of Kidscorona. We also acknowledge funding from La Caixa Foundation (ID 100010434), under agreement LCF/PR/GN17/50300003; and funding from Ministerio de Ciencia, Innovación y Universidades and FEDER, with the project PGC2018-095456-B-I00. This work has been also partially funded by the European Commission - DG Communications Networks, Content and Technology through the contract LC-01485746. ISGlobal receives support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. CISM is supported by the Government of Mozambique and the Spanish Agency for International Development (AECID). NB is supported by an FPU predoctoral fellowship from the Spanish Ministry of Universities (FPU18/04260). BB is a Beatriu de Pino´s postdoctoral fellow granted by the Government of Catalonia’s Secretariat for Universities and Research, and by Marie Sklodowska-Curie Actions COFUND Programme (BP3, 801370). Role of the funding source The funders had no role in the interpretation of the data or in the writing up of the manuscript., Postprint (published version)

To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021–2022 academic year, Postprint (published version)

The transmissibility of omicron using variant screening data from primary care practices (PCP) and hospital admissions. In addition, we used this data from PCP to establish the two periods when delta and omicron were, respectively, dominant (above 95% of cases). After that, we performed a population-based cohort analysis to calculate the rates of hospital and intensive care unit (ICU) admissions for both periods and to estimate reduction in severity. Rate ratios (RR) and 95% confidence intervals (95% CI) were calculated and stratified by age and vaccination status. In a second analysis, the differential substitution model in primary care vs. hospitals allowed us to obtain a population-level average change in severity.We have included 48,874 cases during the delta period and 560,658 during the omicron period. During the delta period, on average, 3.8% of the detected cases required hospitalization for COVID-19. This percentage dropped to 0.9% with omicron [RR of 0.46 (95% CI: 0.43 to 0.49)]. For ICU admissions, it dropped from 0.8 to 0.1% [RR 0.25 (95% CI: 0.21 to 0.28)]. The proportion of cases hospitalized or admitted to ICU was lower in the vaccinated groups, independently of the variant. Omicron was associated with a reduction in risk of admission to hospital and ICU in all age and vaccination status strata. The differential substitution models showed an average RR between 0.19 and 0.50.Both independent methods consistently show an important decrease in severity for omicron relative to delta. The systematic reduction happens regardless of age. The severity is also reduced for non-vaccinated and vaccinated groups, but it remains always higher in the non-vaccinated population. This suggests an overall reduction in severity, which could be intrinsic to the omicron variant. The fact is that the RR in ICU admission is systematically smaller than in hospitalization points in the same direction., MC received funding from la Caixa Foundation ID 100010434, under agreement LCF/PR/GN17/50300003. MC, CP, and SA received funding from Ministerio de Ciencia, Innovación y Universidades and FEDER, with the project PGC2018-095456- B-I00., Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)

The present report aims to provide a comprehensive picture of the pandemic situation of COVID-19 in the EU countries, and to be able to foresee the situation in the next coming days. We provide some figures and tables with several indexes and indicators as well as an Analysissection that discusses a specific topic related with the pandemic. As for the predictions, we employ an empirical model, verified with the evolution of the number of confirmed cases in previous countries where the epidemic is close to conclude, including all provinces of China. The model does not pretend to interpret the causes of the evolution of the cases but to permit the evaluation of the quality of control measures made in each state and a short-term prediction of trends. Note, however, that the effects of the measures’ control that start on a given day are not observed until approximately 7-14 days later. We show an individual report with 8 graphs and a summary table with the main indicators for different countries and regions. We are adjusting the model to countries and regions with at least 4 days with more than 100 confirmed cases and a current load over 200 cases., These reports are funded by the European Commission (DG CONNECT, LC-01485746) PJC and MC received funding from “la Caixa” Foundation (ID 100010434), under agreement LCF/PR/GN17/50300003; CP, DL, SA, MC, received funding from Ministerio de Ciencia, Innovación y Universidades and FEDER, with the project PGC2018-095456-B-I00, Postprint (published version)