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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Beatles&#44; the Olympic rings&#44; the 5 senses&#44; the musical staff&#46; Five is a magic number&#46; We are currently experiencing the fifth wave of the COVID-19 pandemic&#44; which is particularly affecting adolescents and young adults&#46; COVID-19 broke out abruptly in the spring of 2020&#44; bringing high mortality rates&#44; and diagnoses may initially have been underestimated due to the lack of confirmatory tests&#46; The highest infection rates were recorded in the elderly and adults over 50 years of age&#44; and peak mortality rates were recorded in residential centers and nursing homes&#46; The first wave has been followed by successive waves with lower mortality and improved disease diagnosis&#46; A review of incidence over time in the first 4 waves &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> reveals an interesting pattern&#46; Young people aged 20&#8211;29&#44; followed by children aged 10&#8211;19&#44; are the age groups with the highest rate of COVID-19 infection since the second wave&#46; This situation was not generally reflected in respiratory medicine departments or in clinics and hospitals&#44; as the proportion of serious complications due to COVID-19 increases exponentially with age&#44; and most of these children and young people had mild and even practically asymptomatic disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Before this fifth wave&#44; by the end of spring 2021&#44; a vaccination coverage of around 100&#37; had been achieved among the elderly population in Spain&#46; However&#44; since the beginning of summer&#44; young people have been participating in increasingly greater numbers of social and festive activities&#46; This younger population&#44; few of whom are vaccinated &#40;but who have done numerous diagnostic tests&#41;&#44; has been the source of another explosion in infections&#44; with 14-day cumulative case incidence figures of more than 2000&#46; Mortality is much lower than in the first wave&#44; but the number of young adults with severe COVID-19 in intermediate respiratory care units and intensive care units in Spanish hospitals is now increasing&#46; The accusing finger must be pointed at the virus&#44; not at the behavior of our young people&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Further research will quantify the effect of factors such as epidemic fatigue&#44; false information&#44; lack of coordination among different administrative bodies&#44; discrepancies in many autonomous communities between public health services and the legislative reality&#44; and the emergence and spread of the new SARS-CoV-2 variants&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3</span></a> In particular&#44; the delta variant&#44; discovered in December 2020 in India and previously known as B&#46;1&#46;617&#46;2&#44; may be a more than likely causative factor of this fifth wave&#46; Delta is a &#8220;double mutant&#8221; &#40;E484Q and L452R&#41; variant that contains more than a dozen other mutations compared to the original alpha strain detected in Wuhan&#44; China&#44; in December 2019&#46; Delta is already known to have a greater capacity for infection and transmissibility&#44; even in the vaccinated population&#46; Fortunately&#44; the efficacy of the current versions of vaccines against the delta variant seems high&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The percentage of immunity needed to achieve the long-awaited herd immunity will be much higher than the 70&#37; initially estimated&#44; and given the idiosyncrasy of COVID-19&#44; we may never reach it&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our understanding of this new coronavirus is extensive compared to our level of insight just one year ago&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Treatments that have so far shown significant benefits in clinical outcomes of interest include oxygen therapy and&#47;or ventilatory support&#44; prone positioning even in non-intubated patients&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> dexamethasone&#44; tocilizumab&#44; baricitinib&#44; tofacitinib&#44; and REGEN-COV &#40;a combination of casirivimab and imdevimab&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Other treatments are still being evaluated&#46; Social distancing&#44; masks&#44; and hand hygiene&#44; old measures all taken in previous pandemics&#44; remain effective but they need to be used conscientiously and persistently&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There are still many more questions than answers&#44; and it is more than likely that we will face a sixth wave&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In addition to the 4 classic elements &#40;earth&#44; water&#44; fire&#44; and air&#41;&#44; a fifth element&#44; such as ether&#44; will likely be needed to confront this fifth wave of pandemic&#46; In short&#44; COVID-19 is a new disease with global distribution that may become endemic&#46; It will remain a challenge but also an opportunity&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In esoteric thought and numerology&#44; 5 is the number of change&#44; movement&#44; and mutation&#44; guiding us to mastery through experimentation&#46; Will this fifth wave and the pandemic in general help achieve better&#44; universal&#44; free healthcare and lead us toward fairer global governance&#63;</p></span>"
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Editorial
COVID-19 in Youth and the Fifth Wave
COVID-19 en jóvenes y la quinta ola
Joan B. Sorianoa,b,
Corresponding author
jbsoriano2@gmail.com

Corresponding author.
, José Ramón Villagrasac, Julio Ancocheaa,b
a Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, Spain
b Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
c Medicina Preventiva, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Beatles&#44; the Olympic rings&#44; the 5 senses&#44; the musical staff&#46; Five is a magic number&#46; We are currently experiencing the fifth wave of the COVID-19 pandemic&#44; which is particularly affecting adolescents and young adults&#46; COVID-19 broke out abruptly in the spring of 2020&#44; bringing high mortality rates&#44; and diagnoses may initially have been underestimated due to the lack of confirmatory tests&#46; The highest infection rates were recorded in the elderly and adults over 50 years of age&#44; and peak mortality rates were recorded in residential centers and nursing homes&#46; The first wave has been followed by successive waves with lower mortality and improved disease diagnosis&#46; A review of incidence over time in the first 4 waves &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> reveals an interesting pattern&#46; Young people aged 20&#8211;29&#44; followed by children aged 10&#8211;19&#44; are the age groups with the highest rate of COVID-19 infection since the second wave&#46; This situation was not generally reflected in respiratory medicine departments or in clinics and hospitals&#44; as the proportion of serious complications due to COVID-19 increases exponentially with age&#44; and most of these children and young people had mild and even practically asymptomatic disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Before this fifth wave&#44; by the end of spring 2021&#44; a vaccination coverage of around 100&#37; had been achieved among the elderly population in Spain&#46; However&#44; since the beginning of summer&#44; young people have been participating in increasingly greater numbers of social and festive activities&#46; This younger population&#44; few of whom are vaccinated &#40;but who have done numerous diagnostic tests&#41;&#44; has been the source of another explosion in infections&#44; with 14-day cumulative case incidence figures of more than 2000&#46; Mortality is much lower than in the first wave&#44; but the number of young adults with severe COVID-19 in intermediate respiratory care units and intensive care units in Spanish hospitals is now increasing&#46; The accusing finger must be pointed at the virus&#44; not at the behavior of our young people&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Further research will quantify the effect of factors such as epidemic fatigue&#44; false information&#44; lack of coordination among different administrative bodies&#44; discrepancies in many autonomous communities between public health services and the legislative reality&#44; and the emergence and spread of the new SARS-CoV-2 variants&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3</span></a> In particular&#44; the delta variant&#44; discovered in December 2020 in India and previously known as B&#46;1&#46;617&#46;2&#44; may be a more than likely causative factor of this fifth wave&#46; Delta is a &#8220;double mutant&#8221; &#40;E484Q and L452R&#41; variant that contains more than a dozen other mutations compared to the original alpha strain detected in Wuhan&#44; China&#44; in December 2019&#46; Delta is already known to have a greater capacity for infection and transmissibility&#44; even in the vaccinated population&#46; Fortunately&#44; the efficacy of the current versions of vaccines against the delta variant seems high&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The percentage of immunity needed to achieve the long-awaited herd immunity will be much higher than the 70&#37; initially estimated&#44; and given the idiosyncrasy of COVID-19&#44; we may never reach it&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our understanding of this new coronavirus is extensive compared to our level of insight just one year ago&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Treatments that have so far shown significant benefits in clinical outcomes of interest include oxygen therapy and&#47;or ventilatory support&#44; prone positioning even in non-intubated patients&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> dexamethasone&#44; tocilizumab&#44; baricitinib&#44; tofacitinib&#44; and REGEN-COV &#40;a combination of casirivimab and imdevimab&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Other treatments are still being evaluated&#46; Social distancing&#44; masks&#44; and hand hygiene&#44; old measures all taken in previous pandemics&#44; remain effective but they need to be used conscientiously and persistently&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There are still many more questions than answers&#44; and it is more than likely that we will face a sixth wave&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In addition to the 4 classic elements &#40;earth&#44; water&#44; fire&#44; and air&#41;&#44; a fifth element&#44; such as ether&#44; will likely be needed to confront this fifth wave of pandemic&#46; In short&#44; COVID-19 is a new disease with global distribution that may become endemic&#46; It will remain a challenge but also an opportunity&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In esoteric thought and numerology&#44; 5 is the number of change&#44; movement&#44; and mutation&#44; guiding us to mastery through experimentation&#46; Will this fifth wave and the pandemic in general help achieve better&#44; universal&#44; free healthcare and lead us toward fairer global governance&#63;</p></span>"
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        "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">All three authors are members of the COVID Medical Commission of the Universidad Aut&#243;noma de Madrid&#46; JBS was Senior Consultant of the WHO Health Emergency Program COVID-19 Clinical Management Team&#44; World Health Organization HQ&#44; Geneva&#44; Switzerland&#44; between October 2020 and June 2021&#46;</p>"
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ISSN: 03002896
Original language: English
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