101
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Crozier A, Dunning J, Rajan S, Semple MG, Buchan IE. Could expanding the covid-19 case definition improve the UK's pandemic response? BMJ 2021; 374:n1625. [PMID: 34193527 DOI: 10.1136/bmj.n1625] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Alex Crozier
- Division of Biosciences, University College London, London, UK
| | - Jake Dunning
- Royal Free London NHS Foundation Trust, London, UK
- Epidemic Diseases Research Group Oxford, University of Oxford, Oxford, UK
| | - Selina Rajan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Iain E Buchan
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Institute of Population Health, University of Liverpool, Liverpool, UK
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102
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Mazzoni A, Di Lauria N, Maggi L, Salvati L, Vanni A, Capone M, Lamacchia G, Mantengoli E, Spinicci M, Zammarchi L, Kiros ST, Rocca A, Lagi F, Colao MG, Parronchi P, Scaletti C, Turco L, Liotta F, Rossolini GM, Cosmi L, Bartoloni A, Annunziato F. First-dose mRNA vaccination is sufficient to reactivate immunological memory to SARS-CoV-2 in subjects who have recovered from COVID-19. J Clin Invest 2021; 131:149150. [PMID: 33939647 DOI: 10.1172/jci149150] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
The characterization of the adaptive immune response to COVID-19 vaccination in individuals who recovered from SARS-CoV-2 infection may define current and future clinical practice. To determine the effect of the 2-dose BNT162b2 mRNA COVID-19 vaccination schedule in individuals who recovered from COVID-19 (COVID-19-recovered subjects) compared with naive subjects, we evaluated SARS-CoV-2 Spike-specific T and B cell responses, as well as specific IgA, IgG, IgM, and neutralizing antibodies titers in 22 individuals who received the BNT162b2 mRNA COVID-19 vaccine, 11 of whom had a previous history of SARS-CoV-2 infection. Evaluations were performed before vaccination and then weekly until 7 days after second injection. Data obtained clearly showed that one vaccine dose is sufficient to increase both cellular and humoral immune response in COVID-19-recovered subjects without any additional improvement after the second dose. On the contrary, the second dose proved mandatory in naive subjects to further enhance the immune response. These findings were further confirmed at the serological level in a larger cohort of naive (n = 68) and COVID-19-recovered (n = 29) subjects, tested up to 50 days after vaccination. These results question whether a second vaccine injection in COVID-19-recovered subjects is required, and indicate that millions of vaccine doses may be redirected to naive individuals, thus shortening the time to reach herd immunity.
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Affiliation(s)
- Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Cristina Scaletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
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103
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Kirsten C, Unrath M, Lück C, Dalpke AH, Berner R, Armann J. SARS-CoV-2 seroprevalence in students and teachers: a longitudinal study from May to October 2020 in German secondary schools. BMJ Open 2021; 11:e049876. [PMID: 34112645 PMCID: PMC8193693 DOI: 10.1136/bmjopen-2021-049876] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To quantify the number of SARS-CoV-2 infections in secondary schools after their reopening in May 2020. DESIGN Repeated SARS-CoV-2 seroprevalence study after the reopening of schools and 4 months later. SETTING Secondary school in Dresden, Germany. PARTICIPANTS 1538 students grades 8-12 and 507 teachers from 13 schools. INTERVENTIONS Serial blood sampling and SARS-CoV-2 IgG antibody assessment. PRIMARY AND SECONDARY OUTCOME MEASURE Seroprevalence of SARS-CoV-2 antibodies in study population. Number of undetected cases. RESULTS 1538 students and 507 teachers were initially enrolled, and 1334 students and 445 teachers completed both study visits. The seroprevalence for SARS-CoV-2 antibodies was 0.6% in May/June and the same in September/October. Even in schools with reported COVID-19 cases before the lockdown of 13 March, no clusters could be identified. Of 12 persons with positive serology five had a known history of confirmed COVID-19; 23 out of 24 participants with a household history of COVID-91 were seronegative. CONCLUSIONS Schools do not play a crucial role in driving the SARS-CoV-2 pandemic in a low-prevalence setting. Transmission in families occurs very infrequently, and the number of unreported cases is low in this age group. These observations do not support school closures as a strategy fighting the pandemic in a low-prevalence setting. TRIAL REGISTRATION NUMBER DRKS00022455.
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Affiliation(s)
- Carolin Kirsten
- Department of Pediatrics, Technische Universität Dresden, Dresden, Germany
| | - Manja Unrath
- Department of Pediatrics, Technische Universität Dresden, Dresden, Germany
| | - Christian Lück
- Institute for Virology and Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany
| | - Alexander H Dalpke
- Institute for Virology and Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, Technische Universität Dresden, Dresden, Germany
| | - Jakob Armann
- Department of Pediatrics, Technische Universität Dresden, Dresden, Germany
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104
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Loenenbach A, Markus I, Lehfeld AS, An der Heiden M, Haas W, Kiegele M, Ponzi A, Unger-Goldinger B, Weidenauer C, Schlosser H, Beile A, Buchholz U. SARS-CoV-2 variant B.1.1.7 susceptibility and infectiousness of children and adults deduced from investigations of childcare centre outbreaks, Germany, 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34047274 PMCID: PMC8161729 DOI: 10.2807/1560-7917.es.2021.26.21.2100433] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We investigated three SARS-CoV-2 variant B.1.1.7 childcare centre and related household outbreaks. Despite group cohorting, cases occurred in almost all groups, i.e. also among persons without close contact. Children’s secondary attack rates (SAR) were similar to adults (childcare centres: 23% vs 30%; p = 0.15; households: 32% vs 39%; p = 0.27); child- and adult-induced household outbreaks also led to similar SAR. With the advent of B.1.1.7, susceptibility and infectiousness of children and adults seem to converge. Public health measures should be revisited accordingly.
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Affiliation(s)
- Anna Loenenbach
- These authors contributed equally to this article and share first authorship.,Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Inessa Markus
- These authors contributed equally to this article and share first authorship.,Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Ann-Sophie Lehfeld
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | | | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Maya Kiegele
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany.,Federal Office of Administration, Cologne, Germany
| | - André Ponzi
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany.,Federal Office of Administration, Cologne, Germany
| | | | | | - Helen Schlosser
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany
| | - Alexander Beile
- Local Health Authority Bergstraße/Hesse, Heppenheim, Germany
| | - Udo Buchholz
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
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105
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Stevenson M, Metry A, Messenger M. Modelling of hypothetical SARS-CoV-2 point of care tests for routine testing in residential care homes: rapid cost-effectiveness analysis. Health Technol Assess 2021; 25:1-74. [PMID: 34142943 PMCID: PMC8256324 DOI: 10.3310/hta25390] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. OBJECTIVE The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. PERSPECTIVE/SETTING The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. METHODS A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. RESULTS Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. LIMITATIONS There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. CONCLUSIONS SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. FUTURE WORK More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. FUNDING This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Metry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Messenger
- Personalised Medicine and Health, University of Leeds, Leeds, UK
- NIHR Leeds Medtech and In Vitro Diagnostics Co-operative, Leeds, UK
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106
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Jardine J, Morris E. COVID-19 in Women's health: Epidemiology. Best Pract Res Clin Obstet Gynaecol 2021; 73:81-90. [PMID: 33906791 PMCID: PMC8010330 DOI: 10.1016/j.bpobgyn.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
The disease COVID-19 emerged in late 2019 in Wuhan, China, and rapidly spread, causing a pandemic that is ongoing and has resulted in more than two million deaths worldwide. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which spreads effectively by direct contact with an infected person or contaminated surface, droplet or aerosol transmission. Vertical transmission, if it does occur, is rare. Among women of childbearing age, most will have mild or asymptomatic infection; severe illness is uncommon. Severe illness is more common in the later stages of pregnancy, when it is associated with complications, including intensive care admission, maternal death and an increased risk of iatrogenic preterm birth. Women who are older, from minority ethnic groups, who are overweight or obese, who have comorbidities or who live with socioeconomic deprivation are more likely to experience severe illness than women without these characteristics.
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Affiliation(s)
- Jennifer Jardine
- Royal College of Obstetricians and Gynaecologists, London, UK; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Edward Morris
- Royal College of Obstetricians and Gynaecologists, London, UK; Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
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107
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Hsu CY, Wang JT, Huang KC, Fan ACH, Yeh YP, Chen SLS. Household transmission but without the community-acquired outbreak of COVID-19 in Taiwan. J Formos Med Assoc 2021; 120 Suppl 1:S38-S45. [PMID: 33994234 PMCID: PMC8092621 DOI: 10.1016/j.jfma.2021.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Household transmission is responsible for the subsequent outbreak of community-acquired COVID-19. The aim of this study was to elucidate the household transmission mode and to further estimate effective and basic reproductive number with and without non-pharmaceutical interventions (NPIs). METHODS A total of 26 households with 39 family clusters between January, 2020 and February, 2021 in Taiwan were enrolled for analysis. The Becker's chain binomial model was used to analyze the probabilities of being infected and escaping from SARS-COV-2 before and after January 1st, 2021, which were further converted to estimating basic reproductive numbers in the absence of NPIs. The likelihood of leading to the subsequent community-acquired outbreak given NPIs was further assessed. RESULTS The secondary attack rate was 46.2%. Given the saturated Greenwood model selected as the best fitted model, the probability of being infected and escaping from COVID-19 within household was estimated as 44.4% (95% CI: 5.0%-53.7%) and 55.7% (95% CI: 46.3%-65.0%), respectively. In the second period of early 2021, the infected probability was increased to 58.3% (95% CI: 12.7%-90.0%) and the escape probability was lowered to 41.7% (95% CI: 0.0%-86.9%). The corresponding basic reproductive numbers (R0) increased from 4.29 in the first period to 6.73 in the second period without NPIs. However, none of subsequent community-acquired outbreak was noted in Taiwan given very effective NPIs in both periods. CONCLUSION The proposed method and results are useful for designing household-specific containment measures and NPIs to stamp out a large-scale community-acquired outbreak as demonstrated in Taiwan.
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Affiliation(s)
- Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Daichung Hospital, Miaoli, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University, Hospital, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Antoria Chiao-Hsin Fan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Changhua County Public Health Bureau, Changhua, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan.
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108
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Melo P, Barbosa JM, Jardim L, Carrilho E, Portugal J. COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment. Int Dent J 2021; 71:251-262. [PMID: 33879353 PMCID: PMC7874946 DOI: 10.1016/j.identj.2021.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a viral disease declared a pandemic by the World Health Organization (WHO) in March 2020, has posed great changes to many sectors of society across the globe. Its virulence and rapid dissemination have forced the adoption of strict public health measures in most countries, which, collaterally, resulted in economic hardship. This article is the first in a series of 3 that aims to contextualise the clinical impact of COVID-19 for the dental profession. It presents the epidemiological conditions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), namely, its modes of transmission, incubation, and transmissibility period, signs and symptoms, immunity, immunological tests, and risk management in dental care. Individuals in dental care settings are exposed to 3 potential sources of contamination with COVID-19: close interpersonal contacts (<1 m), contact with saliva, and aerosol-generating dental procedures. Thus, a risk management model is propsoed for the provision of dental care depending on the epidemiological setting, the patient's characteristics, and the type of procedures performed in the office environment. Although herd immunity seems difficult to achieve, a significant number of people has been infected throughout the first 9 months of the pandemic and vaccination has been implemented, which means that there will be a growing number of presumable "immune" individuals that might not require many precautions that differ from those before COVID-19. In conclusion, dental care professionals may manage their risk by following the proposed model, which considers the recommendations by local and international health authorities, thus providing a safe environment for both professionals and patients.
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Affiliation(s)
- Paulo Melo
- Faculty of Dental Medicine, EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal.
| | - João Malta Barbosa
- Instituto de Implantologia, Lisbon, Portugal; Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, USA
| | - Luis Jardim
- Faculty of Dental Medicine, University of Lisboa, Lisboa, Portugal
| | - Eunice Carrilho
- Institute for Clinical and Biomedical Research, CIMAGO; Institute of Integrated Clinical Practice; Centre for Innovative Biomedicine and Biotechnology; Clinical Academic Center of Coimbra; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jaime Portugal
- Faculty of Dental Medicine, University of Lisboa, Lisboa, Portugal
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109
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Kahlert CR, Persi R, Güsewell S, Egger T, Leal-Neto OB, Sumer J, Flury D, Brucher A, Lemmenmeier E, Möller JC, Rieder P, Stocker R, Vuichard-Gysin D, Wiggli B, Albrich WC, Babouee Flury B, Besold U, Fehr J, Kuster SP, McGeer A, Risch L, Schlegel M, Friedl A, Vernazza P, Kohler P. Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among hospital workers - A multicentre cross-sectional study. Clin Microbiol Infect 2021; 27:1336-1344. [PMID: 34020033 PMCID: PMC8131187 DOI: 10.1016/j.cmi.2021.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022]
Abstract
Objectives Protecting healthcare workers (HCWs) from coronavirus disease-19 (COVID-19) is critical to preserve the functioning of healthcare systems. We therefore assessed seroprevalence and identified risk factors for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) seropositivity in this population. Methods Between 22 June 22 and 15 August 2020, HCWs from institutions in northern/eastern Switzerland were screened for SARS-CoV-2 antibodies. We recorded baseline characteristics, non-occupational and occupational risk factors. We used pairwise tests of associations and multivariable logistic regression to identify factors associated with seropositivity. Results Among 4664 HCWs from 23 healthcare facilities, 139 (3%) were seropositive. Non-occupational exposures independently associated with seropositivity were contact with a COVID-19-positive household (adjusted OR 59, 95% CI 33–106), stay in a COVID-19 hotspot (aOR 2.3, 95% CI 1.2–4.2) and male sex (aOR 1.9, 95% CI 1.1–3.1). Blood group 0 vs. non-0 (aOR 0.5, 95% CI 0.3–0.8), active smoking (aOR 0.4, 95% CI 0.2–0.7), living with children <12 years (aOR 0.3, 95% CI 0.2–0.6) and being a physician (aOR 0.2, 95% CI 0.1–0.5) were associated with decreased risk. Other occupational risk factors were close contact to COVID-19 patients (aOR 2.7, 95% CI 1.4–5.4), exposure to COVID-19-positive co-workers (aOR 1.9, 95% CI 1.1–2.9), poor knowledge of standard hygiene precautions (aOR 1.9, 95% CI 1.2–2.9) and frequent visits to the hospital canteen (aOR 2.3, 95% CI 1.4–3.8). Discussion Living with COVID-19-positive households showed the strongest association with SARS-CoV-2 seropositivity. We identified several potentially modifiable work-related risk factors, which might allow mitigation of the COVID-19 risk among HCWs. The lower risk among those living with children, even after correction for multiple confounders, is remarkable and merits further study.
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Affiliation(s)
- Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland; Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Raphael Persi
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital of St Gallen, St. Gallen, Switzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Onicio B Leal-Neto
- Epitrack, Recife, Brazil; Department of Economics, University of Zurich, Zurich, Switzerland
| | - Johannes Sumer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - J Carsten Möller
- Centre for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland; Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Jan Fehr
- Department of Public and Global Health, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland; Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein; Centre of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Hippokratia 2021. [DOI: 10.1002/14651858.cd015085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | - Renke Lars Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | - Laura Arnold
- Academy of Public Health Services; Duesseldorf Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR); Mainz Germany
- Department of Psychiatry and Psychotherapy; University Medical Center of the Johannes Gutenberg University Mainz; Mainz Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center; Faculty of Medicine, University of Freiburg; Freiburg Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research; LMU Munich; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
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111
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Li B, Saad D. Impact of presymptomatic transmission on epidemic spreading in contact networks: A dynamic message-passing analysis. Phys Rev E 2021; 103:052303. [PMID: 34134317 DOI: 10.1103/physreve.103.052303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/19/2021] [Indexed: 01/12/2023]
Abstract
Infectious diseases that incorporate presymptomatic transmission are challenging to monitor, model, predict, and contain. We address this scenario by studying a variant of a stochastic susceptible-exposed-infected-recovered model on arbitrary network instances using an analytical framework based on the method of dynamic message passing. This framework provides a good estimate of the probabilistic evolution of the spread on both static and contact networks, offering a significantly improved accuracy with respect to individual-based mean-field approaches while requiring a much lower computational cost compared to numerical simulations. It facilitates the derivation of epidemic thresholds, which are phase boundaries separating parameter regimes where infections can be effectively contained from those where they cannot. These have clear implications on different containment strategies through topological (reducing contacts) and infection parameter changes (e.g., social distancing and wearing face masks), with relevance to the recent COVID-19 pandemic.
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Affiliation(s)
- Bo Li
- Non-linearity and Complexity Research Group, Aston University, Birmingham, B4 7ET, United Kingdom
| | - David Saad
- Non-linearity and Complexity Research Group, Aston University, Birmingham, B4 7ET, United Kingdom
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112
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Understanding the drivers of transmission of SARS-CoV-2. THE LANCET. INFECTIOUS DISEASES 2021; 21:580-581. [PMID: 33545091 PMCID: PMC7906711 DOI: 10.1016/s1473-3099(21)00005-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/25/2023]
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113
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Galow L, Haag L, Kahre E, Blankenburg J, Dalpke AH, Lück C, Berner R, Armann JP. Lower household transmission rates of SARS-CoV-2 from children compared to adults. J Infect 2021; 83:e34-e36. [PMID: 33930468 PMCID: PMC8079264 DOI: 10.1016/j.jinf.2021.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Lukas Galow
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
| | - Luise Haag
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Elisabeth Kahre
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Judith Blankenburg
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Alexander H Dalpke
- Institute for Medical Microbiology and Virology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christian Lück
- Institute for Medical Microbiology and Virology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Reinhard Berner
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jakob P Armann
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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114
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Goodwin L, Hayward T, Krishan P, Nolan G, Nundy M, Ostrishko K, Attili A, Cárceles SB, Epelle EI, Gabl R, Pappa EJ, Stajuda M, Zen S, Dozier M, Anderson N, Viola IM, McQuillan R. Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review. J Glob Health 2021; 11:10002. [PMID: 33828849 PMCID: PMC8021073 DOI: 10.7189/jogh.11.10002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background This rapid evidence review identifies and integrates evidence from epidemiology, microbiology and fluid dynamics on the transmission of SARS-CoV-2 in indoor environments. Methods Searches were conducted in May 2020 in PubMed, medRxiv, arXiv, Scopus, WHO COVID-19 database, Compendex & Inspec. We included studies reporting data on any indoor setting except schools, any indoor activities and any potential means of transmission. Articles were screened by a single reviewer, with rejections assessed by a second reviewer. We used Joanna Briggs Institute and Critical Appraisal Skills Programme tools for evaluating epidemiological studies and developed bespoke tools for the evaluation of study types not covered by these instruments. Data extraction and quality assessment were conducted by a single reviewer. We conducted a meta-analysis of secondary attack rates in household transmission. Otherwise, data were synthesised narratively. Results We identified 1573 unique articles. After screening and quality assessment, fifty-eight articles were retained for analysis. Experimental evidence from fluid mechanics and microbiological studies demonstrates that aerosolised transmission is theoretically possible; however, we found no conclusive epidemiological evidence of this occurring. The evidence suggests that ventilation systems have the potential to decrease virus transmission near the source through dilution but to increase transmission further away from the source through dispersal. We found no evidence for faecal-oral transmission. Laboratory studies suggest that the virus survives for longer on smooth surfaces and at lower temperatures. Environmental sampling studies have recovered small amounts of viral RNA from a wide range of frequently touched objects and surfaces; however, epidemiological studies are inconclusive on the extent of fomite transmission. We found many examples of transmission in settings characterised by close and prolonged indoor contact. We estimate a pooled secondary attack rate within households of 11% (95% confidence interval (CI) = 9, 13). There were insufficient data to evaluate the transmission risks associated with specific activities. Workplace challenges related to poverty warrant further investigation as potential risk factors for workplace transmission. Fluid mechanics evidence on the physical properties of droplets generated by coughing, speaking and breathing reinforce the importance of maintaining 2 m social distance to reduce droplet transmission. Conclusions This review provides a snap-shot of evidence on the transmission of SARS-CoV-2 in indoor environments from the early months of the pandemic. The overall quality of the evidence was low. As the quality and quantity of available evidence grows, it will be possible to reach firmer conclusions on the risk factors for and mechanisms of indoor transmission.
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Affiliation(s)
- Lara Goodwin
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Gemma Nolan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Antonio Attili
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | | | | | - Roman Gabl
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | | | - Mateusz Stajuda
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Simone Zen
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Marshall Dozier
- Information Services, University of Edinburgh, Edinburgh, UK
| | | | - Ignazio M Viola
- School of Engineering, University of Edinburgh, Edinburgh, UK
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115
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Grote U, Arvand M, Brinkwirth S, Brunke M, Buchholz U, Eckmanns T, von Kleist M, Niebank M, Ruehe B, Schulze K, Stoliaroff-Pépin A, Thanheiser M, Schaade L, Said D, Haas W. [Measures to cope with the COVID-19 pandemic in Germany: nonpharmaceutical and pharmaceutical interventions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:435-445. [PMID: 33787944 PMCID: PMC8010780 DOI: 10.1007/s00103-021-03306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
When the emerging novel SARS-CoV‑2 virus first appeared in December 2019, neither specific therapeutic options nor vaccinations were available. The role of nonpharmaceutical interventions (NPIs) became of central importance. At the Robert Koch Institute, a multilayer strategy consisting of population-based and individual preventive measures to control the pandemic was developed, which built upon existing influenza pandemic plans as well as generic plans. This paper explains the recommended NPIs and illustrates the pharmaceutical approaches developed in parallel.Among others, general contact bans, providing material for infection prevention and control, ban of events, closing educational institutions, and restricting travel are counted among population-based measures. Additional individual preventive measures are necessary, e.g., keeping a minimum distance, reducing contacts, and wearing a mouth-nose covering as well as quarantine and isolation. Measures within the health system are based on recommendations of the Commission on Hospital Hygiene and Infection Protection (Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)) and specified and implemented by professional societies. Since November 2020, an antiviral therapy with remdesivir and treatment with the glucocorticoid dexamethasone have been available as pharmaceutical interventions. Monoclonal antibodies are at this time not approved. Therapeutic anticoagulation is recommended.Recommendations are constantly adapted to the increasing knowledge on the pathogen and its means of transmission. A challenge is to strengthen the trust of the population. Many measures have to be applied on an individual basis in order to work together.
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Affiliation(s)
- Ulrike Grote
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
- ÖGD Kontaktstelle: Infektionsepidemiologisches Krisenmanagement, Ausbruchsuntersuchungen und Trainingsprogramme (Fachgebiet 38), Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Mardjan Arvand
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Simon Brinkwirth
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Melanie Brunke
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Udo Buchholz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Tim Eckmanns
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Max von Kleist
- MF Methodenentwicklung und Forschungsinfrastruktur, Robert Koch-Institut, Berlin, Deutschland
| | - Michaela Niebank
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Bettina Ruehe
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Kai Schulze
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | | | - Marc Thanheiser
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS), Robert Koch-Institut, Berlin, Deutschland
| | - Dunja Said
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Walter Haas
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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116
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Ma R, Gan L, Jiang S, Ding P, Chen D, Wu J, Qian J. High expression of SARS-CoV-2 entry factors in human conjunctival goblet cells. Exp Eye Res 2021; 205:108501. [PMID: 33600811 PMCID: PMC7883706 DOI: 10.1016/j.exer.2021.108501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 01/08/2023]
Abstract
The angiotensin-converting enzyme 2 (ACE2) receptor has been proved for SARS-CoV-2 cell entry after auxiliary cellular protease priming by transmembrane protease serine 2 (TMPRSS2), but the co-effect of this molecular mechanism was unknown. Here, single-cell sequencing was performed with human conjunctiva and the results have shown that ACE2 and TMPRSS2 were highly co-expressed in the goblet cells with genes involved in immunity process. This identification of conjunctival cell types which are permissive to virus entry would help to understand the process by which SARS-CoV-2 infection was established. These finding might be suggestive for COVID-19 control and protection.
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Affiliation(s)
- Ruiqi Ma
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lu Gan
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | | | - Peiwen Ding
- BGI-Shenzhen, Shenzhen, 518083, China,BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, 518083, China
| | - Dongsheng Chen
- BGI-Shenzhen, Shenzhen, 518083, China,Corresponding author
| | - Jihong Wu
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Corresponding author. Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
| | - Jiang Qian
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Corresponding author. Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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117
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Fiore VG, DeFelice N, Glicksberg BS, Perl O, Shuster A, Kulkarni K, O’Brien M, Pisauro MA, Chung D, Gu X. Containment of COVID-19: Simulating the impact of different policies and testing capacities for contact tracing, testing, and isolation. PLoS One 2021; 16:e0247614. [PMID: 33788852 PMCID: PMC8011755 DOI: 10.1371/journal.pone.0247614] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022] Open
Abstract
Efficient contact tracing and testing are fundamental tools to contain the transmission of SARS-CoV-2. We used multi-agent simulations to estimate the daily testing capacity required to find and isolate a number of infected agents sufficient to break the chain of transmission of SARS-CoV-2, so decreasing the risk of new waves of infections. Depending on the non-pharmaceutical mitigation policies in place, the size of secondary infection clusters allowed or the percentage of asymptomatic and paucisymptomatic (i.e., subclinical) infections, we estimated that the daily testing capacity required to contain the disease varies between 0.7 and 9.1 tests per thousand agents in the population. However, we also found that if contact tracing and testing efficacy dropped below 60% (e.g. due to false negatives or reduced tracing capability), the number of new daily infections did not always decrease and could even increase exponentially, irrespective of the testing capacity. Under these conditions, we show that population-level information about geographical distribution and travel behaviour could inform sampling policies to aid a successful containment, while avoiding concerns about government-controlled mass surveillance.
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Affiliation(s)
- Vincenzo G. Fiore
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Nicholas DeFelice
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benjamin S. Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York, United States of America
| | - Ofer Perl
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Anastasia Shuster
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kaustubh Kulkarni
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Madeline O’Brien
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - M. Andrea Pisauro
- Department of Experimental Psychology, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Centre for Human Brain Health, University of Birmingham, School of Psychology, Birmingham, United Kingdom
| | - Dongil Chung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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118
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Leng T, White C, Hilton J, Kucharski A, Pellis L, Stage H, Davies NG, Keeling MJ, Flasche S. The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study. Wellcome Open Res 2021; 5:213. [PMID: 33623826 PMCID: PMC7871360 DOI: 10.12688/wellcomeopenres.16164.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.
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Affiliation(s)
- Trystan Leng
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Connor White
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Joe Hilton
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Adam Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Helena Stage
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Nicholas G. Davies
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matt J. Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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119
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Munday JD, Sherratt K, Meakin S, Endo A, Pearson CAB, Hellewell J, Abbott S, Bosse NI, Atkins KE, Wallinga J, Edmunds WJ, van Hoek AJ, Funk S. Implications of the school-household network structure on SARS-CoV-2 transmission under school reopening strategies in England. Nat Commun 2021; 12:1942. [PMID: 33782396 PMCID: PMC8007691 DOI: 10.1038/s41467-021-22213-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/02/2021] [Indexed: 12/28/2022] Open
Abstract
In early 2020 many countries closed schools to mitigate the spread of SARS-CoV-2. Since then, governments have sought to relax the closures, engendering a need to understand associated risks. Using address records, we construct a network of schools in England connected through pupils who share households. We evaluate the risk of transmission between schools under different reopening scenarios. We show that whilst reopening select year-groups causes low risk of large-scale transmission, reopening secondary schools could result in outbreaks affecting up to 2.5 million households if unmitigated, highlighting the importance of careful monitoring and within-school infection control to avoid further school closures or other restrictions. Many countries have closed schools as part of their COVID-19 response. Here, the authors model SARS-CoV-2 transmission on a network of schools and households in England, and find that risk of transmission between schools is lower if primary schools are open than if secondary schools are open.
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Affiliation(s)
- James D Munday
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Katharine Sherratt
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Akira Endo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Carl A B Pearson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nikos I Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katherine E Atkins
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Health, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jacco Wallinga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Albert Jan van Hoek
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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120
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Woon YL, Lee YL, Chong YM, Ayub NA, Krishnabahawan SL, Lau JFW, Subramaniam-Kalianan R, Sam IC, Chan YF, Sevalingam RK, Ramli A, Chuah CH, Mat-Hussin H, Leong CL, Chidambaram SK, Peariasamy KM, Goh PP. Serology surveillance of SARS-CoV-2 antibodies among healthcare workers in COVID-19 designated facilities in Malaysia. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 9:100123. [PMID: 33778796 PMCID: PMC7982055 DOI: 10.1016/j.lanwpc.2021.100123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/13/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
Background Asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections are well documented. Healthcare workers (HCW) are at increased risk of infection due to occupational exposure to infected patients. We aim to determine the prevalence of SARS-CoV-2 antibodies among HCW who did not come to medical attention. Methods We prospectively recruited 400 HCW from the National Public Health Laboratory and two COVID-19 designated public hospitals in Klang Valley, Malaysia between 13/4/2020 and 12/5/2020. Quota sampling was used to ensure representativeness of HCW involved in direct and indirect patient care. All participants answered a self-administered questionnaire and blood samples were taken to test for SARS-CoV-2 antibodies by surrogate virus neutralization test. Findings The study population comprised 154 (38.5%) nurses, 103 (25.8%) medical doctors, 47 (11.8%) laboratory technologists and others (23.9%). A majority (68.9%) reported exposure to SARS-CoV-2 in the past month within their respective workplaces. Adherence to personal protection equipment (PPE) guidelines and hand hygiene were good, ranging from 91-100% compliance. None (95% CI: 0, 0.0095) of the participants had SARS-CoV-2 antibodies detected, despite 182 (45.5%) reporting some symptoms one month prior to study recruitment. One hundred and fifteen (29%) of participants claimed to have had contact with known COVID-19 persons outside of their workplace. Interpretation Zero seroprevalence among HCW suggests a low incidence of undiagnosed COVID-19 infection in our healthcare setting during the first local wave of SARS-CoV-2 infection. The occupational risk of SARS-CoV-2 transmission within healthcare facilities can be prevented by adherence to infection control measures and appropriate use of PPE. Funding Own institutional budget and the Fundamental Research Grant Scheme.
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Affiliation(s)
- Yuan Liang Woon
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Yee Leng Lee
- Clinical Research Center, Sungai Buloh Hospital, Ministry of Health, Malaysia.,Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Yoong Min Chong
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | - Nor Aliya Ayub
- Clinical Research Center, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | | | - June Fei Wen Lau
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Ramani Subramaniam-Kalianan
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | | | - Azura Ramli
- Clinical Research Center, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | - Chuan Huan Chuah
- Infectious Disease Unit, Medical Department, Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - Hani Mat-Hussin
- National Public Health Laboratory, Ministry of Health, Malaysia
| | - Chee Loon Leong
- Infectious Disease Unit, Medical Department, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | - Suresh Kumar Chidambaram
- Infectious Disease Unit, Medical Department, Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Pik Pin Goh
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
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Phillips B, Browne DT, Anand M, Bauch CT. Model-based projections for COVID-19 outbreak size and student-days lost to closure in Ontario childcare centres and primary schools. Sci Rep 2021; 11:6402. [PMID: 33737555 PMCID: PMC7973423 DOI: 10.1038/s41598-021-85302-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
There is a pressing need for evidence-based scrutiny of plans to re-open childcare centres during the COVID-19 pandemic. Here we developed an agent-based model of SARS-CoV-2 transmission within a childcare centre and households. Scenarios varied the student-to-educator ratio (15:2, 8:2, 7:3), family clustering (siblings together versus random assignment) and time spent in class. We also evaluated a primary school setting (with student-educator ratios 30:1, 15:1 and 8:1), including cohorts that alternate weekly. In the childcare centre setting, grouping siblings significantly reduced outbreak size and student-days lost. We identify an intensification cascade specific to classroom outbreaks of respiratory viruses with presymptomatic infection. In both childcare and primary school settings, each doubling of class size from 8 to 15 to 30 more than doubled the outbreak size and student-days lost (increases by factors of 2-5, depending on the scenario. Proposals for childcare and primary school reopening could be enhanced for safety by switching to smaller class sizes and grouping siblings.
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Affiliation(s)
- Brendon Phillips
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Dillon T Browne
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Madhur Anand
- School of Environmental Sciences, University of Guelph, Guelph, ON, Canada
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON, Canada.
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Setiabudi W, Hungerford D, Subramaniam K, Vaselli NM, Shaw VE, Wilton M, Vivancos R, Aston S, Platt G, Moitt T, Jones AP, Gabbay M, Buchan I, Carrol ED, Iturriza-Gomara M, Solomon T, Greenhalf W, Naisbitt DJ, Adams ER, Cunliffe NA, Turtle L, French N. Prospective observational study of SARS-CoV-2 infection, transmission and immunity in a cohort of households in Liverpool City Region, UK (COVID-LIV): a study protocol. BMJ Open 2021; 11:e048317. [PMID: 33737446 PMCID: PMC7977072 DOI: 10.1136/bmjopen-2020-048317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The emergence and rapid spread of COVID-19 have caused widespread and catastrophic public health and economic impact, requiring governments to restrict societal activity to reduce the spread of the disease. The role of household transmission in the population spread of SARS-CoV-2, and of host immunity in limiting transmission, is poorly understood. This paper describes a protocol for a prospective observational study of a cohort of households in Liverpool City Region, UK, which addresses the transmission of SARS-CoV-2 between household members and how immunological response to the infection changes over time. METHODS AND ANALYSIS Households in the Liverpool City Region, in which members have not previously tested positive for SARS-CoV-2 with a nucleic acid amplification test, are followed up for an initial period of 12 weeks. Participants are asked to provide weekly self-throat and nasal swabs and record their activity and presence of symptoms. Incidence of infection and household secondary attack rates of COVID-19 are measured. Transmission of SARS-CoV-2 will be investigated against a range of demographic and behavioural variables. Blood and faecal samples are collected at several time points to evaluate immune responses to SARS-CoV-2 infection and prevalence and risk factors for faecal shedding of SARS-CoV-2, respectively. ETHICS AND DISSEMINATION The study has received approval from the National Health Service Research Ethics Committee; REC Reference: 20/HRA/2297, IRAS Number: 283 464. Results will be disseminated through scientific conferences and peer-reviewed open access publications. A report of the findings will also be shared with participants. The study will quantify the scale and determinants of household transmission of SARS-CoV-2. Additionally, immunological responses before and during the different stages of infection will be analysed, adding to the understanding of the range of immunological response by infection severity.
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Affiliation(s)
- Wega Setiabudi
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Hungerford
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Krishanthi Subramaniam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Natasha Marcella Vaselli
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Victoria E Shaw
- Liverpool Experimental Cancer Medicines Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Moon Wilton
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology North West, Field Service, National Infection Service, Public Health England, London, UK
| | - Stephen Aston
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Gareth Platt
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Tracy Moitt
- Liverpool Clinical Trial Centre, University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trial Centre, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Department of Public Health and Policy, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gomara
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Neurology, Walton Centre, NHS Foundation Trust, Liverpool, UK
| | - William Greenhalf
- Liverpool Experimental Cancer Medicines Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Dean J Naisbitt
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Emily R Adams
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nigel A Cunliffe
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Neil French
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Soriano-Arandes A, Gatell A, Serrano P, Biosca M, Campillo F, Capdevila R, Fàbrega A, Lobato Z, López N, Moreno AM, Poblet M, Riera-Bosch MT, Rius N, Ruiz M, Sánchez A, Valldepérez C, Vilà M, Pineda V, Lazcano U, Díaz Y, Reyes-Urueña J, Soler-Palacín P. Household SARS-CoV-2 transmission and children: a network prospective study. Clin Infect Dis 2021; 73:e1261-e1269. [PMID: 33709135 PMCID: PMC7989526 DOI: 10.1093/cid/ciab228] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains uncertain. Here, we describe the epidemiological and clinical characteristics of children with COVID-19 in Catalonia (Spain) and investigate the dynamics of household transmission. Methods Prospective, observational, multicenter study performed during summer and school periods (1 July-31 October, 2020), in which epidemiological and clinical features, and viral transmission dynamics were analyzed in COVID-19 patients <16 years. A pediatric index case was established when a child was the first individual infected within a household. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infections. Results The study included 1040 COVID-19 patients <16 years. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (p=0.02), and when compared to adults (p=0.006). No individual or environmental risk factors associated with the SAR were identified. Conclusions Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Anna Gatell
- Equip Pediatria Territorial Alt Penedès-Garraf, Barcelona, Spain
| | - Pepe Serrano
- Equip Pediatria Territorial Alt Penedès-Garraf, Barcelona, Spain
| | | | - Ferran Campillo
- Hospital d'Olot i Equip Pediàtric Territorial Garrotxa i Ripollès (EPTGiR), Girona, Spain
| | | | | | | | - Núria López
- Hospital Universitari del Mar, Barcelona, Spain
| | | | - Miriam Poblet
- Equip Territorial Pediàtric Sabadell Nord, Barcelona, Spain
| | | | - Neus Rius
- Hospital Universitari San Joan de Reus, Tarragona, Spain
| | | | | | | | | | - Valentí Pineda
- Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Uxue Lazcano
- Agencia de Qualitat i Avaluació Sanitaria de Catalunya, AQuAS, Generalitat de Catalunya, Barcelona, Spain
| | - Yesika Díaz
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Finkenzeller T, Lenhart S, Reinwald M, Lüth S, Dendl LM, Paetzel C, Szczypien N, Klawonn F, Von Meyer A, Schreyer AG. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". ROFO-FORTSCHR RONTG 2021; 193:537-543. [PMID: 33694146 DOI: 10.1055/a-1393-6668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The recent COVID-19 pandemic has resulted in an increasing overload of the medical system. Healthcare workers (HCW) in radiology departments are exposed to a high infection risk similar to HCWs in the ICU or dedicated COVID wards. The goal of our paper is to evaluate the prevalence of IgG antibody against SARS-CoV-2 among radiology HCWs in two different hospitals and regions in Germany with a low and high COVID-19 prevalence and to compare it to the prevalence in other clinical personnel. Additionally, we assessed the number of radiological procedures performed in patients with a positive PCR test (C+) followed by a short review of the risk for nosocomial infections of radiology HCWs. MATERIALS AND METHODS During the first COVID-19 wave between March and July 2020, we evaluated a region with one of the highest COVID-19 rates (776-1570/100 000) in Germany (Hospital A). Additionally, we assessed Hospital B in a region with a low prevalence (65/100 000). We tested the serum prevalence of SARS-CoV-2 IgG antibodies among the whole staff with a subgroup analysis for radiology in both hospitals. We calculated the total number of different radiological procedures performed in C+ patients. RESULTS In Hospital A 594 PCR-proven C+ patients were treated resulting in 2723 radiological procedures. 24 % (n = 6) of the radiology technicians and 13.35 (n = 2) of radiologists had a positive IgG test. The rates were similar to positive rates in HCWs in COVID-19 wards and ICUs within the hospital. The most frequently performed procedures in C+ patients were chest X-rays (3.17/patient) and CT examinations (1.15/patient). In Hospital B 50 C+ patients were treated, resulting in 64 radiological procedures. None of the HCWs tested IgG positive. The most frequently performed examinations were also chest X-rays (1.04/patient) and CT (0.2/patient). CONCLUSION HCWs in radiology have a high occupational infection risk similar to that of HCWs in ICUs and dedicated COVID wards. KEY POINTS · The risk of acquiring COVID-19 increases with the amount of contact with infected individuals.. · The occupational risk of a SARS-CoV-2 infection for radiology staff is similar to that of nurses and physicians in COVID wards.. · Hygiene concepts and medical resources have to be adapted for further COVID outbreaks.. · Reporting of an occupational disease can be considered in the case of seropositive staff.. CITATION FORMAT · Finkenzeller T, Lenhart S, Reinwald M et al. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". Fortschr Röntgenstr 2021; 193: 537 - 543.
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Affiliation(s)
| | - Stephan Lenhart
- Department of Radiology and Neuroradiology, Hospital Weiden, Germany
| | - Mark Reinwald
- Department of Hematology and Oncology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Stefan Lüth
- Clinic for Gastroenterology, Diabetology & Hepatology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Lena Marie Dendl
- Department of Radiology, Brandenburg Medical School Theodor Fontane, Treuenbrietzen, Germany, Department of Radiology, Johanniter Specialty Clinic Treuenbrietzen, Treuenbrietzen, Germany.,Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Christian Paetzel
- Department of Radiology and Neuroradiology, Hospital Weiden, Germany
| | - Natasza Szczypien
- Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Alexander Von Meyer
- Institute for Laboratory Medicine, Medical Microbiology and Technical Hygienics, Munich Municipal Hospital Group, München, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
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Bousali M, Dimadi A, Kostaki EG, Tsiodras S, Nikolopoulos GK, Sgouras DN, Magiorkinis G, Papatheodoridis G, Pogka V, Lourida G, Argyraki A, Angelakis E, Sourvinos G, Beloukas A, Paraskevis D, Karamitros T. SARS-CoV-2 Molecular Transmission Clusters and Containment Measures in Ten European Regions during the First Pandemic Wave. Life (Basel) 2021; 11:life11030219. [PMID: 33803490 PMCID: PMC8001481 DOI: 10.3390/life11030219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The spatiotemporal profiling of molecular transmission clusters (MTCs) using viral genomic data can effectively identify transmission networks in order to inform public health actions targeting SARS-CoV-2 spread. Methods: We used whole genome SARS-CoV-2 sequences derived from ten European regions belonging to eight countries to perform phylogenetic and phylodynamic analysis. We developed dedicated bioinformatics pipelines to identify regional MTCs and to assess demographic factors potentially associated with their formation. Results: The total number and the scale of MTCs varied from small household clusters identified in all regions, to a super-spreading event found in Uusimaa-FI. Specific age groups were more likely to belong to MTCs in different regions. The clustered sequences referring to the age groups 50–100 years old (y.o.) were increased in all regions two weeks after the establishment of the lockdown, while those referring to the age group 0–19 y.o. decreased only in those regions where schools’ closure was combined with a lockdown. Conclusions: The spatiotemporal profiling of the SARS-CoV-2 MTCs can be a useful tool to monitor the effectiveness of the interventions and to reveal cryptic transmissions that have not been identified through contact tracing.
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Affiliation(s)
- Maria Bousali
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (M.B.); (A.D.); (V.P.)
| | - Aristea Dimadi
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (M.B.); (A.D.); (V.P.)
| | - Evangelia-Georgia Kostaki
- Department of Hygiene Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.-G.K.); (G.M.)
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine & Infectious Diseases, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | | | - Dionyssios N. Sgouras
- Laboratory of Medical Microbiology, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (D.N.S.); (E.A.)
| | - Gkikas Magiorkinis
- Department of Hygiene Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.-G.K.); (G.M.)
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, “Laiko” General Hospital of Athens, 11527 Athens, Greece;
| | - Vasiliki Pogka
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (M.B.); (A.D.); (V.P.)
- Laboratory of Medical Microbiology, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (D.N.S.); (E.A.)
| | - Giota Lourida
- Infectious Diseases Clinic A, Sotiria Chest Diseases Hospital, 11527 Athens, Greece; (G.L.); (A.A.)
| | - Aikaterini Argyraki
- Infectious Diseases Clinic A, Sotiria Chest Diseases Hospital, 11527 Athens, Greece; (G.L.); (A.A.)
| | - Emmanouil Angelakis
- Laboratory of Medical Microbiology, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (D.N.S.); (E.A.)
- IRD, APHM, VITROME, IHU-Mediterranean Infections, Aix Marseille University, 13005 Marseille, France
| | - George Sourvinos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
- Correspondence: (A.B.); (D.P.); (T.K.); Tel.: +30-210-5385697 (A.B.); +30-210-7462114 (D.P.); +30-210-6478871 (T.K.)
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.-G.K.); (G.M.)
- Correspondence: (A.B.); (D.P.); (T.K.); Tel.: +30-210-5385697 (A.B.); +30-210-7462114 (D.P.); +30-210-6478871 (T.K.)
| | - Timokratis Karamitros
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (M.B.); (A.D.); (V.P.)
- Laboratory of Medical Microbiology, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece; (D.N.S.); (E.A.)
- Correspondence: (A.B.); (D.P.); (T.K.); Tel.: +30-210-5385697 (A.B.); +30-210-7462114 (D.P.); +30-210-6478871 (T.K.)
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Miyahara R, Tsuchiya N, Yasuda I, Ko YK, Furuse Y, Sando E, Nagata S, Imamura T, Saito M, Morimoto K, Imamura T, Shobugawa Y, Nishiura H, Suzuki M, Oshitani H. Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February-May 2020. Emerg Infect Dis 2021; 27:915-918. [PMID: 33622475 PMCID: PMC7920650 DOI: 10.3201/eid2703.203882] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The overall coronavirus disease secondary attack rate (SAR) in family members was 19.0% in 10 prefectures of Japan during February 22–May 31, 2020. The SAR was lower for primary cases diagnosed early, within 2 days after symptom onset. The SAR of asymptomatic primary cases was 11.8%.
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Stevenson M, Metry A, Messenger M. Modelling of hypothetical SARS-CoV-2 point-of-care tests on admission to hospital from A&E: rapid cost-effectiveness analysis. Health Technol Assess 2021; 25:1-68. [PMID: 33764295 PMCID: PMC8020197 DOI: 10.3310/hta25210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019. At the time of writing (October 2020), the number of cases of COVID-19 had been approaching 38 million and more than 1 million deaths were attributable to it. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in hospital wards. OBJECTIVE The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests. A further objective was to assess occupancy levels in hospital areas, such as waiting bays, before allocation to an appropriate bay. PERSPECTIVE/SETTING The perspective was that of the UK NHS in 2020. The setting was a hypothetical hospital with an accident and emergency department. METHODS An individual patient model was constructed that simulated the spread of disease and mortality within the hospital and recorded occupancy levels. Thirty-two strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests were modelled. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits, and key patient outcomes, such as death and intensive care unit care, caused directly by COVID-19 were recorded. RESULTS A SARS-CoV-2 point-of-care test with a desirable target product profile appears to have a relatively small number of infections, a low occupancy level within the waiting bays, and a high net monetary benefit. However, if hospital laboratory testing can produce results in 6 hours, then the benefits of point-of-care tests may be reduced. The acceptable target product profiles performed less well and had lower net monetary benefits than both a laboratory-based test with a 24-hour turnaround time and strategies using data from currently available SARS-CoV-2 point-of-care tests. The desirable and acceptable point-of-care test target product profiles had lower requirement for patients to be in waiting bays before being allocated to an appropriate bay than laboratory-based tests, which may be of high importance in some hospitals. Tests that appeared more cost-effective also had better patient outcomes. LIMITATIONS There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. The example hospital simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. CONCLUSIONS Should a SARS-CoV-2 point-of-care test with a desirable target product profile become available, this appears promising, particularly when the reduction on the requirements for waiting bays before allocation to a SARS-CoV-2-infected bay, or a non-SARS-CoV-2-infected bay, is considered. The results produced should be informative to decision-makers who can identify the results most pertinent to their specific circumstances. FUTURE WORK More accurate results could be obtained when there is more certainty on the diagnostic accuracy of, and the reduction in time to test result associated with, SARS-CoV-2 point-of-care tests, and on the impact of these tests on occupancy of waiting bays and isolation bays. These parameters are currently uncertain. FUNDING This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Metry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Messenger
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- NIHR Leeds Medtech and In Vitro Diagnostics Co-operative, Leeds, UK
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Stadler RN, Maurer L, Aguilar-Bultet L, Franzeck F, Ruchti C, Kühl R, Widmer AF, Schindler R, Bingisser R, Rentsch KM, Pargger H, Sutter R, Steiner L, Meier C, Kübler W, Hirsch HH, Egli A, Battegay M, Bassetti S, Tschudin-Sutter S. Systematic screening on admission for SARS-CoV-2 to detect asymptomatic infections. Antimicrob Resist Infect Control 2021; 10:44. [PMID: 33640031 PMCID: PMC7912536 DOI: 10.1186/s13756-021-00912-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
The proportion of asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains elusive and the potential benefit of systematic screening during the SARS-CoV-2-pandemic is controversial. We investigated the proportion of asymptomatic inpatients who were identified by systematic screening for SARS-CoV-2 upon hospital admission. Our analysis revealed that systematic screening of asymptomatic inpatients detects a low total number of SARS-CoV-2 infections (0.1%), questioning the cost-benefit ratio of this intervention. Even when the population-wide prevalence was low, the proportion of asymptomatic carriers remained stable, supporting the need for universal infection prevention and control strategies to avoid onward transmission by undetected SARS-CoV-2-carriers during the pandemic.
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Affiliation(s)
- Rahel N Stadler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Laura Maurer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Fabian Franzeck
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Chantal Ruchti
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Richard Kühl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ruth Schindler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katharina M Rentsch
- Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius Steiner
- Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Meier
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Werner Kübler
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Microbiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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129
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Killeen GF, Kearney PM, Perry IJ, Conroy N. Long, thin transmission chains of Severe Acute Respiratory Syndrome Coronavirus 2 may go undetected for several weeks at low to moderate reproduction numbers: Implications for containment and elimination strategy. Infect Dis Model 2021; 6:474-489. [PMID: 33644500 PMCID: PMC7901309 DOI: 10.1016/j.idm.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/21/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) infections almost always caused overt symptoms, so effective case and contact management enabled its effective eradication within months. However, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) usually causes only mild symptoms, so transmission chains may grow to include several individuals before at least one index case becomes ill enough to self-report for diagnosis and care. Here, simple mathematical models were developed to evaluate the implications of delayed index case detection for retrospective contact tracing and management responses. Specifically, these simulations illustrate how: (1) Contact tracing and management may effectively contain most but not all large SARS-CoV-2 clusters arising at foci with high reproduction numbers because rapidly expanding transmission chains ensure at least one overtly symptomatic index case occurs within two viral generations a week or less apart. (2) However, lower reproduction numbers give rise to thinner transmission chains extending through longer sequences of non-reporting asymptomatic and paucisymptomatic individuals, often spanning three or more viral generations (≥2 weeks of transmission) before an overtly symptomatic index case occurs. (3) Consequently, it is not always possible to fully trace and contain such long, thin transmission chains, so the community transmission they give rise to is underrepresented in surveillance data. (4) Wherever surveillance systems are weak and/or transmission proceeds within population groups with lower rates of overt clinical symptoms and/or self-reporting, case and contact management effectiveness may be more severely limited, even at the higher reproduction numbers associated with larger outbreaks. (5) Because passive surveillance platforms may be especially slow to detect the thinner transmission chains that occur at low reproduction numbers, establishing satisfactory confidence of elimination may require that no confirmed cases are detected for two full months, throughout which presumptive preventative measures must be maintained to ensure complete collapse of undetected residual transmission. (6) Greater scope exists for overcoming these limitations by enhancing field surveillance for new suspected cases than by improving diagnostic test sensitivity. (7) While population-wide active surveillance may enable complete traceability and containment, this goal may also be achievable through enhanced passive surveillance for paucisymptomatic infections, combining readily accessible decentralized testing with population hypersensitization to self-reporting with mild symptoms. Containment and elimination of SARS-CoV-2 will rely far more upon presumptive, population-wide prevention measures than was necessary for SARS-CoV-1, necessitating greater ambition, political will, investment, public support, persistence and patience. Nevertheless, case and contact management may be invaluable for at least partially containing SARS-CoV-2 transmission, especially larger outbreaks, but only if enabled by sufficiently sensitive surveillance. Furthermore, consistently complete transmission chain containment may be enabled by focally enhanced surveillance around manageably small numbers of outbreaks in the end stages of successful elimination campaigns, so that their endpoints may be accelerated and sustained.
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Affiliation(s)
- Gerry F Killeen
- School of Biological, Earth & Environmental Sciences, University College Cork, Cork, Ireland.,Environmental Research Institute, University College Cork, Cork, Ireland
| | | | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Niall Conroy
- Wide Bay Public Health Unit, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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130
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Handal N, Whitworth J, Blomfeldt A, Espvik HJ, Lysaker E, Berdal JE, Bakken Jørgensen S. Comparison of SARS-CoV-2 infections in healthcare workers with high and low exposures to Covid-19 patients in a Norwegian University Hospital. Infect Dis (Lond) 2021; 53:420-429. [PMID: 33620274 DOI: 10.1080/23744235.2021.1885734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION A year into the pandemic, the knowledge of SARS-CoV-2 infection risks among healthcare workers remains limited. In this cross-sectional study, we examined whether healthcare workers with high exposure to Covid-19 patients had a higher risk of SARS-CoV-2 infection than other healthcare workers in a Norwegian University Hospital. We also investigated the prevalence of asymptomatic healthcare workers in a ward with a SARS-CoV-2 outbreak. METHODS Healthcare workers from five wards at Akershus University Hospital were included between May 11 and June 11, 2020. Blood samples were analyzed for SARS-CoV-2 antibodies and seroprevalences compared between participants with high and low exposure to Covid-19 patients. Demographic data and SARS-CoV-2 infection risk factors were recorded in a questionnaire. Naso-/oropharyngeal swabs from participants from the outbreak ward were analyzed by reverse transcriptase-polymerase chain reaction. RESULTS 360/436 (82.6%) healthcare workers participated. 9/262 (3.4%) participants from wards with high exposure to Covid-19 patients were SARS-CoV-2 seropositive versus 3/98 (3.1%) from wards with low exposure (OR 1.13; 95%CI 0.3-4.26, p = .861). SARS-CoV-2 antibodies were found in 11/263 (4.2%) participants who had worked one or more shifts caring for Covid-19 patients versus in 1/85 (1.2%) without any known occupational Covid-19 exposure (OR 3.67; 95%CI 0.46-29.06, p = .187). SARS-CoV-2 was detected in naso-/oropharyngeal swabs from 2/78 (2.6%) participants. CONCLUSION We found no significantly increased risk of SARS-CoV-2 infection in healthcare workers with high exposure to COVID-19 patients. Five healthcare workers had either serologic or molecular evidence of past or present unrecognized SARS-CoV-2 infection.
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Affiliation(s)
- Nina Handal
- Division for Diagnostics and Technology, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - Jimmy Whitworth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anita Blomfeldt
- Division for Diagnostics and Technology, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - Heidi Johanne Espvik
- Division for Diagnostics and Technology, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - Elisabeth Lysaker
- Division for Diagnostics and Technology, Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Jan Erik Berdal
- Division of Medicine, Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - Silje Bakken Jørgensen
- Division for Diagnostics and Technology, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
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131
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López M, Gallego C, Abós-Herrándiz R, Tobella A, Turmo N, Monclús A, Martinez A, Rami A, Navas E, Muñoz MA. Impact of isolating COVID-19 patients in a supervised community facility on transmission reduction among household members. J Public Health (Oxf) 2021; 43:499-507. [PMID: 33554257 PMCID: PMC7928768 DOI: 10.1093/pubmed/fdab002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Isolation of COVID-19 patients has been universally implemented to control transmission of the outbreak. Hotels and other facilities have been adapted to help appropriate isolation be achieved. Our study tested the efficacy of isolating patients in a reconditioned hotel versus isolation in their domiciles to reduce infection transmission. Methods Observational cohort study based on a survey to COVID-19 patients between April and June 2020. One cohort had been isolated in a hotel and the other in their domiciles. Multivariate regression models analyzed the factors related to the occurrence of COVID-19 infection among the household members. Results A total of 229 household members of COVID-19 patients were analyzed, 139 of them belonging to the group of hotel-isolated patients and 90 in the group of domicile-isolated ones. More than half of the household members became infected (53.7%). Higher risk of infection was found in the household members of domicile-isolated patients isolated and in those reporting overcrowding at home, (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.89–3.12) and (OR 1.44, 95% CI 0.81; 2.56), respectively. Conclusions The isolation of COVID-19 patients in community-supervised facilities may protect their household members from transmission of the disease. Overcrowded homes may contribute to the transmission of the infection.
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Affiliation(s)
- Mercé López
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain.,Primary Healthcare Research Unit of Barcelona, Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Claudia Gallego
- Primary Healthcare Centre Sant Andreu, Atencio Primària Barcelona Ciutat, Institut Català de la Salut, 08025, Barcelona, Spain
| | - Rafael Abós-Herrándiz
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain.,Primary Healthcare Research Unit of Barcelona, Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Ana Tobella
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain
| | - Nuria Turmo
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain
| | - Alba Monclús
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain
| | - Alba Martinez
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain
| | - Artur Rami
- Primary Healthcare Centre Passeig de Sant Joan, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08010, Barcelona, Spain
| | - Elena Navas
- Primary Healthcare Research Unit of Barcelona, Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Miguel-Angel Muñoz
- Primary Healthcare Research Unit of Barcelona, Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.,Primary Healthcare Centre Joanic, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08037, Barcelona, Spain
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132
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Ferrari A, Santus E, Cirillo D, Ponce-de-Leon M, Marino N, Ferretti MT, Santuccione Chadha A, Mavridis N, Valencia A. Simulating SARS-CoV-2 epidemics by region-specific variables and modeling contact tracing app containment. NPJ Digit Med 2021; 4:9. [PMID: 33446891 PMCID: PMC7809354 DOI: 10.1038/s41746-020-00374-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/25/2020] [Indexed: 01/12/2023] Open
Abstract
Targeted contact-tracing through mobile phone apps has been proposed as an instrument to help contain the spread of COVID-19 and manage the lifting of nation-wide lock-downs currently in place in USA and Europe. However, there is an ongoing debate on its potential efficacy, especially in light of region-specific demographics. We built an expanded SIR model of COVID-19 epidemics that accounts for region-specific population densities, and we used it to test the impact of a contact-tracing app in a number of scenarios. Using demographic and mobility data from Italy and Spain, we used the model to simulate scenarios that vary in baseline contact rates, population densities, and fraction of app users in the population. Our results show that, in support of efficient isolation of symptomatic cases, app-mediated contact-tracing can successfully mitigate the epidemic even with a relatively small fraction of users, and even suppress altogether with a larger fraction of users. However, when regional differences in population density are taken into consideration, the epidemic can be significantly harder to contain in higher density areas, highlighting potential limitations of this intervention in specific contexts. This work corroborates previous results in favor of app-mediated contact-tracing as mitigation measure for COVID-19, and draws attention on the importance of region-specific demographic and mobility factors to achieve maximum efficacy in containment policies.
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Affiliation(s)
- Alberto Ferrari
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Enrico Santus
- Bayer, Decision Science & Advanced Analytics for MA, PV & RA Division, Leverkusen, Germany
| | - Davide Cirillo
- Barcelona Supercomputing Center (BSC), C/Jordi Girona 29, 08034, Barcelona, Spain
- Women's Brain Project (WBP), Gunterhausen, Switzerland
| | - Miguel Ponce-de-Leon
- Barcelona Supercomputing Center (BSC), C/Jordi Girona 29, 08034, Barcelona, Spain
| | - Nicola Marino
- Women's Brain Project (WBP), Gunterhausen, Switzerland
- Dipartimento di Scienze Madiche e, Universitá di Foggia Chirurgiche, Foggia, Italy
| | | | | | - Nikolaos Mavridis
- Women's Brain Project (WBP), Gunterhausen, Switzerland
- Interactive Robots and Media Laboratory (IRLM), Abu Dhabi, United Arab Emirates
| | - Alfonso Valencia
- Barcelona Supercomputing Center (BSC), C/Jordi Girona 29, 08034, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
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133
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[What role do children in school and kindergarten settings play in transmitting SARS-CoV-2? An evidence-based perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1492-1499. [PMID: 34792612 PMCID: PMC8600106 DOI: 10.1007/s00103-021-03454-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023]
Abstract
Are children and adolescents relevant disease vectors when it comes to the transmission of SARS-CoV-2? Moreover, do they play a role as relevant disease vectors in a school or kindergarten setting? These questions could not be sufficiently answered at the beginning of the pandemic. Consequently, schools and childcare facilities were closed to stop the spread of SARS-CoV‑2. Over the past few months, researchers have gained a more detailed understanding of the overall pandemic situation. The SARS-CoV‑2 infection rate in children below 10 years of age in 2020 has been substantially lower than in adults. In addition, it showed that children had a milder course of disease.Although a majority of the analyses performed in schools and childcare facilities revealed that the virus is transmitted in these facilities, these transmissions did not, however, have a considerable influence on the overall rate of new infections. Despite these findings, German politicians continue to advocate for the closure of childcare facilities, including schools, to fight the pandemic, whereas many specialist societies such as the German Society for Pediatric Infectious Diseases (DGPI) have emphasized that such closures should be the measure of last resort in combating the pandemic. The same message is also conveyed by a German evidence-based S3 guideline established by an interdisciplinary expert group that had already put forward clear recommendations for high incidences in the general population at the beginning of February 2021, indicating that school closures were only required in exceptional cases.In this article, we would like to outline the situation based on the currently available data, try to predict the future, and discuss the circumstances necessary to realize normal classroom teaching without accepting the risk of an uncontrolled spread of SARS-CoV‑2.
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134
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Marik PE, Iglesias J, Varon J, Kory P. A scoping review of the pathophysiology of COVID-19. Int J Immunopathol Pharmacol 2021; 35:20587384211048026. [PMID: 34569339 PMCID: PMC8477699 DOI: 10.1177/20587384211048026] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a highly heterogeneous and complex medical disorder; indeed, severe COVID-19 is probably amongst the most complex of medical conditions known to medical science. While enormous strides have been made in understanding the molecular pathways involved in patients infected with coronaviruses an overarching and comprehensive understanding of the pathogenesis of COVID-19 is lacking. Such an understanding is essential in the formulation of effective prophylactic and treatment strategies. Based on clinical, proteomic, and genomic studies as well as autopsy data severe COVID-19 disease can be considered to be the connection of three basic pathologic processes, namely a pulmonary macrophage activation syndrome with uncontrolled inflammation, a complement-mediated endothelialitis together with a procoagulant state with a thrombotic microangiopathy. In addition, platelet activation with the release of serotonin and the activation and degranulation of mast cells contributes to the hyper-inflammatory state. Auto-antibodies have been demonstrated in a large number of hospitalized patients which adds to the end-organ damage and pro-thrombotic state. This paper provides a clinical overview of the major pathogenetic mechanism leading to severe COVID-19 disease.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Front Line Covid-19 Critical Care Alliance
| | - Jose Iglesias
- Department of Nephrology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
- Front Line Covid-19 Critical Care Alliance
| | - Joseph Varon
- Department of Critical Care Medicine, United Memorial Medical Center, Houston, TX, USA
- Front Line Covid-19 Critical Care Alliance
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135
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Inglis R, Barros L, Checkley W, Cizmeci EA, Lelei-Mailu F, Pattnaik R, Papali A, Schultz MJ, Ferreira JC. Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:12-24. [PMID: 33355072 PMCID: PMC7957241 DOI: 10.4269/ajtmh.20-1128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/06/2020] [Indexed: 11/07/2022] Open
Abstract
Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients' rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs.
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Affiliation(s)
- Rebecca Inglis
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Lia Barros
- Division of Cardiology, University of Washington, Seattle, Washington
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elif A. Cizmeci
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Faith Lelei-Mailu
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
| | | | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Juliana C. Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Division of Cardiology, University of Washington, Seattle, Washington
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
- Division of Critical Care Medicine, Ispat General Hospital, Rourkela, India
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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136
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Bhatia R, Klausner J. Estimating individual risks of COVID-19-associated hospitalization and death using publicly available data. PLoS One 2020; 15:e0243026. [PMID: 33284861 PMCID: PMC7721133 DOI: 10.1371/journal.pone.0243026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/14/2020] [Indexed: 12/23/2022] Open
Abstract
We describe a method to estimate individual risks of hospitalization and death attributable to non-household and household transmission of SARS-CoV-2 using available public data on confirmed-case incidence data along with estimates of the clinical fraction, timing of transmission, isolation adherence, secondary infection risks, contact rates, and case-hospitalization and case-fatality ratios. Using the method, we estimate that risks for a 90-day period at the median daily summertime U.S. county confirmed COVID-19 case incidence of 10.8 per 100,000 and pre-pandemic contact rates range from 0.4 to 8.9 per 100,000 for the four deciles of age between 20 and 60 years. The corresponding 90-day period risk of hospitalization ranges from 13.7 to 69.2 per 100,000. Assuming a non-household secondary infection risk of 4% and pre-pandemic contact rates, the share of transmissions attributable to household settings ranges from 73% to 78%. These estimates are sensitive to the parameter assumptions; nevertheless, they are comparable to the COVID-19 hospitalization and fatality rates observed over the time period. We conclude that individual risk of hospitalization and death from SARS-CoV-2 infection is calculable from publicly available data sources. Access to publicly reported infection incidence data by setting and other exposure characteristics along with setting specific estimates of secondary infection risk would allow for more precise individual risk estimation.
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Affiliation(s)
- Rajiv Bhatia
- Department of Medicine (Affiliated), Stanford University, Stanford, California, United States of America
| | - Jeffrey Klausner
- Department of Medicine and Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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137
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Rǎdulescu A, Williams C, Cavanagh K. Management strategies in a SEIR-type model of COVID 19 community spread. Sci Rep 2020; 10:21256. [PMID: 33277553 PMCID: PMC7719171 DOI: 10.1038/s41598-020-77628-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
The 2019 Novel Corona virus infection (COVID 19) is an ongoing public health emergency of international focus. Significant gaps persist in our knowledge of COVID 19 epidemiology, transmission dynamics, investigation tools and management, despite (or possibly because of) the fact that the outbreak is an unprecedented global threat. On the positive side, enough is currently known about the epidemic process to permit the construction of mathematical predictive models. In our work, we adapt a traditional SEIR epidemic model to the specific dynamic compartments and epidemic parameters of COVID 19, as it spreads in an age-heterogeneous community. We analyze management strategies of the epidemic course (as they were implemented through lockdown and reopening procedures in many of the US states and countries worldwide); however, to more clearly illustrate ideas, we focus on the example of a small scale college town community, with the timeline of control measures introduced in the state of New York. We generate predictions, and assess the efficiency of these control measures (closures, mobility restrictions, social distancing), in a sustainability context.
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Affiliation(s)
- Anca Rǎdulescu
- Department of Mathematics, State University of New York at New Paltz, New Paltz, NY, 12561, USA.
| | - Cassandra Williams
- Department of Mathematics, State University of New York at New Paltz, New Paltz, NY, 12561, USA
| | - Kieran Cavanagh
- Departments of Mathematics and Mechanical Engineering, State University of New York at New Paltz, New Paltz, NY, 12561, USA
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Leng T, White C, Hilton J, Kucharski A, Pellis L, Stage H, Davies NG, Keeling MJ, Flasche S. The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study. Wellcome Open Res 2020; 5:213. [PMID: 33623826 PMCID: PMC7871360 DOI: 10.12688/wellcomeopenres.16164.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 09/01/2023] Open
Abstract
Background: During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.
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Affiliation(s)
- Trystan Leng
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Connor White
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Joe Hilton
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Adam Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Helena Stage
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Nicholas G. Davies
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matt J. Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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