151
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Saldaña F, Velasco-Hernández JX. The trade-off between mobility and vaccination for COVID-19 control: a metapopulation modelling approach. ROYAL SOCIETY OPEN SCIENCE 2021; 8:202240. [PMID: 34109037 PMCID: PMC8170206 DOI: 10.1098/rsos.202240] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/18/2021] [Indexed: 05/05/2023]
Abstract
November 2020 received a string of encouraging results from leading vaccine developers raising hopes for the imminent availability of an effective and safe vaccine against the SARS-CoV-2. In the present work, we discuss the theoretical impact of introducing a vaccine across a range of scenarios. In particular, we investigate how vaccination coverage, efficacy and delivery time affect the control of the transmission dynamics in comparison to mobility restrictions. The analysis is based on a metapopulation epidemic model structured by risk. We perform a global sensitivity analysis using the Sobol method. Our analysis suggest that the reduction of mobility among patches plays a significant role in the mitigation of the disease close to the effect of immunization coverage of 30% achieved in four months. Moreover, for an immunization coverage between 20% and 50% achieved in the first half of 2021 with a vaccine efficacy between 70% and 95%, the percentage reduction in the total number of SARS-CoV-2 infections is between 30% and 50% by the end of 2021 in comparison with the no vaccination scenario.
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Affiliation(s)
- Fernando Saldaña
- Instituto de Matemáticas, Campus Juriquilla, 76230, Universidad Nacional Autónoma de México, Quéretaro, Mexico
| | - Jorge X. Velasco-Hernández
- Instituto de Matemáticas, Campus Juriquilla, 76230, Universidad Nacional Autónoma de México, Quéretaro, Mexico
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152
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Knefati M, Ganim I, Schmidt J, Makkar A, Igtiben S, Landa E, Tarawneh A, Hicks C, Zimmerman S, Sukpraprut-Braaten S. COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture. Cureus 2021; 13:e15310. [PMID: 34211811 PMCID: PMC8236337 DOI: 10.7759/cureus.15310] [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] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.
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Affiliation(s)
| | | | | | | | | | - Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Ahmad Tarawneh
- Pulmonary and Critical Care Medicine, Unity Health, Searcy, USA
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153
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Kim YJ, Koo PH. Effectiveness of Testing and Contact-Tracing to Counter COVID-19 Pandemic: Designed Experiments of Agent-Based Simulation. Healthcare (Basel) 2021; 9:625. [PMID: 34073946 PMCID: PMC8225147 DOI: 10.3390/healthcare9060625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
The widespread outbreak of the novel coronavirus disease COVID-19 has posed an enormous threat to global public health. A different set of policy interventions has been implemented to mitigate the spread in most countries. While the use of personal protective equipment and social distancing has been specifically emphasized, South Korea has deployed massive testing and contact-tracing program from the early stage of the outbreak. This study aims at investigating the effectiveness of testing and contact-tracing to counter the spread of infectious diseases. Based on the SEICR (susceptible-exposed-infectious-confirmed-recovered) model, an agent-based simulation model is developed to represent the behavior of disease spreading with the consideration of testing and contact-tracing in place. Designed experiments are conducted to verify the effects of testing and contact tracing on the peak number of infections. It has been observed that testing combined with contact tracing may lower the peak infections to a great extent, and it can thus be avoided for the hospital bed capacity to be overwhelmed by infected patients. It is implied that an adequate capability of testing and contact-tracing may enable us to become better prepared for an impending risk of infectious diseases.
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Affiliation(s)
| | - Pyung-Hoi Koo
- Department of Systems Management and Engineering, Pukyong National University, Busan 48513, Korea;
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154
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Kwok SWH, Vadde SK, Wang G. Tweet Topics and Sentiments Relating to COVID-19 Vaccination Among Australian Twitter Users: Machine Learning Analysis. J Med Internet Res 2021; 23:e26953. [PMID: 33886492 PMCID: PMC8136408 DOI: 10.2196/26953] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/02/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND COVID-19 is one of the greatest threats to human beings in terms of health care, economy, and society in recent history. Up to this moment, there have been no signs of remission, and there is no proven effective cure. Vaccination is the primary biomedical preventive measure against the novel coronavirus. However, public bias or sentiments, as reflected on social media, may have a significant impact on the progression toward achieving herd immunity. OBJECTIVE This study aimed to use machine learning methods to extract topics and sentiments relating to COVID-19 vaccination on Twitter. METHODS We collected 31,100 English tweets containing COVID-19 vaccine-related keywords between January and October 2020 from Australian Twitter users. Specifically, we analyzed tweets by visualizing high-frequency word clouds and correlations between word tokens. We built a latent Dirichlet allocation (LDA) topic model to identify commonly discussed topics in a large sample of tweets. We also performed sentiment analysis to understand the overall sentiments and emotions related to COVID-19 vaccination in Australia. RESULTS Our analysis identified 3 LDA topics: (1) attitudes toward COVID-19 and its vaccination, (2) advocating infection control measures against COVID-19, and (3) misconceptions and complaints about COVID-19 control. Nearly two-thirds of the sentiments of all tweets expressed a positive public opinion about the COVID-19 vaccine; around one-third were negative. Among the 8 basic emotions, trust and anticipation were the two prominent positive emotions observed in the tweets, while fear was the top negative emotion. CONCLUSIONS Our findings indicate that some Twitter users in Australia supported infection control measures against COVID-19 and refuted misinformation. However, those who underestimated the risks and severity of COVID-19 may have rationalized their position on COVID-19 vaccination with conspiracy theories. We also noticed that the level of positive sentiment among the public may not be sufficient to increase vaccination coverage to a level high enough to achieve vaccination-induced herd immunity. Governments should explore public opinion and sentiments toward COVID-19 and COVID-19 vaccination, and implement an effective vaccination promotion scheme in addition to supporting the development and clinical administration of COVID-19 vaccines.
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Affiliation(s)
| | - Sai Kumar Vadde
- Discipline of Information Technology, Media and Communications, Murdoch University, Perth, Australia
| | - Guanjin Wang
- Discipline of Information Technology, Media and Communications, Murdoch University, Perth, Australia
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155
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Murata T, Sakurai A, Suzuki M, Komoto S, Ide T, Ishihara T, Doi Y. Shedding of Viable Virus in Asymptomatic SARS-CoV-2 Carriers. mSphere 2021; 6:e00019-21. [PMID: 34011679 PMCID: PMC8265619 DOI: 10.1128/msphere.00019-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022] Open
Abstract
Information regarding the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic carriers is scarce. In order to determine the duration of infectivity and its correlation with reverse transcription-PCR (RT-PCR) results and time since initial positive PCR test in this population, we evaluated SARS-CoV-2 cell infectivity in nasopharyngeal samples longitudinally obtained from asymptomatic carriers who disembarked from a cruise ship during a COVID-19 outbreak. Of 166 nasopharyngeal samples collected from 39 asymptomatic carriers every 48 h until two consecutive negative PCR test results were obtained, SARS-CoV-2 was successfully isolated from 9 PCR-positive samples which were obtained from 7 persons (18%; 7/39). Viable viruses were isolated predominantly within 7 days after the initial positive PCR test, except for one person who shed viable virus until day 15. The median crossing point (Cp) value of RT-PCR of culture-positive samples was 24.6 (interquartile range [IQR], 20.4 to 25.8; range, 17.9 to 30.3), and Cp values were significantly associated with isolation of viable virus (odds ratio, 0.496; 95% confidence interval [CI], 0.329 to 0.747; P value, 0.001), which was consistent with existing data for symptomatic patients. Genome sequence analysis of SARS-CoV-2 samples consecutively obtained from a person who shed viable virus for 15 days identified the emergence of two novel single nucleotide variants (C8626T transition and C18452T transition) in the sample collected on day 15, with the latter corresponding to an amino acid substitution in nonstructural protein 14. The impact of these mutations on prolonged viable-virus shedding is unclear. These findings underscore the potential role of asymptomatic carriers in transmission.IMPORTANCE A growing number of studies suggest the potential role of asymptomatic SARS-CoV-2 carriers as a major driver of the COVID-19 pandemic; however, virological assessment of asymptomatic infection has largely been limited to reverse transcription-PCR (RT-PCR), which can be persistently positive without necessarily indicating the presence of viable virus (e.g., replication-competent virus). Here, we evaluated the infectivity of asymptomatic SARS-CoV-2 carriers by detecting SARS-CoV-2-induced cytopathic effects on Vero cells using longitudinally obtained nasopharyngeal samples from asymptomatic carriers. We show that asymptomatic carriers can shed viable virus until 7 days after the initial positive PCR test, with one outlier shedding until day 15. The crossing point (Cp) value of RT-PCR was the leading predictive factor for virus viability. These findings provide additional insights into the role of asymptomatic carriers as a source of transmission and highlight the importance of universal source control measures, along with isolation policy for asymptomatic carriers.
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Affiliation(s)
- Takayuki Murata
- Department of Virology and Parasitology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Aki Sakurai
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masahiro Suzuki
- Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Satoshi Komoto
- Department of Virology and Parasitology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tomihiko Ide
- Department of Virology and Parasitology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Center for Joint Research Facilities Support, Research Promotion and Support Headquarters, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Yohei Doi
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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156
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Tseng WP, Wu JL, Wu CC, Kuo KT, Lin CH, Chung MY, Lee YF, Yang BJ, Huang CH, Chen SY, Yu CJ, Chen SC, Hsueh PR. Seroprevalence Surveys for Anti-SARS-CoV-2 Antibody in Different Populations in Taiwan With Low Incidence of COVID-19 in 2020 and Severe Outbreaks of SARS in 2003. Front Immunol 2021; 12:626609. [PMID: 34084161 PMCID: PMC8167053 DOI: 10.3389/fimmu.2021.626609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Accurate detection of anti-SARS-CoV-2 antibodies provides a more accurate estimation of incident cases, epidemic dynamics, and risk of community transmission. We conducted a cross-sectional seroprevalence study specifically targeting different populations to examine the performance of pandemic control in Taiwan: symptomatic patients with epidemiological risk and negative qRT-PCR test (Group P), frontline healthcare workers (Group H), healthy adult citizens (Group C), and participants with prior virologically-confirmed severe acute respiratory syndrome (SARS) infection in 2003 (Group S). The presence of anti-SARS-CoV-2 total and IgG antibodies in all participants were determined by Roche Elecsys® Anti-SARS-CoV-2 test and Abbott SARS-CoV-2 IgG assay, respectively. Sera that showed positive results by the two chemiluminescent immunoassays were further tested by three anti-SARS-CoV-2 lateral flow immunoassays and line immunoassay (MIKROGEN recomLine SARS-CoV-2 IgG). Between June 29 and July 25, 2020, sera of 2,115 participates, including 499 Group P participants, 464 Group H participants, 1,142 Group C participants, and 10 Group S participants, were tested. After excluding six false-positive samples, SARS-CoV-2 seroprevalence were 0.4, 0, and 0% in Groups P, H, and C, respectively. Cross-reactivity with SARS-CoV-2 antibodies was observed in 80.0% of recovered SARS participants. Our study showed that rigorous exclusion of false-positive testing results is imperative for an accurate estimate of seroprevalence in countries with previous SARS outbreak and low COVID-19 prevalence. The overall SARS-CoV-2 seroprevalence was extremely low among populations of different exposure risk of contracting SARS-CoV-2 in Taiwan, supporting the importance of integrated countermeasures in containing the spread of SARS-CoV-2 before effective COVID-19 vaccines available.
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Affiliation(s)
- Wen-Pin Tseng
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhong-Lin Wu
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research and Department of Integrated Surgery, Hsinchu Biomedical Science Park Medical Center (National Taiwan University Hospital Hsin-Chu Biomedical Park Branch), Hsinchu, Taiwan
| | - Kuan-Ting Kuo
- Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yi Chung
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Fan Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bey-Jing Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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157
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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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158
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Kriegova E, Fillerova R, Raska M, Manakova J, Dihel M, Janca O, Sauer P, Klimkova M, Strakova P, Kvapil P. Excellent option for mass testing during the SARS-CoV-2 pandemic: painless self-collection and direct RT-qPCR. Virol J 2021; 18:95. [PMID: 33947425 PMCID: PMC8094981 DOI: 10.1186/s12985-021-01567-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
The early identification of asymptomatic yet infectious cases is vital to curb the 2019 coronavirus (COVID-19) pandemic and to control the disease in the post-pandemic era. In this paper, we propose a fast, inexpensive and high-throughput approach using painless nasal-swab self-collection followed by direct RT-qPCR for the sensitive PCR detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This approach was validated in a large prospective cohort study of 1038 subjects, analysed simultaneously using (1) nasopharyngeal swabs obtained with the assistance of healthcare personnel and analysed by classic two-step RT-qPCR on RNA isolates and (2) nasal swabs obtained by self-collection and analysed with direct RT-qPCR. Of these subjects, 28.6% tested positive for SARS-CoV-2 using nasopharyngeal swab sampling. Our direct RT-qPCR approach for self-collected nasal swabs performed well with results similar to those of the two-step RT-qPCR on RNA isolates, achieving 0.99 positive and 0.98 negative predictive values (cycle threshold [Ct] < 37). Our research also reports on grey-zone viraemia, including samples with near-cut-off Ct values (Ct ≥ 37). In all investigated subjects (n = 20) with grey-zone viraemia, the ultra-small viral load disappeared within hours or days with no symptoms. Overall, this study underscores the importance of painless nasal-swab self-collection and direct RT-qPCR for mass testing during the SARS-CoV-2 pandemic and in the post-pandemic era.
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Affiliation(s)
- Eva Kriegova
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Regina Fillerova
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Milan Raska
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Jirina Manakova
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Martin Dihel
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Ondrej Janca
- Department of Immunology, OLGEN, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Pavel Sauer
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | | | | | - Petr Kvapil
- Institute of Applied Biotechnologies a.s., Prague, Czech Republic
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159
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Muniz-Rodriguez K, Chowell G, Schwind JS, Ford R, Ofori SK, Ogwara CA, Davies MR, Jacobs T, Cheung CH, Cowan LT, Hansen AR, Chun-Hai Fung I. Time-varying Reproduction Numbers of COVID-19 in Georgia, USA, March 2, 2020 to November 20, 2020. Perm J 2021; 25:20.232. [PMID: 33970085 PMCID: PMC8784042 DOI: 10.7812/tpp/20.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2020, Severe Acute Respiratory Syndrome Coronavirus 2 impacted Georgia, USA. Georgia announced a state-wide shelter-in-place on April 2 and partially lifted restrictions on April 27. We estimated the time-varying reproduction numbers (Rt) of COVID-19 in Georgia, Metro Atlanta, and Dougherty County and environs from March 2, 2020, to November 20, 2020. METHODS We analyzed the daily incidence of confirmed COVID-19 cases in Georgia, Metro Atlanta, and Dougherty County and its surrounding counties, and estimated Rt using the R package EpiEstim. We used a 9-day correction for the date of report to analyze the data by assumed date of infection. RESULTS The median Rt estimate in Georgia dropped from between 2 and 4 in mid-March to < 2 in late March to around 1 from mid-April to November. Regarding Metro Atlanta, Rt fluctuated above 1.5 in March and around 1 since April. In Dougherty County, the median Rt declined from around 2 in late March to 0.32 on April 26. Then, Rt fluctuated around 1 in May through November. Counties surrounding Dougherty County registered an increase in Rt estimates days after a superspreading event occurred in the area. CONCLUSIONS In Spring 2020, Severe Acute Respiratory Syndrome Coronavirus 2 transmission in Georgia declined likely because of social distancing measures. However, because restrictions were relaxed in late April and elections were conducted in November, community transmission continued, with Rt fluctuating around 1 across Georgia, Metro Atlanta, and Dougherty County as of November 2020. The superspreading event in Dougherty County affected surrounding areas, indicating the possibility of local transmission in neighboring counties.
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Affiliation(s)
- Kamalich Muniz-Rodriguez
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Gerardo Chowell
- Department of Population Health Sciences,
School of Public Health,
Georgia State University,
Atlanta,
GA
| | - Jessica S Schwind
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Randall Ford
- Department of Community Health and Health Policy,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Sylvia K Ofori
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Chigozie A Ogwara
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Margaret R Davies
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Terrence Jacobs
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Chi-Hin Cheung
- Independent researcher,
Hong Kong Special Administrative Region
| | - Logan T Cowan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Andrew R Hansen
- Department of Community Health and Health Policy,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
| | - Isaac Chun-Hai Fung
- Department of Biostatistics, Epidemiology and Environmental Health Sciences,
Jiann-Ping Hsu College of Public Health,
Georgia Southern University,
Statesboro,
GA
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160
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de Lima PN, Lempert R, Vardavas R, Baker L, Ringel J, Rutter CM, Ozik J, Collier N. Reopening California : Seeking Robust, Non-Dominated COVID-19 Exit Strategies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.26.21256105. [PMID: 33948599 PMCID: PMC8095206 DOI: 10.1101/2021.04.26.21256105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Amid global scarcity of COVID-19 vaccines and the threat of new variant strains, California and other jurisdictions face the question of when and how to implement and relax COVID-19 Nonpharmaceutical Interventions (NPIs). While policymakers have attempted to balance the health and economic impacts of the pandemic, decentralized decision-making, deep uncertainty, and the lack of widespread use of comprehensive decision support methods can lead to the choice of fragile or inefficient strategies. This paper uses simulation models and the Robust Decision Making (RDM) approach to stress-test California's reopening strategy and other alternatives over a wide range of futures. We find that plans which respond aggressively to initial outbreaks are required to robustly control the pandemic. Further, the best plans adapt to changing circumstances, lowering their stringent requirements to reopen over time or as more constituents are vaccinated. While we use California as an example, our results are particularly relevant for jurisdictions where vaccination roll-out has been slower.
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161
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Choudhry N, Drysdale K, Usai C, Leighton D, Sonagara V, Buchanan R, Nijjar M, Thomas S, Hopkins M, Cutino-Moguel T, Gill US, Foster GR, Kennedy PT. Disparities of SARS-CoV-2 Nucleoprotein-Specific IgG in Healthcare Workers in East London, UK. Front Med (Lausanne) 2021; 8:642723. [PMID: 33987193 PMCID: PMC8111172 DOI: 10.3389/fmed.2021.642723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/19/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction: SARS-CoV-2 antibody detection serves as an important diagnostic marker for past SARS-CoV-2 infection and is essential to determine the spread of COVID-19, monitor potential COVID-19 long-term effects, and to evaluate possible protection from reinfection. A study was conducted across three hospital sites in a large central London NHS Trust in the UK, to evaluate the prevalence and duration of SARS-CoV-2 IgG antibody positivity in healthcare workers. Methods: A matrix equivalence study consisting of 228 participants was undertaken to evaluate the Abbott Panbio™ COVID-19 IgG/IgM rapid test device. Subsequently, 2001 evaluable healthcare workers (HCW), representing a diverse population, were enrolled in a HCW study between June and August 2020. A plasma sample from each HCW was evaluated using the Abbott Panbio™ COVID-19 IgG/IgM rapid test device, with confirmation of IgG-positive results by the Abbott ArchitectTM SARS-CoV-2 IgG assay. 545 participants, of whom 399 were antibody positive at enrolment, were followed up at 3 months. Results: The Panbio™ COVID-19 IgG/IgM rapid test device demonstrated a high concordance with laboratory tests. SARS-CoV-2 antibodies were detected in 506 participants (25.3%) at enrolment, with a higher prevalence in COVID-19 frontline (28.3%) than non-frontline (19.9%) staff. At follow-up, 274/399 antibody positive participants (68.7%) retained antibodies; 4/146 participants negative at enrolment (2.7%) had seroconverted. Non-white ethnicity, older age, hypertension and COVID-19 symptoms were independent predictors of higher antibody levels (OR 1.881, 2.422-3.034, 2.128, and 1.869 respectively), based on Architect™ index quartiles; participants in the first three categories also showed a greater antibody persistence at 3 months. Conclusion: The SARS-CoV-2 anti-nucleocapsid IgG positivity rate among healthcare staff was high, declining by 31.3% during the 3-month follow-up interval. Interestingly, the IgG-positive participants with certain risk factors for severe COVID-19 illness (older age, Black or Asian Ethnicity hypertension) demonstrated greater persistence over time when compared to the IgG-positive participants without these risk factors.
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Affiliation(s)
- Naheed Choudhry
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Kate Drysdale
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Carla Usai
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Dean Leighton
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vinay Sonagara
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Ruaridh Buchanan
- Barts Health NHS Trust, Newham General Hospital, London, United Kingdom
| | - Manreet Nijjar
- Barts Health NHS Trust, Whipps Cross Hospital, London, United Kingdom
| | - Sherine Thomas
- Barts Health NHS Trust, Whipps Cross Hospital, London, United Kingdom
| | - Mark Hopkins
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | | | - Upkar S. Gill
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Graham R. Foster
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Patrick T. Kennedy
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
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162
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Costantino V, Raina MacIntyre C. The Impact of Universal Mask Use on SARS-COV-2 in Victoria, Australia on the Epidemic Trajectory of COVID-19. Front Public Health 2021; 9:625499. [PMID: 33968879 PMCID: PMC8096905 DOI: 10.3389/fpubh.2021.625499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objective(s): To estimate the impact of universal community face mask use in Victoria, Australia along with other routine disease control measures in place. Methods: A mathematical modeling study using an age structured deterministic model for Victoria, was simulated for 123 days between 1 June 2020 and 1 October 2020, incorporating lockdown, contact tracing, and case findings with and without mask use in varied scenarios. The model tested the impact of differing scenarios of the universal use of face masks in Victoria, by timing, varying mask effectiveness, and uptake. Results: A six-week lockdown with standard control measures, but no masks, would have resulted in a large resurgence by September, following the lifting of restrictions. Mask use can substantially reduce the epidemic size, with a greater impact if at least 50% of people wear a mask which has an effectiveness of at least 40%. Early mask use averts more cases than mask usage that is only implemented closer to the peak. No mask use, with a 6-week lockdown, results in 67,636 cases and 120 deaths by 1 October 2020 if no further lockdowns are used. If mask use at 70% uptake commences on 23 July 2020, this is reduced to 7,961 cases and 42 deaths. We estimated community mask effectiveness to be 11%. Conclusion(s): Lockdown and standard control measures may not have controlled the epidemic in Victoria. Mask use can substantially improve epidemic control if its uptake is higher than 50% and if moderately effective masks are used. Early mask use should be considered in other states if community transmission is present, as this has a greater effect than later mask wearing mandates.
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Affiliation(s)
- Valentina Costantino
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Chandini Raina MacIntyre
- The Biosecurity Program, The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
- College of Public Affairs and Community Solutions, Arizona State University, Tempe, AZ, United States
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163
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Chang CT, Lee M, Lee JCY, Lee NCT, Ng TY, Shafie AA, Thong KS. Public KAP towards COVID-19 and Antibiotics Resistance: A Malaysian Survey of Knowledge and Awareness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3964. [PMID: 33918782 PMCID: PMC8069954 DOI: 10.3390/ijerph18083964] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to assess the knowledge of the Malaysian public on the coronavirus disease 2019 (COVID-19) and antibiotics, the practice of preventive measures and attitude towards the new norms. The web-based questionnaire was disseminated online from 1 to 31 October 2020. Out of 2117 respondents, 1405 (66.4%) knew that transmission of COVID-19 virus could happen in asymptomatic people. In term of antibiotics knowledge, 779 (36.8%) respondents were aware that taking antibiotics could not speed up the recovery process of all infections. Less than half of the respondents (49.0%) knew that antibiotics are effective against bacterial infection only. Majority (92.3%) practiced good preventive measures. Majority of the respondents strongly agreed that quarantine should be made mandatory for all arrival from overseas (97.2%) and wearing face masks should be made mandatory in all public areas (94.0%). Respondents of Chinese ethnicity (p = 0.008), middle-aged (p = 0.002), with tertiary education (p = 0.015) and healthcare related education (p < 0.001), from the higher income groups (p = 0.001) were more likely to have better knowledge on COVID-19. The Malaysian public demonstrated good knowledge towards COVID-19, adequate practice of preventive measures and high acceptance towards the new norm. Knowledge on antibiotics use and resistance was poor, which warrants attention from the health authorities.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh 30450, Malaysia;
| | - Ming Lee
- Klinik Kesihatan Kampung Simee, Ministry of Health Malaysia, Ipoh 31400, Malaysia;
| | - Jason Choong Yin Lee
- Perak Pharmaceutical Services Division, Ministry of Health Malaysia, Tanjung Rambutan 31250, Malaysia;
| | - Nicholas Chor Teng Lee
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh 30450, Malaysia; (N.C.T.L.); (K.S.T.)
| | - Tsu Yin Ng
- Klinik Kesihatan Taiping, Perak, Ministry of Health Malaysia, Taiping 30400, Malaysia;
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, University Sains Malaysia, Gelugor 11800, Malaysia
| | - Kah Shuen Thong
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh 30450, Malaysia; (N.C.T.L.); (K.S.T.)
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164
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Mbwogge M. Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review. JMIRX MED 2021; 2:e27254. [PMID: 33857269 PMCID: PMC8045129 DOI: 10.2196/27254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all. OBJECTIVE The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions. METHODS Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included "mass testing," "test and trace," "contact tracing," "COVID-19," "SARS-CoV-2," "effectiveness," "asymptomatic," "symptomatic," "community screening," "UK," and "2020." Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings. RESULTS The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively. CONCLUSIONS There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services.
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Affiliation(s)
- Mathew Mbwogge
- London School of Hygiene & Tropical Medicine London United Kingdom
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165
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Keshaviah A, Hu XC, Henry M. Developing a Flexible National Wastewater Surveillance System for COVID-19 and Beyond. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:45002. [PMID: 33877858 PMCID: PMC8057681 DOI: 10.1289/ehp8572] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Wastewater testing offers a cost-effective strategy for measuring population disease prevalence and health behaviors. For COVID-19, wastewater surveillance addresses testing gaps and provides an early warning for outbreaks. As U.S. federal agencies build a National Wastewater Surveillance System around the pandemic, thinking through ways to develop flexible frameworks for wastewater sampling, testing, and reporting can avoid unnecessary system overhauls for future infectious disease, chronic disease, and drug epidemics. OBJECTIVES We discuss ways to transform a historically academic exercise into a tool for epidemic response. We generalize lessons learned by a global network of wastewater researchers around validation and implementation for COVID-19 and opioids while also drawing on our experience with wastewater-based epidemiology in the United States. DISCUSSION Sustainable wastewater surveillance requires coordination between health and safety officials, utilities, labs, and researchers. Adapting sampling frequency, type, and location to threat level, community vulnerability, biomarker properties, and decisions that wastewater data will inform can increase the practical value of the data. Marketplace instabilities, coupled with a fragmented testing landscape due to specialization, may require officials to engage multiple labs to test for known and unknown threats. Government funding can stabilize the market, balancing commercial pressures with public good, and incentivize data sharing. When reporting results, standardizing metrics and contextualizing wastewater data with health resource data can provide insights into a community's vulnerability and identify strategies to prevent health care systems from being overwhelmed. If wastewater data will inform policy decisions for an entire community, comparing characteristics of the wastewater treatment plant's service population to those of the larger community can help determine whether the wastewater data are generalizable. Ethical protocols may be needed to protect privacy and avoid stigmatization. With data-driven approaches to sample collection, analysis, and interpretation, officials can use wastewater surveillance for adaptive resource allocation, pandemic management, and program evaluation. https://doi.org/10.1289/EHP8572.
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Zaeck LM, Scheibner D, Sehl J, Müller M, Hoffmann D, Beer M, Abdelwhab EM, Mettenleiter TC, Breithaupt A, Finke S. Light Sheet Microscopy-Assisted 3D Analysis of SARS-CoV-2 Infection in the Respiratory Tract of the Ferret Model. Viruses 2021; 13:529. [PMID: 33807059 PMCID: PMC8004956 DOI: 10.3390/v13030529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
The visualization of viral pathogens in infected tissues is an invaluable tool to understand spatial virus distribution, localization, and cell tropism in vivo. Commonly, virus-infected tissues are analyzed using conventional immunohistochemistry in paraffin-embedded thin sections. Here, we demonstrate the utility of volumetric three-dimensional (3D) immunofluorescence imaging using tissue optical clearing and light sheet microscopy to investigate host-pathogen interactions of pandemic SARS-CoV-2 in ferrets at a mesoscopic scale. The superior spatial context of large, intact samples (>150 mm3) allowed detailed quantification of interrelated parameters like focus-to-focus distance or SARS-CoV-2-infected area, facilitating an in-depth description of SARS-CoV-2 infection foci. Accordingly, we could confirm a preferential infection of the ferret upper respiratory tract by SARS-CoV-2 and suggest clustering of infection foci in close proximity. Conclusively, we present a proof-of-concept study for investigating critically important respiratory pathogens in their spatial tissue morphology and demonstrate the first specific 3D visualization of SARS-CoV-2 infection.
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Affiliation(s)
- Luca M. Zaeck
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (D.S.); (M.M.); (E.M.A.)
| | - David Scheibner
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (D.S.); (M.M.); (E.M.A.)
| | - Julia Sehl
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (J.S.); (A.B.)
| | - Martin Müller
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (D.S.); (M.M.); (E.M.A.)
| | - Donata Hoffmann
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (D.H.); (M.B.)
| | - Martin Beer
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (D.H.); (M.B.)
| | - Elsayed M. Abdelwhab
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (D.S.); (M.M.); (E.M.A.)
| | - Thomas C. Mettenleiter
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany;
| | - Angele Breithaupt
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (J.S.); (A.B.)
| | - Stefan Finke
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (D.S.); (M.M.); (E.M.A.)
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Vardavas R, de Lima PN, Baker L. Modeling COVID-19 Nonpharmaceutical Interventions: Exploring periodic NPI strategies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.28.21252642. [PMID: 33688672 PMCID: PMC7941649 DOI: 10.1101/2021.02.28.21252642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We developed a COVID-19 transmission model used as part of RAND's web-based COVID-19 decision support tool that compares the effects of nonpharmaceutical public health interventions (NPIs) on health and economic outcomes. An interdisciplinary approach informed the selection and use of multiple NPIs, combining quantitative modeling of the health/economic impacts of interventions with qualitative assessments of other important considerations (e.g., cost, ease of implementation, equity). This paper provides further details of our model, describes extensions, presents sensitivity analyses, and analyzes strategies that periodically switch between a base NPI level and a higher NPI level. We find that a periodic strategy, if implemented with perfect compliance, could have produced similar health outcomes as static strategies but might have produced better outcomes when considering other measures of social welfare. Our findings suggest that there are opportunities to shape the tradeoffs between economic and health outcomes by carefully evaluating a more comprehensive range of reopening policies.
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168
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Singh DE, Marinescu MC, Guzmán-Merino M, Durán C, Delgado-Sanz C, Gomez-Barroso D, Carretero J. Simulation of COVID-19 Propagation Scenarios in the Madrid Metropolitan Area. Front Public Health 2021; 9:636023. [PMID: 33796497 PMCID: PMC8007867 DOI: 10.3389/fpubh.2021.636023] [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: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
This work presents simulation results for different mitigation and confinement scenarios for the propagation of COVID-19 in the metropolitan area of Madrid. These scenarios were implemented and tested using EpiGraph, an epidemic simulator which has been extended to simulate COVID-19 propagation. EpiGraph implements a social interaction model, which realistically captures a large number of characteristics of individuals and groups, as well as their individual interconnections, which are extracted from connection patterns in social networks. Besides the epidemiological and social interaction components, it also models people's short and long-distance movements as part of a transportation model. These features, together with the capacity to simulate scenarios with millions of individuals and apply different contention and mitigation measures, gives EpiGraph the potential to reproduce the COVID-19 evolution and study medium-term effects of the virus when applying mitigation methods. EpiGraph, obtains closely aligned infected and death curves related to the first wave in the Madrid metropolitan area, achieving similar seroprevalence values. We also show that selective lockdown for people over 60 would reduce the number of deaths. In addition, evaluate the effect of the use of face masks after the first wave, which shows that the percentage of people that comply with mask use is a crucial factor for mitigating the infection's spread.
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Affiliation(s)
- David E Singh
- Department Computer Science, Universidad Carlos III de Madrid, Leganés, Spain
| | | | | | - Christian Durán
- Department Computer Science, Universidad Carlos III de Madrid, Leganés, Spain
| | - Concepción Delgado-Sanz
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Diana Gomez-Barroso
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Jesus Carretero
- Department Computer Science, Universidad Carlos III de Madrid, Leganés, Spain
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169
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Hanrath AT, Schim van der Loeff I, Lendrem DW, Baker KF, Price DA, McDowall P, McDowall K, Cook S, Towns P, Schwab U, Evans A, Dixon J, Collins J, Burton-Fanning S, Saunders D, Harwood J, Samuel J, Schmid ML, Pareja-Cebrian L, Hunter E, Murphy E, Taha Y, Payne BAI, Duncan CJA. SARS-CoV-2 Testing of 11,884 Healthcare Workers at an Acute NHS Hospital Trust in England: A Retrospective Analysis. Front Med (Lausanne) 2021; 8:636160. [PMID: 33777979 PMCID: PMC7994756 DOI: 10.3389/fmed.2021.636160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Healthcare workers (HCWs) are known to be at increased risk of infection with SARS-CoV-2, although whether these risks are equal across all roles is uncertain. Here we report a retrospective analysis of a large real-world dataset obtained from 10 March to 6 July 2020 in an NHS Foundation Trust in England with 17,126 employees. 3,338 HCWs underwent symptomatic PCR testing (14.4% positive, 2.8% of all staff) and 11,103 HCWs underwent serological testing for SARS-CoV-2 IgG (8.4% positive, 5.5% of all staff). Seropositivity was lower than other hospital settings in England but higher than community estimates. Increased test positivity rates were observed in HCWs from BAME backgrounds and residents in areas of higher social deprivation. A multiple logistic regression model adjusting for ethnicity and social deprivation confirmed statistically significant increases in the odds of testing positive in certain occupational groups, most notably domestic services staff, nurses, and health-care assistants. PCR testing of symptomatic HCWs appeared to underestimate overall infection levels, probably due to asymptomatic seroconversion. Clinical outcomes were reassuring, with only a small minority of HCWs with COVID-19 requiring hospitalization (2.3%) or ICU management (0.7%) and with no deaths. Despite a relatively low level of HCW infection compared to other UK cohorts, there were nevertheless important differences in test positivity rates between occupational groups, robust to adjustment for demographic factors such as ethnic background and social deprivation. Quantitative and qualitative studies are needed to better understand the factors contributing to this risk. Robust informatics solutions for HCW exposure data are essential to inform occupational monitoring.
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Affiliation(s)
- Aidan T. Hanrath
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ina Schim van der Loeff
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dennis W. Lendrem
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth F. Baker
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David A. Price
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter McDowall
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kiera McDowall
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Susan Cook
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter Towns
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ulrich Schwab
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adam Evans
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jill Dixon
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer Collins
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - David Saunders
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jayne Harwood
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Julie Samuel
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Matthias L. Schmid
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lucia Pareja-Cebrian
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ewan Hunter
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Murphy
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Yusri Taha
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Brendan A. I. Payne
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher J. A. Duncan
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Tsitsilonis OE, Paraskevis D, Lianidou E, Terpos E, Akalestos A, Pierros V, Kostaki EG, Kastritis E, Moutsatsou P, Politou M, Scorilas A, Sphicopoulos T, Thomaidis N, Trougakos IP, Tsakris A, Voulgaris N, Daskalaki CC, Evangelakou Z, Fouki C, Gianniou DD, Gumeni S, Kostopoulos IV, Manola MS, Orologas-Stavrou N, Panteli C, Papanagnou ED, Rousakis P, Sklirou AD, Smilkou S, Stergiopoulou D, Tsiodras S, Dimopoulos MA, Sfikakis PP. SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response. Vaccines (Basel) 2021; 9:207. [PMID: 33801380 PMCID: PMC7998869 DOI: 10.3390/vaccines9030207] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Between June and November 2020, we assessed plasma antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein in 4996 participants (aged 18-82 years, 34.5% men) from the National and Kapodistrian University of Athens. The weighted overall prevalence was 1.6% and monthly prevalence correlated with viral RNA-confirmed SARS-CoV-2 infections in Greece, in the same period. Notably, 49% of seropositive cases reported no history of SARS-CoV-2 infection-related clinical symptoms and 33% were unsuspected of their previous infection. Additionally, levels of anti-SARS-CoV-2 antibodies against the spike-protein receptor-binding domain were similar between symptomatic and asymptomatic individuals, irrespective of age and gender. Using Food and Drug Administration Emergency Use Authorization-approved assays, these results support the need for such studies on pandemic evaluation and highlight the development of robust humoral immune responses even among asymptomatic individuals. The high percentage of unsuspected/asymptomatic active cases, which may contribute to community transmission for more days than that of cases who are aware and self-isolate, underscores the necessity of measures across the population for the efficient control of the pandemic.
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Affiliation(s)
- Ourania E. Tsitsilonis
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Evi Lianidou
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | | | - Vassilios Pierros
- Department of Informatics and Telecommunications, NKUA, 15784 Athens, Greece; (V.P.); (T.S.)
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, School of Medicine, University General Hospital Attikon, NKUA, 12462 Haidari, Greece;
| | - Marianna Politou
- Hematology Laboratory-Blood Bank, Aretaieio Hospital, School of Medicine, NKUA, 11528 Athens, Greece;
| | - Andreas Scorilas
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Thomas Sphicopoulos
- Department of Informatics and Telecommunications, NKUA, 15784 Athens, Greece; (V.P.); (T.S.)
| | - Nikolaos Thomaidis
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | - Ioannis P. Trougakos
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | | | | | - Christina C. Daskalaki
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Zoi Evangelakou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Christina Fouki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Despoina D. Gianniou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Sentiljana Gumeni
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Ioannis V. Kostopoulos
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Maria S. Manola
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Nikolaos Orologas-Stavrou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Chrysanthi Panteli
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Eleni-Dimitra Papanagnou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Pantelis Rousakis
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Aimilia D. Sklirou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Stavroula Smilkou
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | | | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, School of Medicine, University Hospital Attikon, NKUA, 12462 Haidari, Greece;
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, NKUA, 15772 Athens, Greece;
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Espinoza B, Marathe M, Swarup S, Thakur M. Adaptive Human Behavior in Epidemics: the Impact of Risk Misperception on the Spread of Epidemics. RESEARCH SQUARE 2021:rs.3.rs-220733. [PMID: 33655240 PMCID: PMC7924275 DOI: 10.21203/rs.3.rs-220733/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Infections produced by pre-symptomatic and asymptomatic (non-symptomatic) individuals have been identified as major drivers of COVID-19 transmission. Non-symptomatic individuals unaware of the infection risk they pose to others, may perceive themselves --and being perceived by others-- as not representing risk of infection. Yet many epidemiological models currently in use do not include a behavioral component, and do not address the potential consequences of risk misperception. To study the impact of behavioral adaptations to the perceived infection risk, we use a mathematical model that incorporates individuals' behavioral decisions based on a projection of the future system's state over a finite planning horizon. We found that individuals' risk misperception in the presence of asymptomatic individuals may increase or reduce the final epidemic size. Moreover, under behavioral response the impact of asymptomatic infections is modulated by symptomatic individuals' behavior. Finally, we found that there is an optimal planning horizon that minimizes the final epidemic size.
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Affiliation(s)
- Baltazar Espinoza
- Biocomplexity Institute and Initiative, Network Systems Science and Advanced Computing Division, University of Virginia, Virginia, USA
| | - Madhav Marathe
- Biocomplexity Institute and Initiative, Network Systems Science and Advanced Computing Division, University of Virginia, Virginia, USA
| | - Samarth Swarup
- Biocomplexity Institute and Initiative, Network Systems Science and Advanced Computing Division, University of Virginia, Virginia, USA
| | - Mugdha Thakur
- Biocomplexity Institute and Initiative, Network Systems Science and Advanced Computing Division, University of Virginia, Virginia, USA
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174
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Bilinski A, Salomon JA, Giardina J, Ciaranello A, Fitzpatrick MC. Passing the Test: A model-based analysis of safe school-reopening strategies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.27.21250388. [PMID: 33532804 PMCID: PMC7852255 DOI: 10.1101/2021.01.27.21250388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has induced historic educational disruptions. In December 2020, at least two-thirds of US public school students were not attending full-time in-person education. The Biden Administration has expressed that reopening schools is a priority. OBJECTIVE To compare risks of SARS-COV-2 transmission in schools across different school-based prevention strategies and levels of community transmission. DESIGN We developed an agent-based network model to simulate transmission in elementary and high school communities, including home, school, and inter-household interactions. SETTING We parameterized school structure based on average US classrooms, with elementary schools of 638 students and high schools of 1,451 students. We varied daily community incidence from 1 to 100 cases per 100,000 population. Patients (or Participants). We simulated students, faculty/staff, and adult household members. INTERVENTIONS We evaluated isolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening. MEASUREMENTS We projected transmission among students, staff and families during one month following introduction of a single infection into a school. We also calculated the number of infections expected for a typical 8-week quarter, contingent on community incidence rate. RESULTS School transmission risk varies according to student age and community incidence and is substantially reduced with effective, consistent mitigation measures. Nevertheless, when transmission occurs, it may be difficult to detect without regular, frequent testing due to the subclinical nature of most infections in children. Teacher vaccination can reduce transmission to staff, while asymptomatic screening both improves understanding of local circumstances and reduces transmission, facilitating five-day schedules at full classroom capacity. LIMITATIONS There is uncertainty about susceptibility and infectiousness of children and low precision regarding the effectiveness of specific prevention measures, particularly with emergence of new variants. CONCLUSION With controlled community transmission and moderate school-based prevention measures, elementary schools can open with few in-school transmissions, while high schools require more intensive mitigation. Asymptomatic screening can both reduce transmission and provide useful information for decision-makers.
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Affiliation(s)
- Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences
| | - Joshua A Salomon
- Center for Health Policy & Center for Primary Care and Outcomes Research, Stanford University School of Medicine
| | - John Giardina
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences
| | - Andrea Ciaranello
- Medical Practice Evaluation Center and Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine
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175
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Turbé H, Bjelogrlic M, Robert A, Gaudet-Blavignac C, Goldman JP, Lovis C. Adaptive Time-Dependent Priors and Bayesian Inference to Evaluate SARS-CoV-2 Public Health Measures Validated on 31 Countries. Front Public Health 2021; 8:583401. [PMID: 33553088 PMCID: PMC7862946 DOI: 10.3389/fpubh.2020.583401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 01/19/2023] Open
Abstract
With the rapid spread of the SARS-CoV-2 virus since the end of 2019, public health confinement measures to contain the propagation of the pandemic have been implemented. Our method to estimate the reproduction number using Bayesian inference with time-dependent priors enhances previous approaches by considering a dynamic prior continuously updated as restrictive measures and comportments within the society evolve. In addition, to allow direct comparison between reproduction number and introduction of public health measures in a specific country, the infection dates are inferred from daily confirmed cases and confirmed death. The evolution of this reproduction number in combination with the stringency index is analyzed on 31 European countries. We show that most countries required tough state interventions with a stringency index equal to 79.6 out of 100 to reduce their reproduction number below one and control the progression of the pandemic. In addition, we show a direct correlation between the time taken to introduce restrictive measures and the time required to contain the spread of the pandemic with a median time of 8 days. This analysis is validated by comparing the excess deaths and the time taken to implement restrictive measures. Our analysis reinforces the importance of having a fast response with a coherent and comprehensive set of confinement measures to control the pandemic. Only restrictions or combinations of those have shown to effectively control the pandemic.
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Affiliation(s)
- Hugues Turbé
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Mina Bjelogrlic
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Arnaud Robert
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Gaudet-Blavignac
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Philippe Goldman
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Medical Information Sciences Division, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Medical Information Sciences Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
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176
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Šmigelskas K, Petrikonis K, Kasiulevičius V, Kalėdienė R, Jakaitienė A, Kaselienė S, Sauliūnė S, Beržanskytė A, Stankūnas M. SARS-CoV-2 Seroprevalence in Lithuania: Results of National Population Survey. Acta Med Litu 2021; 28:48-58. [PMID: 34393628 PMCID: PMC8311832 DOI: 10.15388/amed.2020.28.1.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
SUMMARY BACKGROUND Betacoronavirus SARS-CoV-2 has spread in early 2020 worldwide just in several months. The official statistics are consistently collected, but this is mainly based on symptomatic reports. This study was aimed to estimate the seroprevalence of SARS-CoV-2 infection in Lithuanian population. MATERIALS AND METHODS Study was conducted during August-September 2020 in 6 municipalities of Lithuania. The sample comprised 3087 adult participants from the general population (mean age 53.7 years, 64% female). SARS-CoV-2 antibodies were assessed using AMP IgM/IgG Rapid Test, other data were based on self-report. Seroprevalence was assessed as a crude estimate and as adjusted by sensitivity-specificity of the test. RESULTS The crude seroprevalence in the total sample was 1.9%, the adjusted - 1.4%, ranging from 0.8% to 2.4% across municipalities. Among seroprevalent cases, 67.2% had IgG, 29.3% had IgM, and 3.5% had both IgG and IgM. An increased risk for seropositive test was observed among people who reported having had close contacts with SARS-CoV-2 positives (OR=5.49, p<0.001). At the borderline significance were female gender (OR=1.75, p=0.082) and non-smoking status (OR=2.95, p=0.072). Among the seropositive participants, 69.0% reported having had no COVID-19 symptoms since 1 March 2020, while 31.0% reported having had at least one of the symptoms. CONCLUSIONS The SARS-CoV-2 seroprevalence in Lithuanian sample in August-September 2020 was 1.4%, ranging from 0.8% to 2.4% across municipalities. Given the overall official data, by the end of study (11 September 2020) the total COVID-19 rate in Lithuania was 117.5 per 100,000 population or 0.12%. This suggests more than 10 times higher prevalence of virus across the population than the official estimates.
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Affiliation(s)
- Kastytis Šmigelskas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kęstutis Petrikonis
- Department of Neurology, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Ramunė Kalėdienė
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audronė Jakaitienė
- Institute of Data Science and Digital Technologies, Vilnius University, Vilnius, Lithuania
| | - Snieguolė Kaselienė
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Skirmantė Sauliūnė
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aušra Beržanskytė
- Department of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Stankūnas
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
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177
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Contreras S, Dehning J, Loidolt M, Zierenberg J, Spitzner FP, Urrea-Quintero JH, Mohr SB, Wilczek M, Wibral M, Priesemann V. The challenges of containing SARS-CoV-2 via test-trace-and-isolate. Nat Commun 2021; 12:378. [PMID: 33452267 PMCID: PMC7810722 DOI: 10.1038/s41467-020-20699-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/10/2020] [Indexed: 01/19/2023] Open
Abstract
Without a cure, vaccine, or proven long-term immunity against SARS-CoV-2, test-trace-and-isolate (TTI) strategies present a promising tool to contain its spread. For any TTI strategy, however, mitigation is challenged by pre- and asymptomatic transmission, TTI-avoiders, and undetected spreaders, which strongly contribute to "hidden" infection chains. Here, we study a semi-analytical model and identify two tipping points between controlled and uncontrolled spread: (1) the behavior-driven reproduction number [Formula: see text] of the hidden chains becomes too large to be compensated by the TTI capabilities, and (2) the number of new infections exceeds the tracing capacity. Both trigger a self-accelerating spread. We investigate how these tipping points depend on challenges like limited cooperation, missing contacts, and imperfect isolation. Our results suggest that TTI alone is insufficient to contain an otherwise unhindered spread of SARS-CoV-2, implying that complementary measures like social distancing and improved hygiene remain necessary.
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Affiliation(s)
- Sebastian Contreras
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
- Centre for Biotechnology and Bioengineering, Universidad de Chile, Beauchef 851, 8370456, Santiago, Chile
| | - Jonas Dehning
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - Matthias Loidolt
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - Johannes Zierenberg
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - F Paul Spitzner
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - Jorge H Urrea-Quintero
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - Sebastian B Mohr
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
| | - Michael Wilczek
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, University of Göttingen, Friedrich-Hund-Platz 1, 37077, Göttingen, Germany
| | - Michael Wibral
- Campus Institute for Dynamics of Biological Networks, University of Göttingen, Hermann-Rein-Straße 3, 37075, Göttingen, Germany
| | - Viola Priesemann
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, 37077, Göttingen, Germany.
- Institute for the Dynamics of Complex Systems, University of Göttingen, Friedrich-Hund-Platz 1, 37077, Göttingen, Germany.
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178
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Diedhiou BB, Tine JAD, Diabate M, Seck I, Ndiaye M. Profile of Workers Tested Positive for Sars-CoV-2 in Sangalkam Health District (Senegal). Health (London) 2021. [DOI: 10.4236/health.2021.1311093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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179
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Abstract
Contact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing triggered by testing of symptomatic individuals can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases in a population with little immunity. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 contact tracing that broadly test individuals without symptoms, in whatever way is economically feasible—either with fast and cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. These considerations are important both in regions where widespread vaccination has been deployed and in those where few residents have been immunized.
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Affiliation(s)
- Paul Tupper
- Department of Mathematics, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Sarah P. Otto
- Department of Zoology, University of British Columbia, Vancouver, BC V6T1Z4, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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180
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Pouwels KB, House T, Pritchard E, Robotham JV, Birrell PJ, Gelman A, Vihta KD, Bowers N, Boreham I, Thomas H, Lewis J, Bell I, Bell JI, Newton JN, Farrar J, Diamond I, Benton P, Walker AS. Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey. Lancet Public Health 2021; 6:e30-e38. [PMID: 33308423 PMCID: PMC7786000 DOI: 10.1016/s2468-2667(20)30282-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. METHODS Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. FINDINGS Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29-0·54) to 0·06% (0·04-0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17-24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17-24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45-68%, dependent on calendar time. INTERPRETATION Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. FUNDING Department of Health and Social Care.
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Affiliation(s)
- Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK.
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, UK; IBM Research, Hartree Centre, Sci-Tech, Daresbury, UK
| | - Emma Pritchard
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Paul J Birrell
- National Infection Service, Public Health England, London, UK; Medical Research Council (MRC) Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Cambridge, UK
| | - Andrew Gelman
- Department of Statistics, Columbia University, New York, NY, USA
| | - Karina-Doris Vihta
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Iain Bell
- Office for National Statistics, Newport, UK
| | - John I Bell
- Office of the Regius Professor of Medicine, University of Oxford, Oxford, UK
| | - John N Newton
- Health Improvement Directorate, Public Health England, London, UK
| | | | | | | | - Ann Sarah Walker
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; MRC Clinical Trials Unit at University College London, London, UK
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181
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Port JR, Yinda CK, Owusu IO, Holbrook M, Fischer R, Bushmaker T, Avanzato VA, Schulz JE, van Doremalen N, Clancy CS, Munster VJ. SARS-CoV-2 disease severity and transmission efficiency is increased for airborne but not fomite exposure in Syrian hamsters. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.12.28.424565. [PMID: 33398267 PMCID: PMC7781302 DOI: 10.1101/2020.12.28.424565] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Transmission of SARS-CoV-2 is driven by contact, fomite, and airborne transmission. The relative contribution of different transmission routes remains subject to debate. Here, we show Syrian hamsters are susceptible to SARS-CoV-2 infection through intranasal, aerosol and fomite exposure. Different routes of exposure presented with distinct disease manifestations. Intranasal and aerosol inoculation caused more severe respiratory pathology, higher virus loads and increased weight loss. Fomite exposure led to milder disease manifestation characterized by an anti-inflammatory immune state and delayed shedding pattern. Whereas the overall magnitude of respiratory virus shedding was not linked to disease severity, the onset of shedding was. Early shedding was linked to an increase in disease severity. Airborne transmission was more efficient than fomite transmission and dependent on the direction of the airflow. Carefully characterized of SARS-CoV-2 transmission models will be crucial to assess potential changes in transmission and pathogenic potential in the light of the ongoing SARS-CoV-2 evolution.
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Affiliation(s)
- Julia R. Port
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Claude Kwe Yinda
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Irene Offei Owusu
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Myndi Holbrook
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Robert Fischer
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Trenton Bushmaker
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
- Montana State University, Bozeman, Montana, USA
| | - Victoria A. Avanzato
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Jonathan E. Schulz
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Neeltje van Doremalen
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Chad S. Clancy
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
| | - Vincent J. Munster
- Laboratory of Virology, Division of Intramural Research, National Institutes of Health, Hamilton, MT, USA
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182
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Bracis C, Burns E, Moore M, Swan D, Reeves DB, Schiffer JT, Dimitrov D. Widespread testing, case isolation and contact tracing may allow safe school reopening with continued moderate physical distancing: A modeling analysis of King County, WA data. Infect Dis Model 2020; 6:24-35. [PMID: 33294745 PMCID: PMC7695953 DOI: 10.1016/j.idm.2020.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/22/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In late March 2020, a "Stay Home, Stay Healthy" order was issued in Washington State in response to the COVID-19 pandemic. On May 1, a 4-phase reopening plan began. We investigated whether adjunctive prevention strategies would allow less restrictive physical distancing to avoid second epidemic waves and secure safe school reopening. METHODS We developed a mathematical model, stratifying the population by age, infection status and treatment status to project SARS-CoV-2 transmission during and after the reopening period. The model was parameterized with demographic and contact data from King County, WA and calibrated to confirmed cases, deaths and epidemic peak timing. Adjunctive prevention interventions were simulated assuming different levels of pre-COVID physical interactions (pC_PI) restored. RESULTS The best model fit estimated ~35% pC_PI under the lockdown which prevented ~17,000 deaths by May 15. Gradually restoring 75% pC_PI for all age groups between May 15-July 15 would have resulted in ~350 daily deaths by early September 2020. Maintaining <45% pC_PI was required with current testing practices to ensure low levels of daily infections and deaths. Increased testing, isolation of symptomatic infections, and contact tracing permitted 60% pC_PI without significant increases in daily deaths before November and allowed opening of schools with <15 daily deaths. Inpatient antiviral treatment was predicted to reduce deaths significantly without lowering cases or hospitalizations. CONCLUSIONS We predict that widespread testing, contact tracing and case isolation would allow relaxation of physical distancing, as well as opening of schools, without a surge in local cases and deaths.
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Affiliation(s)
- Chloe Bracis
- Université Grenoble Alpes, TIMC-IMAG/BCM, 38000, Grenoble, France
| | | | - Mia Moore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Swan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel B. Reeves
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua T. Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
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183
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Machanick P. Revisiting early-stage COVID-19 strategy options. F1000Res 2020; 9:327. [PMID: 34046170 PMCID: PMC8127020 DOI: 10.12688/f1000research.23524.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Early-stage interventions in a potential pandemic are important to understand as they can make the difference between runaway exponential growth that is hard to turn back and stopping the spread before it gets that far. COVID19 is an interesting case study because there have been very different outcomes in different localities. These variations are best studied after the fact if precision is the goal; while a pandemic is still unfolding less precise analysis is of value in attempting to guide localities to learn lessons of those that preceded them. Methods: I examine two factors that could differentiate strategy: asymptomatic spread and the risks of basing strategy on untested claims, such as potential protective value of the Bacillus Calmette-Guerin (BCG) tuberculosis vaccine. Results: Differences in disease progression as well as the possibility of alternative strategies to prevent COVID-19 from entering the runaway phase or damping it down later can be elucidated by a study of asymptomatic infection. An early study to demonstrate not only what fraction are asymptomatic but how contagious they are would have informed policy on nonpharmaceutical interventions but could still be of value to understand containment during vaccine roll out. Conclusions: When a COVID-19 outbreak is at a level that makes accurate trace-and test possible, investigation of asymptomatic transmission is viable and should be attempted to enhance understanding of spread and variability in the disease as well as policy options for slowing the spread. Understanding mild cases could shed light on the disease in the longer term, including whether vaccines prevent contagiousness.
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Affiliation(s)
- Philip Machanick
- Computer Science, Rhodes University, Makhanda, Eastern Cape, 6140, South Africa
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