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Baumgart SWL, McLachlan A, Kenny H, McKew G, Maddocks S, Chen SCA, Kok J. Deisolation in the Healthcare Setting Following Recent COVID-19 Infection. Viruses 2024; 16:1131. [PMID: 39066294 PMCID: PMC11281359 DOI: 10.3390/v16071131] [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: 05/22/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Deisolation of persons infected with SARS-CoV-2, the virus that causes COVID-19, presented a substantial challenge for healthcare workers and policy makers, particularly during the early phases of the pandemic. Data to guide deisolation of SARS-CoV-2-infected patients remain limited, and the risk of transmitting and acquiring infection has changed with the evolution of SARS-CoV-2 variants and population immunity from previous vaccination or infection, or both. AIMS This review examines the evidence to guide the deisolation of SARS-CoV-2-infected inpatients within the hospital setting when clinically improving and also of healthcare workers with COVID-19 prior to returning to work. METHODS A review was performed using relevant search terms in Medline, EMBASE, Google Scholar, and PubMed. RESULTS AND DISCUSSION The evidence is reviewed with regards to the nature of SARS-CoV-2 transmission, the role of testing to guide deisolation, and the impact of SARS-CoV-2-specific immunity. A paradigm and recommendations are proposed to guide deisolation for inpatients and return to work for healthcare workers.
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Affiliation(s)
- Samuel W. L. Baumgart
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Aidan McLachlan
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Hayden Kenny
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Genevieve McKew
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Susan Maddocks
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
| | - Sharon C.-A. Chen
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology—Public Health, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology—Public Health, Westmead Hospital, Westmead, NSW 2145, Australia
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Oordt-Speets AM, Spinardi JR, Mendoza CF, Yang J, del Carmen Morales G, Kyaw MH. Duration of SARS-CoV-2 shedding: A systematic review. J Glob Health 2024; 14:05005. [PMID: 38547496 PMCID: PMC10978056 DOI: 10.7189/jogh.14.05005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Background Positive viral severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cultures indicate shedding of infectious virus and corresponding transmission risk of coronavirus disease 2019 (COVID-19). The research question of this systematic review was: Is there a discernible pattern in the timing of SARS-CoV-2 virus isolation, and what is the proportion of positive and negative results for isolation of SARS-CoV-2 virus with viral culture relative to the onset of clinical symptoms or the day of diagnosis, as indicated by longitudinal studies? Methods We systematically searched PubMed and Embase from inception to 16 February 2023 for English-language studies with serial viral culture testing within symptomatic or asymptomatic SARS-CoV-2 infected persons during the post-vaccination period. Outcomes of interest were the daily culture status per study and the overall daily culture positivity rate of SARS-CoV-2. We critically appraised the selected studies using the Newcastle-Ottawa quality assessment scale. Results We included 14 viral shedding studies in this systematic review. Positive viral SARS-CoV-2 cultures were detected in samples ranging from 4 days before to 18 days after symptom onset. The daily culture SARS-CoV-2 positivity rate since symptom onset or diagnosis showed a steep decline between day 5 and 9, starting with a peak ranging from 44% to 50% on days -1 to 5, decreasing to 28% on day 7 and 11% on day 9, and finally ranging between 0% and 8% on days 10-17. Conclusions Viral shedding peaked within 5 days since symptom onset or diagnosis and the culture positivity rate rapidly declined hereafter. This systematic review provides an overview of current evidence on the daily SARS-CoV-2 culture positivity rates during the post-vaccination period. These findings could be used to estimate the effectiveness of public health control measures, including treatment and preventive strategies, to reduce the spread of COVID-19.
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Affiliation(s)
| | - Julia R Spinardi
- Vaccine Medical Affairs, Emerging Markets, Pfizer Inc., Itapevi, Brazil
| | | | - Jingyan Yang
- Global Value and Access, Pfizer Inc., New York, USA
| | | | - Moe H Kyaw
- Vaccine Scientific Affairs, Emerging Markets, Pfizer Inc., New York, USA
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van der Zwet W, Klomp-Berens E, Demandt A, Dingemans J, van der Veer B, van Alphen L, Dirks J, Savelkoul P. Analysis of two sequential SARS-CoV-2 outbreaks on a haematology-oncology ward and the role of infection prevention. Infect Prev Pract 2024; 6:100335. [PMID: 38292209 PMCID: PMC10826166 DOI: 10.1016/j.infpip.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 02/01/2024] Open
Abstract
Two SARS-CoV-2 nosocomial outbreaks occurred on the haematology ward of our hospital. Patients on the ward were at high risk for severe infection because of their immunocompromised status. Whole Genome Sequencing proved transmission of a particular SARS-CoV-2 variant in each outbreak. The first outbreak (20 patients/31 healthcare workers (HCW)) occurred in November 2020 and was caused by a variant belonging to lineage B.1.221. At that time, there were still uncertainties on mode of transmission of SARS-CoV-2, and vaccines nor therapy were available. Despite HCW wearing II-R masks in all patient contacts and FFP-2 masks during aerosol generating procedures (AGP), the outbreak continued. Therefore, extra measures were introduced. Firstly, regular PCR-screening of asymptomatic patients and HCW; positive patients were isolated and positive HCW were excluded from work as a rule and they were only allowed to resume their work if a follow-up PCR CT-value was ≥30 and were asymptomatic or having only mild symptoms. Secondly, the use of FFP-2 masks was expanded to some long-lasting, close-contact, non-AGPs. After implementing these measures, the incidence of new cases declined gradually. Thirty-seven percent of patients died due to COVID-19. The second outbreak (10 patients/2 HCW) was caused by the highly transmissible omicron BA.1 variant and occurred in February 2022, where transmission occurred on shared rooms despite the extra infection control measures. It was controlled much faster, and the clinical impact was low as the majority of patients was vaccinated; no patients died and symptoms were relatively mild in both patients and HCW.
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Affiliation(s)
- W.C. van der Zwet
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - E.A. Klomp-Berens
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A.M.P. Demandt
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J. Dingemans
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - B.M.J.W. van der Veer
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - L.B. van Alphen
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - J.A.M.C. Dirks
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - P.H.M. Savelkoul
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
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Badrfam R, Zandifar A, Mohammadian Khonsari N, Qorbani M. Suicidal ideation, burnout, and their correlation among health care workers at the end of the fourth wave of the COVID-19 pandemic in Alborz Province, Iran. Front Psychiatry 2023; 14:1261105. [PMID: 37900293 PMCID: PMC10603268 DOI: 10.3389/fpsyt.2023.1261105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background During the COVID-19 pandemic, Health Care Workers (HCWs) were more vulnerable than ever to Burnout and Suicidal thoughts due to stressful work conditions. This study, investigated the level of Burnout and Suicidal thoughts among HCWs during the fourth wave of the pandemic in Alborz Province in Iran and compared it with the conditions at the beginning of the pandemic. Methods A total of 305 HCWs from 3 referral hospitals for COVID-19, including 155 men and 150 women, participated in the study. A cross-sectional study was carried out with a sample of HCWs dealing with COVID-19 patients using the available sampling method. The results of this online survey, which was conducted from June 7 to July 5, 2021 (at the end of the Fourth Wave of the COVID-19 Pandemic in Iran), have been compared with the conditions of the First Wave of the Pandemic (from February 24 to April 27, 2020). The participants were evaluated by the Beck Scale for Suicidal Ideations (BSSI) and Maslach Burnout Inventory (MBI). Results The mean age of the participants was 36.34 ± 7.37. The means of Suicide Index (SI), Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scores were 0.76 ± 1.74, 19.94 ± 4.69, 4.92 ± 1.51, and 31.30 ± 5.88, respectively. SI and PA were significantly higher in workers other than nurses and physicians and EE was higher among workers with night shifts (p value<0.05 in all indices). Age had a significant and negative correlation with EE (p value<0.01) and DP (p value<0.05) and a significant and positive correlation with PA (p value<0.01). Conclusion This study showed a high level of SI and Burnout indices among HCWs in the fourth wave of the pandemic in Iran. Paying attention to the factors affecting the development of social capital and creating health policy changes may be effective in reducing Burnout indices and high Suicide index among HCWs.
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Affiliation(s)
- Rahim Badrfam
- Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Atefeh Zandifar
- Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Gao Y, Zhao Y, Zhang X, Tian J, Guyatt G, Hao Q. Comparing SARS-CoV-2 testing positivity rates and COVID-19 impact among different isolation strategies: a rapid systematic review and a modelling study. EClinicalMedicine 2023; 61:102058. [PMID: 37360963 PMCID: PMC10285308 DOI: 10.1016/j.eclinm.2023.102058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Background The optimal isolation duration for patients with COVID-19 remains unclear. To support an update of World Health Organization (WHO)'s Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalisation and death among secondary cases. Methods We searched the WHO COVID-19 database for studies up to Feb 27, 2023. We included clinical studies of any design with COVID-19 patients confirmed by PCR test or rapid antigen test addressing the impact of any isolation strategy on preventing the spread of COVID-19. There were no restrictions on publication language, publication status, age of patients, severity of COVID-19, variants of SARS-COV-2, comorbidity of patients, isolation location, or co-interventions. We performed random-effects meta-analyses to summarise testing rates of persistent test positivity rates after COVID-19 infection. We performed pre-specified subgroup analyses by symptom status and meta-regression analyses for the proportion of fully vaccinated patients. We developed a model to compare the effects of three isolation strategies on onward transmission leading to hospitalisation and death. The three isolation strategies were (1) 5-day isolation, with no test to release; (2) removal of isolation based on a negative test; and (3) 10-day isolation, with no test to release. The model incorporates estimates of test positivity rates, effective reproduction number, isolation adherence, false negative rate, and hospitalisation rates or case fatality rates. To assess the impact of varying isolation adherence and false negative rates on rapid antigen testing, we conducted some sensitivity analyses. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. The protocol is registered with PROSPERO (CRD42022348626). Findings Fifteen studies addressing persistent test positivity rates including 4188 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8%-40.0%) had a significantly lower rapid antigen test positive rate than symptomatic patients (68.1%, 95% CI: 40.6%-90.3%) on day 5. The rapid antigen test positive rate was 21.5% (95% CI: 0-64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between 5-day isolation and 10-day isolation in hospitalisations (23 more hospitalisations of secondary cases per 10,000 patients isolated, 95% uncertainty interval (UI) 14 more to 33 more) and mortality (5 more per 10,000 patients, 95% UI 1 to 9 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of 5- versus 10-day isolation was much greater in hospitalisations (RD 186 more per 10,000 patients, 95% UI 113 more to 276 more; very low certainty) and mortality (RD 41 more per 10,000 patients, 95% UI 11 more to 73 more; very low certainty). There may be little or no difference between removing isolation based on a negative antigen test and 10-day isolation in the onward transmission leading to hospitalisation or death, but the average isolation period (mean difference -3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty). Interpretation 5 days versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalisation and mortality; however, in symptomatic patients, the level of onward transmission is concerning and may lead to high hospitalisation and death rates. The evidence is, however, very uncertain. Funding This work was done in collaboration with WHO.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Zhang
- Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Qiukui Hao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Wu Y, Guo Z, Yuan J, Cao G, Wang Y, Gao P, Liu J, Liu M. Duration of viable virus shedding and polymerase chain reaction positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract: a systematic review and meta-analysis. Int J Infect Dis 2023; 129:228-235. [PMID: 36804640 PMCID: PMC9937726 DOI: 10.1016/j.ijid.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES To assess the duration of viable virus shedding and polymerase chain reaction (PCR) positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract. METHODS We systematically searched PubMed, Cochrane, and Web of Science for original articles reporting the duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract from November 11, 2021 to December 11, 2022. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42022357349). We used the DerSimonian-Laird random-effects meta-analyses to obtain the pooled value and the 95% confidence intervals. RESULTS We included 29 studies and 230,227 patients. The pooled duration of viable virus shedding of the SARS-CoV-2 Omicron variant in the upper respiratory tract was 5.16 days (95% CI: 4.18-6.14), and the average duration of PCR positivity was 10.82 days (95% CI: 10.23-11.42). The duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in symptomatic patients was slightly higher than that in asymptomatic patients, but the difference was not significant (P >0.05). CONCLUSION The current study improves our understanding of the status of the literature on the duration of viable virus shedding and PCR positivity of Omicron in the upper respiratory tract. Our findings have implications for pandemic control strategies and infection control measures.
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Affiliation(s)
- Yu Wu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Zirui Guo
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jie Yuan
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Guiying Cao
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Yaping Wang
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Peng Gao
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China.
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