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Reis de Andrade J, Scourfield E, Peswani-Sajnani SL, Poulton K, ap Rees T, Khooshemehri P, Doherty G, Ong S, Ivan IF, Goudarzi N, Gardiner I, Caine E, Maguire TJA, Leightley D, Torrico L, Gasulla A, Menendez-Vazquez A, Ortega-Prieto AM, Pickering S, Jimenez-Guardeño JM, Batra R, Rubinchik S, Tan AVF, Griffin A, Sherrin D, Papaioannou S, Trouillet C, Mischo HE, Giralt V, Wilson S, Kirk M, Neil SJD, Galao RP, Martindale J, Curtis C, Zuckerman M, Razavi R, Malim MH, Martinez-Nunez RT. KCL TEST: an open-source inspired asymptomatic SARS-CoV-2 surveillance programme in an academic institution. Biol Methods Protoc 2024; 9:bpae046. [PMID: 38993523 PMCID: PMC11238426 DOI: 10.1093/biomethods/bpae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/10/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
Rapid and accessible testing was paramount in the management of the COVID-19 pandemic. Our university established KCL TEST: a SARS-CoV-2 asymptomatic testing programme that enabled sensitive and accessible PCR testing of SARS-CoV-2 RNA in saliva. Here, we describe our learnings and provide our blueprint for launching diagnostic laboratories, particularly in low-resource settings. Between December 2020 and July 2022, we performed 158277 PCRs for our staff, students, and their household contacts, free of charge. Our average turnaround time was 16 h and 37 min from user registration to result delivery. KCL TEST combined open-source automation and in-house non-commercial reagents, which allows for rapid implementation and repurposing. Importantly, our data parallel those of the UK Office for National Statistics, though we detected a lower positive rate and virtually no delta wave. Our observations strongly support regular asymptomatic community testing as an important measure for decreasing outbreaks and providing safe working spaces. Universities can therefore provide agile, resilient, and accurate testing that reflects the infection rate and trend of the general population. Our findings call for the early integration of academic institutions in pandemic preparedness, with capabilities to rapidly deploy highly skilled staff, as well as develop, test, and accommodate efficient low-cost pipelines.
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Affiliation(s)
- Joana Reis de Andrade
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Edward Scourfield
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | | | - Kate Poulton
- Department of Infectious Diseases, King’s College London, London, UK
| | - Thomas ap Rees
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | | | - George Doherty
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
- Department of Infectious Diseases, King’s College London, London, UK
| | - Stephanie Ong
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
- Department of Infectious Diseases, King’s College London, London, UK
| | - Iustina-Francisca Ivan
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
- Department of Infectious Diseases, King’s College London, London, UK
| | - Negin Goudarzi
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
- Department of Infectious Diseases, King’s College London, London, UK
| | - Isaac Gardiner
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Estelle Caine
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Thomas J A Maguire
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
- Department of Infectious Diseases, King’s College London, London, UK
| | - Daniel Leightley
- Department of Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | | | | | | | | | - Suzanne Pickering
- Department of Infectious Diseases, King’s College London, London, UK
| | | | - Rahul Batra
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sona Rubinchik
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Aaron V F Tan
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Amy Griffin
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - David Sherrin
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | | | - Celine Trouillet
- Department of Infectious Diseases, King’s College London, London, UK
| | - Hannah E Mischo
- Department of Infectious Diseases, King’s College London, London, UK
| | - Victoriano Giralt
- Area de Sistemas, Servicio Central de Informática, University of Malaga, Malaga, Spain
| | - Samantha Wilson
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Martin Kirk
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Stuart J D Neil
- Department of Infectious Diseases, King’s College London, London, UK
| | - Rui Pedro Galao
- Department of Infectious Diseases, King’s College London, London, UK
| | - Jo Martindale
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Charles Curtis
- Research Management and Innovation Directorate, KCL TEST, King’s College London, London, UK
| | - Mark Zuckerman
- South London Specialist Virology Centre, King’s College Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, King’s College London, London, UK
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Smy L, Ledeboer NA, Wood MG. At-home testing for respiratory viruses: a minireview of the current landscape. J Clin Microbiol 2024; 62:e0031223. [PMID: 38436246 PMCID: PMC11077999 DOI: 10.1128/jcm.00312-23] [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] [Indexed: 03/05/2024] Open
Abstract
The landscape of at-home testing using over-the-counter (OTC) tests has been evolving over the last decade. The United States Food and Drug Administration Emergency Use Authorization rule has been in effect since the early 2000s, and it was widely employed during the severe acute respiratory syndrome coronavirus 2 pandemic to authorize antigen and nucleic acid detection tests for use in central laboratories as well as OTC. During the pandemic, the first at-home tests for respiratory viruses became available for consumer use, which opened the door for additional respiratory virus OTC tests. Concerns may exist regarding the public's ability to properly collect samples, perform testing, interpret results, and report results to public health authorities. However, favorable comparison studies between OTC testing and centralized laboratory test results suggest that OTC testing may have a place in healthcare, and it is likely here to stay. This mini-review of OTC tests for viral respiratory diseases will briefly cover the regulatory and reimbursement environment, current OTC test availability, as well as the advantages and limitations of OTC tests.
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Affiliation(s)
- Laura Smy
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathan A. Ledeboer
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Macy G. Wood
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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3
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Farkas K, Kevill JL, Adwan L, Garcia-Delgado A, Dzay R, Grimsley JMS, Lambert-Slosarska K, Wade MJ, Williams RC, Martin J, Drakesmith M, Song J, McClure V, Jones DL. Near-source passive sampling for monitoring viral outbreaks within a university residential setting. Epidemiol Infect 2024; 152:e31. [PMID: 38329110 PMCID: PMC10894896 DOI: 10.1017/s0950268824000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Wastewater-based epidemiology (WBE) has proven to be a powerful tool for the population-level monitoring of pathogens, particularly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For assessment, several wastewater sampling regimes and methods of viral concentration have been investigated, mainly targeting SARS-CoV-2. However, the use of passive samplers in near-source environments for a range of viruses in wastewater is still under-investigated. To address this, near-source passive samples were taken at four locations targeting student hall of residence. These were chosen as an exemplar due to their high population density and perceived risk of disease transmission. Viruses investigated were SARS-CoV-2 and its variants of concern (VOCs), influenza viruses, and enteroviruses. Sampling was conducted either in the morning, where passive samplers were in place overnight (17 h) and during the day, with exposure of 7 h. We demonstrated the usefulness of near-source passive sampling for the detection of VOCs using quantitative polymerase chain reaction (qPCR) and next-generation sequencing (NGS). Furthermore, several outbreaks of influenza A and sporadic outbreaks of enteroviruses (some associated with enterovirus D68 and coxsackieviruses) were identified among the resident student population, providing evidence of the usefulness of near-source, in-sewer sampling for monitoring the health of high population density communities.
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Affiliation(s)
- Kata Farkas
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
| | - Jessica L. Kevill
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
| | - Latifah Adwan
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
| | | | - Rande Dzay
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
| | - Jasmine M. S. Grimsley
- Data Analytics & Surveillance Group, UK Health Security Agency, London, UK
- The London Data Company, London, UK
| | | | - Matthew J. Wade
- Data Analytics & Surveillance Group, UK Health Security Agency, London, UK
- School of Engineering, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rachel C. Williams
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
| | - Javier Martin
- Division of Vaccines, Medicines and Healthcare Products Regulatory Agency, Hertfordshire, UK
| | - Mark Drakesmith
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
| | - Jiao Song
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
| | - Victoria McClure
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
| | - Davey L. Jones
- School of Environmental and Natural Sciences, Bangor University, Bangor, UK
- Food Futures Institute, Murdoch University, Murdoch, WA, Australia
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4
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Kennedy B, Varotsis G, Hammar U, Nguyen D, Carrasquilla GD, van Zoest V, Kristiansson RS, Fitipaldi H, Dekkers KF, Daivadanam M, Martinell M, Björk J, Fall T. Sociodemographic characteristics and COVID-19 testing rates: spatiotemporal patterns and impact of test accessibility in Sweden. Eur J Public Health 2024; 34:14-21. [PMID: 38011903 PMCID: PMC10843959 DOI: 10.1093/eurpub/ckad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Diagnostic testing is essential for disease surveillance and test-trace-isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates. METHODS We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8-1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood. RESULTS We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5-69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5-14 years) ranging from 0.56 (95% CI 0.47-0.67) to 0.87 (95% CI 0.80-0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10-18% decrease in inhabitants 15-29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70-105, supporting an intervention effect. CONCLUSIONS Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.
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Affiliation(s)
- Beatrice Kennedy
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Georgios Varotsis
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Diem Nguyen
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Germán D Carrasquilla
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vera van Zoest
- Department of Information Technology, Division of Systems and Control, Uppsala University, Uppsala, Sweden
- Department of Systems Science for Defence and Security, Swedish Defence University, Stockholm, Sweden
| | - Robert S Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hugo Fitipaldi
- Diabetic Complications Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund, Sweden
| | - Koen F Dekkers
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Meena Daivadanam
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mats Martinell
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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5
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Burnside G, Cheyne CP, Leeming G, Humann M, Darby A, Green MA, Crozier A, Maskell S, O’Halloran K, Musi E, Carmi E, Khan N, Fisher D, Corcoran R, Dunning J, Edmunds WJ, Tharmaratnam K, Hughes DM, Malki-Epshtein L, Cook M, Roberts BM, Gallagher E, Howell K, Chand M, Kemp R, Boulter M, Fowler T, Semple MG, Coffey E, Ashton M, García-Fiñana M, Buchan IE. COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region. J R Soc Med 2024; 117:11-23. [PMID: 37351911 PMCID: PMC10858718 DOI: 10.1177/01410768231182389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/25/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks, perceived risks and the feasibility of risk mitigations from experimental mass cultural events before coronavirus disease 2019 (COVID-19) restrictions were lifted. DESIGN Prospective, population-wide observational study. SETTING Four events (two nightclubs, an outdoor music festival and a business conference) open to Liverpool City Region UK residents, requiring a negative lateral flow test (LFT) within the 36 h before the event, but not requiring social distancing or face-coverings. PARTICIPANTS A total of 12,256 individuals attending one or more events between 28 April and 2 May 2021. MAIN OUTCOME MEASURES SARS-CoV-2 infections detected using audience self-swabbed (5-7 days post-event) polymerase chain reaction (PCR) tests, with viral genomic analysis of cases, plus linked National Health Service COVID-19 testing data. Audience experiences were gathered via questionnaires, focus groups and social media. Indoor CO2 concentrations were monitored. RESULTS A total of 12 PCR-positive cases (likely 4 index, 8 primary or secondary), 10 from the nightclubs. Two further cases had positive LFTs but no PCR. A total of 11,896 (97.1%) participants with scanned tickets were matched to a negative pre-event LFT: 4972 (40.6%) returned a PCR within a week. CO2 concentrations showed areas for improving ventilation at the nightclubs. Population infection rates were low, yet with a concurrent outbreak of >50 linked cases around a local swimming pool without equivalent risk mitigations. Audience anxiety was low and enjoyment high. CONCLUSIONS We observed minor SARS-CoV-2 transmission and low perceived risks around events when prevalence was low and risk mitigations prominent. Partnership between audiences, event organisers and public health services, supported by information systems with real-time linked data, can improve health security for mass cultural events.
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Affiliation(s)
- Girvan Burnside
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - Christopher P Cheyne
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - Gary Leeming
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - Michael Humann
- Department of Psychology, University of Liverpool, Liverpool L69 7ZA, UK
| | - Alistair Darby
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool L69 3BX, Liverpool, UK
| | - Alexander Crozier
- Division of Biosciences, University College London, London WC1E 6BT, UK
| | - Simon Maskell
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool L69 3BX, UK
| | - Kay O’Halloran
- Department of Communication and Media, University of Liverpool, Liverpool L69 7ZG, UK
| | - Elena Musi
- Department of Communication and Media, University of Liverpool, Liverpool L69 7ZG, UK
| | - Elinor Carmi
- Department of Sociology and Criminology, City University, London EC1V 0HB, UK
| | - Naila Khan
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Debra Fisher
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Rhiannon Corcoran
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford OX3 7DQ, UK
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Kukatharmini Tharmaratnam
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - David M Hughes
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - Liora Malki-Epshtein
- Department of Civil, Environmental and Geomatic Engineering, University College London, London WC1E 6BT, UK
| | - Malcolm Cook
- Building Energy Research Group, School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough LE11 3TU, UK
| | - Ben M Roberts
- Building Energy Research Group, School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough LE11 3TU, UK
| | - Eileen Gallagher
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
| | - Kate Howell
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
| | - Meera Chand
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
| | - Robin Kemp
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Matthew Boulter
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
| | - Tom Fowler
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Malcolm G Semple
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Emer Coffey
- Liverpool City Council, Liverpool L3 1AH, UK
| | - Matt Ashton
- Liverpool City Council, Liverpool L3 1AH, UK
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GB, UK
| | - The COVID-19 Genomics UK (COG-UK) Consortium
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
- Department of Psychology, University of Liverpool, Liverpool L69 7ZA, UK
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
- Department of Geography and Planning, University of Liverpool L69 3BX, Liverpool, UK
- Division of Biosciences, University College London, London WC1E 6BT, UK
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool L69 3BX, UK
- Department of Communication and Media, University of Liverpool, Liverpool L69 7ZG, UK
- Department of Sociology and Criminology, City University, London EC1V 0HB, UK
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
- Pandemic Sciences Institute, University of Oxford, Oxford OX3 7DQ, UK
- Centre for Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Department of Civil, Environmental and Geomatic Engineering, University College London, London WC1E 6BT, UK
- Building Energy Research Group, School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough LE11 3TU, UK
- Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- Liverpool City Council, Liverpool L3 1AH, UK
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GB, UK
- *Shared senior authorship
| | - Marta García-Fiñana
- Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK
| | - Iain E Buchan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GB, UK
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6
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Martinez-Beneito MA, Marí-Dell'Olmo M, Sánchez-Valdivia N, Rodríguez-Sanz M, Pérez G, Pasarín MI, Rius C, Artazcoz L, Prieto R, Pérez K, Borrell C. Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona. Int J Epidemiol 2023; 52:1687-1695. [PMID: 37494962 DOI: 10.1093/ije/dyad105] [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: 11/10/2022] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. METHODS We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. RESULTS A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. CONCLUSION Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.
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Affiliation(s)
| | - Marc Marí-Dell'Olmo
- Unit of Data Management and Analysis, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
| | | | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of Research, Training and Communication, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Glòria Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of COVID-19, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Isabel Pasarín
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Promotion, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Lucía Artazcoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Observatory, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Raquel Prieto
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Katherine Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Health Information Systems, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Executive Director, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
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Leblanc J, Dusserre-Telmon L, Chauvin A, Simon T, Sabbatini CE, Hemming K, Colizza V, Bérard L, Convert J, Lazazga S, Jegou C, Taibi N, Dautheville S, Zaghia D, Gerlier C, Domergue M, Larrouturou F, Bonnet F, Fontanet A, Salhi S, LeGoff J, Crémieux AC. Intensified screening for SARS-CoV-2 in 18 emergency departments in the Paris metropolitan area, France (DEPIST-COVID): A cluster-randomized, two-period, crossover trial. PLoS Med 2023; 20:e1004317. [PMID: 38060611 PMCID: PMC10735176 DOI: 10.1371/journal.pmed.1004317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/21/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Asymptomatic and paucisymptomatic infections account for a substantial portion of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmissions. The value of intensified screening strategies, especially in emergency departments (EDs), in reaching asymptomatic and paucisymptomatic patients and helping to improve detection and reduce transmission has not been documented. The objective of this study was to evaluate in EDs whether an intensified SARS-CoV-2 screening strategy combining nurse-driven screening for asymptomatic/paucisymptomatic patients with routine practice (intervention) could contribute to higher detection of SARS-CoV-2 infections compared to routine practice alone, including screening for symptomatic or hospitalized patients (control). METHODS AND FINDINGS We conducted a cluster-randomized, two-period, crossover trial from February 2021 to May 2021 in 18 EDs in the Paris metropolitan area, France. All adults visiting the EDs were eligible. At the start of the first period, 18 EDs were randomized to the intervention or control strategy by balanced block randomization with stratification, with the alternative condition being applied in the second period. During the control period, routine screening for SARS-CoV-2 included screening for symptomatic or hospitalized patients. During the intervention period, in addition to routine screening practice, a questionnaire about risk exposure and symptoms and a SARS-CoV-2 screening test were offered by nurses to all remaining asymptomatic/paucisymptomatic patients. The primary outcome was the proportion of newly diagnosed SARS-CoV-2-positive patients among all adults visiting the 18 EDs. Primary analysis was by intention-to-treat. The primary outcome was analyzed using a generalized linear mixed model (Poisson distribution) with the center and center by period as random effects and the strategy (intervention versus control) and period (modeled as a weekly categorical variable) as fixed effects with additional adjustment for community incidence. During the intervention and control periods, 69,248 patients and 69,104 patients, respectively, were included for a total of 138,352 patients. Patients had a median age of 45.0 years [31.0, 63.0], and women represented 45.7% of the patients. During the intervention period, 6,332 asymptomatic/paucisymptomatic patients completed the questionnaire; 4,283 were screened for SARS-CoV-2 by nurses, leading to 224 new SARS-CoV-2 diagnoses. A total of 1,859 patients versus 2,084 patients were newly diagnosed during the intervention and control periods, respectively (adjusted analysis: 26.7/1,000 versus 26.2/1,000, adjusted relative risk: 1.02 (95% confidence interval (CI) [0.94, 1.11]; p = 0.634)). The main limitation of this study is that it was conducted in a rapidly evolving epidemiological context. CONCLUSIONS The results of this study showed that intensified screening for SARS-CoV-2 in EDs was unlikely to identify a higher proportion of newly diagnosed patients. TRIAL REGISTRATION Trial registration number: ClinicalTrials.gov NCT04756609.
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Affiliation(s)
- Judith Leblanc
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St Antoine, Clinical Research Platform Paris-East, Paris, France
| | | | - Anthony Chauvin
- AP-HP, Hôpital Lariboisière, Emergency department; Université Paris Cité, INSERM U942 MASCOT, Paris, France
| | - Tabassome Simon
- AP-HP, Hôpital St Antoine, Clinical Research Platform Paris-East; Sorbonne Université, Department of Clinical Pharmacology, Paris, France
| | - Chiara E. Sabbatini
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Karla Hemming
- University of Birmingham, Institute of Applied Health Research, Birmingham, United Kingdom
| | - Vittoria Colizza
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Laurence Bérard
- AP-HP, Hôpital St Antoine, Clinical Research Platform Paris-East, Paris, France
| | - Jérome Convert
- AP-HP, Hôpital Lariboisière, Emergency department, Paris, France
| | - Sonia Lazazga
- Centre Hospitalier de Gonesse, Emergency department, Gonesse, France
| | - Carole Jegou
- AP-HP, Hôpital Avicenne, Emergency department, Bobigny, France
| | - Nabila Taibi
- AP-HP, Hôpital Pitié-Salpêtrière, Emergency department, Paris, France
| | | | - Damien Zaghia
- AP-HP, Hôpital Beaujon, Emergency department, Clichy, France
| | - Camille Gerlier
- Hôpital Paris St Joseph, Emergency department, Paris, France
| | - Muriel Domergue
- AP-HP, Hôpital Européen Georges Pompidou, Emergency department, Paris, France
| | | | - Florence Bonnet
- AP-HP, Hôpital St Antoine, Emergency department, Paris, France
| | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit; PACRI unit, Conservatoire National des Arts et Métiers, Paris, France
| | - Sarah Salhi
- AP-HP, Hôpital St Antoine, Clinical Research Platform Paris-East, Paris, France
| | - Jérome LeGoff
- Université Paris Cité, INSERM U976, INSIGHT Team; AP-HP, Hôpital St Louis, Virology Department, Paris, France
| | - Anne-Claude Crémieux
- AP-HP, Hôpital St Louis, Infectious Diseases Department; Université Paris Cité, FHU PROTHEE, Paris, France
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Ward T, Morris M, Gelman A, Carpenter B, Ferguson W, Overton C, Fyles M. Bayesian spatial modelling of localised SARS-CoV-2 transmission through mobility networks across England. PLoS Comput Biol 2023; 19:e1011580. [PMID: 37956206 PMCID: PMC10756685 DOI: 10.1371/journal.pcbi.1011580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/29/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023] Open
Abstract
In the early phases of growth, resurgent epidemic waves of SARS-CoV-2 incidence have been characterised by localised outbreaks. Therefore, understanding the geographic dispersion of emerging variants at the start of an outbreak is key for situational public health awareness. Using telecoms data, we derived mobility networks describing the movement patterns between local authorities in England, which we have used to inform the spatial structure of a Bayesian BYM2 model. Surge testing interventions can result in spatio-temporal sampling bias, and we account for this by extending the BYM2 model to include a random effect for each timepoint in a given area. Simulated-scenario modelling and real-world analyses of each variant that became dominant in England were conducted using our BYM2 model at local authority level in England. Simulated datasets were created using a stochastic metapopulation model, with the transmission rates between different areas parameterised using telecoms mobility data. Different scenarios were constructed to reproduce real-world spatial dispersion patterns that could prove challenging to inference, and we used these scenarios to understand the performance characteristics of the BYM2 model. The model performed better than unadjusted test positivity in all the simulation-scenarios, and in particular when sample sizes were small, or data was missing for geographical areas. Through the analyses of emerging variant transmission across England, we found a reduction in the early growth phase geographic clustering of later dominant variants as England became more interconnected from early 2022 and public health interventions were reduced. We have also shown the recent increased geographic spread and dominance of variants with similar mutations in the receptor binding domain, which may be indicative of convergent evolution of SARS-CoV-2 variants.
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Affiliation(s)
- Thomas Ward
- UK Health Security Agency, Infectious Disease Modelling Team, London, United Kingdom
| | - Mitzi Morris
- The University of Columbia, Institute for Social and Economic Research and Policy, New York, New York, United States of America
| | - Andrew Gelman
- The University of Columbia, Department of Statistics, New York, New York, United States of America
| | - Bob Carpenter
- The Flatiron Institute, Centre for Computational Mathematics, New York, New York, United Kingdom
| | - William Ferguson
- UK Health Security Agency, Infectious Disease Modelling Team, London, United Kingdom
| | - Christopher Overton
- UK Health Security Agency, Infectious Disease Modelling Team, London, United Kingdom
- The University of Liverpool, Department of Mathematics, Liverpool, United Kingdom
| | - Martyn Fyles
- UK Health Security Agency, Infectious Disease Modelling Team, London, United Kingdom
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9
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Wood AJ, Sanchez AR, Bessell PR, Wightman R, Kao RR. Assessing the importance of demographic risk factors across two waves of SARS-CoV-2 using fine-scale case data. PLoS Comput Biol 2023; 19:e1011611. [PMID: 38011282 PMCID: PMC10703279 DOI: 10.1371/journal.pcbi.1011611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/07/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
For the long term control of an infectious disease such as COVID-19, it is crucial to identify the most likely individuals to become infected and the role that differences in demographic characteristics play in the observed patterns of infection. As high-volume surveillance winds down, testing data from earlier periods are invaluable for studying risk factors for infection in detail. Observed changes in time during these periods may then inform how stable the pattern will be in the long term. To this end we analyse the distribution of cases of COVID-19 across Scotland in 2021, where the location (census areas of order 500-1,000 residents) and reporting date of cases are known. We consider over 450,000 individually recorded cases, in two infection waves triggered by different lineages: B.1.1.529 ("Omicron") and B.1.617.2 ("Delta"). We use random forests, informed by measures of geography, demography, testing and vaccination. We show that the distributions are only adequately explained when considering multiple explanatory variables, implying that case heterogeneity arose from a combination of individual behaviour, immunity, and testing frequency. Despite differences in virus lineage, time of year, and interventions in place, we find the risk factors remained broadly consistent between the two waves. Many of the observed smaller differences could be reasonably explained by changes in control measures.
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Affiliation(s)
- Anthony J. Wood
- Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
| | - Aeron R. Sanchez
- Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
| | - Paul R. Bessell
- Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
| | - Rebecca Wightman
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Rowland R. Kao
- Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
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10
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McCormick E, Hales G, Ampt F, Alpren C. Equitable access to COVID-19 diagnostics: factors associated with the uptake of rapid antigen testing in Victoria, Australia, January - February 2022. BMC Public Health 2023; 23:1978. [PMID: 37821835 PMCID: PMC10568856 DOI: 10.1186/s12889-023-16838-7] [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: 04/06/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Accessible and accurate diagnostics are critical to control communicable diseases. Uptake of COVID-19 rapid antigen (RA) testing requires physical and financial access to tests, knowledge about usage, motivation, and ability to report results. We sought to understand patterns of and factors associated with RA test uptake in Victoria during a period of high caseload, RA test promotion, and difficulty accessing RA and PCR testing. We hypothesise RA test uptake is indicated by the ratio of cases diagnosed by RA test (probable) to those diagnosed using PCR (confirmed) (p:c). METHODS Analysing case records, trends in p:c were assessed, between regions, sex, age groups, socio-economic strata and cultural diversity. Logistic regression assessed associations between case classification, and median age, postcode-level socio-economic disadvantage, and proportion overseas-born. RESULTS We included 591,789 cases. Mean p:c was lower in socio-economically disadvantaged areas (decile 1 + 2: 0.90 vs. decile 9 + 10: 1.10), and in postcodes where the overseas-born population was above the Victorian average (0.83 vs. 1.05). Conversely, p:c was higher in younger age groups; with no difference between sexes overall. In metropolitan Melbourne, odds of RA test usage increased as socio-economic disadvantage decreased (decile 9 + 10, aOR 1.40, 95%CI 1.37-1.43, vs. decile 1 + 2; p < .001), decreased for cases from areas with a higher overseas-born population (aOR 0.85, 0.83-0.86, p < .001), and with older age. CONCLUSIONS Reduced uptake of RA tests in Victoria is associated with socio-economic disadvantage, cultural diversity, and older age. Equitable access to COVID-19 diagnostics requires elimination of financial barriers, and greater engagement with culturally diverse and older groups. Inequitable RA test uptake may lead to case under-ascertainment, affecting resource allocation, effective control strategy development, in turn impacting COVID-19 morbidity and mortality, and could indicate relative engagement with response initiatives.
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Affiliation(s)
- Erica McCormick
- Western Public Health Unit, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, VIC, 3021, Australia.
| | - Gabrielle Hales
- Western Public Health Unit, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, VIC, 3021, Australia
| | - Frances Ampt
- Western Public Health Unit, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, VIC, 3021, Australia
| | - Charles Alpren
- Western Public Health Unit, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, VIC, 3021, Australia
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Littlecott H, Herd C, O'Rourke J, Chaparro LT, Keeling M, James Rubin G, Fearon E. Effectiveness of testing, contact tracing and isolation interventions among the general population on reducing transmission of SARS-CoV-2: a systematic review. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230131. [PMID: 37611628 PMCID: PMC10446909 DOI: 10.1098/rsta.2023.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
We conducted a systematic literature review of general population testing, contact tracing, case isolation and contact quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented in real-world settings. We designed a broad search strategy and aimed to identify peer-reviewed studies of any design provided there was a quantitative measure of effectiveness on a transmission outcome. Studies that assessed the effect of testing or diagnosis on disease outcomes via treatment, but did not assess a transmission outcome, were not included. We focused on interventions implemented among the general population rather than in specific settings; these were from anywhere in the world and published any time after 1 January 2020 until the end of 2022. From 26 720 titles and abstracts, 1181 were reviewed as full text, and 25 met our inclusion criteria. These 25 studies included one randomized control trial (RCT) and the remaining 24 analysed empirical data and made some attempt to control for confounding. Studies included were categorized by the type of intervention: contact tracing (seven studies); specific testing strategies (12 studies); strategies for isolating cases/contacts (four studies); and 'test, trace, isolate' (TTI) as a part of a package of interventions (two studies). None of the 25 studies were rated at low risk of bias and many were rated as serious risk of bias, particularly due to the likely presence of uncontrolled confounding factors, which was a major challenge in assessing the independent effects of TTI in observational studies. These confounding factors are to be expected from observational studies during an on-going pandemic, when the emphasis was on reducing the epidemic burden rather than trial design. Findings from these 25 studies suggested an important public health role for testing followed by isolation, especially where mass and serial testing was used to reduce transmission. Some of the most compelling analyses came from examining fine-grained within-country data on contact tracing; while broader studies which compared behaviour between countries also often found TTI led to reduced transmission and mortality, this was not universal. There was limited evidence for the benefit of isolation of cases/contacts away from the home environment. One study, an RCT, showed that daily testing of contacts could be a viable strategy to replace lengthy quarantine of contacts. Based on the scarcity of robust empirical evidence, we were not able to draw any firm quantitative conclusions about the quantitative impact of TTI interventions in different epidemic contexts. While the majority of studies found that testing, tracing and isolation reduced transmission, evidence for the scale of this impact is only available for specific scenarios and hence is not necessarily generalizable. Our review therefore emphasizes the need to conduct robust experimental studies that help inform the likely quantitative impact of different TTI interventions on transmission and their optimal design. Work is needed to support such studies in the context of future emerging epidemics, along with assessments of the cost-effectiveness of TTI interventions, which was beyond the scope of this review but will be critical to decision-making. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
- Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Germany
| | - Clare Herd
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - John O'Rourke
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Lina Toncon Chaparro
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Matt Keeling
- Zeeman Institute (SBIDER), Mathematics Institute and School of Life Sciences, University of Warwick, Coventry, UK
- JUNIPER consortium, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Elizabeth Fearon
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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12
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Boivin P, Coulibaly A, Richard Z, Gomes de Medeiros S, Dutra Da Nóbrega RE, de Araujo Oliveira SR, Cloos P, Chabrol F, Ridde V, Zinszer K. Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali. Soc Sci Med 2023; 335:116230. [PMID: 37716184 DOI: 10.1016/j.socscimed.2023.116230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Lara Gautier
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Camille Beaujoin
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada.
| | - Pauline Boivin
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Abdourahmane Coulibaly
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Zoé Richard
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Stéphanie Gomes de Medeiros
- Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife PE 50670-901, Brazil.
| | - Raylson Emanuel Dutra Da Nóbrega
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Sydia Rosana de Araujo Oliveira
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Patrick Cloos
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada; School of Social Work, University of Montréal, 3150 Rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada.
| | - Fanny Chabrol
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Valéry Ridde
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Kate Zinszer
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
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13
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Beale S, Yavlinsky A, Hoskins S, Nguyen V, Byrne T, Fong WLE, Kovar J, Van Tongeren M, Aldridge RW, Hayward A. Between-occupation differences in work-related COVID-19 mitigation strategies over time: Analysis of the Virus Watch Cohort in England and Wales. Scand J Work Environ Health 2023; 49:350-362. [PMID: 37066842 PMCID: PMC10713985 DOI: 10.5271/sjweh.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES COVID-19 mitigations have had a profound impact on workplaces, however, multisectoral comparisons of how work-related mitigations were applied are limited. This study aimed to investigate (i) occupational differences in the usage of key work-related mitigations over time and (ii) workers' perceptions of these mitigations. METHODS Employed/self-employed Virus Watch study participants (N=6279) responded to a mitigation-related online survey covering the periods of December 2020-February 2022. Logistic regression was used to investigate occupation- and time-related differences in the usage of work-related mitigation methods. Participants' perceptions of mitigation methods were investigated descriptively using proportions. RESULTS Usage of work-related mitigation methods differed between occupations and over time, likely reflecting variation in job roles, workplace environments, legislation and guidance. Healthcare workers had the highest predicted probabilities for several mitigations, including reporting frequent hand hygiene [predicted probability across all survey periods 0.61 (95% CI 0.56-0.66)] and always wearing face coverings [predicted probability range 0.71 (95% CI 0.66-0.75) - 0.80 (95% CI 0.76-0.84) across survey periods]. There were significant cross-occupational trends towards reduced mitigations during periods of less stringent national restrictions. The majority of participants across occupations (55-88%) agreed that most mitigations were reasonable and worthwhile even after the relaxation of national restrictions; agreement was lower for physical distancing (39-44%). CONCLUSIONS While usage of work-related mitigations appeared to vary alongside stringency of national restrictions, agreement that most mitigations were reasonable and worthwhile remained substantial. Further investigation into the factors underlying between-occupational differences could assist pandemic planning and prevention of workplace COVID-19 transmission.
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Affiliation(s)
- Sarah Beale
- Institute of Epidemiology and Health Care, University College London, London, UK, WC1E 7HB.
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14
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Landier J, Bassez L, Bendiane MK, Chaud P, Franke F, Nauleau S, Danjou F, Malfait P, Rebaudet S, Gaudart J. Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region. Front Public Health 2023; 11:1162711. [PMID: 37250096 PMCID: PMC10213643 DOI: 10.3389/fpubh.2023.1162711] [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: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. Methods We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. Results We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. Conclusion We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.
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Affiliation(s)
- Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Léa Bassez
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Pascal Chaud
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Florian Franke
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Steve Nauleau
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Fabrice Danjou
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Philippe Malfait
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Marseille, France
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15
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Wang J, Kwan MP, Liu D, Peng X. Assessing the spatial distribution of and inequality in 15-minute PCR test site accessibility in Beijing and Guangzhou, China. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2023; 154:102925. [PMID: 36941950 PMCID: PMC10017274 DOI: 10.1016/j.apgeog.2023.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
China has been planning to construct SARS-CoV-2 antigen testing sites within a 15-min walk in most major cities to timely identify asymptomatic cases and stop the transmission of COVID-19. However, little is known about the spatial distribution of 15-min accessibility to PCR test sites. In this study, we analyze the spatial distribution of and inequality in 15-min accessibility to PCR test sites in two major Chinese cities (Beijing and Guangzhou) based on the cumulative-opportunity model. The results indicate that the current distribution of 15-min accessibility to PCR test sites is satisfactory when normal commuting is not disrupted. However, disruptions of normal commuting (e.g., due to work-from-home restrictions) can negatively influence 15-min accessibility to PCR test sites and increase its inequality. Our study provides policymakers with up-to-date knowledge about the spatial distribution of 15-min accessibility to PCR test sites, identifies the disadvantaged neighborhoods in terms of test site accessibility, and highlights the changes in accessibility and inequality because of travel disruptions.
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Affiliation(s)
- Jianying Wang
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Dong Liu
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Institute of Future Cities, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Xia Peng
- Tourism College, Beijing Union University, Beijing, China
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16
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Supplisson O, Charmet T, Galmiche S, Schaeffer L, Chény O, Lévy A, Jeandet N, Omar F, David C, Mailles A, Fontanet A. SARS-CoV-2 self-test uptake and factors associated with self-testing during Omicron BA.1 and BA.2 waves in France, January to May 2022. Euro Surveill 2023; 28:2200781. [PMID: 37140451 PMCID: PMC10161682 DOI: 10.2807/1560-7917.es.2023.28.18.2200781] [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: 09/28/2022] [Accepted: 03/03/2023] [Indexed: 05/05/2023] Open
Abstract
BackgroundFollowing the SARS-CoV-2 Omicron variant spread, the use of unsupervised antigenic rapid diagnostic tests (self-tests) increased.AimThis study aimed to measure self-test uptake and factors associated with self-testing.MethodsIn this cross-sectional study from 20 January to 2 May 2022, the case series from a case-control study on factors associated with SARS-CoV-2 infection were used to analyse self-testing habits in France. A multivariable quasi-Poisson regression was used to explore the variables associated with self-testing among symptomatic cases who were not contacts of another infected individual. The control series from the same study was used as a proxy for the self-test background rate in the non-infected population of France.ResultsDuring the study period, 179,165 cases who tested positive through supervised tests were recruited. Of these, 64.7% had performed a self-test in the 3 days preceding this supervised test, of which 79,038 (68.2%) were positive. The most frequently reported reason for self-testing was the presence of symptoms (64.6%). Among symptomatic cases who were not aware of being contacts of another case, self-testing was positively associated with being female, higher education, household size, being a teacher and negatively associated with older age, not French by birth, healthcare-related work and immunosuppression. Among the control series, 12% self-tested during the 8 days preceding questionnaire filling, with temporal heterogeneity.ConclusionThe analysis showed high self-test uptake in France with some inequalities which must be addressed through education and facilitated access (cost and availability) for making it a more efficient epidemic control tool.
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Affiliation(s)
- Olivier Supplisson
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology Unit, Paris, France
- Center for Interdisciplinary Research in Biology, Ecology and Evolution of Health team (Collège de France, CNRS/UMR 7241, Inserm U1050), Paris, France
- Sorbonne Université, Paris, France
| | - Tiffany Charmet
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology Unit, Paris, France
| | - Simon Galmiche
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology Unit, Paris, France
- Sorbonne Université, Paris, France
| | - Laura Schaeffer
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology Unit, Paris, France
| | - Olivia Chény
- Institut Pasteur, Université Paris Cité, Clinical Operation Coordination Office, Paris, France
| | - Anne Lévy
- Caisse Nationale d'Assurance Maladie, Paris, France
| | | | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology Unit, Paris, France
- Conservatoire National des Arts et Métiers, unité PACRI, Paris, France
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17
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Kim Y, Donnelly CA, Nouvellet P. Drivers of SARS-CoV-2 testing behaviour: a modelling study using nationwide testing data in England. Nat Commun 2023; 14:2148. [PMID: 37059861 PMCID: PMC10103662 DOI: 10.1038/s41467-023-37813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
During the COVID-19 pandemic, national testing programmes were conducted worldwide on unprecedented scales. While testing behaviour is generally recognised as dynamic and complex, current literature demonstrating and quantifying such relationships is scarce, despite its importance for infectious disease surveillance and control. Here, we characterise the impacts of SARS-CoV-2 transmission, disease susceptibility/severity, risk perception, and public health measures on SARS-CoV-2 PCR testing behaviour in England over 20 months of the pandemic, by linking testing trends to underlying epidemic trends and contextual meta-data within a systematic conceptual framework. The best-fitting model describing SARS-CoV-2 PCR testing behaviour explained close to 80% of the total deviance in NHS test data. Testing behaviour showed complex associations with factors reflecting transmission level, disease susceptibility/severity (e.g. age, dominant variant, and vaccination), public health measures (e.g. testing strategies and lockdown), and associated changes in risk perception, varying throughout the pandemic and differing between infected and non-infected people.
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Affiliation(s)
- Younjung Kim
- Department of Evolution, Behaviour, and Environment, School of Life Sciences, University of Sussex, Brighton, UK
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
- MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Pierre Nouvellet
- Department of Evolution, Behaviour, and Environment, School of Life Sciences, University of Sussex, Brighton, UK.
- MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK.
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18
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Hughes DM, Bird SM, Cheyne CP, Ashton M, Campbell MC, García-Fiñana M, Buchan I. Rapid antigen testing in COVID-19 management for school-aged children: an observational study in Cheshire and Merseyside, UK. J Public Health (Oxf) 2023; 45:e38-e47. [PMID: 35137216 PMCID: PMC8903429 DOI: 10.1093/pubmed/fdac003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Twice weekly lateral flow tests (LFTs) for secondary school children was UK Government policy from 8 March 2021. We evaluate use of LFTs (both supervised at test centres, and home test kits) in school-aged children in Cheshire and Merseyside. METHODS We report (i) number of LFT positives (ii) proportion of LFT positive with confirmatory reverse transcription polymerase chain reaction (PCR) test within 2 days, and (iii) agreement between LFT-positive and confirmatory PCR, and dependence of (i-iii) on COVID-19 prevalence. FINDINGS 1 248 468 LFTs were taken by 211 255 12-18 years old, and 163 914 by 52 116 5-11 years old between 6 November 2020 and 31 July 2021. Five thousand three hundred and fourteen (2.5%) 12-18 years old and 1996 (3.8%) 5-11 years old returned LFT positives, with 3829 (72.1%) and 1535 (76.9%) confirmatory PCRs, and 3357 (87.7%) and 1383 (90.1%) confirmatory PCR-positives, respectively.Monthly proportions of LFT positive with PCR negative varied between 4.7% and 35.3% in 12-18 years old (corresponding proportion of all tests positive: 9.7% and 0.3%).Deprivation and non-White ethnicity were associated with reduced uptake of confirmatory PCR. INTERPRETATION Substantial inequalities in confirmatory testing need more attention to avoid further disadvantage through education loss. When prevalence is low additional measures, including confirmatory testing, are needed. Local Directors of Public Health taking more control over schools testing may be needed. FUNDING DHSC, MRC, NIHR, EPSRC.
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Affiliation(s)
- David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sheila M Bird
- MRC Biostatistics Unit, Cambridge, UK.,Edinburgh University's College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Matthew Ashton
- Department of Public Health, Liverpool City Council, Liverpool, UK
| | | | | | - Iain Buchan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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19
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Risk assessment of SARS-CoV-2 transmission in hospitality employees in a highly frequented tourist area. Heliyon 2022; 8:e12177. [PMID: 36510570 PMCID: PMC9729582 DOI: 10.1016/j.heliyon.2022.e12177] [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: 10/27/2021] [Revised: 02/08/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Right from the start of the COVID pandemic in January 2020, the entire tourism sector was put under immense pressure because of its assumed role in SARS-CoV-2 transmission and infection dynamics. Based on reports of single superspreading events in the early days of the pandemic, the hotel industry appeared in a bad light that impaired a strategic risk-assessment of existing transmission risks between tourists and employees. We prospectively analysed samples of 679 employees of 21 hotels and restaurants from July 2020 to December 2020, a time during which more than 1.5 million tourists visited the Lübeck/Ostholstein Baltic Sea vacation area in Northern Germany. Employees were tested up to three times for an acute SARS-CoV-2 infection (PCR from nasopharyngeal swabs) and the presence of SARS-CoV-2 specific antibodies, and were asked to complete a short questionnaire. Despite the massive increase in tourist influx, no significant increase in SARS-CoV-2 cases was observed amongst employees of the tourism sector from July to September 2020. In a cluster-outbreak analysis of 104 study participants of one single hotel in the Lübeck/Ostholstein region in October 2020 being employed in the low-wage sector "housekeeping" could be determined as major risk factor for becoming infected. In conclusion, in a low incidence setting, touristic activities are safe under COVID-related hygiene measures for both the local population and employees of the tourism sector. Whereas, the field of work is a potential risk factor for increased infection dynamics.
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20
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Green MA, Hungerford DJ, Hughes DM, Garcia-Fiñana M, Turtle L, Cheyne C, Ashton M, Leeming G, Semple MG, Singleton A, Buchan I. Changing patterns of SARS-CoV-2 infection through Delta and Omicron waves by vaccination status, previous infection and neighbourhood deprivation: a cohort analysis of 2.7 M people. BMC Infect Dis 2022; 22:889. [PMID: 36435775 PMCID: PMC9701390 DOI: 10.1186/s12879-022-07878-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Our study examines if SARS-CoV-2 infections varied by vaccination status, if an individual had previously tested positive and by neighbourhood socioeconomic deprivation across the Delta and Omicron epidemic waves of SARS-CoV-2. METHODS Population cohort study using electronic health records for 2.7 M residents in Cheshire and Merseyside, England (3rd June 2021 to 1st March 2022). Our outcome variable was registered positive test for SARS-CoV-2. Explanatory variables were vaccination status, previous registered positive test and neighbourhood socioeconomic deprivation. Cox regression models were used to analyse associations. RESULTS Originally higher SARS-CoV-2 rates in the most socioeconomically deprived neighbourhoods changed to being higher in the least deprived neighbourhoods from the 1st September 2021, and were inconsistent during the Omicron wave. Individuals who were fully vaccinated (two doses) were associated with fewer registered positive tests (e.g., individuals engaged in testing between 1st September and 27th November 2021-Hazards Ratio (HR) = 0.48, 95% Confidence Intervals (CIs) = 0.47-0.50. Individuals with a previous registered positive test were also less likely to have a registered positive test (e.g., individuals engaged in testing between 1st September and 27th November 2021-HR = 0.16, 95% CIs = 0.15-0.18. However, the Omicron period saw smaller effect sizes for both vaccination status and previous registered positive test. CONCLUSIONS Changing patterns of SARS-CoV-2 infections during the Delta and Omicron waves reveals a dynamic pandemic that continues to affect diverse communities in sometimes unexpected ways.
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Affiliation(s)
- Mark A Green
- Department of Geography and Planning, University of Liverpool, Liverpool, UK.
| | - Daniel J Hungerford
- Centre for Global Vaccine Research, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
| | - David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Lance Turtle
- Centre for Global Vaccine Research, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
| | - Christopher Cheyne
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Gary Leeming
- Civic Data Cooperative, University of Liverpool, Liverpool, UK
| | - Malcolm G Semple
- Centre for Global Vaccine Research, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Alex Singleton
- Department of Geography and Planning, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK
- Civic Data Cooperative, University of Liverpool, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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21
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Zhang X, Barr B, Green M, Hughes D, Ashton M, Charalampopoulos D, García-Fiñana M, Buchan I. Impact of community asymptomatic rapid antigen testing on covid-19 related hospital admissions: synthetic control study. BMJ 2022; 379:e071374. [PMID: 36418047 PMCID: PMC9682337 DOI: 10.1136/bmj-2022-071374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the impact of voluntary rapid testing for SARS-CoV-2 antigen in Liverpool city on covid-19 related hospital admissions. DESIGN Synthetic control analysis comparing hospital admissions for small areas in the intervention population with a group of control areas weighted to be similar for past covid-19 related hospital admission rates and sociodemographic factors. SETTING Liverpool city, UK, 6 November 2020 to 2 January 2021, under the intervention of Covid-SMART (systematic meaningful asymptomatic repeated testing) voluntary, open access supervised self-testing with lateral flow devices, compared with control areas selected from the rest of England. POPULATION General population of Liverpool (n=498 042) and a synthetic control population from the rest of England. MAIN OUTCOME MEASURE Weekly covid-19 related hospital admissions for neighbourhoods in England. RESULTS The introduction of community testing was associated with a 43% (95% confidence interval 29% to 57%) reduction (146 (96 to 192) in total) in covid-19 related hospital admissions in Liverpool compared with the synthetic control population (non-adjacent set of neighbourhoods with aggregate trends in covid-19 hospital admissions similar to Liverpool) for the initial period of intensive testing with military assistance in national lockdown from 6 November to 3 December 2020. A 25% (11% to 35%) reduction (239 (104 to 333) in total) was estimated across the overall intervention period (6 November 2020 to 2 January 2021), involving fewer testing centres, before England's national roll-out of community testing, after adjusting for regional differences in tiers of covid-19 restrictions from 3 December 2020 to 2 January 2021. CONCLUSIONS The city-wide pilot of community based asymptomatic testing for SARS-CoV-2 was associated with substantially reduced covid-19 related hospital admissions. Large scale asymptomatic rapid testing for SARS-CoV-2 could help reduce transmission and prevent hospital admissions.
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Affiliation(s)
- Xingna Zhang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - Mark Green
- Department of Geography and Planning, University of Liverpool, Liverpool, UK
| | - David Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | | | | | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
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22
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Gorji H, Lunati I, Rudolf F, Vidondo B, Hardt WD, Jenny P, Engel D, Schneider J, Jamnicki M, Leuthold R, Risch L, Risch M, Bühler M, Sommer A, Caduff A. Results from Canton Grisons of Switzerland suggest repetitive testing reduces SARS-CoV-2 incidence (February-March 2021). Sci Rep 2022; 12:19538. [PMID: 36376420 PMCID: PMC9663184 DOI: 10.1038/s41598-022-23986-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
In February 2021, in response to emergence of more transmissible SARS-CoV-2 virus variants, the Canton Grisons launched a unique RNA mass testing program targeting the labour force in local businesses. Employees were offered weekly tests free of charge and on a voluntary basis. If tested positive, they were required to self-isolate for ten days and their contacts were subjected to daily testing at work. Thereby, the quarantine of contact persons could be waved.Here, we evaluate the effects of the testing program on the tested cohorts. We examined 121,364 test results from 27,514 participants during February-March 2021. By distinguishing different cohorts of employees, we observe a noticeable decrease in the test positivity rate and a statistically significant reduction in the associated incidence rate over the considered period. The reduction in the latter ranges between 18 and 50%. The variability is partly explained by different exposures to exogenous infection sources (e.g., contacts with visiting tourists or cross-border commuters). Our analysis provides the first empirical evidence that applying repetitive mass testing to a real population over an extended period of time can prevent spread of COVID-19 pandemic. However, to overcome logistic, uptake, and adherence challenges it is important that the program is carefully designed and that disease incursion from the population outside of the program is considered and controlled.
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Affiliation(s)
- Hossein Gorji
- Laboratory of Multiscale Studies in Building Physics, Empa, Dübendorf, Switzerland.
| | - Ivan Lunati
- Laboratory of Multiscale Studies in Building Physics, Empa, Dübendorf, Switzerland
| | - Fabian Rudolf
- D-BSSE ETH Zürich, Swiss Institute of Bioinformatics, Basel, Switzerland
- Federal Office of Public Health FOPH, 3097, Bern, Switzerland
| | - Beatriz Vidondo
- Department of Clinical Research and Veterinary Public Health, University of Bern, Bern, Switzerland
| | | | - Patrick Jenny
- Department of Mechanical and Process Engineering, ETH Zürich, Zurich, Switzerland
| | - Doortje Engel
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Jörg Schneider
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Marina Jamnicki
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Rudolf Leuthold
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Lorenz Risch
- Clinical Microbiology, Labormedizinisches Zentrum Dr. Risch, 9470, Buchs, SG, Switzerland
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, 9495, Triesen, Liechtenstein
| | - Martin Risch
- Clinical Microbiology, Labormedizinisches Zentrum Dr. Risch, 9470, Buchs, SG, Switzerland
| | - Martin Bühler
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Adrian Sommer
- Department of Justice, Security and Health, Canton Grisons, Switzerland
| | - Alexa Caduff
- Department of Justice, Security and Health, Canton Grisons, Switzerland
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23
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Swann OV, Lone NI, Harrison EM, Tomlinson LA, Walker AJ, Seaborne MJ, Pollock L, Farrell J, Hall PS, Seth S, Williams TC, Preston J, Ainsworth JS, Semple FF, Baillie JK, Katikireddi SV, Akbari A, Lyons R, Simpson CR, Semple MG, Goldacre B, Brophy S, Sheikh A, Docherty AB. Studying the Long-term Impact of COVID-19 in Kids (SLICK). Healthcare use and costs in children and young people following community-acquired SARS-CoV-2 infection: protocol for an observational study using linked primary and secondary routinely collected healthcare data from England, Scotland and Wales. BMJ Open 2022; 12:e063271. [PMID: 36356998 PMCID: PMC9659708 DOI: 10.1136/bmjopen-2022-063271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION SARS-CoV-2 infection rarely causes hospitalisation in children and young people (CYP), but mild or asymptomatic infections are common. Persistent symptoms following infection have been reported in CYP but subsequent healthcare use is unclear. We aim to describe healthcare use in CYP following community-acquired SARS-CoV-2 infection and identify those at risk of ongoing healthcare needs. METHODS AND ANALYSIS We will use anonymised individual-level, population-scale national data linking demographics, comorbidities, primary and secondary care use and mortality between 1 January 2019 and 1 May 2022. SARS-CoV-2 test data will be linked from 1 January 2020 to 1 May 2022. Analyses will use Trusted Research Environments: OpenSAFELY in England, Secure Anonymised Information Linkage (SAIL) Databank in Wales and Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 in Scotland (EAVE-II). CYP aged ≥4 and <18 years who underwent SARS-CoV-2 reverse transcription PCR (RT-PCR) testing between 1 January 2020 and 1 May 2021 and those untested CYP will be examined.The primary outcome measure is cumulative healthcare cost over 12 months following SARS-CoV-2 testing, stratified into primary or secondary care, and physical or mental healthcare. We will estimate the burden of healthcare use attributable to SARS-CoV-2 infections in the 12 months after testing using a matched cohort study of RT-PCR positive, negative or untested CYP matched on testing date, with adjustment for confounders. We will identify factors associated with higher healthcare needs in the 12 months following SARS-CoV-2 infection using an unmatched cohort of RT-PCR positive CYP. Multivariable logistic regression and machine learning approaches will identify risk factors for high healthcare use and characterise patterns of healthcare use post infection. ETHICS AND DISSEMINATION This study was approved by the South-Central Oxford C Health Research Authority Ethics Committee (13/SC/0149). Findings will be preprinted and published in peer-reviewed journals. Analysis code and code lists will be available through public GitHub repositories and OpenCodelists with meta-data via HDR-UK Innovation Gateway.
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Affiliation(s)
- Olivia V Swann
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Louisa Pollock
- Department of Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - James Farrell
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Peter S Hall
- Institute of Cancer and Genetics, The University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- School of Informatics, The University of Edinburgh, Edinburgh, UK
| | - Thomas C Williams
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Jennifer Preston
- Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
| | - J Samantha Ainsworth
- Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
| | - Freya F Semple
- School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Colin R Simpson
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
- Respiratory Paediatrics, Alder Hey Children's Hospital, Liverpool, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sinead Brophy
- Health Data Research, Swansea University Medical School, Swansea, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Brunner FS, Brown MR, Bassano I, Denise H, Khalifa MS, Wade MJ, van Aerle R, Kevill JL, Jones DL, Farkas K, Jeffries AR, Cairns E, Wierzbicki C, Paterson S. City-wide wastewater genomic surveillance through the successive emergence of SARS-CoV-2 Alpha and Delta variants. WATER RESEARCH 2022; 226:119306. [PMID: 36369689 PMCID: PMC9614697 DOI: 10.1016/j.watres.2022.119306] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 05/08/2023]
Abstract
Genomic surveillance of SARS-CoV-2 has provided a critical evidence base for public health decisions throughout the pandemic. Sequencing data from clinical cases has helped to understand disease transmission and the spread of novel variants. Genomic wastewater surveillance can offer important, complementary information by providing frequency estimates of all variants circulating in a population without sampling biases. Here we show that genomic SARS-CoV-2 wastewater surveillance can detect fine-scale differences within urban centres, specifically within the city of Liverpool, UK, during the emergence of Alpha and Delta variants between November 2020 and June 2021. Furthermore, wastewater and clinical sequencing match well in the estimated timing of new variant rises and the first detection of a new variant in a given area may occur in either clinical or wastewater samples. The study's main limitation was sample quality when infection prevalence was low in spring 2021, resulting in a lower resolution of the rise of the Delta variant compared to the rise of the Alpha variant in the previous winter. The correspondence between wastewater and clinical variant frequencies demonstrates the reliability of wastewater surveillance. However, discrepancies in the first detection of the Alpha variant between the two approaches highlight that wastewater monitoring can also capture missing information, possibly resulting from asymptomatic cases or communities less engaged with testing programmes, as found by a simultaneous surge testing effort across the city.
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Affiliation(s)
- F S Brunner
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 7ZB, UK
| | - M R Brown
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK; School of Engineering, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - I Bassano
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK; Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK
| | - H Denise
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK
| | - M S Khalifa
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK; Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University, London, UB8 3PH, UK
| | - M J Wade
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK; School of Engineering, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - R van Aerle
- International Centre of Excellence for Aquatic Animal Health, Centre for Environment, Fisheries & Aquaculture Science, Dorset, DT4 8UB, UK
| | - J L Kevill
- International Centre of Excellence for Aquatic Animal Health, Centre for Environment, Fisheries & Aquaculture Science, Dorset, DT4 8UB, UK
| | - D L Jones
- International Centre of Excellence for Aquatic Animal Health, Centre for Environment, Fisheries & Aquaculture Science, Dorset, DT4 8UB, UK; Food Futures Institute, Murdoch University, Murdoch WA 6105, Australia
| | - K Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - A R Jeffries
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD, UK
| | - E Cairns
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 7ZB, UK
| | - C Wierzbicki
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 7ZB, UK
| | - S Paterson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, L69 7ZB, UK.
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Dragano N, Dortmann O, Timm J, Mohrmann M, Wehner R, Rupprecht CJ, Scheider M, Mayatepek E, Wahrendorf M. Association of Household Deprivation, Comorbidities, and COVID-19 Hospitalization in Children in Germany, January 2020 to July 2021. JAMA Netw Open 2022; 5:e2234319. [PMID: 36190730 PMCID: PMC9530965 DOI: 10.1001/jamanetworkopen.2022.34319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Adults in disadvantaged socioeconomic positions have elevated risks of a severe course of COVID-19, but it is unclear whether this holds true for children. OBJECTIVE To investigate whether young people from disadvantaged households have a higher risk of COVID-19 hospitalization and whether differences were associated with comorbidities that predispose children to severe courses. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all children and adolescents (aged 0-18 years) who were enrolled in a statutory health insurance carrier in Germany during the observation period of January 1, 2020, to July 13, 2021. Logistic regressions were calculated to compare children from households with and without an indication of poverty. Age, sex, days under observation, nationality, and comorbidities (eg, obesity, diabetes) were controlled for to account for explanatory factors. EXPOSURES Disadvantage on the household level was assessed by the employment status of the insurance holder (ie, employed, long- or short-term unemployed, low-wage employment, economically inactive). Socioeconomic characteristics of the area of residence were also assessed. MAIN OUTCOMES AND MEASURES Daily hospital diagnoses of COVID-19 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes U07.1 and U07.2) were recorded. Comorbidities were assessed using inpatient and outpatient diagnoses contained in the insurance records. RESULTS A total of 688 075 children and adolescents were included, with a mean (SD) age of 8.3 (5.8) years and 333 489 (48.4%) female participants. COVID-19 hospital diagnosis was a rare event (1637 participants [0.2%]). Children whose parents were long-term unemployed were 1.36 (95% CI, 1.22-1.51) times more likely than those with employed parents to be hospitalized. Elevated odds were also found for children whose parents had low-wage employment (odds ratio, 1.29; 95% CI, 1.05-1.58). Those living in low-income areas had 3.02 (95% CI, 1.73-5.28) times higher odds of hospitalization than those in less deprived areas. Comorbidities were associated with hospitalization, but their adjustment did not change main estimates for deprivation. CONCLUSIONS AND RELEVANCE In this cohort study, children who had parents who were unemployed and those who lived in low-income areas were at higher risk of COVID-19 hospitalization. This finding suggests that attention must be paid to children with SARS-CoV-2 from vulnerable families and closer monitoring should be considered. A number of explanatory factors, including comorbidities, were taken into account, but their analysis yielded no clear picture about underlying processes.
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Affiliation(s)
- Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Germany
| | - Olga Dortmann
- Department of Health Management, Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Jörg Timm
- Institute of Virology, Heinrich Heine University, University Hospital and Medical Faculty, University of Duesseldorf, Germany
| | - Matthias Mohrmann
- Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Rosemarie Wehner
- Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Christoph J. Rupprecht
- Department of Health Policy and Health Economics, Allgemeine Ortskrankenkasse Rhineland/Hamburg – Die Gesundheitskasse, Duesseldorf, Germany
| | - Maria Scheider
- Department of Health Management, Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Germany
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26
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Hubert CRJ, Acosta N, Waddell BJM, Hasing ME, Qiu Y, Fuzzen M, Harper NBJ, Bautista MA, Gao T, Papparis C, Van Doorn J, Du K, Xiang K, Chan L, Vivas L, Pradhan P, McCalder J, Low K, England WE, Kuzma D, Conly J, Ryan MC, Achari G, Hu J, Cabaj JL, Sikora C, Svenson L, Zelyas N, Servos M, Meddings J, Hrudey SE, Frankowski K, Parkins MD, Pang XL, Lee BE. Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta, Canada. Emerg Infect Dis 2022. [PMID: 35867051 DOI: 10.1101/2022.03.07.22272055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021-January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.
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Walsh KA, Broderick N, Ahern S, Fawsitt CG, O’Brien KM, Carrigan M, Harrington P, O’Neill M, Smith SM, Spillane S, Teljeur C, Ryan M. Effectiveness of rapid antigen testing for screening of asymptomatic individuals to limit the transmission of SARS-CoV-2: A rapid review. Rev Med Virol 2022; 32:e2350. [PMID: 35348276 PMCID: PMC9111057 DOI: 10.1002/rmv.2350] [Citation(s) in RCA: 2] [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: 12/22/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 01/21/2023]
Abstract
Rapid antigen detection tests (RADTs) offer advantages over gold-standard reverse transcription polymerase chain reaction (RT-PCR) tests in that they are cheaper and provide faster results, thus enabling prompt isolation of positive SARS-CoV-2 cases and quarantine of close contacts. The aim of this study was to collate and synthesise empirical evidence on the effectiveness of rapid antigen testing for the screening (including serial testing) and surveillance of asymptomatic individuals to limit the transmission of SARS-CoV-2. A rapid review was undertaken in MEDLINE (EBSCO), EMBASE (OVID), Cochrane Library, Europe PMC and Google Scholar up until 19 July 2021, supplemented by a grey literature search. Of the identified 1222 records, 19 reports referring to 16 studies were included. Eight included studies examined the effectiveness of RADTs for population-level screening, four for pre-event screening and four for serial testing (schools, a prison, a university sports programme and in care homes). Overall, there is uncertainty regarding the effectiveness of rapid antigen testing for the screening of asymptomatic individuals to limit the transmission of SARS-CoV-2. This uncertainty is due to the inconsistent results, the relatively low number of studies identified, the predominantly observational and/or uncontrolled nature of the study designs used, and concerns regarding methodological quality. Given this uncertainty, more real-world research evidence in relevant settings, which is of good quality and timely, as well as economic evaluation, is required to inform public policy on the widespread use of RADTs in asymptomatic individuals.
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Affiliation(s)
| | | | - Susan Ahern
- Health Information and Quality AuthorityDublinIreland
| | | | | | | | | | | | - Susan M. Smith
- Department of General PracticeRoyal College of Surgeons in IrelandDublinIreland
- Department of Public Health and Primary CareSchool of MedicineTrinity College DublinDublinIreland
| | | | - Conor Teljeur
- Health Information and Quality AuthorityDublinIreland
| | - Máirín Ryan
- Health Information and Quality AuthorityDublinIreland
- Department of Pharmacology & TherapeuticsTrinity College DublinTrinity Health SciencesDublinIreland
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28
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Hubert CRJ, Acosta N, Waddell BJM, Hasing ME, Qiu Y, Fuzzen M, Harper NBJ, Bautista MA, Gao T, Papparis C, Van Doorn J, Du K, Xiang K, Chan L, Vivas L, Pradhan P, McCalder J, Low K, England WE, Kuzma D, Conly J, Ryan MC, Achari G, Hu J, Cabaj JL, Sikora C, Svenson L, Zelyas N, Servos M, Meddings J, Hrudey SE, Frankowski K, Parkins MD, Pang XL, Lee BE. Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta, Canada. Emerg Infect Dis 2022; 28:1770-1776. [PMID: 35867051 PMCID: PMC9423933 DOI: 10.3201/eid2809.220476] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021-January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.
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29
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Berrig C, Andreasen V, Frost Nielsen B. Heterogeneity in testing for infectious diseases. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220129. [PMID: 35600424 PMCID: PMC9114977 DOI: 10.1098/rsos.220129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/28/2022] [Indexed: 05/03/2023]
Abstract
Testing strategies have varied widely between nation states during the COVID-19 pandemic, in intensity as well as methodology. Some countries have mainly performed diagnostic testing while others have opted for mass-screening for the presence of SARS-CoV-2 as well. COVID passport solutions have been introduced, in which access to several aspects of public life requires either testing, proof of vaccination or a combination thereof. This creates a coupling between personal activity levels and testing behaviour which, as we show in a mathematical model, leverages heterogeneous behaviours in a population and turns this heterogeneity from a disadvantage to an advantage for epidemic control.
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Affiliation(s)
- Christian Berrig
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Viggo Andreasen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Bjarke Frost Nielsen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
- Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
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30
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Lamothe AS, Mikanagu R, Cloos P, Ridde V, Zinszer K. Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study. BMC Public Health 2022; 22:749. [PMID: 35422030 PMCID: PMC9008388 DOI: 10.1186/s12889-022-13163-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). METHODS Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. RESULTS Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. CONCLUSIONS These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada.
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada.
| | - Lara Gautier
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- Department of health management, evaluation and policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Camille Beaujoin
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Ashley Savard Lamothe
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Rachel Mikanagu
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Patrick Cloos
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- School of Social Work, University of Montréal, Montréal, Canada
| | - Valéry Ridde
- Centre Population et Développement, Institut de recherche pour le développement (IRD), Université de Paris, Paris, France
| | - Kate Zinszer
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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Witte AK, Grosch J, Conrady B, Schomakers L, Grohmann M. Free PoC Testing for SARS-CoV-2 in Germany: Factors Expanding Access to Various Communities in a Medium-Sized City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084721. [PMID: 35457587 PMCID: PMC9027734 DOI: 10.3390/ijerph19084721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022]
Abstract
During the third wave of the COVID-19 (coronavirus disease 2019) pandemic in Germany, free SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) point-of-care (PoC) antigen tests were offered to citizens at least once a week to prevent spreading by asymptomatic infected individuals. This study investigated user groups, timing, frequency, and test center locations in a typical medium-sized European city. We analyzed 27,369 pseudonymized datasets from eight centers over 12 weeks. Those were evaluated according to age, residence, appointment, and potential repeated test occurrence. The centers were visited by different groups; some centers were preferred by a predominantly younger demographic, whereas a mobile option attracted an older age group by reaching districts with few other testing possibilities. Elderly individuals were tested more spontaneously than younger individuals, and a test center at a ‘park and ride’ had more spontaneous visitors from outside of the city compared to other test locations. Only a small proportion of less than 4% came for testing more than five times. To preferably address many people for voluntary antigen testing, it is crucial to offer different test opportunities accounting for individual behavioral patterns, despite this requiring more complex and costly design than conventional forms.
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Affiliation(s)
- Anna Kristina Witte
- HTK Hygiene Technologie Kompetenzzentrum GmbH, Heinrichstr. 6, 96047 Bamberg, Germany; (J.G.); (L.S.); (M.G.)
- Correspondence:
| | - Janina Grosch
- HTK Hygiene Technologie Kompetenzzentrum GmbH, Heinrichstr. 6, 96047 Bamberg, Germany; (J.G.); (L.S.); (M.G.)
| | - Beate Conrady
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark;
- Complexity Science Hub Vienna, 1080 Vienna, Austria
| | - Lena Schomakers
- HTK Hygiene Technologie Kompetenzzentrum GmbH, Heinrichstr. 6, 96047 Bamberg, Germany; (J.G.); (L.S.); (M.G.)
| | - Marcus Grohmann
- HTK Hygiene Technologie Kompetenzzentrum GmbH, Heinrichstr. 6, 96047 Bamberg, Germany; (J.G.); (L.S.); (M.G.)
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32
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The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020–2021. Arch Public Health 2022; 80:109. [PMID: 35366953 PMCID: PMC8976211 DOI: 10.1186/s13690-022-00856-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/18/2022] [Indexed: 02/08/2023] Open
Abstract
Background In Belgium, current research on socio-economic inequalities in the coronavirus disease 2019 (COVID-19) crisis has mainly focused on excess mortality and data from the first epidemiological wave. The current study adds onto this by examining the association between COVID-19 incidence and area deprivation during the first five wave and interwave periods, thus adding a temporal gradient to the analyses. Methods We use all confirmed COVID-19 cases between March 2020 and June 2021 in Belgium, aggregated at the municipality-level. These data were collected by the national laboratory-based COVID-19 surveillance system. A level of area deprivation was assigned to each Belgian municipality using data of three socio-economic variables: the share of unemployed persons in the active population, the share of households without a car and the share of low-educated persons. The spatio-temporal association between COVID-19 incidence and area deprivation was assessed by performing multivariate negative-binomial regression analyses and computing population attributable fractions. Results A significant association between COVID-19 incidence and area deprivation was found over the entire study period, with the incidence in the most deprived areas predicted to be 24% higher than in the least deprived areas. This effect was dependent on the period during the COVID-19 crisis. The largest socio-economic inequalities in COVID-19 infections could be observed during wave 2 and wave 3, with a clear disadvantage for deprived areas. Conclusion Our results provide new insights into spatio-temporal patterns of socio-economic inequalities in COVID-19 incidence in Belgium. They reveal the existence of inequalities and a shift of these patterns over time. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00856-9.
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Dalili MN, Long J, Wadley E, Sloan J, Cross A, Thomas KH, Morgan G. Who is accessing community lateral flow device testing and why? Characteristics and motivations of individuals participating in COVID-19 community testing in two English local authority areas. BMC Public Health 2022; 22:588. [PMID: 35337297 PMCID: PMC8956328 DOI: 10.1186/s12889-022-12986-4] [Citation(s) in RCA: 4] [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: 10/28/2021] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antigen testing using lateral flow devices (LFDs) plays an important role in the management of the novel coronavirus pandemic of 2019 (COVID-19) by rapidly identifying individuals who are asymptomatically carrying high levels of the virus. By January 2021, LFD community testing sites were set up across English local authority areas to support the management and containment of regional COVID-19 cases, initially targeting essential workers unable to work from home during the national lockdown. This study aimed to examine the characteristics and motivations of individuals accessing community LFD testing across two local authority areas (LAAs) in the South West of England. METHODS Data were collected as part of a service evaluation from December 22nd 2020 until March 15th 2021 for two LAAs. Demographic and postcode data were collected from an online test appointment booking platform and the National Health Service testing service online system, with data accessed from Public Health England. An online survey was sent to individuals who made a testing appointment at an LAA1 site using the online booking platform, consisting of 12 questions to collect data on individual's motivations for and experiences of testing. RESULTS Data were available for individuals who completed 12,516 tests in LAA1 and 12,327 tests in LAA2. Most individuals who engaged with testing were female, working age, white, and worked as early years or education staff, health and social care staff, and supermarket or food production staff. 1249 individuals completed the survey with 60% of respondents reported getting tested for work-related reasons. Individuals first heard about LFD testing through various channels including work, media, and word of mouth, and decided to get tested based on the ease and convenience of testing, workplace communications, and to identify asymptomatic cases to help stop the spread. Most tests were completed by individuals living in less deprived areas based on national deciles of deprivation. CONCLUSIONS While national and local COVID-19 testing strategies have evolved, community and personal LFD testing remains a crucial pillar of the testing strategy. Future studies should collect quantitative and qualitative data from residents to most effectively shape testing offers based on the needs and preferences of their population.
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Affiliation(s)
- Michael N Dalili
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
- South Gloucestershire Council, Yate, UK.
| | - Jo Long
- South Gloucestershire Council, Yate, UK
| | | | | | | | - Kyla H Thomas
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Gloucestershire Council, Yate, UK
| | - Gemma Morgan
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Gloucestershire Council, Yate, UK
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French CE, Denford S, Brooks-Pollock E, Wehling H, Hickman M. Low uptake of COVID-19 lateral flow testing among university students: a mixed methods evaluation. Public Health 2022; 204:54-62. [PMID: 35176622 PMCID: PMC8755476 DOI: 10.1016/j.puhe.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate COVID-19 lateral flow testing (LFT) among asymptomatic university students. STUDY DESIGN This study was a mixed methods evaluation of LFT among University of Bristol students. METHODS We conducted (1) an analysis of testing uptake and exploration of demographic variations in uptake using logistic regression; (2) an online student survey about views on university testing; and (3) qualitative interviews to explore participants' experiences of testing and subsequent behaviour, analysed using a thematic approach. RESULTS A total of 12,391 LFTs were conducted on 8025 of 36,054 (22.3%) students. Only one in 10 students had the recommended two tests. There were striking demographic disparities in uptake with those from ethnic minority groups having lower uptake (e.g. 3% of Chinese students were tested vs 30.7% of White students) and variations by level and year of study (ranging from 5.3% to 33.7%), place of residence (29.0%-35.6%) and faculty (15.2%-32.8%). Differences persisted in multivariable analyses. A total of 436 students completed the online survey, and 20 in-depth interviews were conducted. Barriers to engagement with testing included a lack of awareness, knowledge and understanding, and concerns about the accuracy and safety. Students understood the limitations of LFTs but requested further information about test accuracy. Tests were used to inform behavioural decisions, often in combination with other information, such as the potential for exposure to the virus and perceptions of vulnerability. CONCLUSIONS The low uptake of testing brings into question the role of mass LFT in university settings. Innovative strategies may be needed to increase LFT uptake among students.
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Affiliation(s)
- C E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - S Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; School of Psychological Science, University of Bristol, Bristol BS8 1TU, UK.
| | - E Brooks-Pollock
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; Bristol Veterinary School, University of Bristol, Langford BS40 5DU, UK
| | - H Wehling
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; Behavioural Science & Insights Unit, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Smith LE, Potts HW, Amlôt R, Fear NT, Michie S, Rubin GJ. Who is engaging with lateral flow testing for COVID-19 in the UK? The COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study. BMJ Open 2022; 12:e058060. [PMID: 35144956 PMCID: PMC8845094 DOI: 10.1136/bmjopen-2021-058060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate uptake of lateral flow testing, reporting of test results and psychological, contextual and socio-demographic factors associated with testing. DESIGN A series of four fortnightly online cross-sectional surveys. SETTING Data collected from 19 April 2021 to 2 June 2021. PARTICIPANTS People living in England and Scotland, aged 18 years or over, excluding those who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1600 per survey). MAIN OUTCOME MEASURES Having completed at least one lateral flow test (LFT) in the last 7 days. RESULTS We used binary logistic regressions to investigate factors associated with having taken at least one LFT. Increased uptake of testing was associated with being vaccinated (adjusted ORs (aORs)=1.52-2.45, 95% CI 1.25 to 3.07, analysed separately by vaccine dose), employed (aOR=1.94, 95% CI 1.63 to 2.32), having been out to work in the last week (aOR=2.30, 95% CI 1.94 to 2.73) and working in a sector that adopted LFT early (aOR=2.54, 95% CI 2.14 to 3.02) . Uptake was higher in people who reported cardinal COVID-19 symptoms in the last week (aOR=1.89, 95% CI 1.34 to 2.66). People who had heard more about LFTs (aOR=2.28, 95% CI 2.06 to 2.51) and knew they were eligible to receive regular LFTs (aOR=2.98, 95% CI 2.35 to 3.78) were also more likely to have tested. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case (aOR=0.51, 95% CI 0.47 to 0.55). CONCLUSIONS Uptake of lateral flow testing is low. Encouraging testing through workplaces and places of study is likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing and addressing common misconceptions may drive uptake.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
- UK Health Security Agency, Salisbury, UK
| | - Nicola T Fear
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - G James Rubin
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
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Affiliation(s)
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of applied Health Research, University of Birmingham, Birmingham, UK
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García-Fiñana M, Hughes DM, Cheyne CP, Burnside G, Stockbridge M, Fowler TA, Fowler VL, Wilcox MH, Semple MG, Buchan I. Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study. BMJ 2021; 374:n1637. [PMID: 34230058 PMCID: PMC8259455 DOI: 10.1136/bmj.n1637] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the performance of the SARS-CoV-2 antigen rapid lateral flow test (LFT) versus polymerase chain reaction testing in the asymptomatic general population attending testing centres. DESIGN Observational cohort study. SETTING Community LFT pilot at covid-19 testing sites in Liverpool, UK. PARTICIPANTS 5869 asymptomatic adults (≥18 years) voluntarily attending one of 48 testing sites during 6-29 November 2020. INTERVENTIONS Participants were tested using both an Innova LFT and a quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) test based on supervised self-administered swabbing at testing sites. MAIN OUTCOME MEASURES Sensitivity, specificity, and predictive values of LFT compared with RT-qPCR in an epidemic steady state of covid-19 among adults with no classic symptoms of the disease. RESULTS Of 5869 test results, 22 (0.4%) LFT results and 343 (5.8%) RT-qPCR results were void (that is, when the control line fails to appear within 30 minutes). Excluding the void results, the LFT versus RT-qPCR showed a sensitivity of 40.0% (95% confidence interval 28.5% to 52.4%; 28/70), specificity of 99.9% (99.8% to 99.99%; 5431/5434), positive predictive value of 90.3% (74.2% to 98.0%; 28/31), and negative predictive value of 99.2% (99.0% to 99.4%; 5431/5473). When the void samples were assumed to be negative, a sensitivity was observed for LFT of 37.8% (26.8% to 49.9%; 28/74), specificity of 99.6% (99.4% to 99.8%; 5431/5452), positive predictive value of 84.8% (68.1% to 94.9%; 28/33), and negative predictive value of 93.4% (92.7% to 94.0%; 5431/5814). The sensitivity in participants with an RT-qPCR cycle threshold (Ct) of <18.3 (approximate viral loads >106 RNA copies/mL) was 90.9% (58.7% to 99.8%; 10/11), a Ct of <24.4 (>104 RNA copies/mL) was 69.4% (51.9% to 83.7%; 25/36), and a Ct of >24.4 (<104 RNA copies/mL) was 9.7% (1.9% to 23.7%; 3/34). LFT is likely to detect at least three fifths and at most 998 in every 1000 people with a positive RT-qPCR test result with high viral load. CONCLUSIONS The Innova LFT can be useful for identifying infections among adults who report no symptoms of covid-19, particularly those with high viral load who are more likely to infect others. The number of asymptomatic adults with lower Ct (indicating higher viral load) missed by LFT, although small, should be considered when using single LFT in high consequence settings. Clear and accurate communication with the public about how to interpret test results is important, given the chance of missing some cases, even at high viral loads. Further research is needed to understand how infectiousness is reflected in the viral antigen shedding detected by LFT versus the viral loads approximated by RT-qPCR.
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Affiliation(s)
- Marta García-Fiñana
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Christopher P Cheyne
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Tom A Fowler
- Department of Health and Social Care, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Mark H Wilcox
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Iain Buchan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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