India's resurgence of COVID-19: urgent actions needed

COVID-19 Vaccine Coverage in India: A District-Level Analysis

India implemented the largest COVID-19 vaccination drive in the world, through which it vaccinated the majority of its population. Lessons from the Indian COVID-19 vaccination experience can be invaluable for other LMICs as well as for preparedness for future outbreaks. Our study is designed to explore the factors associated with COVID-19 vaccination coverage in India at the district level. We used data from COVID-19 vaccination in India combined with several other administrative data to create a unique data set that facilitated a spatio-temporal exploratory analysis by uncovering the factors associated with vaccination rates across different vaccination phases and districts. We found evidence that past reported infection rates were positively correlated with COVID-19 vaccination outcomes. Past cumulative COVID-19 deaths as a proportion of district populations were associated with lower COVID-19 vaccination, but the percentage of past reported infection was positively correlated with first-dose COVID-19 vaccination, which might indicate a positive role of higher awareness created by a higher reported infection rate. Districts that on average had a higher population burden per health centre were likely to have lower COVID-19 vaccination rates. Vaccination rates were lower in rural areas relative to urban areas, whereas the association with literacy rate was positive. Districts with a higher percentage of children with complete immunisation were associated with higher COVID-19 vaccination, whereas low vaccination was observed in districts that had higher percentages of wasted children. COVID-19 vaccination was lower among pregnant and lactating women. Higher vaccination was observed among populations with higher blood pressure and hypertension (which were a few of the co-morbidities associated with COVID-19 infection).

Developing a Roadmap for Mass Vaccination of COVID-19 in Iran: A Qualitative Study

BACKGROUND

Nowadays, the Covid-19 pandemic is 1 of the most important challenges worldwide, especially in terms of health. The most important strategy to prevent and control the Covid-19 pandemic is mass vaccination. This study aimed at developing a roadmap for the mass vaccination of COVID-19 in Iran.

METHODS

The current study was conducted using a qualitative approach with a content analysis method. In the first step, the review of literature and documents was carried out by a search in scientific databases. In the next step, the data were amassed via in-depth and semi-structured interviews with experts who were selected purposefully, including policymakers, health care workers, and managers. After this, 3 multidisciplinary expert panels for roadmap development were held.

RESULTS

Based on the literature review, interviews, and 3 stages of an expert panel, the final roadmap was developed with 5 dimensions. These included outcomes, planning and preparation, strategies, and preparation, implementation, monitoring, and evaluation.

CONCLUSIONS

This roadmap was developed to improve mass vaccination during the COVID-19 pandemic. According to our findings, it is strongly recommended that the vaccination roadmap with all the above-mentioned features and comprehensive structure should be applied to mitigate the consequences of the COVID-19 pandemic.

Detecting and mitigating simultaneous waves of COVID-19 infections

The sudden spread of COVID-19 infections in a region can catch its healthcare system by surprise. Can one anticipate such a spread and allow healthcare administrators to prepare for a surge a priori? We posit that the answer lies in distinguishing between two types of waves in epidemic dynamics. The first kind resembles a spatio-temporal diffusion pattern. Its gradual spread allows administrators to marshal resources to combat the epidemic. The second kind is caused by super-spreader events, which provide shocks to the disease propagation dynamics. Such shocks simultaneously affect a large geographical region and leave little time for the healthcare system to respond. We use time-series analysis and epidemiological model estimation to detect and react to such simultaneous waves using COVID-19 data from the time when the B.1.617.2 (Delta) variant of the SARS-CoV-2 virus dominated the spread. We first analyze India's second wave from April to May 2021 that overwhelmed the Indian healthcare system. Then, we analyze data of COVID-19 infections in the United States (US) and countries with a high and low Indian diaspora. We identify the Kumbh Mela festival as the likely super-spreader event, the exogenous shock, behind India's second wave. We show that a multi-area compartmental epidemiological model does not fit such shock-induced disease dynamics well, in contrast to its performance with diffusion-type spread. The insufficient fit to infection data can be detected in the early stages of a shock-wave propagation and can be used as an early warning sign, providing valuable time for a planned healthcare response. Our analysis of COVID-19 infections in the US reveals that simultaneous waves due to super-spreader events in one country (India) can lead to simultaneous waves in other places. The US wave in the summer of 2021 does not fit a diffusion pattern either. We postulate that international travels from India may have caused this wave. To support that hypothesis, we demonstrate that countries with a high Indian diaspora exhibit infection growth soon after India's second wave, compared to countries with a low Indian diaspora. Based on our data analysis, we provide concrete policy recommendations at various stages of a simultaneous wave, including how to avoid it, how to detect it quickly after a potential super-spreader event occurs, and how to proactively contain its spread.

Field Evaluation of the New Rapid NG-Test® SARS-CoV-2 Ag for Diagnosis of COVID-19 in the Emergency Department of an Academic Referral Hospital

Background

As the COVID-19 pandemic resurges affecting large numbers of patients, rapid, and accurate diagnosis using point-of-care tests is very important.

Objectives

To evaluate the NG-Test^® SARS-CoV-2 Ag (NG-Test) immunoassay for qualitative detection of SARS-CoV-2 antigen in nasopharyngeal (NP) and oropharyngeal (OP) samples compared with RT-PCR, in patients attending the Emergencies of an academic referral hospital.

Methods

All adult ambulatory patients presenting to the Emergencies of “Attikon” University hospital (Athens, Greece) within three consecutive hours per day between December 2020 and March 2021 and for whom SARS-CoV-2 PCR testing was requested were included. Two NP and one OP samples obtained from each participant were analyzed to determine the diagnostic performance [sensitivity, specificity, positive/negative predictive values (PPV/NPV)] of the NG-Test (NP/OP swabs) in comparison to the reference RT-PCR (NP swab).

Results

Overall, 134/263 (51%) patients tested were RT-PCR positive, whereof 108 (overall sensitivity 81%, 95% CI 73–87%) were NP NG-Test positive (PPV 99%, NPV 83%) and 68 (overall sensitivity 51%, 95% CI 42–59%) were OP NG-Test positive (PPV 100%, NPV 66%). The test's specificity (95% CI) was 99% (95–100%) and 100% (96–100%) for NP and OP swabs, respectively. The assay's sensitivity (95% CI) for high viral load (C_t ≤25) was 99% (92–100%) and 71% (60–81%) for NP and OP swabs, respectively.

Conclusions

NG-Test using NP swabs detected almost all patients with high viral loads, showing satisfactory performance as a point-of-care test for NP samples obtained from patients with acute infection.

COVID-19 pandemic waves: how prepared is West Africa for managing a high COVID-19 caseload? Urgent actions needed

The ECOWAS Region and the world have learnt a lot in the last year and a half concerning the pandemic. As the pandemic continues to evolve, the region needs to put together all these lessons in other to better protect its people, rebuild its economy and strengthen the regional health security for better regional prosperity. We reviewed the response mounted by the region from January 2020 to July 2021 and the existing body of knowledge. We recommend that the region quickly increase the COVID-19 immunization coverage, sustain the enhance genomic surveillance, improve testing and the strengthen point of entry surveillance.

Development and Efficacy of Lateral Flow Point-of-Care Testing Devices for Rapid and Mass COVID-19 Diagnosis by the Detections of SARS-CoV-2 Antigen and Anti-SARS-CoV-2 Antibodies

The COVID-19 pandemic is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2021. COVID-19 is becoming one of the most fatal pandemics in history and brings a huge challenge to the global healthcare system. Opportune detection, confinement, and early treatment of infected cases present the first step in combating COVID-19. Diagnosis via viral nucleic acid amplification tests (NAATs) is frequently employed and considered the standard procedure. However, with an increasing urge for point-of-care tests, rapid and cheaper immunoassays are widely utilized, such as lateral flow immunoassay (LFIA), which can be used for rapid, early, and large-scale detection of SARS-CoV-2 infection. In this narrative review, the principle and technique of LFIA applied in COVID-19 antigen and antibody detection are introduced. The diagnostic sensitivity and specificity of the commercial LFIA tests are outlined and compared. Generally, LFIA antigen tests for SARS-CoV-2 are less sensitive than viral NAATs, the "gold standard" for clinical COVID-19 diagnosis. However, antigen tests can be used for rapid and mass testing in high-risk congregate housing to quickly identify people with COVID-19, implementing infection prevention and control measures, thus preventing transmission. LFIA anti-SARS-CoV-2 antibody tests, IgM and/or IgG, known as serology tests, are used for identification if a person has previously been exposed to the virus or vaccine immunization. Notably, advanced techniques, such as LFT-based CRISPR-Cas9 and surface-enhanced Raman spectroscopy (SERS), have added new dimensions to the COVID-19 diagnosis and are also discussed in this review.

Strategies for COVID-19 Epidemiological Surveillance in India: Overall Policies Till June 2021

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has gripped the entire world, almost paralysing the human race in its entirety. The virus rapidly transmits via human-to-human medium resulting in a massive increase of patients with COVID-19. In order to curb the spread of the disease, an immediate action of complete lockdown was implemented across the globe. India with a population of over 1.3 billion was not an exception and took the challenge to execute phase-wise lockdown, unlock and partial lockdown activities. In this study, we intend to summarise these different phases that the Government of India (GoI) imposed to fight against SARS-CoV-2 so that it can act as a reference guideline to help controlling future waves of COVID-19 and similar pandemic situations in India.

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge

Together with the ongoing serious COVID-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in COVID-19-recovered patients. Colloquially known as 'black fungus', mucormycosis commonly causes necrosis in the head and neck including the nose, paranasal sinuses, orbits, and facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that it progresses rapidly and diagnosis is often delayed. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found to be linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant, which has spread rapidly throughout the country. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA and UK. We present the findings of a study conducted on COVID-19 associated mucormycosis (CAM) patients, and discuss the associated risk factors to raise awareness for OMFS colleagues.