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Park M, Jeong S, Park Y, Kim S, Kim Y, Kim E, Kong SY. Influencing Factors of Delayed Diagnosis of COVID-19 in Gangwon, South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:641. [PMID: 38791855 PMCID: PMC11121085 DOI: 10.3390/ijerph21050641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
This study aimed to identify the time to diagnosis among COVID-19 patients and factors associated with delayed diagnosis (DD). Data from COVID-19 patients in Gangwon, South Korea, diagnosed between 22 February 2020 and 29 January 2022, were analyzed, excluding asymptomatic cases and those who underwent mandatory testing. DD was defined as a period exceeding 2 or more days from symptom recognition to COVID-19 diagnosis. Univariate analysis was performed to investigate the demographic characteristics, COVID-19 symptoms, and underlying medical conditions associated with DD, followed by multivariate logistic regression analysis for significant variables. Among 2683 patients, 584 (21.8%) were diagnosed within a day of symptom onset. DD rates were lower in patients with febrile symptoms but higher among those with cough, myalgia, or anosmia/ageusia. High-risk underlying medical conditions were not significantly associated with DD. Older age groups, the Wonju medical service area, time of diagnosis between November 2020 and July 2021, symptom onset on nonworkdays, and individuals in nonwhite collar sectors were significantly associated with increased DD risks. These findings were consistent in the sensitivity analysis. This study underscores the need for enhanced promotion and system adjustments to ensure prompt testing upon symptom recognition.
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Affiliation(s)
- Minhye Park
- Infectious Disease Control Division, Gangwon State Government, Chuncheon 25425, Gangwon, Republic of Korea;
| | - Seungmin Jeong
- Gangwon State Center for Infectious Diseases (Affiliated to Korea Disease Control and Prevention Agency and, Gangwon State Government), Chuncheon 24280, Gangwon, Republic of Korea; (Y.P.); (S.K.); (Y.K.); (E.K.)
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon 24289, Gangwon, Republic of Korea
| | - Yangjun Park
- Gangwon State Center for Infectious Diseases (Affiliated to Korea Disease Control and Prevention Agency and, Gangwon State Government), Chuncheon 24280, Gangwon, Republic of Korea; (Y.P.); (S.K.); (Y.K.); (E.K.)
| | - Saerom Kim
- Gangwon State Center for Infectious Diseases (Affiliated to Korea Disease Control and Prevention Agency and, Gangwon State Government), Chuncheon 24280, Gangwon, Republic of Korea; (Y.P.); (S.K.); (Y.K.); (E.K.)
| | - Yeojin Kim
- Gangwon State Center for Infectious Diseases (Affiliated to Korea Disease Control and Prevention Agency and, Gangwon State Government), Chuncheon 24280, Gangwon, Republic of Korea; (Y.P.); (S.K.); (Y.K.); (E.K.)
| | - Eunmi Kim
- Gangwon State Center for Infectious Diseases (Affiliated to Korea Disease Control and Prevention Agency and, Gangwon State Government), Chuncheon 24280, Gangwon, Republic of Korea; (Y.P.); (S.K.); (Y.K.); (E.K.)
| | - So Yeon Kong
- Strategic Research, Laerdal Medical, 4002 Stavanger, Norway;
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Khalifeh Z, Saluja S, Lam CN, Kaplan C. Disparities in access to COVID-19 testing in Los Angeles County. Prev Med Rep 2024; 37:102567. [PMID: 38205170 PMCID: PMC10776643 DOI: 10.1016/j.pmedr.2023.102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
COVID-19 has disparately impacted low-income persons and racial and ethnic minorities-primarily Black and Hispanic populations. Our objective is to quantify disparities in access to COVID-19 testing and identify barriers to testing during the winter 2020-2021 surge in COVID-19 infections in Los Angeles County. An online survey was administered between December 2020 and January 2021 through which respondents were asked about their use of COVID testing and the barriers to testing they experienced. Our sample of 1,984 was reweighted to match the demographics of Los Angeles County. Despite similar testing rates to White residents, Hispanic residents were more likely to report testing positive. Persons with an annual income of $20,000 or less were less likely to receive a test than those with an income of $100,000 or more. Barriers to testing were more prevalent among racial/ethnic minorities and low-income persons. White respondents and high-income persons were more likely to report the ability to take time off work to await test results. Rates of testing were not commensurate with the rates of infection across racial/ethnic groups, which may be explained by higher rates of reported barriers to testing among Black and Hispanic residents. These findings may inform policies that address structural barriers to testing that disproportionately impact racial/ethnic minorities and low-income populations.
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Affiliation(s)
- Zain Khalifeh
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sonali Saluja
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cameron Kaplan
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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3
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Bonner C, Batcup C, Cvejic E, Ayre J, Pickles K, Copp T, Cornell S, Nickel B, Dhahir M, McCaffery K. Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments. JMIR Public Health Surveill 2023; 9:e40441. [PMID: 37172319 PMCID: PMC10337324 DOI: 10.2196/40441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. OBJECTIVE We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. METHODS The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). RESULTS In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. CONCLUSIONS This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.
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Affiliation(s)
- Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carys Batcup
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Erin Cvejic
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Ayre
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kristen Pickles
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tessa Copp
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samuel Cornell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mustafa Dhahir
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Blasingame M, Mallett V, Cook M, Im W, Wilus D, Kimbrough R, Ikwuezunma G, Orok E, Reed B, Akanbi V, Amoo-Asante A, Sanderson M. Association of Psychosocial Factors on COVID-19 Testing among YWCA Service Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1297. [PMID: 36674054 PMCID: PMC9859612 DOI: 10.3390/ijerph20021297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to examine how psychosocial factors affect receipt of COVID-19 testing among Black and Hispanic women. In this cross-sectional study of Black and Hispanic women who received services from the YWCAs in Atlanta, El Paso, Nashville, and Tucson between 2019 and 2021 (n = 662), we used Patient-Reported Outcomes Measurement Information Systems (PROMIS) item bank 1.0 short forms to examine the impact of psychosocial factors (i.e., depression, anxiety, social isolation, instrumental support, emotional support, and companionship) on COVID-19 testing. Multivariable logistic regression models were used to estimate odds ratios and 95% confidence intervals for receipt of a COVID-19 test associated with psychosocial factors while adjusting for confounders. There was little effect of moderate/severe depressions or anxiety on receipt of COVID-19 testing. Black (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.26-1.29) and Hispanic (OR 0.61, 95% CI 0.38-0.96) women with high levels of emotional support were less likely to receive the COVID-19 test. While high levels of instrumental support was associated with less likely receipt of the COVID-19 test among Black women (OR 0.75, 95% CI 0.34-1.66), it was associated with more likely receipt among Hispanic women (OR 1.19, 95% CI 0.74-1.92). Our findings suggest that certain psychosocial factors influence one's decision to get a COVID-19 test which can be useful in encouraging preventive healthcare such as screening and vaccination.
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Affiliation(s)
- Miaya Blasingame
- Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Veronica Mallett
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Mekeila Cook
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Wansoo Im
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Derek Wilus
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Robin Kimbrough
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Gini Ikwuezunma
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Ekemini Orok
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Breia Reed
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Victoria Akanbi
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Aurdie Amoo-Asante
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
| | - Maureen Sanderson
- Center for Women’s Health Research, Meharry Medical College, Nashville, TN 37208, USA
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Tang SGH, Hadi MHH, Arsad SR, Ker PJ, Ramanathan S, Afandi NAM, Afzal MM, Yaw MW, Krishnan PS, Chen CP, Tiong SK. Prerequisite for COVID-19 Prediction: A Review on Factors Affecting the Infection Rate. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12997. [PMID: 36293576 PMCID: PMC9602751 DOI: 10.3390/ijerph192012997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Since the year 2020, coronavirus disease 2019 (COVID-19) has emerged as the dominant topic of discussion in the public and research domains. Intensive research has been carried out on several aspects of COVID-19, including vaccines, its transmission mechanism, detection of COVID-19 infection, and its infection rate and factors. The awareness of the public related to the COVID-19 infection factors enables the public to adhere to the standard operating procedures, while a full elucidation on the correlation of different factors to the infection rate facilitates effective measures to minimize the risk of COVID-19 infection by policy makers and enforcers. Hence, this paper aims to provide a comprehensive and analytical review of different factors affecting the COVID-19 infection rate. Furthermore, this review analyses factors which directly and indirectly affect the COVID-19 infection risk, such as physical distance, ventilation, face masks, meteorological factor, socioeconomic factor, vaccination, host factor, SARS-CoV-2 variants, and the availability of COVID-19 testing. Critical analysis was performed for the different factors by providing quantitative and qualitative studies. Lastly, the challenges of correlating each infection risk factor to the predicted risk of COVID-19 infection are discussed, and recommendations for further research works and interventions are outlined.
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Affiliation(s)
- Shirley Gee Hoon Tang
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Muhamad Haziq Hasnul Hadi
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Siti Rosilah Arsad
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Pin Jern Ker
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Santhi Ramanathan
- Faculty of Business, Multimedia University, Jalan Ayer Keroh Lama, Malacca 75450, Malaysia
| | - Nayli Aliah Mohd Afandi
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Madihah Mohd Afzal
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Mei Wyin Yaw
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Prajindra Sankar Krishnan
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Chai Phing Chen
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Sieh Kiong Tiong
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
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El Halabi M, Feghali J, Bahk J, Tallón de Lara P, Narasimhan B, Ho K, Sehmbhi M, Saabiye J, Huang J, Osorio G, Mathew J, Wisnivesky J, Steiger D. A novel evidence-based predictor tool for hospitalization and length of stay: insights from COVID-19 patients in New York city. Intern Emerg Med 2022; 17:1879-1889. [PMID: 35773370 PMCID: PMC9245868 DOI: 10.1007/s11739-022-03014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
Predictive models for key outcomes of coronavirus disease 2019 (COVID-19) can optimize resource utilization and patient outcome. We aimed to design and internally validate a web-based calculator predictive of hospitalization and length of stay (LOS) in a large cohort of COVID-19-positive patients presenting to the Emergency Department (ED) in a New York City health system. The study cohort consisted of consecutive adult (> 18 years) patients presenting to the ED of Mount Sinai Health System hospitals between March 2020 and April 2020, diagnosed with COVID-19. Logistic regression was utilized to construct predictive models for hospitalization and prolonged (> 3 days) LOS. Discrimination was evaluated using area under the receiver operating curve (AUC). Internal validation with bootstrapping was performed, and a web-based calculator was implemented. From 5859 patients, 65% were hospitalized. Independent predictors of hospitalization and extended LOS included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation (p < 0.001). Additional predictors of hospitalization included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. AUCs of 0.881 and 0.770 were achieved for hospitalization and LOS, respectively. Elevated levels of CRP, creatinine, and ferritin were key determinants of hospitalization and LOS (p < 0.05). A calculator was made available under the following URL: https://covid19-outcome-prediction.shinyapps.io/COVID19_Hospitalization_Calculator/ . This study yielded internally validated models that predict hospitalization risk in COVID-19-positive patients, which can be used to optimize resource allocation. Predictors of hospitalization and extended LOS included older age, CKD, fever, oxygen desaturation, elevated C-reactive protein, creatinine, and ferritin.
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Affiliation(s)
- Maan El Halabi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeeyune Bahk
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - Paulino Tallón de Lara
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - Bharat Narasimhan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - Kam Ho
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - Mantej Sehmbhi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY, USA
| | - Joseph Saabiye
- Division of Infectious Disease, Department of Medicine, Mount Sinai Morningside and Mount Sinai West Medical Center, New York, NY, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Georgina Osorio
- Division of Infectious Disease, Department of Medicine, Mount Sinai Morningside and Mount Sinai West Medical Center, New York, NY, USA
| | - Joseph Mathew
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai Morningside and Mount Sinai West Medical Center, New York, NY, 10019, USA
| | - Juan Wisnivesky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - David Steiger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai Morningside and Mount Sinai West Medical Center, New York, NY, 10019, USA.
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7
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Embrett M, Sim SM, Caldwell HAT, Boulos L, Yu Z, Agarwal G, Cooper R, AJ AJG, Bielska IA, Chishtie J, Stone K, Curran J, Tricco A. Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review. BMC Public Health 2022; 22:750. [PMID: 35422031 PMCID: PMC9008387 DOI: 10.1186/s12889-022-13127-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada’s COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers.
Methods
Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing.
Results
From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing).
Conclusion
Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.
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Bevan I, Stage Baxter M, Stagg HR, Street A. Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review. Diagnostics (Basel) 2021; 11:1685. [PMID: 34574026 PMCID: PMC8472251 DOI: 10.3390/diagnostics11091685] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
Testing programs for COVID-19 depend on the voluntary actions of members of the public for their success. Understanding people's knowledge, attitudes, and behavior related to COVID-19 testing is, therefore, key to the design of effective testing programs worldwide. This paper reports on the findings of a rapid scoping review to map the extent, characteristics, and scope of social science research on COVID-19 testing and identifies key themes from the literature. Main findings include the discoveries that people are largely accepting of testing technologies and guidelines and that a sense of social solidarity is a key motivator of testing uptake. The main barriers to accessing and undertaking testing include uncertainty about eligibility and how to access tests, difficulty interpreting symptoms, logistical issues including transport to and from test sites and the discomfort of sample extraction, and concerns about the consequences of a positive result. The review found that existing research was limited in depth and scope. More research employing longitudinal and qualitative methods based in under-resourced settings and examining intersections between testing and experiences of social, political, and economic vulnerability is needed. Last, the findings of this review suggest that testing should be understood as a social process that is inseparable from processes of contact tracing and isolation and is embedded in people's everyday routines, livelihoods and relationships.
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Affiliation(s)
- Imogen Bevan
- School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK;
| | - Mats Stage Baxter
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK; (M.S.B.); (H.R.S.)
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK; (M.S.B.); (H.R.S.)
| | - Alice Street
- School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK;
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Mehta SH, Clipman SJ, Wesolowski A, Solomon SS. Holiday gatherings, mobility and SARS-CoV-2 transmission: results from 10 US states following Thanksgiving. Sci Rep 2021; 11:17328. [PMID: 34462499 PMCID: PMC8405672 DOI: 10.1038/s41598-021-96779-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022] Open
Abstract
Public health officials discouraged travel and non-household gatherings for Thanksgiving, but data suggests that travel increased over the holidays. The objective of this analysis was to assess associations between holiday gatherings and SARS-CoV-2 positivity in the weeks following Thanksgiving. Using an online survey, we sampled 7770 individuals across 10 US states from December 4-18, 2020, about 8-22 days post-Thanksgiving. Participants were asked about Thanksgiving, COVID-19 symptoms, and SARS-CoV-2 testing and positivity in the prior 2 weeks. Logistic regression was used to identify factors associated with SARS-CoV-2 positivity and COVID-19 symptoms in the weeks following Thanksgiving. An activity score measured the total number of non-essential activities an individual participated in the prior 2 weeks. The probability of community transmission was estimated using Markov Chain Monte Carlo (MCMC) methods. While 47.2% had Thanksgiving at home with household members, 26.9% had guests and 25.9% traveled. There was a statistically significant interaction between how people spent Thanksgiving, the frequency of activities, and SARS-CoV-2 test positivity in the prior 2 weeks (p < 0.05). Those who had guests for Thanksgiving or traveled were only more likely to test positive for SARS-CoV-2 if they also had high activity (e.g., participated in > one non-essential activity/day in the prior 2 weeks). Had individuals limited the number and frequency of activities post-Thanksgiving, cases in surveyed individuals would be reduced by > 50%. As travel continues to increase and the more contagious Delta variant starts to dominate transmission, it is critical to promote how to gather in a "low-risk" manner (e.g., minimize other non-essential activities) to mitigate the need for nationwide shelter-at-home orders.
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Affiliation(s)
- Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, Baltimore, MD, 21205, USA.
| | - Steven J Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Cagnazzo F, Arquizan C, Derraz I, Dargazanli C, Lefevre PH, Riquelme C, Gaillard N, Mourand I, Gascou G, Bonafe A, Costalat V. Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature. J Neurol 2021; 268:2656-2665. [PMID: 33125542 PMCID: PMC7597753 DOI: 10.1007/s00415-020-10285-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients METHODS: A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied. RESULTS 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients (p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients. CONCLUSION This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%.
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Affiliation(s)
- Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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11
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Singh A, Gupta V. SARS-CoV-2 therapeutics: how far do we stand from a remedy? Pharmacol Rep 2021; 73:750-768. [PMID: 33389724 PMCID: PMC7778692 DOI: 10.1007/s43440-020-00204-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 02/07/2023]
Abstract
The SARS-CoV-2 has affected millions worldwide and has posed an immediate need for effective pharmacological interventions. Ever since the outbreak was declared, the medical fraternity across the world is facing a unique situation of offering assistance and simultaneously generating reliable data with high-quality evidence to extend the scope of finding a treatment. With no proven vaccine or other interventions available hitherto, there is a frenzied urgency of sharing preliminary data from laboratories and trials to shape a global response against the virus. Several clinical trials with investigational and approved repurposed therapeutics have shown promising results. This review aims to compile the information of the reported molecules approved for emergency use and those under clinical trials and still others with good results in the studies conducted so far. Being an RNA virus, SARS-CoV-2 is prone to mutation; thus, the possibility of gaining resistance to available drugs is high. Consequently, a cocktail therapy based on drug interaction with different stages of its replicative cycle is desirable to reduce the chances of evolving drug resistance. Since this virus encodes several proteins, including 16 nonstructural and 4 structural proteins, this review also offers an insight into potential drug targets within SARS-CoV-2.
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Affiliation(s)
- Anurag Singh
- Department of Microbiology, Ram Lal Anand College, University of Delhi, Benito Juarez Road, New Delhi, 110021, India
| | - Vandana Gupta
- Department of Microbiology, Ram Lal Anand College, University of Delhi, Benito Juarez Road, New Delhi, 110021, India.
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12
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Pilgram L, Eberwein L, Wille K, Koehler FC, Stecher M, Rieg S, Kielstein JT, Jakob CEM, Rüthrich M, Burst V, Prasser F, Borgmann S, Müller RU, Lanznaster J, Isberner N, Tometten L, Dolff S. Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease. Infection 2021; 49:725-737. [PMID: 33851328 PMCID: PMC8043429 DOI: 10.1007/s15010-021-01597-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
Purpose The ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study’s aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD. Methods We analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified. Results Comparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15–65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27–33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66–147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49–54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17–8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13–10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68–1.93, p = 0.611). Conclusion The identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01597-7.
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Affiliation(s)
- Lisa Pilgram
- Department of Internal Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Lukas Eberwein
- 4th Department of Internal Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Kai Wille
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Klinikum, University of Bochum, Minden, Germany
| | - Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany.,Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jan T Kielstein
- Medical Clinic V, Academic Teaching Hospital Braunschweig, Brunswick, Germany
| | - Carolin E M Jakob
- Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Maria Rüthrich
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Volker Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Prasser
- Charite, University Hospital Berlin, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany.,Systems Biology of Ageing Cologne (Sybacol), University of Cologne, Cologne, Germany
| | - Julia Lanznaster
- Department of Internal Medicine 2, Klinikum Passau, Passau, Germany
| | - Nora Isberner
- Division of Infectious Diseases, Department of Medicine II, University of Würzburg Medical Center, Würzburg, Germany
| | - Lukas Tometten
- Department of Gastroenterology and Infectiology, Klinikum Ernst-von-Bergmann, Potsdam, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
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