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Drysdale HRE, Watters DA, Leang Y, N J Thomson B, Brown WA, Wilson A. Victoria's surgical response to the COVID-19 pandemic: the first two years. ANZ J Surg 2023; 93:476-486. [PMID: 36757821 DOI: 10.1111/ans.18311] [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: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
Victoria suffered three major waves during the first two years of the COVID-19 pandemic. Melbourne became the longest locked down city in the world at 267 days. This narrative review documents the chronological waves of COVID-19 in Victoria and key themes influencing the State-wide surgical response. In 2020, Victoria needed to secure supplies of personal protective equipment (PPE) and later, recognizing the importance of aerosol transmission, introduced a respiratory protection program to protect health care workers (HCWs) with fit-tested N-95 masks. It established routine preoperative PCR testing for periods when community prevalence was high and developed strategies to restrict elective surgery when hospital capacity was limited. In 2021, three short-term outbreaks were contained and eliminated whilst vaccination of HCWs and the vulnerable was taking place. A third major wave (Delta) occurred July to November 2021, succeeded by another involving the Omicron variant from December 2021. Planned surgery waiting list numbers, and waiting times for surgery, doubled between March 2020 and March 2022. In early 2022, almost 300 patients underwent surgery when infected with Omicron, with a low mortality (2.6%), though mortality was significantly higher in the unvaccinated (7.3% versus 1.4%). In conclusion, the Victorian response to COVID-19 involved tight state-wide social restrictions, contact tracing, furlough, escalating PPE guidance and respiratory protection. HCW infections were greatly reduced in 2021 compared with 2020. Pre-operative PCR testing gave confidence for emergency and urgent elective surgery to proceed during pandemic waves. Other elective cases were performed as health system capacity allowed, without compromising outcomes.
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Affiliation(s)
- Henry Richard Edward Drysdale
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
- School of Medicine and Health Sciences, Deakin University, Geelong, Victoria, Australia
| | - David Allan Watters
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
- School of Medicine and Health Sciences, Deakin University, Geelong, Victoria, Australia
| | - Yit Leang
- Departmentof Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Benjamin N J Thomson
- Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wendy Ann Brown
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
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de Bock E, Filipe MD, Simmermacher RKJ, Kroese AC, Vriens MR, Richir MC. Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients. BMJ Open 2022; 12:e058389. [PMID: 35798523 PMCID: PMC9263349 DOI: 10.1136/bmjopen-2021-058389] [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] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients. DESIGN Systematic review and meta-analysis. DATA SOURCES Pubmed and Embase databases were searched through 20 February 2022. ELIGIBILITY CRITERIA All COVID-19 articles including preoperative asymptomatic patients were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients. RESULTS Twenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%. CONCLUSIONS The pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | | | - A Christiaan Kroese
- Department of Anaesthesiology, University Medical Centre, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
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Azami M, Moradi Y, Moradkhani A, Aghaei A. SARS-CoV-2 seroprevalence around the world: an updated systematic review and meta-analysis. Eur J Med Res 2022; 27:81. [PMID: 35655237 PMCID: PMC9160514 DOI: 10.1186/s40001-022-00710-2] [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: 03/11/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Covid-19 has been one of the major concerns around the world in the last 2 years. One of the challenges of this disease has been to determine its prevalence. Conflicting results of the serology test in Covid explored the need for an updated meta-analysis on this issue. Thus, this systematic review aimed to estimate the prevalence of global SARS-CoV-2 serology in different populations and geographical areas. METHODS To identify studies evaluating the seroprevalence of SARS-CoV-2, a comprehensive literature search was performed from international databases, including Medline (PubMed), Web of Sciences, Scopus, EMBASE, and CINHAL. RESULTS In this meta-analysis, the results showed that SARS-CoV-2 seroprevalence is between 3 and 15% worldwide. In Eastern Mediterranean, the pooled estimate of seroprevalence SARS-CoV-2 was 15% (CI 95% 5-29%), and in Africa, the pooled estimate was 6% (CI 95% 1-13%). In America, the pooled estimate was 8% (CI 95% 6-11%), and in Europe, the pooled estimate was 5% (CI 95% 4-6%). Also the last region, Western Pacific, the pooled estimate was 3% (CI 95% 2-4%). Besides, we analyzed three of these areas separately. This analysis estimated the prevalence in subgroups such as study population, diagnostic methods, sampling methods, time, perspective, and type of the study. CONCLUSION The present meta-analysis showed that the seroprevalence of SARS-CoV-2 has been between 3 and 15% worldwide. Even considering the low estimate of this rate and the increasing vaccination in the world, many people are still susceptible to SARS-CoV-2.
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Affiliation(s)
- Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Asra Moradkhani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abbas Aghaei
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran.
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Trauer JM, Lydeamore MJ, Dalton GW, Pilcher D, Meehan MT, McBryde ES, Cheng AC, Sutton B, Ragonnet R. Understanding how Victoria, Australia gained control of its second COVID-19 wave. Nat Commun 2021; 12:6266. [PMID: 34725323 PMCID: PMC8560916 DOI: 10.1038/s41467-021-26558-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022] Open
Abstract
During 2020, Victoria was the Australian state hardest hit by COVID-19, but was successful in controlling its second wave through aggressive policy interventions. We calibrated a detailed compartmental model of Victoria's second wave to multiple geographically-structured epidemic time-series indicators. We achieved a good fit overall and for individual health services through a combination of time-varying processes, including case detection, population mobility, school closures, physical distancing and face covering usage. Estimates of the risk of death in those aged ≥75 and of hospitalisation were higher than international estimates, reflecting concentration of cases in high-risk settings. We estimated significant effects for each of the calibrated time-varying processes, with estimates for the individual-level effect of physical distancing of 37.4% (95%CrI 7.2-56.4%) and of face coverings of 45.9% (95%CrI 32.9-55.6%). That the multi-faceted interventions led to the dramatic reversal in the epidemic trajectory is supported by our results, with face coverings likely particularly important.
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Affiliation(s)
- James M Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Michael J Lydeamore
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia
| | - Gregory W Dalton
- Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael T Meehan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia
| | - Brett Sutton
- Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia
| | - Romain Ragonnet
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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MacIntyre CR, Veness B, Berger D, Hamad N, Bari N. Thrombosis with Thrombocytopenia Syndrome (TTS) following AstraZeneca ChAdOx1 nCoV-19 (AZD1222) COVID-19 vaccination - A risk-benefit analysis for people < 60 years in Australia. Vaccine 2021; 39:4784-4787. [PMID: 34272095 PMCID: PMC8270740 DOI: 10.1016/j.vaccine.2021.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
The AstraZeneca ChAdOx1 nCoV-19 (AZD1222) vaccine is associated with Thrombosis with Thrombocytopenia Syndrome (TTS) in 3/100,000 vaccinations with high fatality rates reported in many countries. We conducted a risk-benefit analysis for Australians aged 18-59 years, comparing the risk of vaccination versus infection, and rate of TTS to other vaccines which prompted policy change following rare adverse events - rotavirus, smallpox and oral polio vaccines. COVID-19 deaths over 12 months range from 0 to 417 in current and future worst case scenarios. In the past 15 months 20 COVID-19 deaths occurred in people < 60 years compared to 890 deaths over 60 years. The estimated possible number of TTS cases is 347, with vaccine-related deaths ranging from 17 to 153if 80% of adults 18-59 years are vaccinated. The reported rate of TTS is in the same range as rare but serious adverse events associated with other vaccines that have been subject to policy change. In Australia, the potential risks of the AZD1222 vaccine in younger adults, who are at low risk of dying from COVID-19, may outweigh the benefits.
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Affiliation(s)
| | - Benjamin Veness
- Psychiatry Department, Public hospital, Melbourne, Victoria, Australia
| | | | - Nada Hamad
- St Vincent's Clinical School, University of New South Wales, Australia and University of Notre Dame, Australia
| | - Noor Bari
- Western Sydney Local Health District, NSW, Australia
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Postigo-Martin P, Cantarero-Villanueva I, Lista-Paz A, Castro-Martín E, Arroyo-Morales M, Seco-Calvo J. A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists. J Clin Med 2021; 10:1691. [PMID: 33920035 PMCID: PMC8071011 DOI: 10.3390/jcm10081691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Ana Lista-Paz
- Faculty of Physiotherapy, University of La Coruña, 15006 La Coruña, Spain;
| | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Jesús Seco-Calvo
- Physiotherapy Department, Institute of Biomedicine (IBIOMED), University of Leon, Campus de Vegazana s/n, 24071 Leon, Spain;
- Department of Physiology, Visiting Professor and Researcher of University of the Basque Country, 48940 Leioa, Spain
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Watters DA. Preoperative screening and testing for COVID-19 during Victoria's second wave. ANZ J Surg 2021; 91:6-8. [PMID: 33590623 PMCID: PMC8012980 DOI: 10.1111/ans.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- David A Watters
- Department of Surgery, Deakin University and Barwon Health, Geelong, Victoria, Australia.,Victorian Perioperative Consultative Council, Melbourne, Victoria, Australia
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