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Novelli S, Opatowski L, Manto C, Rahib D, de Lamballerie X, Warszawski J, Meyer L, EpiCoV Study Group OBOT. Risk Factors for Community and Intrahousehold Transmission of SARS-CoV-2: Modeling in a Nationwide French Population-Based Cohort Study, the EpiCoV Study. Am J Epidemiol 2024; 193:134-148. [PMID: 37605838 PMCID: PMC10773479 DOI: 10.1093/aje/kwad174] [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: 12/28/2022] [Revised: 06/05/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
We assessed the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from household and community exposure according to age, family ties, and socioeconomic and living conditions using serological data from a nationwide French population-based cohort study, the Epidémiologie et Conditions de Vie (EpiCoV) Study. A history of SARS-CoV-2 infection was defined by a positive anti-SARS-CoV-2 enzyme-linked immunosorbent assay immunoglobulin G result in November-December 2020. We applied stochastic chain binomial models fitted to the final distribution of household infections to data from 17,983 individuals aged ≥6 years from 8,165 households. Models estimated the competing risks of being infected from community and household exposure. The age group 18-24 years had the highest risk of extrahousehold infection (8.9%, 95% credible interval (CrI): 7.5, 10.4), whereas the oldest (≥75 years) and youngest (6-10 years) age groups had the lowest risk, at 2.6% (95% CrI: 1.8, 3.5) and 3.4% (95% CrI: 1.9, 5.2), respectively. Extrahousehold infection was also associated with socioeconomic conditions. Within households, the probability of person-to-person transmission increased with age, from 10.6% (95% CrI: 5.0, 17.9) among children aged 6-10 years to 43.1% (95% CrI: 32.6, 53.2) among adults aged 65-74 years. Transmission was higher between partners (29.9%, 95% CrI: 25.6, 34.3) and from mother to child (29.1%, 95% CrI: 21.4, 37.3) than between individuals related by other family ties. In 2020 in France, the main factors identified for extrahousehold SARS-CoV-2 infection were age and socioeconomic conditions. Intrahousehold infection mainly depended on age and family ties.
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Affiliation(s)
| | - Lulla Opatowski
- Correspondence to Dr. Lulla Opatowski, Epidemiology and Modelling of Antibiotic Evasion Unit, Institut Pasteur, 25 rue du Docteur Roux, Paris 75015, France (e-mail: )
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Recanatini C, GeurtsvanKessel CH, Pas SD, Broens EM, Maas M, van Mansfeld R, Mutsaers-van Oudheusden AJG, van Rijen M, Schippers EF, Stegeman A, Tami A, Veldkamp KE, Visser H, Voss A, Wegdam-Blans MCA, Wertheim HFL, Wever PC, Koopmans MPG, Kluytmans JAJW, Kluytmans-van den Bergh MFQ. Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in Dutch hospitals after the 2020 first wave: a multicentre cross-sectional study with prospective follow-up. Antimicrob Resist Infect Control 2023; 12:137. [PMID: 38031155 PMCID: PMC10688070 DOI: 10.1186/s13756-023-01324-x] [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: 04/22/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND We aimed to estimate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and describe its determinants and associated symptoms among unvaccinated healthcare workers (HCWs) after the first wave of the pandemic. METHODS HCWs from 13 Dutch hospitals were screened for antibodies against the spike protein of SARS-CoV-2 in June-July 2020 and after three months. Participants completed a retrospective questionnaire on determinants for occupational and community exposure to SARS-CoV-2 and symptoms suggestive of COVID-19 experienced since January 2020. The seroprevalence was calculated per baseline characteristic and symptom at baseline and after follow-up. Adjusted odds ratios (aOR) for seropositivity were determined using logistic regression. RESULTS Among 2328 HCWs, 323 (13.9%) were seropositive at enrolment, 49 of whom (15%) reported no previous symptoms suggestive of COVID-19. During follow-up, only 1% of the tested participants seroconverted. Seroprevalence was higher in younger HCWs compared to the mid-age category (aOR 1.53, 95% CI 1.07-2.18). Nurses (aOR 2.21, 95% CI 1.34-3.64) and administrative staff (aOR 1.87, 95% CI 1.02-3.43) had a higher seroprevalence than physicians. The highest seroprevalence was observed in HCWs in the emergency department (ED) (aOR 1.79, 95% CI 1.10-2.91), the lowest in HCWs in the intensive, high, or medium care units (aOR 0.47, 95% CI 0.31-0.71). Chronic respiratory disease, smoking, and having a dog were independently associated with a lower seroprevalence, while HCWs with diabetes mellitus had a higher seroprevalence. In a multivariable model containing all self-reported symptoms since January 2020, altered smell and taste, fever, general malaise/fatigue, and muscle aches were positively associated with developing antibodies, while sore throat and chills were negatively associated. CONCLUSIONS The SARS-CoV-2 seroprevalence in unvaccinated HCWs of 13 Dutch hospitals was 14% in June-July 2020 and remained stable after three months. A higher seroprevalence was observed in the ED and among nurses, administrative and young staff, and those with diabetes mellitus, while a lower seroprevalence was found in HCWs in intensive, high, or medium care, and those with self-reported lung disease, smokers, and dog owners. A history of altered smell or taste, fever, muscle aches and fatigue were independently associated with the presence of SARS-CoV-2 antibodies in unvaccinated HCWs.
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Affiliation(s)
- Claudia Recanatini
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | - Suzan D Pas
- Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Els M Broens
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Martje Maas
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Miranda van Rijen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Emile F Schippers
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - Arjan Stegeman
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hannah Visser
- Department of Internal Medicine, Beatrix Hospital, Gorinchem, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolijn C A Wegdam-Blans
- Catharina Hospital, Eindhoven, The Netherlands
- Hospital St. Jans Gasthuis, Weert, The Netherlands
- Department of Medical Microbiology, Stichting PAMM, Veldhoven, The Netherlands
| | - Heiman F L Wertheim
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Marion P G Koopmans
- Viroscience Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
- Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands
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Ribeiro RM, Choudhary MC, Deo R, Giganti MJ, Moser C, Ritz J, Greninger AL, Regan J, Flynn JP, Wohl DA, Currier JS, Eron JJ, Hughes MD, Smith DM, Chew KW, Daar ES, Perelson AS, Li JZ. Variant-Specific Viral Kinetics in Acute COVID-19. J Infect Dis 2023; 228:S136-S143. [PMID: 37650233 PMCID: PMC10469346 DOI: 10.1093/infdis/jiad314] [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] [Indexed: 09/01/2023] Open
Abstract
Understanding variant-specific differences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral kinetics may explain differences in transmission efficiency and provide insights on pathogenesis and prevention. We evaluated SARS-CoV-2 kinetics from nasal swabs across multiple variants (Alpha, Delta, Epsilon, Gamma) in placebo recipients of the ACTIV-2/A5401 trial. Delta variant infection led to the highest maximum viral load and shortest time from symptom onset to viral load peak. There were no significant differences in time to viral clearance across the variants. Viral decline was biphasic with first- and second-phase decays having half-lives of 11 hours and 2.5 days, respectively, with differences among variants, especially in the second phase. These results suggest that while variant-specific differences in viral kinetics exist, post-peak viral load all variants appeared to be efficiently cleared by the host. Clinical Trials Registration. NCT04518410.
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Affiliation(s)
- Ruy M Ribeiro
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, New Mexico
| | - Manish C Choudhary
- Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Rinki Deo
- Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Mark J Giganti
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Carlee Moser
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Justin Ritz
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - James Regan
- Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - James P Flynn
- Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - David A Wohl
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Judith S Currier
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph J Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California
| | - Kara W Chew
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Eric S Daar
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, New Mexico
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Pensieroso L, Sommacal A, Spolverini G. Intergenerational coresidence and the Covid-19 pandemic in the United States. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101230. [PMID: 36738638 PMCID: PMC9876014 DOI: 10.1016/j.ehb.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/14/2022] [Accepted: 01/17/2023] [Indexed: 05/06/2023]
Abstract
This paper investigates the relation between intergenerational coresidence and mortality from Covid-19 in 2020. Using a cross-section of U.S. counties, we show that this association is positive, sizeable, significant, and robust to the inclusion of several demographic and socio-economic controls. Furthermore, using evidence from past, pre-pandemic years, we argue that this positive, sizeable and significant association is somewhat specific to the Covid-19 pandemic.
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Affiliation(s)
| | | | - Gaia Spolverini
- IRES/LIDAM, UCLouvain, Belgium; Fonds de la Recherche Scientifique - FNRS, Belgium.
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The spread of SARS-CoV-2 at school through the different pandemic waves: a population-based study in Italy. Eur J Pediatr 2023; 182:173-179. [PMID: 36266518 PMCID: PMC9589607 DOI: 10.1007/s00431-022-04654-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 01/21/2023]
Abstract
UNLABELLED Proactive school closures are often considered an effective strategy by policy-makers and the public to limit SARS-CoV-2 transmission. While evidence on the role of students in the spread is debated, the effects of closures on children's well-being are well known. In the light of this, we aimed to assess viral spread in educational settings, by calculating the rate of secondary infections per school class and identifying factors associated with cluster generation. We conducted a combined longitudinal and cross-sectional population-based study between October 2020 and November 2021. Secondary screening was conducted whenever a SARS-CoV-2 positive subject had been in the school environment in 48 h prior to symptoms onset or on the date of swab, if asymptomatic. The effect of selected variables on COVID-19 cluster generation was assessed by logistic regression. We identified 1623 primary COVID-19 cases. Of these, 72.5% resulted in no secondary case, 15.6% in 1, and 11.9% in 2 + . The probability of generating a 2 + cluster was lower when the index case was a student, rather than school staff (AOR = 0.42; 95%CI: 0.29-0.60). The number of clusters per week was in line with COVID-19 incidence trend in the general population. CONCLUSIONS Index cases at school led to no secondary case in about three out of four times and only to a secondary case in about 15%. School environment does not facilitate viral spread, but rather reflects circulation in the community. Appropriate measures and timely monitoring of cases make school a safe place. Given the effects on children's learning and well-being, it is essential to favour school attendance over distance learning. WHAT IS KNOWN • During the COVID-19 pandemic, most European countries resorted to school closures to counter viral transmission. • Although the scientific debate on the suitability of school closures as a non-pharmaceutical intervention is still open and the role of school children in facilitating the spread of SARS-CoV-2 is not supported by unequivocal evidence, there is now a growing awareness of the impact on children's well-being. WHAT IS NEW • The contribution of educational settings and students in facilitating viral spread appears limited, as exposure to a positive individual in the school environment led to no secondary cases among students in 72% of cases and only one secondary case in about 15%. • The likelihood of generating school clusters was approximately halved when the index case was a student compared to teachers or other school personnel.
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Rudan I, Millington T, Antal K, Grange Z, Fenton L, Sullivan C, Buelo A, Wood R, Woolford L, Swann OV, Murray JL, Cullen LA, Moore E, Haider F, Almaghrabi F, McMenamin J, Agrawal U, Shah SA, Kerr S, Simpson CR, Katikireddi SV, Ritchie SLD, Robertson C, Sheikh SA. BNT162b2 COVID-19 vaccination uptake, safety, effectiveness and waning in children and young people aged 12-17 years in Scotland. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100513. [PMID: 36189425 PMCID: PMC9514975 DOI: 10.1016/j.lanepe.2022.100513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The two-dose BNT162b2 (Pfizer-BioNTech) vaccine has demonstrated high efficacy against COVID-19 disease in clinical trials of children and young people (CYP). Consequently, we investigated the uptake, safety, effectiveness and waning of the protective effect of the BNT162b2 against symptomatic COVID-19 in CYP aged 12-17 years in Scotland. Methods The analysis of the vaccine uptake was based on information from the Turas Vaccination Management Tool, inclusive of Mar 1, 2022. Vaccine safety was evaluated using national data on hospital admissions and General Practice (GP) consultations, through a self-controlled case series (SCCS) design, investigating 17 health outcomes of interest. Vaccine effectiveness (VE) against symptomatic COVID-19 disease for Delta and Omicron variants was estimated using a test-negative design (TND) and S-gene status in a prospective cohort study using the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. The waning of the VE following each dose of BNT162b2 was assessed using a matching process followed by conditional logistic regression. Findings Between Aug 6, 2021 and Mar 1, 2022, 75.9% of the 112,609 CYP aged 16-17 years received the first and 49.0% the second COVID-19 vaccine dose. Among 237,681 CYP aged 12-15 years, the uptake was 64.5% and 37.2%, respectively. For 12-17-year-olds, BNT162b2 showed an excellent safety record, with no increase in hospital stays following vaccination for any of the 17 investigated health outcomes. In the 16-17-year-old group, VE against symptomatic COVID-19 during the Delta period was 64.2% (95% confidence interval [CI] 59.2-68.5) at 2-5 weeks after the first dose and 95.6% (77.0-99.1) at 2-5 weeks after the second dose. The respective VEs against symptomatic COVID-19 in the Omicron period were 22.8% (95% CI -6.4-44.0) and 65.5% (95% CI 56.0-73.0). In children aged 12-15 years, VE against symptomatic COVID-19 during the Delta period was 65.4% (95% CI 61.5-68.8) at 2-5 weeks after the first dose, with no observed cases at 2-5 weeks after the second dose. The corresponding VE against symptomatic COVID-19 during the Omicron period were 30.2% (95% CI 18.4-40.3) and 81.2% (95% CI 77.7-84.2). The waning of the protective effect against the symptomatic disease began after five weeks post-first and post-second dose. Interpretation During the study period, uptake of BNT162b2 in Scotland has covered more than two-thirds of CYP aged 12-17 years with the first dose and about 40% with the second dose. We found no increased likelihood of admission to hospital with a range of health outcomes in the period after vaccination. Vaccination with both doses was associated with a substantial reduction in the risk of COVID-19 symptomatic disease during both the Delta and Omicron periods, but this protection began to wane after five weeks. Funding UK Research and Innovation (Medical Research Council); Research and Innovation Industrial Strategy Challenge Fund; Chief Scientist's Office of the Scottish Government; Health Data Research UK; National Core Studies - Data and Connectivity.
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Affiliation(s)
- Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | - Rachael Wood
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Glasgow, UK
| | - Lana Woolford
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Olivia V. Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK
| | | | | | | | - Fasih Haider
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R. Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
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van der Ploeg T, Gobbens RJJ. Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation. JMIR Public Health Surveill 2022; 8:e38450. [PMID: 36 PMCID: PMC9586255 DOI: 10.2196/38450] [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: 04/02/2022] [Revised: 06/14/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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9
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Schmid A, Anker D, Dubois J, Bureau-Franz I, Piccardi N, Colombo Mottaz S, Cullati S, Chiolero A, Rodondi PY. SARS-CoV-2 infection among employees working from home and on site: An occupational study in Switzerland. Front Public Health 2022; 10:980482. [PMID: 36187688 PMCID: PMC9523570 DOI: 10.3389/fpubh.2022.980482] [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: 06/28/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023] Open
Abstract
During the COVID-19 pandemic, many companies implemented working from home to mitigate the spread of the disease among their employees. Using data from Corona Immunitas Nestlé, a seroepidemiological study conducted among employees from two Nestlé sites in Switzerland, we aimed to investigate whether there was a difference in SARS-CoV-2 infection rates between employees working most of the time from home and employees mobilized in a workplace equipped with a specialized occupational safety unit and strict sanitary measures. We also investigated whether this association was modified by household size, living with children, vulnerability, worries about an infection, and worries about adverse health consequences if infected. Data were collected between 8 December 2020, and 11 February 2021. Previous SARS-CoV-2 infections were ascertained by the presence of anti-SARS-CoV-2 IgG antibodies in the blood. Of the 425 employees included (53% women; mean age 42 years ranging between 21 and 64 years), 37% worked most of the time from home in 2020 and 16% had been infected with SARS-CoV-2. Participants who worked most of the time from home in 2020 had slightly higher odds of being infected with SARS-CoV-2 compared to participants who never or only sometimes worked from home (adjusted OR 1.29, 95% CI 0.73-2.27). The association was stronger in participants living alone or with one other person (adjusted OR 2.62, 95% CI 1.13-6.25). Among participants living with two or more other persons (adjusted OR 0.66, 95% CI 0.30-1.39) and among vulnerable participants (adjusted OR 0.53, 95% CI 0.13-1.93), working from home tended to be associated with lower odds of infection. In conclusion, in a context of strict sanitary measures implemented in the workplace, employees working from home did not seem to be at lower risk of infection compared to those working on site, especially if living alone or with one other person.
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Affiliation(s)
- Alexia Schmid
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland,*Correspondence: Alexia Schmid
| | - Daniela Anker
- Population Health Laboratory PopHealthLab, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | | | | | | | - Stéphane Cullati
- Population Health Laboratory PopHealthLab, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland,Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory PopHealthLab, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland,Institute of Primary Health Care, Faculty of Medicine (BIHAM), University of Bern, Bern, Switzerland,School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Pierre-Yves Rodondi
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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10
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Hilton J, Riley H, Pellis L, Aziza R, Brand SPC, K. Kombe I, Ojal J, Parisi A, Keeling MJ, Nokes DJ, Manson-Sawko R, House T. A computational framework for modelling infectious disease policy based on age and household structure with applications to the COVID-19 pandemic. PLoS Comput Biol 2022; 18:e1010390. [PMID: 36067212 PMCID: PMC9481179 DOI: 10.1371/journal.pcbi.1010390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/16/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
The widespread, and in many countries unprecedented, use of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic has highlighted the need for mathematical models which can estimate the impact of these measures while accounting for the highly heterogeneous risk profile of COVID-19. Models accounting either for age structure or the household structure necessary to explicitly model many NPIs are commonly used in infectious disease modelling, but models incorporating both levels of structure present substantial computational and mathematical challenges due to their high dimensionality. Here we present a modelling framework for the spread of an epidemic that includes explicit representation of age structure and household structure. Our model is formulated in terms of tractable systems of ordinary differential equations for which we provide an open-source Python implementation. Such tractability leads to significant benefits for model calibration, exhaustive evaluation of possible parameter values, and interpretability of results. We demonstrate the flexibility of our model through four policy case studies, where we quantify the likely benefits of the following measures which were either considered or implemented in the UK during the current COVID-19 pandemic: control of within- and between-household mixing through NPIs; formation of support bubbles during lockdown periods; out-of-household isolation (OOHI); and temporary relaxation of NPIs during holiday periods. Our ordinary differential equation formulation and associated analysis demonstrate that multiple dimensions of risk stratification and social structure can be incorporated into infectious disease models without sacrificing mathematical tractability. This model and its software implementation expand the range of tools available to infectious disease policy analysts.
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Affiliation(s)
- Joe Hilton
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - Heather Riley
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
- The Alan Turing Institute for Data Science and Artificial Intelligence, London, United Kingdom
| | - Rabia Aziza
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
| | - Samuel P. C. Brand
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ivy K. Kombe
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - John Ojal
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrea Parisi
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
| | - Matt J. Keeling
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - D. James Nokes
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Zeeman Institue (SBIDER), University of Warwick, Coventry, United Kingdom
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
- The Alan Turing Institute for Data Science and Artificial Intelligence, London, United Kingdom
- IBM Research Europe, Hartree Centre, Daresbury, United Kingdom
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11
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Af Geijerstam A, Mehlig K, Hunsberger M, Åberg M, Lissner L. Children in the household and risk of severe COVID-19 during the first three waves of the pandemic: a prospective registry-based cohort study of 1.5 million Swedish men. BMJ Open 2022; 12:e063640. [PMID: 35953248 PMCID: PMC9378946 DOI: 10.1136/bmjopen-2022-063640] [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: 11/04/2022] Open
Abstract
OBJECTIVE To investigate whether Swedish men living with children had elevated risk for severe COVID-19 or infection with SARS-CoV-2 during the first three waves of the pandemic. DESIGN Prospective registry-based cohort study. PARTICIPANTS 1 557 061 Swedish men undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years. MAIN OUTCOME MEASURES Infection with SARS-CoV-2 and hospitalisation due to COVID-19 from March 2020 to September 2021. RESULTS There was a protective association between preschool children at home and hospitalisation due to COVID-19 during the first and third waves compared with only older or no children at all, with ORs (95% CIs) 0.63 (0.46 to 0.88) and 0.75 (0.68 to 0.94) respectively. No association was observed for living with children 6-12 years old, but for 13-17 years old, the risk increased. Age in 2020 did not explain these associations. Further adjustment for socioeconomic and health factors did not attenuate the results. Exposure to preschool children also had a protective association with testing positive with SARS-CoV-2, with or without hospitalisation, OR=0.91 (95% CI 0.89 to 0.93), while living with children of other ages was associated with increased odds of infection. CONCLUSIONS Cohabiting with preschool children was associated with reduced risk for severe COVID-19. Living with school-age children between 6 and 12 years had no association with severe COVID-19, but sharing the household with teenagers and young adults was associated with elevated risk. Our results are of special interest since preschools and compulsory schools (age 6-15 years) in Sweden did not close in 2020.
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Affiliation(s)
- Agnes Af Geijerstam
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Monica Hunsberger
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
- Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
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12
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Husby A, Corn G, Grove Krause T. SARS-CoV-2 infection in households with and without young children: Nationwide cohort study, Denmark, 27 February 2020 to 26 February 2021. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35959688 PMCID: PMC9373601 DOI: 10.2807/1560-7917.es.2022.27.32.2101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundInfections with seasonally spreading coronaviruses are common among young children during winter months in the northern hemisphere; the immunological response lasts around a year. However, it is not clear if living with young children changes the risk of SARS-CoV-2 infection among adults.AimOur aim was to investigate the association between living in a household with younger children and the risk of SARS-CoV-2 infections and hospitalisation.MethodsIn a nationwide cohort study, we followed all adults in Denmark aged 18 to 60 years from 27 February 2020 to 26 February 2021. Hazard ratios of SARS-CoV-2 infection by number of 10 months to 5 year-old children in the household were estimated using Cox regression adjusted for adult age, sex and other potential confounders. In a sensitivity analysis, we investigated the effect of the children's age.ResultsAmong 450,007 adults living in households with young children, 19,555 were tested positive for SARS-CoV-2, while among 2,628,500 adults without young children in their household, 110,069 were tested positive for SARS-CoV-2 (adjusted hazard ratio (aHR) = 1.10; 95% confidence interval (CI): 1.08-1.12). Among adults with young children, 620 were hospitalised with SARS-CoV-2, while 4,002 adults without children were hospitalised with SARS-CoV-2 (aHR = 0.97; 95% CI: 0.88-1.08). Sensitivity analyses found that an increasing number of younger children substantially increased the risk of SARS-CoV-2 infection but not hospitalisation.ConclusionLiving in a household with young children was associated with a small increased risk of SARS-CoV-2 infection.
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Affiliation(s)
- Anders Husby
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Giulia Corn
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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13
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Patel H, McArdle A, Seaby E, Levin M, Whittaker E. The immunopathogenesis of SARS-CoV-2 infection in children: diagnostics, treatment and prevention. Clin Transl Immunology 2022; 11:e1405. [PMID: 35903804 PMCID: PMC9314314 DOI: 10.1002/cti2.1405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/21/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Symptoms and outcomes for paediatric COVID-19 differ vastly from those for adults, with much lower morbidity and mortality. Immunopathogenesis drives severe outcomes in adults, and it is likely that age-related differences in both the innate and specific immune responses underlie much of the variation. Understanding the protective features of the paediatric immune system may be crucial to better elucidate disease severity in adult COVID-19 and may pave the way for novel therapeutic approaches. However, as well as uncommon cases of severe paediatric acute COVID-19, there have been children who have presented with delayed multisystem inflammation, including cardiac, gastrointestinal, skin, mucosa and central nervous system involvement. The occurrence of coronary artery aneurysms has drawn comparisons with Kawasaki Disease, but similarities with the inflammatory phase of adult acute COVID-19 have also been drawn. In this review, we summarise findings from studies investigating pre-existing immunity, cytokine profiles, innate, B-cell, antibody, T-cell and vaccine responses in children with acute COVID-19 and multisystem inflammation, compared with COVID-19 adults and controls. We further consider the relevance to therapeutics in the context of limited evidence in children and highlight key questions to be answered about the immune response of children to SARS-CoV-2.
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Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Andrew McArdle
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Eleanor Seaby
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Genomic Informatics GroupUniversity of SouthamptonSouthamptonUK
- Translational Genomics GroupBroad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Michael Levin
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
| | - Elizabeth Whittaker
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
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14
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Nash D, Qasmieh S, Robertson M, Rane M, Zimba R, Kulkarni SG, Berry A, You W, Mirzayi C, Westmoreland D, Parcesepe A, Waldron L, Kochhar S, Maroko AR, Grov C. Household factors and the risk of severe COVID-like illness early in the U.S. pandemic. PLoS One 2022; 17:e0271786. [PMID: 35862418 PMCID: PMC9302833 DOI: 10.1371/journal.pone.0271786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. METHODS We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. RESULTS In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings. CONCLUSION Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Saba Qasmieh
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Madhura Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Sarah G. Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Drew Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Angela Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
| | - Andrew R. Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York, United States of America
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York, United States of America
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15
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Author Response to: Letter to Editor in Response to the association between contact with children and the clinical course of COVID-19. Epidemiol Infect 2022; 150:e139. [PMID: 35811426 PMCID: PMC9335903 DOI: 10.1017/s0950268822001133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Jannuzzi P, Panza GA. The Association between Contact with Children and the Clinical Course of COVID-19. Epidemiol Infect 2022; 150:1-23. [PMID: 35249579 PMCID: PMC8943224 DOI: 10.1017/s0950268822000474] [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: 11/03/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
We examined the association between contact with children and the clinical course of COVID-19 among COVID-19-positive adult patients. Participants completed a survey to assess demographics, medical information related to their COVID-19 diagnosis, contact with children at home and at the workplace. Patients were aged 45.68 ± 14.38 years, mostly female (72.1%), 842 were not hospitalized and 167 were hospitalized. At home, there were no differences between groups for the number of child contact hours or total child hours (hours × number of children) per week (P s > 0.05). The number of children at home was greater among patients not hospitalized (P < 0.05), however this was no longer significant after controlling for covariates (P > 0.05). At the workplace, there were no differences between groups (all P s > 0.05). Sub-group analysis found the proportion of patients that were treated in the intensive care unit (ICU) was greater among patients with no child contact (P < 0.05). A secondary analysis found that patients with no child contact had an increased likelihood of thromboembolism (P < 0.05) and a trend towards more overall COVID-19-related complications (P = 0.076). Overall, an association between contact with children and hospitalization was not found when adjusting for covariates. Sub-group analysis indicated a possible protective effect for more severe disease; however, these findings need further study.
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Affiliation(s)
- Peter Jannuzzi
- Integrated Care Partners, Hartford HealthCare, Hartford, CT, USA
- Unionville Pediatrics, LLC, Unionville, CT, USA
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17
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Marchant E, Griffiths L, Crick T, Fry R, Hollinghurst J, James M, Cowley L, Abbasizanjani H, Torabi F, Thompson DA, Kennedy J, Akbari A, Gravenor MB, Lyons RA, Brophy S. COVID-19 mitigation measures in primary schools and association with infection and school staff wellbeing: An observational survey linked with routine data in Wales, UK. PLoS One 2022; 17:e0264023. [PMID: 35226680 PMCID: PMC8884508 DOI: 10.1371/journal.pone.0264023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION School-based COVID-19 mitigation strategies have greatly impacted the primary school day (children aged 3-11) including: wearing face coverings, two metre distancing, no mixing of children, and no breakfast clubs or extra-curricular activities. This study examines these mitigation measures and association with COVID-19 infection, respiratory infection, and school staff wellbeing between October to December 2020 in Wales, UK. METHODS A school staff survey captured self-reported COVID-19 mitigation measures in the school, participant anxiety and depression, and open-text responses regarding experiences of teaching and implementing measures. These survey responses were linked to national-scale COVID-19 test results data to examine association of measures in the school and the likelihood of a positive (staff or pupil) COVID-19 case in the school (clustered by school, adjusted for school size and free school meals using logistic regression). Linkage was conducted through the SAIL (Secure Anonymised Information Linkage) Databank. RESULTS Responses were obtained from 353 participants from 59 primary schools within 15 of 22 local authorities. Having more direct non-household contacts was associated with a higher likelihood of COVID-19 positive case in the school (1-5 contacts compared to none, OR 2.89 (1.01, 8.31)) and a trend to more self-reported cold symptoms. Staff face covering was not associated with a lower odds of school COVID-19 cases (mask vs. no covering OR 2.82 (1.11, 7.14)) and was associated with higher self-reported cold symptoms. School staff reported the impacts of wearing face coverings on teaching, including having to stand closer to pupils and raise their voices to be heard. 67.1% were not able to implement two metre social distancing from pupils. We did not find evidence that maintaining a two metre distance was associated with lower rates of COVID-19 in the school. CONCLUSIONS Implementing, adhering to and evaluating COVID-19 mitigation guidelines is challenging in primary school settings. Our findings suggest that reducing non-household direct contacts lowers infection rates. There was no evidence that face coverings, two metre social distancing or stopping children mixing was associated with lower odds of COVID-19 or cold infection rates in the school. Primary school staff found teaching challenging during COVID-19 restrictions, especially for younger learners and those with additional learning needs.
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Affiliation(s)
- Emily Marchant
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
| | - Lucy Griffiths
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Tom Crick
- School of Education, Swansea University, Swansea, United Kingdom
| | - Richard Fry
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
| | - Joe Hollinghurst
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Michaela James
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
| | - Laura Cowley
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
- Research and Evaluation Division, Public Health Knowledge and Research Directorate, Public Health Wales, Cardiff, United Kingdom
| | - Hoda Abbasizanjani
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Fatemeh Torabi
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Daniel A. Thompson
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Jonathan Kennedy
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
| | - Ashley Akbari
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Michael B. Gravenor
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Ronan A. Lyons
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Sinead Brophy
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
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18
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Wood R, Thomson E, Galbraith R, Gribben C, Caldwell D, Bishop J, Reid M, Shah ASV, Templeton K, Goldberg D, Robertson C, Hutchinson SJ, Colhoun HM, McKeigue PM, McAllister DA. Sharing a household with children and risk of COVID-19: a study of over 300 000 adults living in healthcare worker households in Scotland. Arch Dis Child 2021; 106:1212-1217. [PMID: 33737319 PMCID: PMC7985971 DOI: 10.1136/archdischild-2021-321604] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Children are relatively protected from COVID-19, due to a range of potential mechanisms. We investigated if contact with children also affords adults a degree of protection from COVID-19. DESIGN Cohort study based on linked administrative data. SETTING Scotland. STUDY POPULATION All National Health Service Scotland healthcare workers and their household contacts as of March 2020. MAIN EXPOSURE Number of young children (0-11 years) living in the participant's household. MAIN OUTCOMES COVID-19 requiring hospitalisation, and any COVID-19 (any positive test for SARS-CoV-2) in adults aged ≥18 years between 1 March and 12 October 2020. RESULTS 241 266, 41 198, 23 783 and 3850 adults shared a household with 0, 1, 2 and 3 or more young children, respectively. Over the study period, the risk of COVID-19 requiring hospitalisation was reduced progressively with increasing numbers of household children-fully adjusted HR (aHR) 0.93 per child (95% CI 0.79 to 1.10). The risk of any COVID-19 was similarly reduced, with the association being statistically significant (aHR per child 0.93; 95% CI 0.88 to 0.98). After schools reopened to all children in August 2020, no association was seen between exposure to young children and risk of any COVID-19 (aHR per child 1.03; 95% CI 0.92 to 1.14). CONCLUSION Between March and October 2020, living with young children was associated with an attenuated risk of any COVID-19 and COVID-19 requiring hospitalisation among adults living in healthcare worker households. There was no evidence that living with young children increased adults' risk of COVID-19, including during the period after schools reopened.
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Affiliation(s)
- Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma Thomson
- MRC Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Anoop S V Shah
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate Templeton
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | | - Helen M Colhoun
- Public health Scotland, Glasgow, UK
- Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | | | - David A McAllister
- Public health Scotland, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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19
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Abstract
[Figure: see text].
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK.,Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK. The members of the sKIDs Investigation Team are provided in the supplementary materials
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Verd S, Ramakers J, Vinuela I, Martin-Delgado MI, Prohens A, Díez R. Does breastfeeding protect children from COVID-19? An observational study from pediatric services in Majorca, Spain. Int Breastfeed J 2021; 16:83. [PMID: 34663389 PMCID: PMC8521512 DOI: 10.1186/s13006-021-00430-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/05/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It has been demonstrated that children who had been breastfed remain better protected against various infections, and notably respiratory tract infections, well beyond infancy. Since the role of breastfeeding to explain why children are less affected by COVID-19 has not been studied until now, the aim of this study was to determine whether any history of breastfeeding reduces the incidence rate of COVID-19 in children. METHODS This was a secondary analysis of an observational study on clinical and epidemiological characteristics of pediatric COVID-19 in Majorca. A total of 691 children were recruited during the 5 months of August-December 2020. Eligible participants were children under 14 who were tested for SARS-CoV-2 in pediatric emergency services. The independent explanatory variable was any breastfeeding. Bivariate analyses were conducted through the Chi-square test, the Fisher's Exact test or the Student's T test. All children had the same demographic, epidemiological and clinical data collected through a study team member interview and via the participants medical records. RESULTS Within the sample of children who visited emergency services with symptoms of potential COVID-19, we found higher prevalence of positive SARS-CoV-2 RT-PCR test results among those who were exclusively formula fed compared with those who were ever breastfed (OR 2.48; 95% CI 1.45, 3.51; P = 0.036). CONCLUSIONS The present study suggests that ever breastfeeding reduces the risk of COVID-19 among children, as documented for other infections.
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Affiliation(s)
- Sergio Verd
- Pediatric Unit. La Vileta Surgery. Department of Primary Care, Matamusinos Street, 07013, Palma de Mallorca, Spain. .,Balearic Islands Health Research Institute (IdISBa), 79 Valldemossa Road, 07120, Palma de Mallorca, Spain.
| | - Jan Ramakers
- Department of Pediatrics, Son Espases University Hospital, 79 Valldemossa Road, 07120, Palma de Mallorca, Spain
| | - Isabel Vinuela
- Department of Pediatrics, Son Espases University Hospital, 79 Valldemossa Road, 07120, Palma de Mallorca, Spain
| | - Maria-Isabel Martin-Delgado
- Pediatric Unit. Santa Ponsa Surgery. Department of Primary Care, Riu Sil Street, 07180, Calvia, Mallorca, Spain
| | - Aina Prohens
- Department of Pediatrics, Son Llatzer University Hospital, Manacor Road, 07120 07198, Palma de Mallorca, Spain
| | - Ruth Díez
- Department of Pediatrics, Son Espases University Hospital, 79 Valldemossa Road, 07120, Palma de Mallorca, Spain
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21
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Koirala A, Goldfeld S, Bowen AC, Choong C, Ryan K, Wood N, Winkler N, Danchin M, Macartney K, Russell FM. Lessons learnt during the COVID-19 pandemic: Why Australian schools should be prioritised to stay open. J Paediatr Child Health 2021; 57:1362-1369. [PMID: 34101922 PMCID: PMC8242752 DOI: 10.1111/jpc.15588] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
In 2020, school and early childhood educational centre (ECEC) closures affected over 1.5 billion school-aged children globally as part of the COVID-19 pandemic response. Attendance at school and access to ECEC is critical to a child's learning, well-being and health. School closures increase inequities by disproportionately affecting vulnerable children. Here, we summarise the role of children and adolescents in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and that of schools and ECECs in community transmission and describe the Australian experience. In Australia, most SARS-CoV-2 cases in schools were solitary (77% in NSW and 67% in Victoria); of those that did progress to an outbreak, >90% involved fewer than 10 cases. Australian and global experience has demonstrated that SARS-CoV-2 is predominantly introduced into schools and ECECs during periods of heightened community transmission. Implementation of public health mitigation strategies, including effective testing, tracing and isolation of contacts, means schools and ECECs can be safe, not drivers of transmission. Schools and ECEC are essential services and so they should be prioritised to stay open for face-to-face learning. This is particularly critical as we continue to manage the next phase of the COVID-19 pandemic.
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Affiliation(s)
- Archana Koirala
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Infectious Diseases, Nepean HospitalKingswoodNew South WalesAustralia
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's HospitalParkvilleVictoriaAustralia,Population Health, Murdoch Children's Research InstituteParkvilleVictoriaAustralia,Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia
| | - Asha C Bowen
- Department of Infectious DiseasesPerth Children's HospitalNedlandsWestern AustraliaAustralia,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids InstituteNedlandsWestern AustraliaAustralia,School of Medicine, The University of Western AustraliaPerthWestern AustraliaAustralia,Centre for Child Health ResearchThe University of Western AustraliaPerthWestern AustraliaAustralia,Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia,Institute for Health ResearchThe University of Notre Dame AustraliaFremantleWestern AustraliaAustralia
| | - Catherine Choong
- School of Medicine, The University of Western AustraliaPerthWestern AustraliaAustralia,Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia,Department of Endocrinology, Perth Children's HospitalNedlandsWestern AustraliaAustralia
| | - Kathleen Ryan
- Population Health, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Paediatrics, The Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Noni Winkler
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralian Capitol TerritoryAustralia
| | - Margie Danchin
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia,Department of General Medicine, Royal Children's HospitalParkvilleVictoriaAustralia,Infection and Immunity, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Infectious Diseases, The Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Fiona M Russell
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia,Infection and Immunity, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
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22
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Herrmann Y, Starck T, Brindl N, Kitchen PJ, Rädeker L, Sebastian J, Köppel L, Tobian F, Souares A, Mihaljevic AL, Merle U, Hippchen T, Herth F, Knorr B, Welker A, Denkinger CM. Description and analysis of representative COVID-19 cases-A retrospective cohort study. PLoS One 2021; 16:e0255513. [PMID: 34329364 PMCID: PMC8323911 DOI: 10.1371/journal.pone.0255513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Most data on COVID-19 was collected in hospitalized cases. Much less is known about the spectrum of disease in entire populations. In this study, we examine a representative cohort of primarily symptomatic cases in an administrative district in Southern Germany. METHODS We contacted all confirmed SARS-CoV-2 cases in the administrative district. Consenting participants answered a retrospective survey either via a telephone, electronically or via mail. Clinical and sociodemographic features were compared between hospitalized and non-hospitalized patients. Additionally, we assessed potential risk factors for hospitalization and time to hospitalization in a series of regression models. RESULTS We included 897 participants in our study, 69% out of 1,305 total cases in the district with a mean age of 47 years (range 2-97), 51% of which were female and 47% had a pre-existing illness. The percentage of asymptomatic, mild, moderate (leading to hospital admission) and critical illness (requiring mechanical ventilation) was 54 patients (6%), 713 (79%), 97 (11%) and 16 (2%), respectively. Seventeen patients (2%) died. The most prevalent symptoms were fatigue (65%), cough (62%) and dysgeusia (60%). The risk factors for hospitalization included older age (OR 1.05 per year increase; 95% CI 1.04-1.07) preexisting lung conditions (OR 3.09; 95% CI 1.62-5.88). Female sex was a protective factor (OR 0.51; 95% CI 0.33-0.77). CONCLUSION This representative analysis of primarily symptomatic COVID-19 cases confirms age, male sex and preexisting lung conditions but not cardiovascular disease as risk factors for severe illness. Almost 80% of infection take a mild course, whereas 13% of patients suffer moderate to severe illness. TRIAL REGISTRATION German Clinical Trials Register, DRKS00022926. URL: https://www.drks.de/drks_web/setLocale_EN.do.
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Affiliation(s)
- Yannis Herrmann
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
- * E-mail: (CMD); (YH)
| | - Tim Starck
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Niall Brindl
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Philip J. Kitchen
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Lukas Rädeker
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Jakob Sebastian
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Lisa Köppel
- Division of Tropical Medicine, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Tobian
- Division of Tropical Medicine, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Chest Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Britta Knorr
- Department of Public Health, Landratsamt Rhein-Neckar, Heidelberg, Germany
| | - Andreas Welker
- Department of Public Health, Landratsamt Rhein-Neckar, Heidelberg, Germany
| | - Claudia M. Denkinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail: (CMD); (YH)
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23
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The Type I interferon antiviral gene program is impaired by lockdown and preserved by caregiving. Proc Natl Acad Sci U S A 2021; 118:2105803118. [PMID: 34272291 PMCID: PMC8307615 DOI: 10.1073/pnas.2105803118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Previous research has linked perceived social isolation (loneliness) to reduced antiviral immunity, but the immunologic effects of the objective social isolation imposed by pandemic "shelter in place" (SIP) policies is unknown. We assessed the immunologic impact of SIP by relocating 21 adult male rhesus macaques from 2,000-m2 field cage communities of 70 to 132 other macaques to 2 wk of individual housing in indoor shelters. SIP was associated with 30% to 50% reductions in all circulating immune cell populations (lymphocytes, monocytes, and granulocytes), down-regulation of Type I interferon (IFN) antiviral gene expression, and a relative up-regulation of CD16- classical monocytes. These effects emerged within the first 48 h of SIP, persisted for at least 2 wk, and abated within 4 wk of return to social housing. A subsequent round of SIP in the presence of a novel juvenile macaque showed comparable reductions in circulating immune cell populations but reversal of Type I IFN reductions and classical monocyte increases observed during individual SIP. Analyses of lymph node tissues showed parallel up-regulation of Type I IFN genes and enhanced control of viral gene expression during juvenile-partnered SIP compared to isolated SIP. These results identify a significant adverse effect of SIP social isolation on antiviral immune regulation in both circulating immune cells and lymphoid tissues, and they suggest a potential behavioral strategy for ameliorating gene regulatory impacts (but not immune cell declines) by promoting prosocial engagement during SIP.
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24
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McKeigue PM, McAllister DA, Caldwell D, Gribben C, Bishop J, McGurnaghan S, Armstrong M, Delvaux J, Colville S, Hutchinson S, Robertson C, Lone N, McMenamin J, Goldberg D, Colhoun HM. Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study. BMC Med 2021; 19:149. [PMID: 34158021 PMCID: PMC8219469 DOI: 10.1186/s12916-021-02021-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. METHODS In a matched case-control design, all 178,578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression. RESULTS With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. CONCLUSIONS The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David A McAllister
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - David Caldwell
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Ciara Gribben
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jen Bishop
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - Matthew Armstrong
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Joke Delvaux
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sam Colville
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sharon Hutchinson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Jim McMenamin
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David Goldberg
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Helen M Colhoun
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland.
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25
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Kahlert CR, Persi R, Güsewell S, Egger T, Leal-Neto OB, Sumer J, Flury D, Brucher A, Lemmenmeier E, Möller JC, Rieder P, Stocker R, Vuichard-Gysin D, Wiggli B, Albrich WC, Babouee Flury B, Besold U, Fehr J, Kuster SP, McGeer A, Risch L, Schlegel M, Friedl A, Vernazza P, Kohler P. Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among hospital workers - A multicentre cross-sectional study. Clin Microbiol Infect 2021; 27:1336-1344. [PMID: 34020033 PMCID: PMC8131187 DOI: 10.1016/j.cmi.2021.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022]
Abstract
Objectives Protecting healthcare workers (HCWs) from coronavirus disease-19 (COVID-19) is critical to preserve the functioning of healthcare systems. We therefore assessed seroprevalence and identified risk factors for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) seropositivity in this population. Methods Between 22 June 22 and 15 August 2020, HCWs from institutions in northern/eastern Switzerland were screened for SARS-CoV-2 antibodies. We recorded baseline characteristics, non-occupational and occupational risk factors. We used pairwise tests of associations and multivariable logistic regression to identify factors associated with seropositivity. Results Among 4664 HCWs from 23 healthcare facilities, 139 (3%) were seropositive. Non-occupational exposures independently associated with seropositivity were contact with a COVID-19-positive household (adjusted OR 59, 95% CI 33–106), stay in a COVID-19 hotspot (aOR 2.3, 95% CI 1.2–4.2) and male sex (aOR 1.9, 95% CI 1.1–3.1). Blood group 0 vs. non-0 (aOR 0.5, 95% CI 0.3–0.8), active smoking (aOR 0.4, 95% CI 0.2–0.7), living with children <12 years (aOR 0.3, 95% CI 0.2–0.6) and being a physician (aOR 0.2, 95% CI 0.1–0.5) were associated with decreased risk. Other occupational risk factors were close contact to COVID-19 patients (aOR 2.7, 95% CI 1.4–5.4), exposure to COVID-19-positive co-workers (aOR 1.9, 95% CI 1.1–2.9), poor knowledge of standard hygiene precautions (aOR 1.9, 95% CI 1.2–2.9) and frequent visits to the hospital canteen (aOR 2.3, 95% CI 1.4–3.8). Discussion Living with COVID-19-positive households showed the strongest association with SARS-CoV-2 seropositivity. We identified several potentially modifiable work-related risk factors, which might allow mitigation of the COVID-19 risk among HCWs. The lower risk among those living with children, even after correction for multiple confounders, is remarkable and merits further study.
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Affiliation(s)
- Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland; Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Raphael Persi
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital of St Gallen, St. Gallen, Switzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Onicio B Leal-Neto
- Epitrack, Recife, Brazil; Department of Economics, University of Zurich, Zurich, Switzerland
| | - Johannes Sumer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - J Carsten Möller
- Centre for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland; Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Jan Fehr
- Department of Public and Global Health, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland; Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein; Centre of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
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26
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Forbes H, Morton CE, Bacon S, McDonald HI, Minassian C, Brown JP, Rentsch CT, Mathur R, Schultze A, DeVito NJ, MacKenna B, Hulme WJ, Croker R, Walker AJ, Williamson EJ, Bates C, Mehrkar A, Curtis HJ, Evans D, Wing K, Inglesby P, Drysdale H, Wong AYS, Cockburn J, McManus R, Parry J, Hester F, Harper S, Douglas IJ, Smeeth L, Evans SJW, Bhaskaran K, Eggo RM, Goldacre B, Tomlinson LA. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England. BMJ 2021; 372:n628. [PMID: 33737413 PMCID: PMC7970340 DOI: 10.1136/bmj.n628] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic. DESIGN Population based cohort study, on behalf of NHS England. SETTING Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). PARTICIPANTS Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020. MAIN OUTCOME MEASURES Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household. RESULTS Among 9 334 392adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions. CONCLUSIONS In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.
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Affiliation(s)
- Harriet Forbes
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Helen I McDonald
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Minassian
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy P Brown
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rohini Mathur
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Schultze
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas J DeVito
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - William J Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Elizabeth J Williamson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bates
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Kevin Wing
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Henry Drysdale
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Angel Y S Wong
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Robert McManus
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - John Parry
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Frank Hester
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Sam Harper
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Ian J Douglas
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen J W Evans
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalind M Eggo
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Laurie A Tomlinson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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