Characteristics and outcomes of health and social care workers testing positive for SARS-CoV-2 in the Tayside region of Scotland

Usefulness of linked data for infectious disease events: a systematic review

Surveillance is a key public health function to enable early detection of infectious disease events and inform public health action. Data linkage may improve the depth of data for response to infectious disease events. This study aimed to describe the uses of linked data for infectious disease events. A systematic review was conducted using Pubmed, CINAHL and Web of Science. Studies were included if they used data linkage for an acute infectious disease event (e.g. outbreak of disease). We summarised the event, study aims and designs; data sets; linkage methods; outcomes reported; and benefits and limitations. Fifty-four studies were included. Uses of linkage for infectious disease events included assessment of severity of disease and risk factors; improved case finding and contact tracing; and vaccine uptake, safety and effectiveness. The ability to conduct larger scale population level studies was identified as a benefit, in particular for rarer exposures, risk factors or outcomes. Limitations included timeliness, data quality and inability to collect additional variables. This review demonstrated multiple uses of data linkage for infectious disease events. As infectious disease events occur without warning, there is a need to establish pre-approved protocols and the infrastructure for data-linkage to enhance information available during an event.

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

OBJECTIVES

The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making.

DESIGN

Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care.

SETTING AND PARTICIPANTS

Residents and staff in care settings such as nursing homes and long-term care facilities.

METHODS

PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables.

RESULTS

Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success.

CONCLUSIONS AND IMPLICATIONS

High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.

The association between SARS-CoV-2 RT-PCR cycle threshold and mortality in a community cohort

A coronavirus disease 2019 (COVID-19) diagnosis is widely made by the use of reverse transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When using RT-PCR, the infectivity of SARS-CoV-2 can be inferred from the threshold cycle (Ct) value [1]. It is best practice to confirm the validity of the standard curve using reference materials or in-house plasmid controls with known viral copy numbers [2]. As the Ct value represents the cycle number at which the signal breaches the threshold for positivity, a lower Ct value is indicative of a higher viral load. Although some studies suggest that viral load is associated with mortality and infectiousness [3, 4], a systematic review has identified little difference in viral load between pre-symptomatic, asymptomatic and symptomatic patients [5]. As a result, the clinical relevance of viral load remains controversial, and it is not used in clinical practice [6]. Here, we report the relationship between the Ct value and all-cause mortality for people who tested positive for SARS-CoV-2 on a combined nasal and pharyngeal swab in the Tayside region of Scotland, UK. This is a community cohort study and includes the local population of the region, as well as symptomatic health and social care workers tested as part of a screening programme [7]. In order to obtain clinical characteristics and outcomes for those who tested positive, anonymised record linkage was conducted between routine healthcare datasets as described previously [8]. All positive PCR tests from 12 March until 1 May, 2020 were included, and all deaths recorded by National Records Scotland until 20 May, 2020. Approval for anonymised data linkage was granted by the local Data Protection Officer (Caldicott Guardian).

Ct values from RT-PCR tests are associated with risk of mortality in SARS-CoV-2 infection. Hazards of Ct values <20 compared to >30 were 2.20 (95% CI 1.28–3.76) in a model adjusted for age, sex, comorbidities and hospitalisation.https://bit.ly/3gjuqdU

Association between cycle threshold (Ct ) values and clinical and laboratory data in inpatients with COVID-19 and asymptomatic health workers

In‐house assays for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) by quantitative reverse‐transcription polymerase chain reaction (qRT‐PCR), are feasible alternatives, particularly in developing countries. Cycle threshold (C_t) values obtained by qRT‐PCR were compared with clinical and laboratory data from saliva of inpatients with COVID‐19 and asymptomatic health workers (AHW) were studied. Saliva specimens from 58 inpatients confirmed by qRT‐PCR for SARS‐CoV‐2 using nasopharyngeal specimens, and 105 AHW were studied by qRT‐PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS‐CoV‐2, according to the CDC Diagnostic Panel protocol, showing a positivity of 88% for inpatients and 8% for AHW. Bivariate analysis revealed an association between C_t < 38.0 values for N2 and mechanical ventilation assistance among patients (p = .013). In addition, values of aspartate‐transaminase, lactate dehydrogenase, and ferritin showed significant correlations with C_t values of N1 and N3 genes in inpatients. Therefore, our results show that C_t values correlate with some relevant clinical data for inpatients with COVID‐19.

Healthcare Workers' Knowledge, Attitude, and Practice Regarding Personal Protective Equipment for the Prevention of COVID-19

PURPOSE

Adequate knowledge, positive attitude, and proper practice of personal protective equipment by healthcare workers are necessary to get protection from COVID-19 infection. But this area is yet to be explored. Hence, we aimed to assess the knowledge, attitude, and practice (KAP) regarding personal protective equipment (PPE) among healthcare workers, along with a survey of the possible determinants.

SUBJECTS AND METHODS

For this cross-sectional study, online and offline surveys were conducted among a sample of 393 healthcare workers from five different districts of Bangladesh. A validated self-administered questionnaire comprising five sections (socio-demography, work-related information, knowledge, attitude, and practice) was used for data collection. Multivariate stepwise forward logistic regression was applied to find significant factors associated with good attitude, and practice using SPSS version 25.

RESULTS

The average age of the 393 participants was 28.9±5.2 years with a male-female ratio of one. Of them, 99.5% (n=391) had good knowledge, 88.8% (n=349) had positive attitude and 51.7% (n=203) had good practice regarding PPE. Results revealed that being a physician and living at home were significantly associated with a positive attitude. While being a non-physician, having lower education, working in private hospitals, and using office transport were associated with good practice regarding PPE.

CONCLUSION

The findings demonstrated that the healthcare workers had an overall good knowledge and a positive attitude but a poor practice regarding PPE. This study also highlighted the factors influencing KAP towards PPE that must be addressed in future education, awareness, and counseling programs.

Pandemic trials: evidence-based medicine on steroids

Research is the only exit strategy from current coronavirus disease 2019 (COVID-19) restrictions. The second wave of COVID-19 infections currently affecting most of Europe emphasises that COVID-19, the disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is likely to require strict control measures impacting on the daily life of most citizens until either a highly effective approach to treatment or effective vaccines are in widespread use [1–3].

Small trials have been largely overlooked in the early part of the COVID-19 pandemic in favour of “mega-trials”. As new therapies are urgently needed, phase 2 “proof of concept” studies are crucial as we move into a new phase of pandemic research.https://bit.ly/3o0K9kl

Healthcare workers with COVID-19 in Mexico

I read with interest the recently published report by Siddiquiet al. [1], which described the characteristics and outcomes of health and social care workers testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Tayside region of Scotland.

Healthcare workers can be infected in the community, and in interactions with colleagues; therefore, such infections are not always the result of acquisition from infected patientshttps://bit.ly/30opbTk