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Luijnenburg O, Samsi K, Kessler I, Norrie C, Martineau S, Manthorpe J. 'I wasn't on the front line per se, but I was part of health care': Contributions and experiences of ancillary staff in care homes in England during the COVID-19 pandemic. J Health Serv Res Policy 2024; 29:143-152. [PMID: 38642016 PMCID: PMC11151701 DOI: 10.1177/13558196241246178] [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: 04/22/2024]
Abstract
OBJECTIVES Ancillary staff - cleaning, catering, housekeeping and laundry workers - play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. METHODS Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). RESULTS Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. CONCLUSIONS Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well.
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Affiliation(s)
- Olivia Luijnenburg
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Kritika Samsi
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Ian Kessler
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Caroline Norrie
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Stephen Martineau
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King’s College London, London, UK
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Ryan F, Cole-Hamilton J, Dandamudi N, Futschik ME, Needham A, Saquib R, Kulasegaran-Shylini R, Blandford E, Kidd M, O'Moore É, Hall I, Sudhanva M, Klapper P, Dodgson A, Moore A, Duke M, Tunkel S, Kenny C, Fowler T. Faster detection of asymptomatic COVID-19 cases among care home staff in England through the combination of SARS-CoV-2 testing technologies. Sci Rep 2024; 14:7475. [PMID: 38553484 PMCID: PMC10980794 DOI: 10.1038/s41598-024-57817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
To detect SARS-CoV-2 amongst asymptomatic care home staff in England, a dual-technology weekly testing regime was introduced on 23 December 2020. A lateral flow device (LFD) and quantitative reverse transcription polymerase chain reaction (qRT-PCR) test were taken on the same day (day 0) and a midweek LFD test was taken three to four days later. We evaluated the effectiveness of using dual-technology to detect SARS-CoV-2 between December 2020 to April 2021. Viral concentrations derived from qRT-PCR were used to determine the probable stage of infection and likely level of infectiousness. Day 0 PCR detected 1,493 cases of COVID-19, of which 53% were in the early stages of infection with little to no risk of transmission. Day 0 LFD detected 83% of cases that were highly likely to be infectious. On average, LFD results were received 46.3 h earlier than PCR, enabling removal of likely infectious staff from the workplace quicker than by weekly PCR alone. Demonstrating the rapidity of LFDs to detect highly infectious cases could be combined with the ability of PCR to detect cases in the very early stages of infection. In practice, asymptomatic care home staff were removed from the workplace earlier, breaking potential chains of transmission.
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Affiliation(s)
- Finola Ryan
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
- King's College Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Joanna Cole-Hamilton
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Niharika Dandamudi
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Matthias E Futschik
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alexander Needham
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Rida Saquib
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Raghavendran Kulasegaran-Shylini
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Edward Blandford
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | | | - Éamonn O'Moore
- National Health Protection Office, HSE, Dublin, D01 A4A3, Ireland
| | - Ian Hall
- Department of Mathematics, The University of Manchester, Manchester, UK
- Advanced Analytics, Analytics & Data Science, UK Health Security Agency, London, UK
| | - Malur Sudhanva
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Klapper
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
- Clinical Virology, Division of Evolution, Infections and Genomics, University of Manchester, Manchester, UK
| | - Andrew Dodgson
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Adam Moore
- Operational Policy, UK Health Security Agency, London, UK
| | - Madeleine Duke
- Operational Policy, UK Health Security Agency, London, UK
| | - Sarah Tunkel
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Chris Kenny
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK
| | - Tom Fowler
- Public Health and Clinical Oversight (PHCO), Clinical and Public Health Group, UK Health Security Agency, 10 South Colonade, Canary Wharf, London, E14 4PU, UK.
- Queen Mary University of London William Harvey Research Institute, London, UK.
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Keene CM, Dickinson S, Naidoo R, Andersen-Waine B, Ferguson-Lewis A, Polner A, Amswych M, White L, Molyneux S, Wanat M. Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review. BMJ Open 2024; 14:e084437. [PMID: 38553081 PMCID: PMC10982762 DOI: 10.1136/bmjopen-2024-084437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Testing for COVID-19 was a key component of the UK's response to the COVID-19 pandemic. This strategy relied on positive individuals self-isolating to reduce transmission, making isolation the lynchpin in the public health approach. Therefore, we scoped evidence to systematically identify and categorise barriers and facilitators to compliance with self-isolation guidance during the COVID-19 pandemic in the UK, to inform public health strategies in future pandemics. DESIGN A rapid scoping review was conducted. SEARCH STRATEGY Key terms were used to search literature databases (PubMed, Scopus and the WHO COVID-19 Research Database, on 7 November 2022), Google Scholar and stakeholder-identified manuscripts, ultimately including evidence published in English from UK-based studies conducted between 2020 and 2022. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised into themes, organised broadly into capability, opportunity and motivation, and reviewed with key stakeholders from the UK Health Security Agency (UKHSA). RESULTS We included 105 sources, with 63 identified from UKHSA and used to inform their decision-making during the pandemic. Influences on the decision to comply with isolation guidance were categorised into six themes: perceived ability to isolate; information and guidance; logistics; social influences, including trust; perceived value; and perceived consequences. Individuals continuously assessed these factors in deciding whether or not to comply with guidance and self-isolate. CONCLUSIONS Decisions to self-isolate after a positive test were influenced by multiple factors, including individuals' beliefs, concerns, priorities and personal circumstances. Future testing strategies must facilitate meaningful financial, practical and mental health support to allow individuals to overcome the perceived and actual negative consequences of isolating. Clear, consistent communication of the purpose and procedures of isolating will also be critical to support compliance with self-isolation guidance, and should leverage people's perceived value in protecting others. Building public trust is also essential, but requires investment before the next pandemic starts.
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Affiliation(s)
- Claire Marriott Keene
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sophie Dickinson
- UKI Health Sciences and Wellness, Ernst & Young (EY), London, UK
| | - Reshania Naidoo
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- UKI Health Sciences and Wellness, Ernst & Young (EY), London, UK
| | | | | | - Anastasia Polner
- UKI Health Sciences and Wellness, Ernst & Young (EY), London, UK
| | - Ma'ayan Amswych
- UKI Health Sciences and Wellness, Ernst & Young (EY), London, UK
| | - Lisa White
- Department of Biology, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Adams N, Stirrup O, Blackstone J, Krutikov M, Cassell JA, Cadar D, Henderson C, Knapp M, Goscé L, Leiser R, Regan M, Cullen-Stephenson I, Fenner R, Verma A, Gordon A, Hopkins S, Copas A, Freemantle N, Flowers P, Shallcross L. Shaping care home COVID-19 testing policy: a protocol for a pragmatic cluster randomised controlled trial of asymptomatic testing compared with standard care in care home staff (VIVALDI-CT). BMJ Open 2023; 13:e076210. [PMID: 37963697 PMCID: PMC10649600 DOI: 10.1136/bmjopen-2023-076210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Care home residents have experienced significant morbidity, mortality and disruption following outbreaks of SARS-CoV-2. Regular SARS-CoV-2 testing of care home staff was introduced to reduce transmission of infection, but it is unclear whether this remains beneficial. This trial aims to investigate whether use of regular asymptomatic staff testing, alongside funding to reimburse sick pay for those who test positive and meet costs of employing agency staff, is a feasible and effective strategy to reduce COVID-19 impact in care homes. METHODS AND ANALYSIS The VIVALDI-Clinical Trial is a multicentre, open-label, cluster randomised controlled, phase III/IV superiority trial in up to 280 residential and/or nursing homes in England providing care to adults aged >65 years. All regular and agency staff will be enrolled, excepting those who opt out. Homes will be randomised to the intervention arm (twice weekly asymptomatic staff testing for SARS-CoV-2) or the control arm (current national testing guidance). Staff who test positive for SARS-CoV-2 will self-isolate and receive sick pay. Care providers will be reimbursed for costs associated with employing temporary staff to backfill for absence arising directly from the trial.The trial will be delivered by a multidisciplinary research team through a series of five work packages.The primary outcome is the incidence of COVID-19-related hospital admissions in residents. Secondary outcomes include the number and duration of outbreaks and home closures. Health economic and modelling analyses will investigate the cost-effectiveness and cost consequences of the testing intervention. A process evaluation using qualitative interviews will be conducted to understand intervention roll out and identify areas for optimisation to inform future intervention scale-up, should the testing approach prove effective and cost-effective. Stakeholder engagement will be undertaken to enable the sector to plan for results and their implications and to coproduce recommendations on the use of testing for policy-makers. ETHICS AND DISSEMINATION The study has been approved by the London-Bromley Research Ethics Committee (reference number 22/LO/0846) and the Health Research Authority (22/CAG/0165). The results of the trial will be disseminated regardless of the direction of effect. The publication of the results will comply with a trial-specific publication policy and will include submission to open access journals. A lay summary of the results will also be produced to disseminate the results to participants. TRIAL REGISTRATION NUMBER ISRCTN13296529.
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Affiliation(s)
- Natalie Adams
- Institute of Health informatics, University College London, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Maria Krutikov
- Institute of Health informatics, University College London, London, UK
| | - Jackie A Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- UK Health Security Agency, London, UK
| | - Dorina Cadar
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Lara Goscé
- Institute for Global Health, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Leiser
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Martyn Regan
- UK Health Security Agency, London, UK
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences & Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Iona Cullen-Stephenson
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Robert Fenner
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Arpana Verma
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Adam Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
- Applied Research Collaboration-East Midlands (ARC-EM), NIHR, Nottingham, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paul Flowers
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Laura Shallcross
- Institute of Health informatics, University College London, London, UK
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Marshall F, Gordon AL, Gladman JRF, Bishop S. "Crack on": a qualitative study of care home managers experiences and responses to system-led setbacks during the crisis of the COVID-19 Pandemic in England. Eur Geriatr Med 2023; 14:811-821. [PMID: 37278920 PMCID: PMC10241602 DOI: 10.1007/s41999-023-00804-y] [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: 12/30/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore care home managers' experiences of systems working with various organisations, including statutory, third sector and private, during the second wave of the COVID-19 pandemic from Sept 2020 to April 2021 DESIGN: An exploratory qualitative interview study using a systems theory approach focussing on the intersections of relationship interdependencies with other organisations. SETTING Conducted remotely with care home managers and key advisors who had worked since the start of the pandemic in/with care homes for older people across the East Midlands, UK. PARTICIPANTS 8 care home managers and 2 end-of-life advisors who participated during the second wave of the pandemic from Sept 2020. A total of 18 care home managers participated in the wider study from April 2020 to April 2021 RESULTS: Four organisational relationship interdependencies were identified: care practices, resources governance and wise working. Managers identified changes in their care practices as a shift towards the normalisation of care, with an emphasis on navigating pandemic restrictions to fit the context. Resources such as staffing, clinical reviews, pharmaceutical and equipment supplies were challenged, leading to a sense of precarity and tension. National polices and local guidance were fragmented, complex and disconnected from the reality of managing a care home. As a response a highly pragmatic reflexive style of management was identified which encompassed the use of mastery to navigate and in some cases circumvent official systems and mandates. Managers' experience of persistent and multiple setbacks were viewed as negative and confirmed their views that care homes as a sector ere marginalised by policy makers and statutory bodies. CONCLUSIONS Interactions with various organisations shaped the ways in which care home managers responded to and sought to maximise residents and staff well-being. Some relationships dissolved over time, such as when local business and schools returned to normal obligations. Other newly formed relationships became more robust including those with other care home managers, families, and hospices. Significantly, most managers viewed their relationship with local authority and national statutory bodies as detrimental to effective working, leading to a sense of increased mistrust and ambiguity. Respect, recognition and meaningful collaboration with the care home sector should underpin any future attempts to introduce practice change in the sector.
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Affiliation(s)
- Fiona Marshall
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
- Knowledge and Intelligence Team, Derbyshire County Council, Matlock, UK
| | - Adam L Gordon
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK.
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK.
| | - John R F Gladman
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Bishop
- Nottingham University Business School, Nottingham, UK
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Whitfield CA, Hall I. Modelling the impact of repeat asymptomatic testing policies for staff on SARS-CoV-2 transmission potential. J Theor Biol 2023; 557:111335. [PMID: 36334850 PMCID: PMC9626407 DOI: 10.1016/j.jtbi.2022.111335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Repeat asymptomatic testing in order to identify and quarantine infectious individuals has become a widely-used intervention to control SARS-CoV-2 transmission. In some workplaces, and in particular health and social care settings with vulnerable patients, regular asymptomatic testing has been deployed to staff to reduce the likelihood of workplace outbreaks. We have developed a model based on data available in the literature to predict the potential impact of repeat asymptomatic testing on SARS-CoV-2 transmission. The results highlight features that are important to consider when modelling testing interventions, including population heterogeneity of infectiousness and correlation with test-positive probability, as well as adherence behaviours in response to policy. Furthermore, the model based on the reduction in transmission potential presented here can be used to parameterise existing epidemiological models without them having to explicitly simulate the testing process. Overall, we find that even with different model paramterisations, in theory, regular asymptomatic testing is likely to be a highly effective measure to reduce transmission in workplaces, subject to adherence. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".
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Affiliation(s)
- Carl A Whitfield
- Department of Mathematics, University of Manchester, United Kingdom.
| | - Ian Hall
- Department of Mathematics, University of Manchester, United Kingdom
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Ricco M. A systematic review on rapid antigen test devices for SARS-CoV-2 in nursing homes: Useful, but handle with care. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:412-414. [PMID: 35906037 PMCID: PMC9321411 DOI: 10.1016/j.eimce.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Matteo Ricco
- AUSL - IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza negli ambienti di Lavoro (SPSAL), Reggio Emilia, RE, Italy.
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Borro M, Salerno G, Montori A, Petrucca A, Anibaldi P, Marcolongo A, Bonfini R, Simmaco M, Santino I. SARS-CoV-2 Transmission Control Measures in the Emergency Department: The Role of Rapid Antigenic Testing in Asymptomatic Subjects. Healthcare (Basel) 2022; 10:healthcare10050790. [PMID: 35627926 PMCID: PMC9140606 DOI: 10.3390/healthcare10050790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/30/2022] Open
Abstract
Limiting transmission of SARS-CoV-2 from asymptomatic people assumes the paramount importance of keeping fragile subjects protected. We evaluated the utility of rapid SARS-CoV-2 antigen testing in asymptomatic subjects attending emergency departments in non-COVID-19 areas, using a single nasopharyngeal swab specimen collected in universal transport medium to perform both rapid antigen testing and rRT-PCR (used as reference standard) in a cohort of 899 patients. In the overall sample, the rapid antigen test had 43.9% sensitivity, 100% specificity, 100% positive predictive value, 93.6% negative predictive value. Considering subjects with rRT-PCR cycle threshold ≤30, the test had 80.4% sensitivity, 100% specificity, 100% positive predictive value, 98.8% negative predictive value. Considering subjects with rRT-PCR cycle threshold ≤25, the test had 94.7% sensitivity, 100% specificity, 100% positive predictive value and 99.7% negative predictive value. Despite low sensitivity, routine application of rapid antigen testing in the emergency department can lead to isolation in less than 30 min of about a half of asymptomatic COVID-19 subjects assigned to non-COVID-19 areas by clinical triage. The rapid test correctly identified 94.7% of asymptomatic patients with cycle threshold ≤ 25 that are supposed to be more infective; thus, it could be a useful measure to contain viral transmission in non-COVID-19 areas.
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Affiliation(s)
- Marina Borro
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (M.S.); (I.S.)
- Laboratory of Clinical Biochemistry, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
- Correspondence: (M.B.); (G.S.)
| | - Gerardo Salerno
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (M.S.); (I.S.)
- Laboratory of Clinical Biochemistry, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
- Correspondence: (M.B.); (G.S.)
| | - Andrea Montori
- Microbiology Unit, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Andrea Petrucca
- Laboratory of Clinical Biochemistry, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Paolo Anibaldi
- Medical Direction, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Adriano Marcolongo
- General Direction, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Rita Bonfini
- Emergency Department Unit, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (M.S.); (I.S.)
- Laboratory of Clinical Biochemistry, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Iolanda Santino
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (M.S.); (I.S.)
- Microbiology Unit, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy;
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Mathers J, Poyner C, Thompson D, Rudge G, Pritchett RV. Exploration of the uptake of asymptomatic COVID-19 lateral flow testing in Birmingham, UK: survey and qualitative research. BMJ Open 2022; 12:e056606. [PMID: 35443954 PMCID: PMC9021457 DOI: 10.1136/bmjopen-2021-056606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM To examine public perspectives on lateral flow testing (LFT) for COVID-19. DESIGN Online survey with nested semi-structured interviews. SETTING Birmingham, UK. PARTICIPANTS 220 Birmingham residents, 21 of whom took part in an interview. RESULTS Fifty-six per cent of respondents had taken an LFT. Reasons for not testing included adherence to other government COVID-19 guidance, having had a vaccination and not thinking LFTs were accurate. In 16% of households with children nobody, including children, was testing. In households where children were testing, their parents or other adults were often not. Those who were testing and eligible for workplace and school testing were more likely to be testing twice weekly. In other settings, respondents were more likely to be testing on a one-off or ad hoc basis. Approximately half of respondents said that they were likely to visit friends and family after a negative test result and 10% that they were unlikely to self-isolate following a positive test result. In interviews, participants who were testing described the peace of mind that testing afforded them prior to activities or interactions with family and friends, including those they considered to be vulnerable. Interviewees who were not testing described concerns about test accuracy and also cited a lack of face-to-face interaction with others precluding the need to test. Participants were often testing flexibly according to circumstances and perceived risk of COVID-19 transmission. CONCLUSIONS While some choose not to test, others are doing so in order to provide peace of mind to engage in personal interactions they might otherwise have avoided. This peace of mind may be a necessary pre-requisite for some to more fully re-engage in pre-pandemic activities. Despite clear concerns about test accuracy among those not testing, those who are testing held generally positive attitudes towards the continued use of LFTs.
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Affiliation(s)
- Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher Poyner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dean Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
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10
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Matteo R. A systematic review on rapid antigen test devices for SARS-CoV-2 in nursing homes: Useful, but handle with care. Enferm Infecc Microbiol Clin 2022; 40:412-414. [PMID: 35261421 PMCID: PMC8890974 DOI: 10.1016/j.eimc.2022.02.012] [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: 12/23/2022]
Affiliation(s)
- Ricco' Matteo
- AUSL - IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza negli ambienti di Lavoro (SPSAL), Via Amendola n.2, Reggio Emilia (RE), Italy
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Smith LE, Potts HW, Amlôt R, Fear NT, Michie S, Rubin GJ. Who is engaging with lateral flow testing for COVID-19 in the UK? The COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study. BMJ Open 2022; 12:e058060. [PMID: 35144956 PMCID: PMC8845094 DOI: 10.1136/bmjopen-2021-058060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate uptake of lateral flow testing, reporting of test results and psychological, contextual and socio-demographic factors associated with testing. DESIGN A series of four fortnightly online cross-sectional surveys. SETTING Data collected from 19 April 2021 to 2 June 2021. PARTICIPANTS People living in England and Scotland, aged 18 years or over, excluding those who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1600 per survey). MAIN OUTCOME MEASURES Having completed at least one lateral flow test (LFT) in the last 7 days. RESULTS We used binary logistic regressions to investigate factors associated with having taken at least one LFT. Increased uptake of testing was associated with being vaccinated (adjusted ORs (aORs)=1.52-2.45, 95% CI 1.25 to 3.07, analysed separately by vaccine dose), employed (aOR=1.94, 95% CI 1.63 to 2.32), having been out to work in the last week (aOR=2.30, 95% CI 1.94 to 2.73) and working in a sector that adopted LFT early (aOR=2.54, 95% CI 2.14 to 3.02) . Uptake was higher in people who reported cardinal COVID-19 symptoms in the last week (aOR=1.89, 95% CI 1.34 to 2.66). People who had heard more about LFTs (aOR=2.28, 95% CI 2.06 to 2.51) and knew they were eligible to receive regular LFTs (aOR=2.98, 95% CI 2.35 to 3.78) were also more likely to have tested. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case (aOR=0.51, 95% CI 0.47 to 0.55). CONCLUSIONS Uptake of lateral flow testing is low. Encouraging testing through workplaces and places of study is likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing and addressing common misconceptions may drive uptake.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
- UK Health Security Agency, Salisbury, UK
| | - Nicola T Fear
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - G James Rubin
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
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Smith DRM, Duval A, Zahar JR, Opatowski L, Temime L. Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk. Nat Commun 2022; 13:236. [PMID: 35017499 PMCID: PMC8752617 DOI: 10.1038/s41467-021-27845-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.
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Affiliation(s)
- David R M Smith
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France.
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France.
| | - Audrey Duval
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Jean Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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