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Koiso S, Gulbas E, Dike L, Mulroy NM, Ciaranello AL, Freedberg KA, Jalali MS, Walker AT, Ryan ET, LaRocque RC, Hyle EP. Modeling approaches to inform travel-related policies for COVID-19 containment: a scoping review and future directions. Travel Med Infect Dis 2024:102730. [PMID: 38830442 DOI: 10.1016/j.tmaid.2024.102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Travel-related strategies to reduce the spread of COVID-19 evolved rapidly in response to changes in the understanding of SARS-CoV-2 and newly available tools for prevention, diagnosis, and treatment. Modeling is an important methodology to investigate the range of outcomes that could occur from different disease containment strategies. METHODS We examined 43 articles published from December 2019 through September 2022 that used modeling to evaluate travel-related COVID-19 containment strategies. We extracted and synthesized data regarding study objectives, methods, outcomes, populations, settings, strategies, and costs. We used a standardized approach to evaluate each analysis according to 26 criteria for modeling quality and rigor. RESULTS The most frequent approaches included compartmental modeling to examine quarantine, isolation, or testing. Early in the pandemic, the goal was to prevent travel-related COVID-19 cases with a focus on individual-level outcomes and assessing strategies such as travel restrictions, quarantine without testing, social distancing, and on-arrival PCR testing. After the development of diagnostic tests and vaccines, modeling studies projected population-level outcomes and investigated these tools to limit COVID-19 spread. Very few published studies included rapid antigen screening strategies, costs, explicit model calibration, or critical evaluation of the modeling approaches. CONCLUSION Future modeling analyses should leverage open-source data, improve the transparency of modeling methods, incorporate newly available prevention, diagnostics, and treatments, and include costs and cost-effectiveness so that modeling analyses can be informative to address future SARS-CoV-2 variants of concern and other emerging infectious diseases (e.g., mpox and Ebola) for travel-related health policies.
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Affiliation(s)
- Satoshi Koiso
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA.
| | - Eren Gulbas
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
| | - Lotanna Dike
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
| | - Nora M Mulroy
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Mohammad S Jalali
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St., Suite 1010, Boston, MA, USA
| | - Allison T Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Edward T Ryan
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA; Travelers' Advice and Immunization Center, Massachusetts General Hospital, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA, USA
| | - Regina C LaRocque
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Travelers' Advice and Immunization Center, Massachusetts General Hospital, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Travelers' Advice and Immunization Center, Massachusetts General Hospital, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA, USA.
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Liu S, Anzai A, Nishiura H. Evaluation of the exit screening policy among travelers arriving from Asian and pacific nations. BMC Infect Dis 2024; 24:464. [PMID: 38698328 PMCID: PMC11067274 DOI: 10.1186/s12879-024-09327-8] [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: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The Japanese government has instituted border control measures against COVID-19, including entry and exit screening of people arriving from overseas. We sought to evaluate the effectiveness of the exit screening policy in Japan in reducing the risk of importing COVID-19 cases among travelers from Asian and Pacific countries. METHODS The study period was stratified based on the timing of exit screening: (i) the control period (the pre-exit screening period from 25 October 2020 to 16 January 2021), (ii) the time period with the Alpha variant from 17 January to 10 April 2021, and (iii) the time period with the Delta variant from 2 May to 2 October 2021. Incidence data in the countries of origin were used to adjust for the risk of infection among travelers. The positivity rate of entry screening in Japan was compared among the three different study periods, adjusting for the risk of infection in the country of origin. RESULTS The adjusted relative risk of positivity was greatly reduced and substantially below the value of 1 during the Alpha variant period compared with the control period. Although the relative risks increased when comparing the Delta variant period against control, the estimate remained below 1, except for among travelers from India and Myanmar. The relative risk reduction was greatest in high-income countries, with estimates of 100% and 96% risk reduction during the Alpha and Delta variant periods, respectively, followed by upper-middle-income countries with estimates of 90% and 76%, respectively. CONCLUSIONS Even in the presence of the Alpha and Delta variants, exit screening clearly reduced the risk of infection among travelers arriving from Asian and Pacific nations. As the testing relies on the country of origin, the effectiveness varied greatly by the socioeconomic income status and epidemiological situation of those countries. Test standardization and quality assurance may be required in low- and middle-income countries.
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Affiliation(s)
- Shiqi Liu
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan
| | - Asami Anzai
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan
| | - Hiroshi Nishiura
- Kyoto University School of Public Health, Yoshidakonoe cho, Sakyo-ku, Kyoto City, 6068501, Japan.
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Milwid RM, Gabriele-Rivet V, Ogden NH, Turgeon P, Fazil A, London D, de Montigny S, Rees EE. A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021. BMC Public Health 2024; 24:1088. [PMID: 38641571 PMCID: PMC11027292 DOI: 10.1186/s12889-024-18563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk. METHODS A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers). RESULTS In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 - 0.65%) than non-essential travellers (0.12 - 0.24%), they contributed fewer weekly cases (62 - 154) than non-essential travellers (84 - 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2). CONCLUSIONS The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures.
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Affiliation(s)
- Rachael M Milwid
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada
- Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Vanessa Gabriele-Rivet
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada.
- Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.
| | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Patricia Turgeon
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Aamir Fazil
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Guelph, ON, Canada
| | - David London
- Physique Des Particules, Université de Montréal, Faculté Des Arts Et Des Sciences, Montréal, QC, Canada
| | - Simon de Montigny
- Emergency Management Branch, Global Public Health Intelligence Network Tiger Team, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Erin E Rees
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
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Kakulu RK, Kimaro EG, Mpolya EA. Effectiveness of Point of Entry Health Screening Measures among Travelers in the Detection and Containment of the International Spread of COVID-19: A Review of the Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:410. [PMID: 38673323 PMCID: PMC11049967 DOI: 10.3390/ijerph21040410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 04/28/2024]
Abstract
COVID-19 remains a communicable disease with the capacity to cause substantial damage to health and health systems. Enhanced health screening at points of entry (POEs) is a public health measure implemented to support early detection, prevention and response to communicable diseases, such as COVID-19. The purpose of this study was to review the available evidence on the effectiveness of POE health screening in the detection and containment of the COVID-19 pandemic. This study was registered under PROSPERO and followed PRISMA guidelines in which the literature between 2019 and 2022 was retrieved from Scopus, PubMed, Web of Science, Global Health, CINAHL, Embase, Google Scholar and international organizations. A total of 33,744 articles were screened for eligibility, from which 43 met the inclusion criteria. The modeling studies predicted POE screening able to detect COVID-19 in a range of 8.8% to 99.6%, while observational studies indicated a detection rate of 2% to 77.9%, including variants of concern depending on the screening method employed. The literature also indicated these measures can delay onset of the epidemic by 7 to 32 days. Based on our review findings, if POE screening measures are implemented in combination with other public health interventions such as rapid tests, they may help detect and reduce the spread of COVID-19.
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Affiliation(s)
- Remidius Kamuhabwa Kakulu
- Department of Health and Biomedical Sciences, School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha P.O. Box 447, Tanzania; (E.G.K.); (E.A.M.)
- Department of Preventive Services, Ministry of Health, Dodoma P.O. Box 743, Tanzania
| | - Esther Gwae Kimaro
- Department of Health and Biomedical Sciences, School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha P.O. Box 447, Tanzania; (E.G.K.); (E.A.M.)
| | - Emmanuel Abraham Mpolya
- Department of Health and Biomedical Sciences, School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha P.O. Box 447, Tanzania; (E.G.K.); (E.A.M.)
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
- Center for Global Health (CGH), Perelman School of Medicine University of Pennsylvania, 240 John Morgan Bldg., 3620 Hamilton Walk, Philadelphia, PA 19104, USA
- Institute for Health Metrics and Evaluation (IHME), Population Health Building/Hans Rosling Center, 3980 15th Ave. NE, Seattle, WA 98195, USA
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Liu Y, Yin Y, Ward MP, Li K, Chen Y, Duan M, Wong PPY, Hong J, Huang J, Shi J, Zhou X, Chen X, Xu J, Yuan R, Kong L, Zhang Z. Optimization of Screening Strategies for COVID-19: Scoping Review. JMIR Public Health Surveill 2024; 10:e44349. [PMID: 38412011 PMCID: PMC10933748 DOI: 10.2196/44349] [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: 11/17/2022] [Revised: 06/29/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND COVID-19 screening is an effective nonpharmaceutical intervention for identifying infected individuals and interrupting viral transmission. However, questions have been raised regarding its effectiveness in controlling the spread of novel variants and its high socioeconomic costs. Therefore, the optimization of COVID-19 screening strategies has attracted great attention. OBJECTIVE This review aims to summarize the evidence and provide a reference basis for the optimization of screening strategies for the prevention and control of COVID-19. METHODS We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. We conducted a scoping review of the present publications on the optimization of COVID-19 screening strategies. We searched the PubMed, Web of Science, and Elsevier ScienceDirect databases for publications up to December 31, 2022. English publications related to screening and testing strategies for COVID-19 were included. A data-charting form, jointly developed by 2 reviewers, was used for data extraction according to the optimization directions of the screening strategies. RESULTS A total of 2770 unique publications were retrieved from the database search, and 95 abstracts were retained for full-text review. There were 62 studies included in the final review. We summarized the results in 4 major aspects: the screening population (people at various risk conditions such as different regions and occupations; 12/62, 19%), the timing of screening (when the target population is tested before travel or during an outbreak; 12/62, 19%), the frequency of screening (appropriate frequencies for outbreak prevention, outbreak response, or community transmission control; 6/62, 10%), and the screening and detection procedure (the choice of individual or pooled detection and optimization of the pooling approach; 35/62, 56%). CONCLUSIONS This review reveals gaps in the optimization of COVID-19 screening strategies and suggests that a number of factors such as prevalence, screening accuracy, effective allocation of resources, and feasibility of strategies should be carefully considered in the development of future screening strategies.
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Affiliation(s)
- Yuanhua Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yun Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Michael P Ward
- Sydney School of Veterinary Science, The University of Sydney, NSW, Australia
| | - Ke Li
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mengwei Duan
- Department of Mathematics and Physics, North China Electric Power University, Baoding, China
| | | | - Jie Hong
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jiaqi Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jin Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xuan Zhou
- Department of Mathematics and Physics, North China Electric Power University, Baoding, China
| | - Xi Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jiayao Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Rui Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Lingcai Kong
- Department of Mathematics and Physics, North China Electric Power University, Baoding, China
| | - Zhijie Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Waite LL, Nahhas A, Irvahn J, Garden G, Kerfonta CM, Killelea E, Ferng W, Cummins JJ, Mereness R, Austin T, Jones S, Olson N, Wilson M, Isaac B, Pepper CA, Koolhof IS, Armstrong J. COVID-19 passenger screening to reduce travel risk and translocation of disease. Epidemiol Infect 2024; 152:e36. [PMID: 38326275 PMCID: PMC10945944 DOI: 10.1017/s0950268824000220] [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: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Aviation passenger screening has been used worldwide to mitigate the translocation risk of SARS-CoV-2. We present a model that evaluates factors in screening strategies used in air travel and assess their relative sensitivity and importance in identifying infectious passengers. We use adapted Monte Carlo simulations to produce hypothetical disease timelines for the Omicron variant of SARS-CoV-2 for travelling passengers. Screening strategy factors assessed include having one or two RT-PCR and/or antigen tests prior to departure and/or post-arrival, and quarantine length and compliance upon arrival. One or more post-arrival tests and high quarantine compliance were the most important factors in reducing pathogen translocation. Screening that combines quarantine and post-arrival testing can shorten the length of quarantine for travelers, and variability and mean testing sensitivity in post-arrival RT-PCR and antigen tests decrease and increase with the greater time between the first and second post-arrival test, respectively. This study provides insight into the role various screening strategy factors have in preventing the translocation of infectious diseases and a flexible framework adaptable to other existing or emerging diseases. Such findings may help in public health policy and decision-making in present and future evidence-based practices for passenger screening and pandemic preparedness.
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Affiliation(s)
| | - Ahmad Nahhas
- The Boeing Company, Arlington, Virginia, United States
| | - Jan Irvahn
- The Boeing Company, Arlington, Virginia, United States
| | - Grace Garden
- The Boeing Company, Arlington, Virginia, United States
| | | | | | - William Ferng
- The Boeing Company, Arlington, Virginia, United States
| | | | | | - Thomas Austin
- The Boeing Company, Arlington, Virginia, United States
| | - Stephen Jones
- The Boeing Company, Arlington, Virginia, United States
| | - Nels Olson
- The Boeing Company, Arlington, Virginia, United States
| | - Mark Wilson
- The Boeing Company, Arlington, Virginia, United States
| | - Benson Isaac
- The Boeing Company, Arlington, Virginia, United States
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7
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Panasci A, Gearhart S, Shaum A, Simental AJ, Mitchell C, Mitcham D, Williams G, Shake N, Brown C, Gertz AM. Demographic and travel characteristics and self-reported predeparture SARS-CoV-2 testing behavior in air passengers entering the United States from foreign destinations from July to September 2021. Immun Inflamm Dis 2023; 11:e1019. [PMID: 38156393 PMCID: PMC10732182 DOI: 10.1002/iid3.1019] [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: 01/09/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION From January 2021 to June 2022, the United States Centers for Disease Control and Prevention required predeparture SARS-CoV-2 testing for all air passengers arriving into the United States from a foreign country. METHODS Using data collected during a surveillance project, we described predeparture testing behavior among a convenience sample of international air passengers entering the United States from July to September 2021 at six US ports of entry. We analyzed pairwise relationships between self-reported test type, test timing, demographic and travel characteristics, and COVID-19 vaccination status using chi-square and Fisher's exact tests. RESULTS Participants were more likely to get a NAAT versus antigen test if they identified as non-Hispanic Asian or Pacific Islander (68.2%, n = 173), non-Hispanic Black (62.6%, n = 147), or if they preferred not to report race and ethnicity (60.8%, n = 209) when compared to those who identified as non-Hispanic White (47.1%, n = 1086, all p < 0.05). Those who identified as Hispanic or Latino (n = 671) were less likely to get a NAAT than the non-Hispanic White group (39.5% vs. 47.1%, p < 0.05). Participants arriving in the US from the Americas were less likely to get a NAAT (38.5%, n = 871) compared to those arriving from Europe (45.5%, n = 1165, p < 0.05). Participants who reported receiving their predeparture test 2 days or 3 or more days before departure were more likely to report receiving a NAAT (52.2%, n = 879, and 60.2%, n = 410, respectively) than those who reported testing within 1 day (41.4%, n = 1040, all p < 0.001) of departure. DISCUSSION Test type was significantly associated with race and ethnicity, departure region, and test timing. Differences likely reflected regional disparities in the availability of tests at the time of the activity. Discrepancies in predeparture test timing and type worldwide may have consequences for the effectiveness and equity of travel requirements in future pandemics.
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Affiliation(s)
- Anthony Panasci
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
- Oak Ridge Institute for Science and Education (ORISE) Fellowship ProgramOak RidgeTennesseeUSA
| | - Shannon Gearhart
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
| | - Anna Shaum
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
| | - Arthur J. Simental
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
| | - Colby Mitchell
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
- Oak Ridge Institute for Science and Education (ORISE) Fellowship ProgramOak RidgeTennesseeUSA
| | - Dionne Mitcham
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
- Oak Ridge Institute for Science and Education (ORISE) Fellowship ProgramOak RidgeTennesseeUSA
| | - Gilandria Williams
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
- Oak Ridge Institute for Science and Education (ORISE) Fellowship ProgramOak RidgeTennesseeUSA
| | - Nadim Shake
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
- Oak Ridge Institute for Science and Education (ORISE) Fellowship ProgramOak RidgeTennesseeUSA
| | - Clive Brown
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
| | - Alida M. Gertz
- Centers for Disease Control and PreventionDivision of Global Migration and QuarantineAtlantaGeorgiaUSA
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8
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Judson TJ, Zhang S, Lindan CP, Boothroyd D, Grumbach K, Bollyky JB, Sample HA, Huang B, Desai M, Gonzales R, Maldonado Y, Rutherford G. Association of protective behaviors with SARS-CoV-2 infection: results from a longitudinal cohort study of adults in the San Francisco Bay Area. Ann Epidemiol 2023; 86:1-7. [PMID: 37524216 DOI: 10.1016/j.annepidem.2023.07.009] [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: 12/12/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE In an effort to decrease transmission during the first years of the COVID-19 pandemic, public health officials encouraged masking, social distancing, and working from home, and restricted travel. However, many studies of the effectiveness of these measures had significant methodologic limitations. In this analysis, we used data from the TrackCOVID study, a longitudinal cohort study of a population-based sample of 3846 adults in the San Francisco Bay Area, to evaluate the association between self-reported protective behaviors and incidence of SARS-CoV-2 infection. METHODS Participants without SARS-CoV2 infection were enrolled from August to December 2020 and followed monthly with testing and surveys (median of four visits). RESULTS A total of 118 incident infections occurred (3.0% of participants). At baseline, 80.0% reported always wearing a mask; 56.0% avoided contact with nonhousehold members some/most of the time; 9.6% traveled outside the state; and 16.0% worked 20 or more hours per week outside the home. Factors associated with incident infection included being Black or Latinx, having less than a college education, and having more household residents. The only behavioral factor associated with incident infection was working outside the home (adjusted hazard ratio 1.62, 95% confidence interval 1.02-2.59). CONCLUSIONS Focusing on protecting people who cannot work from home could help prevent infections during future waves of COVID-19, or future pandemics from respiratory viruses. This focus must be balanced with the known importance of directing resources toward those at risk of severe infections.
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Affiliation(s)
- Timothy J Judson
- Department of Medicine, University of California San Francisco, San Francisco.
| | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Christina P Lindan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Derek Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Kevin Grumbach
- Department of Family and Community Medicine, University of California San Francisco, San Francisco
| | - Jennifer B Bollyky
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA
| | - Hannah A Sample
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Beatrice Huang
- Department of Medicine, University of California San Francisco, San Francisco
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Ralph Gonzales
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco
| | - Yvonne Maldonado
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA; Department of Medicine, School of Medicine, Stanford University, Stanford, CA
| | - George Rutherford
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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9
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Hüsser AP, Ohnmacht T. A comparative study of eight COVID-19 protective measures and their impact on Swiss tourists' travel intentions. TOURISM MANAGEMENT 2023; 97:104734. [PMID: 36712143 PMCID: PMC9874056 DOI: 10.1016/j.tourman.2023.104734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
A comparative vignette-based experimental survey design incorporating various socio-psychological factors, linked to the Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and the Domain-Specific Risk-Taking scale (DOSPERT) was carried out to test variations in eight travel-related COVID-19 protective measures on Swiss tourists' travel intentions. Among the tested measures, vaccination passports, surgical masks and quarantining are those that stand out the most, with surgical masks having the greatest acceptance and willingness to adopt while traveling. Quarantining, on the other hand, appears to have a deterrent influence on travel intentions, and vaccination passports have the lowest perceived barriers during travel, but the highest perceived benefits in mitigating the spread of the infection. The discussion of individual differences has specific implications for tourism management against the background of our empirical findings.
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Affiliation(s)
- Andreas Philippe Hüsser
- Lucerne University of Applied Sciences and Arts, Institute of Tourism and Mobility ITM, Rösslimatte 48, CH-6002, Lucerne, Switzerland
| | - Timo Ohnmacht
- Lucerne University of Applied Sciences and Arts, Institute of Tourism and Mobility ITM, Rösslimatte 48, CH-6002, Lucerne, Switzerland
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10
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Murphy C, Wong JY, Cowling BJ. Nonpharmaceutical interventions for managing SARS-CoV-2. Curr Opin Pulm Med 2023; 29:184-190. [PMID: 36856551 PMCID: PMC10090342 DOI: 10.1097/mcp.0000000000000949] [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] [Indexed: 03/02/2023]
Abstract
PURPOSE OF REVIEW Initial response strategies to the COVID-19 pandemic were heavily reliant on nonpharmaceutical interventions (NPIs), a set of measures implemented to slow or even stop the spread of infection. Here, we reviewed key measures used during the COVID-19 pandemic. RECENT FINDINGS Some NPIs were successful in reducing the transmission of SARS-CoV-2. Personal protective measures such as face masks were widely used, and likely had some effect on transmission. The development and production of rapid antigen tests allowed self-diagnosis in the community, informing isolation and quarantine measures. Community-wide measures such as school closures, workplace closures and complete stay-at-home orders were able to reduce contacts and prevent transmission. They were widely used in the pandemic and contributed to reduce transmission in the community; however, there were also negative unintended consequences in the society and economy. SUMMARY NPIs slowed the spread of SARS-CoV-2 and are essential for pandemic preparedness and response. Understanding which measures are more effective at reducing transmission with lower costs is imperative.
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Affiliation(s)
- Caitriona Murphy
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam
| | - Jessica Y. Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
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11
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Bart SM, Smith TC, Guagliardo SAJ, Walker AT, Rome BH, Li SL, Aichele TWS, Stein R, Ernst ET, Morfino RC, Cetron MS, Friedman CR. Effect of Predeparture Testing on Postarrival SARS-CoV-2-Positive Test Results Among International Travelers - CDC Traveler-Based Genomic Surveillance Program, Four U.S. Airports, March-September 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:206-209. [PMID: 36821719 PMCID: PMC9949849 DOI: 10.15585/mmwr.mm7208a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics.
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12
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Shaum A, Figueroa A, Lee D, Ertl A, Rothney E, Borntrager D, Davenport E, Gulati RK, Brown CM. Cross-sectional survey of SARS-CoV-2 testing at US airports and one health department’s proactive management of travelers. Trop Dis Travel Med Vaccines 2022; 8:8. [PMID: 35305682 PMCID: PMC8934201 DOI: 10.1186/s40794-022-00164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many health departments and private enterprises began offering SARS-CoV-2 testing to travelers at US airports in 2020. Persons with positive SARS-CoV-2 test results who have planned upcoming travel may be subject to US federal public health travel restrictions.
We assessed availability of testing for SARS-CoV-2 at major US airports. We then describe the management of cases and close contacts at Denver International Airport’s testing site.
Methods
We selected 100 US airports. Online surveys were conducted during November–December 2020 and assessed availability of testing for air travelers, flight crew, and airport employees. Respondents included health department (HD) staff or airport directors.
We analyzed testing data and management practices for persons who tested positive and their close contacts at one airport (Denver International) from 12/21/2020 to 3/31/2021.
Results
Among the 100 selected airports, we received information on 77 airports; 38 (49%) had a testing site and several more planned to offer one (N = 7; 9%). Most sites began testing in the fall of 2020. The most frequently offered tests were RT-PCR or other NAAT tests (N = 28).
Denver International Airport offered voluntary SARS-CoV-2 testing. Fifty-four people had positive results among 5724 tests conducted from 12/21/2020 to 3/31/2021 for a total positivity of < 1%. Of these, 15 were travelers with imminent flights. The Denver HD issued an order requiring the testing site to immediately report cases and notify airlines to cancel upcoming flight itineraries for infected travelers and their traveling close contacts, minimizing the use of federal travel restrictions.
Conclusions
As of December 2020, nearly half of surveyed US airports had SARS-CoV-2 testing sites. Such large-scale adoption of airport testing for a communicable disease is unprecedented and presents new challenges for travelers, airlines, airports, and public health authorities. This assessment was completed before the US and other countries began enforcing entry testing requirements; testing at airports will likely increase as travel demand returns and test requirements for travel evolve.
Lessons from Denver demonstrate how HDs can play a key role in engaging airport testing sites to ensure people who test positive for SARS-CoV-2 immediately before travel do not travel on commercial aircraft.
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13
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Letizia AG, Goforth CW, Ge Y, Termini MS, Schilling MA, Sugiharto VA, Chen HW, Ramos I, Sealfon SC. Lessons Learned From a Prospective Observational Study of U.S. Marine Recruits During a Supervised Quarantine, Spring‒Fall 2020. AJPM FOCUS 2022; 1:100003. [PMID: 36896336 PMCID: PMC9485796 DOI: 10.1016/j.focus.2022.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Quarantining is commonly used to mitigate the spread of SARS-CoV-2. However, questions remain regarding what specific interventions are most effective. Methods After a 2-week home quarantine, U.S. Marine Corps recruits underwent a supervised 2-week quarantine at a hotel from August 11 to September 21, 2020. All recruits were assessed for symptoms through oral questioning and had their temperatures checked daily. Study participants answered a written clinical questionnaire and were tested for SARS-CoV-2 by polymerase chain reaction shortly after arrival in quarantine and on Days 7 and 14. The results were compared with those of a previously reported Marine-supervised quarantine at a college campus from May until July 2020 utilizing the same study, laboratory, and statistical procedures. Results A total of 1,401 of 1,514 eligible recruits (92.5%) enrolled in the study, 93.1% of whom were male. At the time of enrollment, 12 of 1,401 (0.9%) participants were polymerase chain reaction positive for SARS-CoV-2, 9 of 1,376 (0.7%) were positive on Day 7, and 1 of 1,358 (0.1%) was positive on Day 14. Only 12 of 22 (54.5%) participants endorsed any symptoms on a study questionnaire, and none of the participants had an elevated temperature or endorsed symptoms during daily screening for SARS-CoV-2. Participation rate (92%) was much greater than the approximately 58.8% (1,848 of 3,143) rate observed in the previous Marine-supervised college campus quarantine, suggesting the changing attitudes of recruits during the pandemic (p<0.001). Approximately 1% of participants were quantitative polymerase chain reaction positive after self-quarantine in both studies. Conclusions Key findings include the shifting attitudes of young adults during the pandemic, the limitations of self-quarantine, and the ineffectiveness of daily temperature and symptom screening to identify SARS-CoV-2‒positive recruits.
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Affiliation(s)
- Andrew G Letizia
- Naval Medical Research Center, Navy Medicine, Silver Spring, Maryland
| | - Carl W Goforth
- Naval Medical Research Center, Navy Medicine, Silver Spring, Maryland
| | - Yongchao Ge
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S Termini
- Navy Medicine Readiness and Training Command Beaufort, Navy Medicine, Beaufort, South Carolina
| | - Megan A Schilling
- Naval Medical Research Center, Navy Medicine, Silver Spring, Maryland
| | - Victor A Sugiharto
- Naval Medical Research Center, Navy Medicine, Silver Spring, Maryland.,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Hua Wei Chen
- Naval Medical Research Center, Navy Medicine, Silver Spring, Maryland.,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Irene Ramos
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart C Sealfon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Hyle EP, Le MH, Rao SR, Mulroy NM, Walker AT, Ryan ET, LaRocque RC. High-risk US international travelers seeking pretravel consultation during the COVID-19 pandemic. Open Forum Infect Dis 2022; 9:ofac399. [PMID: 36000001 PMCID: PMC9384642 DOI: 10.1093/ofid/ofac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background To assess the implications of coronavirus disease 2019 (COVID-19)–related travel disruptions, we compared demographics and travel-related circumstances of US travelers seeking pretravel consultation regarding international travel at US Global TravEpiNet (GTEN) sites before and after the initiation of COVID-19 travel warnings. Methods We analyzed data in the GTEN database regarding traveler demographics and travel-related circumstances with standard questionnaires in the pre-COVID-19 period (January–December 2019) and the COVID-19 period (April 2020–March 2021), excluding travelers from January to March 2020. We conducted descriptive analyses of differences in demographics, travel-related circumstances, routine and travel-related vaccinations, and medications. Results Compared with 16 903 consultations in the pre-COVID-19 period, only 1564 consultations were recorded at GTEN sites during the COVID-19 period (90% reduction), with a greater proportion of travelers visiting friends and relatives (501/1564 [32%] vs 1525/16 903 [9%]), individuals traveling for >28 days (824/1564 [53%] vs 2522/16 903 [15%]), young children (6 mo–<6 y: 168/1564 [11%] vs 500/16 903 [3%]), and individuals traveling to Africa (1084/1564 [69%] vs 8049/16 903 [48%]). A smaller percentage of vaccine-eligible travelers received vaccines at pretravel consultations during the COVID-19 period than before, except for yellow fever and Japanese encephalitis vaccinations. Conclusions Compared with the pre-COVID-19 period, a greater proportion of travelers during the COVID-19 period were young children, were planning to visit friends and relatives, were traveling for >28 days, or were traveling to Africa, which are circumstances that contribute to high risk for travel-related infections. Fewer vaccine-eligible travelers were administered travel-related vaccines at pretravel consultations. Counseling and vaccination focused on high-risk international travelers must be prioritized during the COVID-19 pandemic.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
| | - Mylinh H Le
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health , Boston, MA , USA
| | - Nora M Mulroy
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
| | - Allison T Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention , Atlanta, GA , USA
| | - Edward T Ryan
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
- Harvard T.H. Chan School of Public Heath , Boston, MA , USA
| | - Regina C LaRocque
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
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15
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Sender R, Bar-On Y, Woo Park S, Noor E, Dushoff J, Milo R. The unmitigated profile of COVID-19 infectiousness. eLife 2022; 11:79134. [PMID: 35913120 PMCID: PMC9391043 DOI: 10.7554/elife.79134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Quantifying the temporal dynamics of infectiousness of individuals infected with SARS-CoV-2 is crucial for understanding the spread of COVID-19 and for evaluating the effectiveness of mitigation strategies. Many studies have estimated the infectiousness profile using observed serial intervals. However, statistical and epidemiological biases could lead to underestimation of the duration of infectiousness. We correct for these biases by curating data from the initial outbreak of the pandemic in China (when mitigation was minimal), and find that the infectiousness profile of the original strain is longer than previously thought. Sensitivity analysis shows our results are robust to model structure, assumed growth rate and potential observational biases. Although unmitigated transmission data is lacking for variants of concern (VOCs), previous analyses suggest that the alpha and delta variants have faster within-host kinetics, which we extrapolate to crude estimates of variant-specific unmitigated generation intervals. Knowing the unmitigated infectiousness profile of infected individuals can inform estimates of the effectiveness of isolation and quarantine measures. The framework presented here can help design better quarantine policies in early stages of future epidemics.
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Affiliation(s)
- Ron Sender
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Yinon Bar-On
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Sang Woo Park
- Department of Ecology and Evolutionary, Princeton University, Princeton, United States
| | - Elad Noor
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | | | - Ron Milo
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
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16
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Liu Y, Zhao S, Ryu S, Ran J, Fan J, He D. Estimating the incubation period of SARS-CoV-2 Omicron BA.1 variant in comparison with that during the Delta variant dominance in South Korea. One Health 2022; 15:100425. [PMID: 35942477 PMCID: PMC9349028 DOI: 10.1016/j.onehlt.2022.100425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022] Open
Abstract
Based on exposure history and symptom onset of 22 Omicron BA.1 cases in South Korea from November to December 2021, we estimated mean incubation period of 3.5 days (95% CI: 2.5, 3.8), and then compared to that of 6.5 days (95% CI: 5.3, 7.7) for 64 cases during Delta variants' dominance in June 2021. For Omicron BA.1 variants, we found that 95% of symptomatic cases developed clinical conditions within 6.0 days (95% CI: 4.3, 6.6) after exposure. Thus, a shorter quarantine period may be considered based on symptoms, or similarly laboratory testing, when Omicron BA.1 variants are circulating.
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17
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Wells CR, Gokcebel S, Pandey A, Galvani AP, Townsend JP. Testing for COVID-19 is Much More Effective When Performed Immediately Prior to Social Mixing. Int J Public Health 2022; 67:1604659. [PMID: 35967267 PMCID: PMC9363582 DOI: 10.3389/ijph.2022.1604659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To quantify the utility of RT-PCR and rapid antigen tests in preventing post-arrival transmission based on timing of the pre-departure test.Methods: We derived analytical expressions to compute post-arrival transmission when no test is performed, and when either an RT-PCR or any of 18 rapid antigen tests is performed at specified times before arrival. We determined the diagnostic sensitivity of the rapid antigen tests by propagating their RT-PCR percent positive agreement onto known RT-PCR diagnostic sensitivity.Results: Depending on the rapid antigen test used, conducting a rapid antigen test immediately before departure reduces post-arrival transmission between 37.4% (95% CrI: 28.2%–40.7%) and 46.7% (95% CrI:40.0%–49.3%), compared to a 31.1% (95% CrI: 26.3%–33.5%) reduction using an RT-PCR 12 h before arrival. Performance of each rapid antigen test differed by diagnostic sensitivity over the course of disease. However, these differences were smaller than those engendered by testing too early.Conclusion: Testing closer to arrival—ideally on the day of arrival—is more effective at reducing post-arrival transmission than testing earlier. Rapid antigen tests perform the best in this application due to their short turnaround time.
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Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Senay Gokcebel
- Yale School of Public Health, New Haven, CT, United States
- Grinnell College, Grinnell, IA, United States
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Jeffrey P. Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
- Program in Microbiology, Yale University, New Haven, CT, United States
- *Correspondence: Jeffrey P. Townsend,
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18
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Wegrzyn RD, Appiah GD, Morfino R, Milford SR, Walker AT, Ernst ET, Darrow WW, Li SL, Robison K, MacCannell D, Dai D, Girinathan BP, Hicks AL, Cosca B, Woronoff G, Plocik AM, Simen BB, Moriarty L, Guagliardo SAJ, Cetron MS, Friedman CR. Early Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Variants Using Traveler-based Genomic Surveillance at 4 US Airports, September 2021-January 2022. Clin Infect Dis 2022; 76:e540-e543. [PMID: 35686436 PMCID: PMC9214179 DOI: 10.1093/cid/ciac461] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
We enrolled arriving international air travelers in a severe acute respiratory syndrome coronavirus 2 genomic surveillance program. We used molecular testing of pooled nasal swabs and sequenced positive samples for sublineage. Traveler-based surveillance provided early-warning variant detection, reporting the first US Omicron BA.2 and BA.3 in North America.
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Affiliation(s)
- Renee D Wegrzyn
- Correspondence: C. R. Friedman, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H16-4, Atlanta, GA 30333 ()
| | - Grace D Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Duncan MacCannell
- Office of Advanced Molecular Detection, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dongjuan Dai
- Ginkgo Bioworks, Inc, Boston, Massachusetts, USA
| | | | | | - Bryan Cosca
- Ginkgo Bioworks, Inc, Boston, Massachusetts, USA
| | | | | | | | - Leah Moriarty
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin S Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Blanford JI, Jong NBD, Schouten SE, Friedrich AW, Araújo-Soares V. Navigating travel in Europe during the pandemic: from mobile apps, certificates and quarantine to traffic-light system. J Travel Med 2022; 29:6520892. [PMID: 35134215 PMCID: PMC9155998 DOI: 10.1093/jtm/taac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ever since 2020, travelling has become complex, and increasingly so as the COVID-19 pandemic continues. To reopen Europe safely, a consensus of travel measures has been agreed between countries to enable movement between countries with as few restrictions as possible. However, communication of these travel measures and requirements for entry are not always clear and easily available. The aim of this study was to assess the availability, accessibility and harmonization of current travel information available in Europe. METHODS We performed a systematic documental analysis of online publicly available information and synthesized travel entry requirements for all countries in the European Union and Schengen Area (N = 31). For each country we assessed entry requirements, actions after entry, how risk was assessed, and how accessible the information was. RESULTS We found varying measures implemented across Europe for entry and a range of exemptions and restrictions, some of which were consistent between countries. Information was not always easy to find taking on average 10 clicks to locate. Twenty-one countries required pre-travel forms to be completed. Forty apps were in use, 11 serving as digital certification checkers. All countries required some form of COVID-19 certification for entry with some exemptions (e.g. children). Nineteen percent (n = 6) of countries used the ECDC risk assessment system; 80% (n = 25) defined their own. Forty-eight percent (n = 15) of countries used a traffic-light system with 2-5 risk classifications. CONCLUSION A comprehensive set of measures has been developed to enable continued safe travel in Europe. However further refinements and coordination is needed to align travel measures throughout the EU to minimize confusion and maximize adherence to requested measures. We recommend that, along with developing travel measures based on a common set of rules, a standard approach is taken to communicate what these measures are.
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Affiliation(s)
- Justine I Blanford
- Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, the Netherlands
| | - Nienke Beerlage-de Jong
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Stephanie E Schouten
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Vera Araújo-Soares
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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20
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Molero-Salinas A, Rico-Luna C, Losada C, Buenestado-Serrano S, de la Cueva García VM, Egido J, Adán-Jiménez J, Catalán P, Muñoz P, Pérez-Lago L, García de Viedma D. High SARS-CoV-2 viral load in travellers arriving in Spain with a negative COVID-19 test prior to departure. J Travel Med 2022; 29:6428778. [PMID: 34791355 PMCID: PMC8690021 DOI: 10.1093/jtm/taab180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022]
Abstract
Hundred and ninety-six travellers with negative-COVID-19-tests prior to departure tested positive, on arrival at Madrid (April/June 2021), from a total of 45 211 travellers tested (0.43%). Viral loads (Ct: 20.3) were higher compared to the general population (Ct: 27.09). Our data reveal weaknesses in pre-departure testing and alert about high-viral-load-SARS-CoV-2 carriers in intercontinental flights.
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Affiliation(s)
- Andrea Molero-Salinas
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Carla Rico-Luna
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Carmen Losada
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Sergio Buenestado-Serrano
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Víctor Manuel de la Cueva García
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - José Egido
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Javier Adán-Jiménez
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Pilar Catalán
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Departamento de Medicina, Universidad Complutense, Madrid 28040, Spain
| | - Laura Pérez-Lago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain
| | - Darío García de Viedma
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Marañón General University Hospital, Madrid 28007, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid 28007, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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21
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Estimating the generation interval from the incidence rate, the optimal quarantine duration and the efficiency of fast switching periodic protocols for COVID-19. Sci Rep 2022; 12:4623. [PMID: 35301351 PMCID: PMC8929281 DOI: 10.1038/s41598-022-08197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/03/2022] [Indexed: 11/08/2022] Open
Abstract
The transmissibility of an infectious disease is usually quantified in terms of the reproduction number [Formula: see text] representing, at a given time, the average number of secondary cases caused by an infected individual. Recent studies have enlightened the central role played by w(z), the distribution of generation times z, namely the time between successive infections in a transmission chain. In standard approaches this quantity is usually substituted by the distribution of serial intervals, which is obtained by contact tracing after measuring the time between onset of symptoms in successive cases. Unfortunately, this substitution can cause important biases in the estimate of [Formula: see text]. Here we present a novel method which allows us to simultaneously obtain the optimal functional form of w(z) together with the daily evolution of [Formula: see text], over the course of an epidemic. The method uses, as unique information, the daily series of incidence rate and thus overcomes biases present in standard approaches. We apply our method to one year of data from COVID-19 officially reported cases in the 21 Italian regions, since the first confirmed case on February 2020. We find that w(z) has mean value [Formula: see text] days with a standard deviation [Formula: see text] day, for all Italian regions, and these values are stable even if one considers only the first 10 days of data recording. This indicates that an estimate of the most relevant transmission parameters can be already available in the early stage of a pandemic. We use this information to obtain the optimal quarantine duration and to demonstrate that, in the case of COVID-19, post-lockdown mitigation policies, such as fast periodic switching and/or alternating quarantine, can be very efficient.
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22
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Factors Associated with an Outbreak of COVID-19 in Oilfield Workers, Kazakhstan, 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063291. [PMID: 35328978 PMCID: PMC8955266 DOI: 10.3390/ijerph19063291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023]
Abstract
From March to May 2020, 1306 oilfield workers in Kazakhstan tested positive for SARS-CoV-2. We conducted a case-control study to assess factors associated with SARS-CoV-2 transmission. The cases were PCR-positive for SARS-CoV-2 during June–September 2020. Controls lived at the same camp and were randomly selected from the workers who were PCR-negative for SARS-CoV-2. Data was collected telephonically by interviewing the oil workers. The study had 296 cases and 536 controls with 627 (75%) men, and 527 (63%) were below 40 years of age. Individual factors were the main drivers of transmission, with little contribution by environmental factors. Of the twenty individual factors, rare hand sanitizer use, travel before shift work, and social interactions outside of work increased SARS-CoV-2 transmission. Of the twenty-two environmental factors, only working in air-conditioned spaces was associated with SARS-CoV-2 transmission. Communication messages may enhance workers’ individual responsibility and responsibility for the safety of others to reduce SARS-CoV-2 transmission.
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23
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Aggarwal D, Page AJ, Schaefer U, Savva GM, Myers R, Volz E, Ellaby N, Platt S, Groves N, Gallagher E, Tumelty NM, Le Viet T, Hughes GJ, Chen C, Turner C, Logan S, Harrison A, Peacock SJ, Chand M, Harrison EM. Genomic assessment of quarantine measures to prevent SARS-CoV-2 importation and transmission. Nat Commun 2022; 13:1012. [PMID: 35197443 PMCID: PMC8866425 DOI: 10.1038/s41467-022-28371-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023] Open
Abstract
Mitigation of SARS-CoV-2 transmission from international travel is a priority. We evaluated the effectiveness of travellers being required to quarantine for 14-days on return to England in Summer 2020. We identified 4,207 travel-related SARS-CoV-2 cases and their contacts, and identified 827 associated SARS-CoV-2 genomes. Overall, quarantine was associated with a lower rate of contacts, and the impact of quarantine was greatest in the 16-20 age-group. 186 SARS-CoV-2 genomes were sufficiently unique to identify travel-related clusters. Fewer genomically-linked cases were observed for index cases who returned from countries with quarantine requirement compared to countries with no quarantine requirement. This difference was explained by fewer importation events per identified genome for these cases, as opposed to fewer onward contacts per case. Overall, our study demonstrates that a 14-day quarantine period reduces, but does not completely eliminate, the onward transmission of imported cases, mainly by dissuading travel to countries with a quarantine requirement.
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Affiliation(s)
- Dinesh Aggarwal
- University of Cambridge, Department of Medicine, Cambridge, UK. .,Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK. .,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK. .,Wellcome Sanger Institute, Hinxton, Cambridge, UK.
| | - Andrew J Page
- Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Ulf Schaefer
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - George M Savva
- Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Richard Myers
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Erik Volz
- Imperial College London, Department of Infectious Disease Epidemiology, London, UK
| | - Nicholas Ellaby
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Steven Platt
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Natalie Groves
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | | | - Niamh M Tumelty
- University of Cambridge, Cambridge University Libraries, Cambridge, UK
| | - Thanh Le Viet
- Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Gareth J Hughes
- Public Health England National Infections Service, Field Service, Leeds, UK
| | - Cong Chen
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Charlie Turner
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Sophie Logan
- Public Health England, National Infections Service, Field Service, Nottingham, UK
| | - Abbie Harrison
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | | | - Sharon J Peacock
- University of Cambridge, Department of Medicine, Cambridge, UK.,Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK.,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.,Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Meera Chand
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Ewan M Harrison
- University of Cambridge, Department of Medicine, Cambridge, UK. .,Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK. .,Wellcome Sanger Institute, Hinxton, Cambridge, UK. .,University of Cambridge, Department of Public Health and Primary Care, Cambridge, UK.
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24
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Liu AB, Davidi D, Landsberg HE, Francesconi M, Platt JT, Nguyen GT, Yune S, Deckard A, Puglin J, Haase SB, Hamer DH, Springer M. Association of COVID-19 Quarantine Duration and Postquarantine Transmission Risk in 4 University Cohorts. JAMA Netw Open 2022; 5:e220088. [PMID: 35212750 PMCID: PMC8881770 DOI: 10.1001/jamanetworkopen.2022.0088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Optimal quarantine length for COVID-19 infection is unclear, in part owing to limited empirical data. Objective To assess postquarantine transmission risk for various quarantine lengths and potential associations between quarantine strictness and transmission risk. Design, Setting, and Participants Retrospective cohort study in 4 US universities from September 2020 to February 2021, including 3641 university students and staff who were identified as close contacts to individuals who tested positive for SARS-CoV-2 infection. Individuals were tested throughout the 10 to 14-day quarantine, and follow-up testing continued at least weekly throughout the 2020-2021 academic year. Exposures Strict quarantine, including designated housing with a private room, private bathroom, and meal delivery, vs nonstrict, which potentially included interactions with household members. Main Outcomes and Measures Dates of last known exposure, last negative test result, and first positive test result during quarantine. Results This study included 301 quarantined university students and staff who tested SARS-CoV-2-positive (of 3641 quarantined total). These 301 individuals had a median (IQR) age of 22.0 (20.0-25.0) years; 131 (43.5%) identified as female; and 20 (6.6%) were staff. Of the 287 self-reporting race and ethnicity according to university-defined classifications, 21 (7.3%) were African American or Black, 60 (20.9%) Asian, 17 (5.9%) Hispanic or Latinx, 174 (60.6%) White, and 15 (5.2%) other (including multiracial and/or multiethnic). Of the 301 participants, 40 (13.3%; 95% CI, 9.9%-17.6%) had negative test results and were asymptomatic on day 7 compared with 15 (4.9%; 95% CI, 3.0%-8.1%) and 4 (1.4%; 95% CI, 0.4%-3.5%) on days 10 and 14, respectively. Individuals in strict quarantine tested positive less frequently than those in nonstrict quarantine (10% vs 12%; P = .04). Conclusions and Relevance To maintain the 5% transmission risk used as the basis for US Centers for Disease Control and Prevention's 7-day test-based quarantine guidance, our data suggest that quarantine with quantitative polymerase chain reaction testing 1 day before intended release should be 10 days for nonstrict quarantine and 8 days for strict quarantine, as ongoing exposure during quarantine may be associated with the higher rate of positive test results following nonstrict quarantine.
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Affiliation(s)
- Andrew Bo Liu
- Bioinformatics and Integrative Genomics PhD Program, Harvard Medical School, Boston, Massachusetts
| | - Dan Davidi
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Judy T. Platt
- Student Health Services, Boston University, Boston, Massachusetts
| | - Giang T. Nguyen
- Harvard University Health Services, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sehyo Yune
- Student Affairs Northeastern University, Boston, Massachusetts
| | - Anastasia Deckard
- Office of Information Technology, Duke University, Durham, North Carolina
| | - Jamie Puglin
- Office of Assessment, Duke University, Durham, North Carolina
| | - Steven B. Haase
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts
| | - Michael Springer
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
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25
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Wells CR, Pandey A, Moghadas SM, Singer BH, Krieger G, Heron RJL, Turner DE, Abshire JP, Phillips KM, Michael Donoghue A, Galvani AP, Townsend JP. Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation. COMMUNICATIONS MEDICINE 2022; 2:84. [PMID: 35822105 PMCID: PMC9271059 DOI: 10.1038/s43856-022-00147-y] [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: 08/31/2021] [Accepted: 06/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Rapid antigen (RA) tests are being increasingly employed to detect SARS-CoV-2 infections in quarantine and surveillance. Prior research has focused on RT-PCR testing, a single RA test, or generic diagnostic characteristics of RA tests in assessing testing strategies. Methods We have conducted a comparative analysis of the post-quarantine transmission, the effective reproduction number during serial testing, and the false-positive rates for 18 RA tests with emergency use authorization from The United States Food and Drug Administration and an RT-PCR test. To quantify the extent of transmission, we developed an analytical mathematical framework informed by COVID-19 infectiousness, test specificity, and temporal diagnostic sensitivity data. Results We demonstrate that the relative effectiveness of RA tests and RT-PCR testing in reducing post-quarantine transmission depends on the quarantine duration and the turnaround time of testing results. For quarantines of two days or shorter, conducting a RA test on exit from quarantine reduces onward transmission more than a single RT-PCR test (with a 24-h delay) conducted upon exit. Applied to a complementary approach of performing serial testing at a specified frequency paired with isolation of positives, we have shown that RA tests outperform RT-PCR with a 24-h delay. The results from our modeling framework are consistent with quarantine and serial testing data collected from a remote industry setting. Conclusions These RA test-specific results are an important component of the tool set for policy decision-making, and demonstrate that judicious selection of an appropriate RA test can supply a viable alternative to RT-PCR in efforts to control the spread of disease.
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Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL USA
| | - Gary Krieger
- NewFields E&E, Boulder, CO USA.,Skaggs School of Pharmacy and Pharmaceutical Science, , University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | | | | | | | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Jeffrey P Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, CT USA.,Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT USA.,Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT USA.,Program in Microbiology, Yale University, New Haven, CT USA
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26
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SARS-CoV-2 B.1.1.529 (Omicron) Variant - United States, December 1-8, 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1731-1734. [PMID: 34914670 PMCID: PMC8675659 DOI: 10.15585/mmwr.mm7050e1] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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27
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Zhang S, Ventura MJ, Yang H. Network Modeling and Analysis of COVID-19 Testing Strategies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2003-2006. [PMID: 34891680 DOI: 10.1109/embc46164.2021.9629754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The COVID-19 preparedness plans by the Centers for Disease Control and Prevention strongly underscores the need for efficient and effective testing strategies. This, in turn, calls upon the design and development of statistical sampling and testing of COVID-19 strategies. However, the evaluation of operational details requires a detailed representation of human behaviors in epidemic simulation models. Traditional epidemic simulations are mainly based upon system dynamic models, which use differential equations to study macro-level and aggregated behaviors of population subgroups. As such, individual behaviors (e.g., personal protection, commute conditions, social patterns) can't be adequately modeled and tracked for the evaluation of health policies and action strategies. Therefore, this paper presents a network-based simulation model to optimize COVID-19 testing strategies for effective identifications of virus carriers in a spatial area. Specifically, we design a data-driven risk scoring system for statistical sampling and testing of COVID-19. This system collects real-time data from simulated networked behaviors of individuals in the spatial network to support decision-making during the virus spread process. Experimental results showed that this framework has superior performance in optimizing COVID-19 testing decisions and effectively identifying virus carriers from the population.
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28
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Xin H, Li Y, Wu P, Li Z, Lau EHY, Qin Y, Wang L, Cowling BJ, Tsang T, Li Z. Estimating the latent period of coronavirus disease 2019 (COVID-19). Clin Infect Dis 2021; 74:1678-1681. [PMID: 34453527 DOI: 10.1093/cid/ciab746] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Indexed: 01/12/2023] Open
Abstract
Using detailed exposure information on COVID-19 cases, we estimated the mean latent period to be 5.5 days (95% confidence interval: 5.1-5.9 days), shorter than the mean incubation period (6.9 days). Laboratory testing may allow shorter quarantines since 95% of COVID-19 cases shed virus within 10.6 days (95%CI: 9.6-11.6) of infection.
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Affiliation(s)
- Hualei Xin
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Zhili Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Ying Qin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Tim Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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29
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Peng B, Zhou W, Pettit RW, Yu P, Matos PG, Greninger AL, McCashin J, Amos CI. Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study. BMJ Open 2021; 11:e050473. [PMID: 34272225 PMCID: PMC8290949 DOI: 10.1136/bmjopen-2021-050473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules. DESIGN We performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies. RESULTS We found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine. CONCLUSIONS Testing could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.
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Affiliation(s)
- Bo Peng
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Wen Zhou
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Rowland W Pettit
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Patrick Yu
- Corporate Medical Advisors, Houston, Texas, USA
| | | | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher I Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
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30
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Xin H, Wong JY, Murphy C, Yeung A, Ali ST, Wu P, Cowling BJ. The incubation period distribution of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Clin Infect Dis 2021; 73:2344-2352. [PMID: 34117868 DOI: 10.1093/cid/ciab501] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/14/2022] Open
Abstract
Incubation period is an important parameter to inform quarantine period and to study transmission dynamics of infectious diseases. We conducted a systematic review and meta-analysis on published estimates of the incubation period distribution of COVID-19, and showed that the pooled median of the point estimates of the mean, median and 95 th percentile for incubation period are 6.3 days (range: 1.8 to 11.9 days), 5.4 days (range: 2.0 to 17.9 days) and 13.1 days (range: 3.2 to 17.8 days) respectively. Estimates of the mean and 95 th percentile of the incubation period distribution were considerably shorter before the epidemic peak in China compared to after the peak, and variation was also noticed for different choices of methodological approach in estimation. Our findings implied that corrections may be needed before directly applying estimates of incubation period into control of or further studies on emerging infectious diseases.
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Affiliation(s)
- Hualei Xin
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jessica Y Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Caitriona Murphy
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Amy Yeung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sheikh Taslim Ali
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, New Territories, Hong Kong
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, New Territories, Hong Kong
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, New Territories, Hong Kong
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31
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In pursuit of the right tail for the COVID-19 incubation period. Public Health 2021; 194:149-155. [PMID: 33915459 PMCID: PMC7997403 DOI: 10.1016/j.puhe.2021.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 01/08/2023]
Abstract
Definition of the incubation period for COVID-19 is critical for implementing quarantine and thus infection control. Whereas the classical definition relies on the time from exposure to time of first symptoms, a more practical working definition is the time from exposure to time of first live virus excretion. For COVID-19, average incubation period times commonly span 5–7 days which are generally longer than for most typical other respiratory viruses. There is considerable variability reported however for the late right-hand statistical distribution. A small but yet epidemiologically important subset of patients may have the late end of the incubation period extend beyond the 14 days that is frequently assumed. Conservative assumptions of the right tail end distribution favor safety, but pragmatic working modifications may be required to accommodate high rates of infection and/or healthcare worker exposures. Despite the advent of effective vaccines, further attention and study in these regards are warranted. It is predictable that vaccine application will be associated with continued confusion over protection and its longevity. Measures for the application of infectivity will continue to be extremely relevant.
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Kiang MV, Chin ET, Huynh BQ, Chapman LAC, Rodríguez-Barraquer I, Greenhouse B, Rutherford GW, Bibbins-Domingo K, Havlir D, Basu S, Lo NC. Routine asymptomatic testing strategies for airline travel during the COVID-19 pandemic: a simulation study. THE LANCET. INFECTIOUS DISEASES 2021; 21:929-938. [PMID: 33765417 PMCID: PMC7984872 DOI: 10.1016/s1473-3099(21)00134-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Routine viral testing strategies for SARS-CoV-2 infection might facilitate safe airline travel during the COVID-19 pandemic and mitigate global spread of the virus. However, the effectiveness of these test-and-travel strategies to reduce passenger risk of SARS-CoV-2 infection and population-level transmission remains unknown. METHODS In this simulation study, we developed a microsimulation of SARS-CoV-2 transmission in a cohort of 100 000 US domestic airline travellers using publicly available data on COVID-19 clinical cases and published natural history parameters to assign individuals one of five health states of susceptible to infection, latent period, early infection, late infection, or recovered. We estimated a per-day risk of infection with SARS-CoV-2 corresponding to a daily incidence of 150 infections per 100 000 people. We assessed five testing strategies: (1) anterior nasal PCR test within 3 days of departure, (2) PCR within 3 days of departure and 5 days after arrival, (3) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection), (4) rapid antigen test on the day of travel and PCR test 5 days after arrival, and (5) PCR test 5 days after arrival. Strategies 2 and 4 included a 5-day quarantine after arrival. The travel period was defined as 3 days before travel to 2 weeks after travel. Under each scenario, individuals who tested positive before travel were not permitted to travel. The primary study outcome was cumulative number of infectious days in the cohort over the travel period without isolation or quarantine (population-level transmission risk), and the key secondary outcome was the number of infectious people detected on the day of travel (passenger risk of infection). FINDINGS We estimated that in a cohort of 100 000 airline travellers, in a scenario with no testing or screening, there would be 8357 (95% uncertainty interval 6144-12831) infectious days with 649 (505-950) actively infectious passengers on the day of travel. The pre-travel PCR test reduced the number of infectious days from 8357 to 5401 (3917-8677), a reduction of 36% (29-41) compared with the base case, and identified 569 (88% [76-92]) of 649 actively infectious travellers on the day of flight; the addition of post-travel quarantine and PCR reduced the number of infectious days to 2520 days (1849-4158), a reduction of 70% (64-75) compared with the base case. The rapid antigen test on the day of travel reduced the number of infectious days to 5674 (4126-9081), a reduction of 32% (26-38) compared with the base case, and identified 560 (86% [83-89]) actively infectious travellers; the addition of post-travel quarantine and PCR reduced the number of infectious days to 3124 (2356-495), a reduction of 63% (58-66) compared with the base case. The post-travel PCR alone reduced the number of infectious days to 4851 (3714-7679), a reduction of 42% (35-49) compared with the base case. INTERPRETATION Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting. FUNDING University of California, San Francisco.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Elizabeth T Chin
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Benjamin Q Huynh
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Lloyd A C Chapman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Rodríguez-Barraquer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA; Research and Population Health, Collective Health, San Francisco, CA, USA; School of Public Health, Imperial College, London, UK
| | - Nathan C Lo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Chen LH, Steffen R. SARS-CoV-2 testing to assure safety in air travel. J Travel Med 2021; 28:taaa241. [PMID: 33410482 PMCID: PMC7928769 DOI: 10.1093/jtm/taaa241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
To support the resumption of travel, rational and consistent testing and quarantine guidelines will be critical. Uniformity in the documentation of COVID-19 test results and vaccination will also be important. We discuss evidence to support standardized testing and quarantine requirements and propose a strategy to allow ease in travel planning.
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Affiliation(s)
- Lin H Chen
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Faculty of Medicine, Boston, MA, USA
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Center on Travellers’ Health, University of Zurich, Zürich, Switzerland
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
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