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Deckert A, Anders S, Morales I, De Allegri M, Nguyen HT, Souares A, McMahon S, Meurer M, Burk R, Lou D, Brugnara L, Sand M, Koeppel L, Maier-Hein L, Ross T, Adler TJ, Brenner S, Dyer C, Herbst K, Ovchinnikova S, Marx M, Schnitzler P, Knop M, Bärnighausen T, Denkinger CM. Comparison of Four Active SARS-CoV-2 Surveillance Strategies in Representative Population Sample Points: Two-Factor Factorial Randomized Controlled Trial. JMIR Public Health Surveill 2023; 9:e44204. [PMID: 37235704 PMCID: PMC10437130 DOI: 10.2196/44204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/30/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is characterized by rapid increases in infection burden owing to the emergence of new variants with higher transmissibility and immune escape. To date, monitoring the COVID-19 pandemic has mainly relied on passive surveillance, yielding biased epidemiological measures owing to the disproportionate number of undetected asymptomatic cases. Active surveillance could provide accurate estimates of the true prevalence to forecast the evolution of the pandemic, enabling evidence-based decision-making. OBJECTIVE This study compared 4 different approaches of active SARS-CoV-2 surveillance focusing on feasibility and epidemiological outcomes. METHODS A 2-factor factorial randomized controlled trial was conducted in 2020 in a German district with 700,000 inhabitants. The epidemiological outcome comprised SARS-CoV-2 prevalence and its precision. The 4 study arms combined 2 factors: individuals versus households and direct testing versus testing conditioned on symptom prescreening. Individuals aged ≥7 years were eligible. Altogether, 27,908 addresses from 51 municipalities were randomly allocated to the arms and 15 consecutive recruitment weekdays. Data collection and logistics were highly digitized, and a website in 5 languages enabled low-barrier registration and tracking of results. Gargle sample collection kits were sent by post. Participants collected a gargle sample at home and mailed it to the laboratory. Samples were analyzed with reverse transcription loop-mediated isothermal amplification (RT-LAMP); positive and weak results were confirmed with real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Recruitment was conducted between November 18 and December 11, 2020. The response rates in the 4 arms varied between 34.31% (2340/6821) and 41.17% (2043/4962). The prescreening classified 16.61% (1207/7266) of the patients as COVID-19 symptomatic. Altogether, 4232 persons without prescreening and 7623 participating in the prescreening provided 5351 gargle samples, of which 5319 (99.4%) could be analyzed. This yielded 17 confirmed SARS-CoV-2 infections and a combined prevalence of 0.36% (95% CI 0.14%-0.59%) in the arms without prescreening and 0.05% (95% CI 0.00%-0.108%) in the arms with prescreening (initial contacts only). Specifically, we found a prevalence of 0.31% (95% CI 0.06%-0.58%) for individuals and 0.35% (95% CI 0.09%-0.61%) for households, and lower estimates with prescreening (0.07%, 95% CI 0.0%-0.15% for individuals and 0.02%, 95% CI 0.0%-0.06% for households). Asymptomatic infections occurred in 27% (3/11) of the positive cases with symptom data. The 2 arms without prescreening performed the best regarding effectiveness and accuracy. CONCLUSIONS This study showed that postal mailing of gargle sample kits and returning home-based self-collected liquid gargle samples followed by high-sensitivity RT-LAMP analysis is a feasible way to conduct active SARS-CoV-2 population surveillance without burdening routine diagnostic testing. Efforts to improve participation rates and integration into the public health system may increase the potential to monitor the course of the pandemic. TRIAL REGISTRATION Deutsches Register Klinischer Studien (DRKS) DRKS00023271; https://tinyurl.com/3xenz68a. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-021-05619-5.
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Affiliation(s)
| | - Simon Anders
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | - Ivonne Morales
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hoa Thi Nguyen
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | | | - Matthias Meurer
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | - Robin Burk
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | - Dan Lou
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | - Lucia Brugnara
- evaplan GmbH at the University Hospital, Heidelberg, Germany
| | - Matthias Sand
- GESIS Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Lisa Koeppel
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Centre, Heidelberg, Germany
| | - Tobias Ross
- Division of Computer Assisted Medical Interventions, German Cancer Research Centre, Heidelberg, Germany
| | - Tim J Adler
- Division of Computer Assisted Medical Interventions, German Cancer Research Centre, Heidelberg, Germany
| | | | | | - Konrad Herbst
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | | | - Michael Marx
- evaplan GmbH at the University Hospital, Heidelberg, Germany
| | - Paul Schnitzler
- Center of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knop
- Center for Molecular Biology Heidelberg, Heidelberg, Germany
| | | | - Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Myck M, Oczkowska M, Garten C, Król A, Brandt M. Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland. BMC Public Health 2023; 23:177. [PMID: 36703167 PMCID: PMC9878483 DOI: 10.1186/s12889-022-14909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Given the nature of the spread of SARS-CoV-2, strong regional patterns in the fatal consequences of the COVID-19 pandemic related to local characteristics such as population and health care infrastructures were to be expected. In this paper we conduct a detailed examination of the spatial correlation of deaths in the first year of the pandemic in two neighbouring countries - Germany and Poland, which, among high income countries, seem particularly different in terms of the death toll associated with the COVID-19 pandemic. The analysis aims to yield evidence that spatial patterns of mortality can provide important clues as to the reasons behind significant differences in the consequences of the COVID-19 pandemic in these two countries. METHODS Based on official health and population statistics on the level of counties, we explore the spatial nature of mortality in 2020 in the two countries - which, as we show, reflects important contextual differences. We investigate three different measures of deaths: the officially recorded COVID-19 deaths, the total values of excessive deaths and the difference between the two. We link them to important pre-pandemic regional characteristics such as population, health care and economic conditions in multivariate spatial autoregressive models. From the point of view of pandemic related fatalities we stress the distinction between direct and indirect consequences of COVID-19, separating the latter further into two types, the spatial nature of which is likely to differ. RESULTS The COVID-19 pandemic led to much more excess deaths in Poland than in Germany. Detailed spatial analysis of deaths at the regional level shows a consistent pattern of deaths officially registered as related to COVID-19. For excess deaths, however, we find strong spatial correlation in Germany but little such evidence in Poland. CONCLUSIONS In contrast to Germany, for Poland we do not observe the expected spatial pattern of total excess deaths and the excess deaths over and above the official COVID-19 deaths. This difference cannot be explained by pre-pandemic regional factors such as economic and population structures or by healthcare infrastructure. The findings point to the need for alternative explanations related to the Polish policy reaction to the pandemic and failures in the areas of healthcare and public health, which resulted in a massive loss of life.
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Affiliation(s)
- Michał Myck
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441, Szczecin, Poland. .,University of Greifswald, 17489, Greifswald, Germany. .,Institute for the Study of Labor, 53113, Bonn, Germany.
| | - Monika Oczkowska
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441 Szczecin, Poland
| | - Claudius Garten
- grid.5675.10000 0001 0416 9637TU Dortmund University, August-Schmidt-Straße 4, 44227 Dortmund, Germany
| | - Artur Król
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441 Szczecin, Poland
| | - Martina Brandt
- grid.5675.10000 0001 0416 9637TU Dortmund University, August-Schmidt-Straße 4, 44227 Dortmund, Germany
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Li H, Zhu X, Yu R, Qian X, Huang Y, Chen X, Lin H, Zheng H, Zhang Y, Lin J, Deng Y, Zhong W, Ji Y, Li Q, Fang J, Yang X, Lin R, Chen F, Su Z, Xie B, Li H. The effects of vaccination on the disease severity and factors for viral clearance and hospitalization in Omicron-infected patients: A retrospective observational cohort study from recent regional outbreaks in China. Front Cell Infect Microbiol 2022; 12:988694. [PMID: 36420118 PMCID: PMC9677104 DOI: 10.3389/fcimb.2022.988694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/14/2022] [Indexed: 08/04/2023] Open
Abstract
Object This study attempted to explore the effects of vaccination on disease severity and the factors for viral clearance and hospitalization in omicron-infected patients. Methods The clinical manifestations of 3,265 Omicron-infected patients (BA.2 lineage variant; the Omicron group) were compared with those of 226 Delta-infected patients (the Delta group). A Multi-class logistic regression model was employed to analyze the impacts of vaccination doses and intervals on disease severity; a logistic regression model to evaluate the risk factors for hospitalization; R 4.1.2 data analysis to investigate the factors for time for nucleic acid negativization (NAN). Results Compared with the Delta group, the Omicron group reported a fast transmission, mild symptoms, and lower severity incidence, and a significant inverse correlation of vaccination dose with clinical severity (OR: 0.803, 95%CI: 0.742-0.868, p<0.001). Of the 7 or 5 categories of vaccination status, the risk of severity significantly decreased only at ≥21 days after three doses (OR: 0.618, 95% CI: 0.475-0.803, p<0.001; OR: 0.627, 95% CI: 0.482-0.815, p<0.001, respectively). The Omicron group also reported underlying illness as an independent factor for hospitalization, sore throat as a protective factor, and much shorter time for NAN [15 (12,19) vs. 16 (12,22), p<0.05]. NAN was associated positively with age, female gender, fever, cough, and disease severity, but negatively with vaccination doses. Conclusion Booster vaccination should be advocated for COVID-19 pandemic-related control and prevention policies and adequate precautions should be taken for patients with underlying conditions.
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Affiliation(s)
- Hongru Li
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Big Data Engineering, Fujian Provincial Hospital, Fuzhou, China
| | - Xiongpeng Zhu
- Department of Hematology, Quanzhou First Hospital, Quanzhou, China
| | - Rongguo Yu
- Department of Surgical Critical Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Xin Qian
- Fujian Provincial Hospital, Emergency Center of Fujian Provincial Hospital, National Emergency Rescue Team (Fujian), Fuzhou, China
| | - Yu Huang
- Fujian Provincial Health Commission, Fujian, Fuzhou, China
| | - Xiaoping Chen
- College of Mathematics and Statistics & Fujian Key Laboratory of Mathematical Analysisand Applications (FJKLMAA), Fujian Normal University, Fuzhou, China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Huiming Zheng
- Department of Pediatric Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Yi Zhang
- Department of Endocrinology, Quanzhou First Hospital, Quanzhou, China
| | - Jiarong Lin
- Medical Affairs Office, Quanzhou First Hospital, Quanzhou, China
| | - Yanqin Deng
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Wen Zhong
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yuejiao Ji
- College of Mathematics and Statistics & Fujian Key Laboratory of Mathematical Analysisand Applications (FJKLMAA), Fujian Normal University, Fuzhou, China
| | - Qing Li
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jiabin Fang
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojie Yang
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Rong Lin
- Department of Infectious Diseases, Quanzhou First Hospital, Fuzhou, China
| | - Fangsu Chen
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhijun Su
- Department of Infectious Diseases, Quanzhou First Hospital, Fuzhou, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Hong Li
- Fujian Provincial Key Laboratory of Medical Big Data Engineering, Fujian Provincial Hospital, Fuzhou, China
- Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
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