COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021

BACKGROUND

COVID-19 vaccinations have been prioritised for high risk individuals.

AIM

Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2.

STUDY DESIGN

Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.

SETTING

Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.

METHODS

We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services.

RESULTS

The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds.

CONCLUSIONS

Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.

Multiscaled causality of infections on viral testing volumes: The case of COVID-19 in Tunisia

Objectives

Coronavirus disease (COVID‐19) is one of the most detrimental pandemics that affected the humanity throughout the ages. The irregular historical progression of the virus over the first year of the pandemic was accompanied with far‐reaching health and social damages. To prepare logistically against this worsening disaster, many public authorities around the world had set up screening and forecasting studies. This article aims to analyse the time‐frequency co‐evolution of the number of confirmed cases (NCC) in Tunisia and the related number of performed polymerase chain reaction (PCR) tests over the COVID‐19 first year. Accurately predicting such a relationship allows Tunisian authorities to set up an effective health prevention plan.

Study Design

In order to keep pace with the speed of evolution of the virus, we used uninterrupted daily time series from the Tunisian Ministry of Public Health (TMPH) recorded over the COVID‐19 first year. The objective is to: (1) analyse the time‐frequency progress of the NCC in relationship with the number of PCR tests, (2) identify a multi‐scale two‐factor stochastic model in order to develop a robust bivariate forecasting technique.

Methods

We assume a bivariate stochastic process which is projected onto a set of wavelet sub‐spaces to investigate the scale‐by‐scale co‐evolvement the NCC/PCR over the COVID‐19 first year. A wavelet‐based multiresolutional causality test is then performed.

Results

The main results recommend the rejection of the null hypothesis of no instantaneous causality in both directions, while the statistics of the Granger test suggest failing to reject the null hypothesis of non‐causality. However, by proceeding scale‐by‐scale, the Granger causality is proven significant in both directions over varying frequency bands.

Conclusions

It is important to include the NCC and PCR variables in any time series model intended to predict one of these variables. Such a bivariate and multi‐scale model is supposed to better predict the needs of the public health sector in screening tests. On this basis, testing campaigns with multiple periodicities can be planned by the Tunisian authorities.

We test the causality of COVID‐19 infections on viral testing volumes in Tunisia

A wavelet‐based approach is applied to examine the relationship scale‐by‐scale

The results recommend the rejection of the noncausality at all frequency bands

Screening campaigns with multiple periodicities can be conducted by Tunisian MOH

Restoration of elective spine surgery during the first wave of COVID-19 : a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study

Aims

With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic.

Methods

A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay.

Results

In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication.

Conclusion

This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units.

Cite this article: Bone Jt Open 2021;2(12):1096–1101.

Repeatedly negative PCR results in patients with COVID-19 symptoms: Do they have SARS-CoV-2 infection or not?

OBJECTIVE

To point out possible infection with SARS-CoV-2 in symptomatic patients despite repeated negative nasopharyngeal swab tests for SARS-CoV-2.

MATERIAL AND METHODS

A retrospective observational study carried out at the Na Bulovce Hospital from the beginning of the pandemic until November 2020 included patients (1) who had symptoms compatible with COVID-19; (2) whose nasopharyngeal swab PCR tests in the presence of acute respiratory infection symptoms yielded two consecutive negative results; (3) in whom SARS-CoV-2 infection was subsequently confirmed by serology. Basic demographic and epidemiological data, symptoms, laboratory test results, X-ray findings and timing of virological tests were analysed for these patients.

RESULTS

Seventeen patients met the inclusion criteria, 14 men and three women, aged 19-84 years with a median of 59 years, of whom 14 were hospitalized and three were treated as outpatients. Only seven patients were aware of the previous contact with an infected person. The main symptoms were fever, cough, headache, weakness, fatigue and shortness of breath. Pneumonia was found in 12 patients, four of whom developed respiratory insufficiency requiring ventilatory support. Most patients showed a uniform combination of haematological, biochemical and radio-logical findings: absence of eosinophils and increased polymorphonuclear/lymphocyte ratio; elevation of serum lactate dehydrogenase; elevation of CRP without rise of procalcitonin; typical chest CT or X-ray findings. All patients recovered. Coronavirus antigen test was performed in six patients, with all of them testing negative. SARS-CoV-2 infection was confirmed serologically by the detection of specific IgG and IgA in all 17 patients and also IgM in six patients, not before day 8 of the onset of symptoms.

CONCLUSIONS

Our study showed that some patients with acute COVID-19 may test repeatedly negative by nasopharyngeal swab PCR. These cases should be interpreted as a low viral load in the upper respiratory tract rather than false negativity of PCR. Such alternative is not envisaged in the algorithms used. Considering our results, the following recommendation can be made: If, despite negative PCR tests, COVID-19 is still suspected based on clinical symptoms and epidemiological evidence, preliminary diagnosis can be made on the basis of comprehensive assessment of the laboratory test and X-ray findings. Final confirmation of the aetiology relies on serological tests performed two weeks after the onset of symptoms.

Clinical Characteristics of Patients With Coronavirus Disease 2019 in Japan: A Single-Center Case Series

We report a case series of 6 patients with confirmed COVID-19 in Wakayama prefecture, Japan. All 6 of the patients tested positive in pharyngeal swab PCR tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities (GGO) on computed tomography (CT). This paper also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.