Low prevalence of active COVID-19 in Slovenia: a nationwide population study of a probability-based sample

Creation of a pandemic memory by tracing COVID-19 infections and immunity in Luxembourg (CON-VINCE)

BACKGROUND

During the COVID-19 pandemic swift implementation of research cohorts was key. While many studies focused exclusively on infected individuals, population based cohorts are essential for the follow-up of SARS-CoV-2 impact on public health. Here we present the CON-VINCE cohort, estimate the point and period prevalence of the SARS-CoV-2 infection, reflect on the spread within the Luxembourgish population, examine immune responses to SARS-CoV-2 infection and vaccination, and ascertain the impact of the pandemic on population psychological wellbeing at a nationwide level.

METHODS

A representative sample of the adult Luxembourgish population was enrolled. The cohort was followed-up for twelve months. SARS-CoV-2 RT-qPCR and serology were conducted at each sampling visit. The surveys included detailed epidemiological, clinical, socio-economic, and psychological data.

RESULTS

One thousand eight hundred sixty-five individuals were followed over seven visits (April 2020-June 2021) with the final weighted period prevalence of SARS-CoV-2 infection of 15%. The participants had similar risks of being infected regardless of their gender, age, employment status and education level. Vaccination increased the chances of IgG-S positivity in infected individuals. Depression, anxiety, loneliness and stress levels increased at a point of study when there were strict containment measures, returning to baseline afterwards.

CONCLUSION

The data collected in CON-VINCE study allowed obtaining insights into the infection spread in Luxembourg, immunity build-up and the impact of the pandemic on psychological wellbeing of the population. Moreover, the study holds great translational potential, as samples stored at the biobank, together with self-reported questionnaire information, can be exploited in further research.

TRIAL REGISTRATION

Trial registration number: NCT04379297, 10 April 2020.

Seroprevalence and SARS-CoV-2 invasion in general populations: A scoping review over the first year of the pandemic

Since the beginning of the COVID-19 pandemic, counting infected people has underestimated asymptomatic cases. This literature scoping review assessed the seroprevalence progression in general populations worldwide over the first year of the pandemic. Seroprevalence studies were searched in PubMed, Web of Science and medRxiv databases up to early April 2021. Inclusion criteria were a general population of all ages or blood donors as a proxy. All articles were screened for the title and abstract by two readers, and data were extracted from selected articles. Discrepancies were resolved with a third reader. From 139 articles (including 6 reviews), the seroprevalence estimated in 41 countries ranged from 0 to 69%, with a heterogenous increase over time and continents, unevenly distributed among countries (differences up to 69%) and sometimes among regions within a country (up to 10%). The seroprevalence of asymptomatic cases ranged from 0% to 31.5%. Seropositivity risk factors included low income, low education, low smoking frequency, deprived area residency, high number of children, densely populated centres, and presence of a case in a household. This review of seroprevalence studies over the first year of the pandemic documented the progression of this virus across the world in time and space and the risk factors that influenced its spread.

Prevalence of COVID-19 in West Gondar Zone, Northwest Ethiopia: A Population-Based Retrospective Study

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, affecting every community directly or indirectly. Therefore, this study aims to investigate the prevalence of COVID-19 infection in the population of the West Gondar zone.

METHOD

A retrospective cross-sectional study was conducted from November 2020 to January 2021, in the West Gondar zone, Northwest Ethiopia. Records of study participants with required information like age, gender, travel history, type of specimen taken, and site of specimen taken were included. For analysis, the statistical package for social sciences (SPSS) version 20 software was used. Descriptive statistics were summarized as percentages and means ± standard deviation. The chi-squared test is used to compare categorical data.

RESULTS

A total of 1,166 participants were enrolled in this study. Of them, 16 individuals had positive results, giving a prevalence of 1.37% (95% CI: 0.66-2.08). Living in an urban area (P-value = 0.035) and being female (P-value = 0.045) was statistically associated with the positive rate for COVID-19.

CONCLUSIONS

This study revealed a low prevalence of COVID-19 infection in the study area despite the increasing and rapid dissemination of the disease. State-wide population prevalence study should be done to estimate the general prevalence of COVID-19 in Ethiopia.

Methodological problems of SARS-CoV-2 rapid point-of-care tests when used in mass testing

The aim of the current study is to perform model calculations on the possible use of SARS-CoV-2-rapid point-of-care tests as mass tests, using the quality criteria extracted from evidence-based research as an example for the Federal Republic of Germany. In addition to illustrating the problem of false positive test results, these calculations are used to examine their possible influence on the 7-day incidence. For a substantial period of time, this parameter formed the decisive basis for decisions on measures to protect the population in the wake of the COVID pandemic, which were taken by the government. Primarily, model calculations were performed for a base model of 1,000,000 SARS-CoV-2-rapid point-of-care tests per week using various sensitivities and specificities reported in the literature, followed by sequential testing of the test positives obtained by a SARS-CoV-2 PCR test. Furthermore, a calculation was performed for an actual maximum model based on self-test contingents by the German Federal Ministry of Health. Assuming a number of 1,000,000 tests per week at a prevalence of 0.5%, a high number of false positive test results, a low positive predictive value, a high negative predictive value, and an increase in the 7-day incidence due to the additional antigen rapid tests of approx. 5/100,000 were obtained. A previous maximum calculation based on contingent numbers for self-tests given by the German Federal Ministry of Health even showed an additional possible influence on the 7-day incidence of 84.6/100,000. The model calculations refer in each case to representative population samples that would have to be drawn if the successive results were comparable which should be given, as far-reaching actions were based on this parameter. The additionally performed SARS-CoV-2-rapid point-of-care tests increase the 7-day incidence in a clear way depending on the number of tests and clearly show their dependence on the respective number of tests. SARS-CoV-2-rapid point-of-care tests as well as the SARS-CoV-2-PCR test method should both be used exclusively in the presence of corresponding respiratory symptoms and not in symptom-free persons.

Distance Learning during the COVID-19 Pandemic. A Comparison between European Countries

COVID-19 has shaped and changed our normalities, and, with the discovery of new variants, the long-COVID syndrome, and stress disorders, the end of the pandemic seems distant. The current scenario is impacting all aspects of our lives. In particular, many studies reported that the pandemic resulted in increased psychiatric disorders and grief-related symptoms in adolescents. The project developed between Italy and Slovenia investigated students’ experiences during the lockdown and, in particular, reported the perception of distanced learning, producing a transparent qualitative analysis that can inform future research and open to discussions on learning strategies. A survey was conducted with secondary school students in Southern Italy between 1 April and 31 May 2020 and in Central Slovenia between 16 March and 28 February 2021. Qualitative and quantitative data were collected based on students’ perception of distanced learning, via an online survey platform. The results focused on three main aspects: learning experience, relationships with peers and teachers, and anxiety levels. The data showed similarities and differences in the two cohorts and suggested strategies to improve education (e.g., with blended approaches) to prepare students, teachers, and tutors for the challenges of returning to classes. In particular, data showed that it is recommended to foster collaboration between EU countries and to work to prevent students’ social isolation.

Duration of SARS-CoV-2 sero-positivity in a large longitudinal sero-surveillance cohort: the COVID-19 Community Research Partnership

BACKGROUND

Estimating population prevalence and incidence of prior SARS-CoV-2 infection is essential to formulate public health recommendations concerning the COVID-19 pandemic. However, interpreting estimates based on sero-surveillance requires an understanding of the duration of elevated antibodies following SARS-CoV-2 infection, especially in the large number of people with pauci-symptomatic or asymptomatic disease.

METHODS

We examined > 30,000 serology assays for SARS-CoV-2 specific IgG and IgM assays acquired longitudinally in 11,468 adults between April and November 2020 in the COVID-19 Community Research Partnership.

RESULTS

Among participants with serologic evidence for infection but few or no symptoms or clinical disease, roughly 50% sero-reverted in 30 days of their initial positive test. Sero-reversion occurred more quickly for IgM than IgG and for antibodies targeting nucleocapsid protein compared with spike proteins, but was not associated with age, sex, race/ethnicity, or healthcare worker status.

CONCLUSIONS

The short duration of antibody response suggests that the true population prevalence of prior SARS-CoV-2 infection may be significantly higher than presumed based on earlier sero-surveillance studies. The impact of the large number of minimally symptomatic COVID-19 cases with only a brief antibody response on population immunity remains to be determined.

Population-based prevalence surveys during the Covid-19 pandemic: A systematic review

Population-based prevalence surveys of Covid-19 contribute to establish the burden of infection, the role of asymptomatic and mild infections in transmission, and allow more precise decisions about reopen policies. We performed a systematic review to evaluate qualitative aspects of these studies, assessing their reliability and compiling practices that can influence the methodological quality. We searched MEDLINE, EMBASE, bioRxiv and medRxiv, and included cross-sectional studies using molecular and/or serological tests to estimate the prevalence of Covid-19 in the general population. Survey quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. A correspondence analysis correlated methodological parameters of each study to identify patterns related to higher, intermediate and lower risks of bias. The available data described 37 surveys from 19 countries. The majority were from Europe and America, used antibody testing, and reached highly heterogeneous sample sizes and prevalence estimates. Minority communities were disproportionately affected by Covid-19. Important risk of bias was detected in four domains: sample size, data analysis with sufficient coverage, measurements in standard way and response rate. The correspondence analysis showed few consistent patterns for high risk of bias. Intermediate risk of bias was related to American and European studies, municipal and regional initiatives, blood samples and prevalence >1%. Low risk of bias was related to Asian studies, nationwide initiatives, reverse-transcriptase polymerase chain reaction tests and prevalence <1%. We identified methodological standards applied worldwide in Covid-19 prevalence surveys, which may assist researchers with the planning, execution and reporting of future population-based surveys.

Estimating seroprevalence of SARS-CoV-2 in Ohio: A Bayesian multilevel poststratification approach with multiple diagnostic tests

Globally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 59 million people and killed more than 1.39 million. Designing and monitoring interventions to slow and stop the spread of the virus require knowledge of how many people have been and are currently infected, where they live, and how they interact. The first step is an accurate assessment of the population prevalence of past infections. There are very few population-representative prevalence studies of SARS-CoV-2 infections, and only two states in the United States-Indiana and Connecticut-have reported probability-based sample surveys that characterize statewide prevalence of SARS-CoV-2. One of the difficulties is the fact that tests to detect and characterize SARS-CoV-2 coronavirus antibodies are new, are not well characterized, and generally function poorly. During July 2020, a survey representing all adults in the state of Ohio in the United States collected serum samples and information on protective behavior related to SARS-CoV-2 and coronavirus disease 2019 (COVID-19). Several features of the survey make it difficult to estimate past prevalence: 1) a low response rate; 2) a very low number of positive cases; and 3) the fact that multiple poor-quality serological tests were used to detect SARS-CoV-2 antibodies. We describe a Bayesian approach for analyzing the biomarker data that simultaneously addresses these challenges and characterizes the potential effect of selective response. The model does not require survey sample weights; accounts for multiple imperfect antibody test results; and characterizes uncertainty related to the sample survey and the multiple imperfect, potentially correlated tests.

The Escalating Magnitude of COVID-19 Infections among the Northeastern Ethiopia Region: A Community-Based Cross-Sectional Study

Background

The novel coronavirus disease (COVID-19) is lethal and extremely contagious, with a rapidly rising global prevalence. The World Health Organization has declared the outbreak a global pandemic; it is reported to have spread to nearly every country in the world. However, the prevalence varies across developed and developing countries, as well as within different regions of the same country. It is not hidden that estimating the magnitude of COVID-19 infection from the community surveys is critical for public health policymakers to make decisions to deal with the outbreak, optimize measures, and design mitigation plans.

Methods

A community-based cross-sectional study was conducted from 01 July to 31 August 2020 in the northeastern Ethiopia region. A simple random sampling technique was used to select study participants from the community survey, contact traces from confirmed cases, and infection suspects. After extraction of viral nucleic acid from oropharyngeal specimen, the real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting novel coronavirus.

Results

A total of 8752 study participants were included in this study. About 63.6% were males and 36.4% were females. Out of the total 8752 study participants, 291 (3.3%) were found to be infected with the virus. The first laboratory-confirmed cases of COVID-19 were detected in the fourth week of the study period, that is, from July 24 to July 31, 2020, and the peak prevalence was observed in the last two weeks. The COVID-19 infection was more prevalent among males and in the age group of 36–52 years. Participants tested via contact trace had 1.65 times (AOR = 1.65, 95% CI = 1.09–2.51, P=0.018) the likelihood of COVID-19 infection in comparison to the other forms of community surveys.

Conclusion

The trend in the prevalence of COVID-19 infection in the northeastern region has shown increment, and increasing testing capacity has a greater benefit in identifying early infection for the prevention, treatment, and control of the international pandemic.

Seroprevalence of severe acute respiratory syndrome coronavirus 2 in Slovenia: results of two rounds of a nationwide population study on a probability-based sample, challenges and lessons learned

Objectives

Seroprevalence surveys provide crucial information on cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. This Slovenian nationwide population study is the first longitudinal 6-month serosurvey using probability-based samples across all age categories.

Methods

Each participant supplied two blood samples: 1316 samples in April 2020 (first round) and 1211 in October/November 2020 (second round). The first-round sera were tested using Euroimmun Anti-SARS-CoV-2 ELISA IgG (ELISA) and, because of uncertain estimates, were retested using Elecsys Anti-SARS-CoV-2 (Elecsys-N) and Elecsys Anti-SARS-CoV-2 S (Elecsys-S). The second-round sera were concomitantly tested using Elecsys-N/Elecsys-S.

Results

The populations of both rounds matched the overall population (n = 3000), with minor settlement type and age differences. The first-round seroprevalence corrected for the ELISA manufacturer's specificity was 2.78% (95% highest density interval [HDI] 1.81%–3.80%), corrected using pooled ELISA specificity calculated from published data 0.93% (95% CI 0.00%–2.65%), and based on Elecsys-N/Elecsys-S results 0.87% (95% HDI 0.40%–1.38%). The second-round unadjusted lower limit of seroprevalence on 11 November 2020 was 4.06% (95% HDI 2.97%–5.16%) and on 3 October 2020, unadjusted upper limit was 4.29% (95% HDI 3.18%–5.47%).

Conclusions

SARS-CoV-2 seroprevalence in Slovenia increased four-fold from late April to October/November 2020, mainly due to a devastating second wave. Significant logistic/methodological challenges accompanied both rounds. The main lessons learned were a need for caution when relying on manufacturer-generated assay evaluation data, the importance of multiple manufacturer-independent assay performance assessments, the need for concomitant use of highly-specific serological assays targeting different SARS-CoV-2 proteins in serosurveys conducted in low-prevalence settings or during epidemic exponential growth and the usefulness of a Bayesian approach for overcoming complex methodological challenges.

The importance of anosmia, ageusia and age in community presentation of symptomatic and asymptomatic SARS-CoV-2 infection in Louisiana, USA; a cross-sectional prevalence study

OBJECTIVE

While many seroprevalence studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been performed, few are demographically representative. This investigation focused on defining the nature and frequency of symptomatic and asymptomatic SARS-CoV-2 infection in a representative, cross-sectional sample of communities in Louisiana, USA.

METHODS

A sample of 4778 adults from New Orleans and Baton Rouge, Louisiana were given a survey of symptoms and co-morbidities, nasopharyngeal swab to test for active infection (PCR), and blood draw to test for past infection (IgG). Odds ratios, cluster analysis, quantification of virus and antibody, and linear modelling were used to understand whether certain symptoms were associated with a positive test, how symptoms grouped together, whether virus or antibody varied by symptom status, and whether being symptomatic was different across the age span.

RESULTS

Reported anosmia/ageusia was strongly associated with a positive test; 40.6% (93/229) tested positive versus 4.8% (218/4549) positivity in those who did not report anosmia/ageusia (OR 13.6, 95% CI 10.1-18.3). Of the people who tested positive, 47.3% (147/311) were completely asymptomatic. Symptom presentation clustered into three groups; low/no symptoms (0.4 ± 0.9, mean ± SD), highly symptomatic (7.5 ± 1.9) or moderately symptomatic (4.0 ± 1.5). Quantity of virus was lower in the asymptomatic versus symptomatic group (cycle number 23.3 ± 8.3 versus 17.3 ± 9.0; p < 0.001). Modelling the probability of symptoms showed changes with age; the highest probability of reporting symptoms was 64.6% (95% CI 50.4-76.5) at age 29 years, which decreased to a probability of 49.3% (95% CI 36.6-62.0) at age 60 years and only 25.1% (95% CI 5.0-68.1) at age 80 years.

CONCLUSION

Anosmia/ageusia can be used to differentiate SARS-CoV-2 infection from other illnesses, and, given the high ratio of asymptomatic individuals, contact tracing should include those without symptoms. Regular testing in congregant settings of those over age 60 years may help mitigate asymptomatic spread.

Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden

OBJECTIVES

Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking.

METHODS

We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved.

RESULTS

During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174).

CONCLUSIONS

In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that obstetric units in regions with low SARS-CoV-2 burden enforce rational use of personal protective equipment and diligent screening protocols using targeted questionnaires, whereas SARS-CoV-2 laboratory testing should be performed only in screen-positives: those with high clinical suspicion of COVID-19 and/or suspected epidemiological history.

Knowledge, Attitude and Practice Toward COVID-19 Pandemic Among Population Visiting Dessie Health Center for COVID-19 Screening, Northeast Ethiopia

BACKGROUND

Coronavirus 2019 (COVID-19) is currently a global health threat and an international public health emergency. As of 21 January 2021, 97.8 million cases with more than two million deaths were recorded worldwide while in Ethiopia 132,326 confirmed cases and 2057 deaths were reported. Hence, the aim of the present study was to determine the magnitude of knowledge, attitude, and practice toward COVID-19 among the population who visited the health center for COVID-19 screening.

METHODS

A health institution-based cross-sectional study was conducted among the 384 study population visiting Dessie health center for COVID-19 screening from September 1, to October 21, 2020 using a simple random sampling technique. A structured questionnaire was used to obtain information related to sociodemographic characteristics, Knowledge (eleven questions), attitude (six questions) and practice (nin questions). Both bivariable and multivariable logistic regression analyses with a 95% confidence interval were used to identify factors associated with poor knowledge and practice. A P-value of <0.05 was considered statistically significant.

RESULTS

Out of the total study participants 61.5% were males, 52.6% of them were aged between 30 and 49 years and 85.2% of them were living in urban areas. The magnitude of poor knowledge and poor practice was 187 (48.7%) and 160 (41.7%), respectively. Poor knowledge had statistically significant association with Illiteracy (AOR= 5.53, 95%CI= 1.03-29.68, P= 0.046) and having no contact history (AOR=0.39, 95%CI=0.21-0.73, P=0.003). Statistically significant association existed between poor practice and parameters which addressed educational status, travel history, and poor knowledge level of study participants.

CONCLUSION

Alarmingly high poor knowledge, negatively skewed attitude, and poor practice regarding the COVID-19 pandemic was indicated. Therefore, health education programs aimed at mobilizing and improving COVID-19-related knowledge, attitude, and practice are urgently needed, especially for those who are illiterate, having travel and contact history, or generally among underprivileged populations.

Systematic review: bioethical implications for COVID-19 research in low prevalence countries, a distinctly different set of problems

Background

The COVID-19 pandemic has presented extraordinary challenges to worldwide healthcare systems, however, prevalence remains low in some countries. While the challenges of conducting research in high-prevalence countries are well published, there is a paucity from low COVID-19 countries.

Methods

A PRISMA guided systematic review was conducted using the databases Ovid-Medline, Embase, Scopus and Web of Science to identify relevant articles discussing ethical issues relating to research in low prevalence COVID-19 countries.

Results

The search yielded 133 original articles of which only 2 fit the inclusion criteria and aim, with neither specific to low prevalence. Most of the available literature focused on clinical management and resource allocation related to high prevalence countries. These results will be discussed under the ethical dimensions of equity, individual liberty, privacy and confidentiality, proportionality, public protection, provision of care, reciprocity, stewardship and trust..

Conclusions

A systematic review failed to identify articles relating to COVID-19 research ethics, specific to low prevalence countries. It shows that there is a significant gap in the literature that warrants further investigation. Common ethical principles were used to present a distinct set of challenges experienced by a country with a low prevalence of COVID-19. This unique perspective of some of the common ethical problems surrounding research, may help guide further discussion and guide research in similar countries.

Antibody Response against SARS-CoV-2 and Seasonal Coronaviruses in Nonhospitalized COVID-19 Patients

The majority of infections with SARS-CoV-2 are asymptomatic or mild without the necessity of hospitalization. It is of importance to reveal if these patients develop an antibody response against SARS-CoV-2 and to define which antibodies confer virus neutralization. We conducted a comprehensive serological survey of 49 patients with a mild course of disease and quantified neutralizing antibody responses against a clinical SARS-CoV-2 isolate employing human cells as targets. Four patients (8%), even though symptomatic, did not develop antibodies against SARS-CoV-2, and two other patients (4%) were positive in only one of the six serological assays employed. For the remaining 88%, antibody response against the S protein correlated with serum neutralization whereas antibodies against the nucleocapsid were poor predictors of virus neutralization. None of the sera enhanced infection of human cells with SARS-CoV-2 at any dilution, arguing against antibody-dependent enhancement of infection in our system. Regarding neutralization, only six patients (12%) could be classified as high neutralizers. Furthermore, sera from several individuals with fairly high antibody levels had only poor neutralizing activity. In addition, employing a novel serological Western blot system to characterize antibody responses against seasonal coronaviruses, we found that antibodies against the seasonal coronavirus 229E might contribute to SARS-CoV-2 neutralization. Altogether, we show that there is a wide breadth of antibody responses against SARS-CoV-2 in patients that differentially correlate with virus neutralization. This highlights the difficulty to define reliable surrogate markers for immunity against SARS-CoV-2.

IMPORTANCE There is strong interest in the nature of the neutralizing antibody response against SARS-CoV-2 in infected individuals. For vaccine development, it is especially important which antibodies confer protection against SARS-CoV-2, if there is a phenomenon called antibody-dependent enhancement (ADE) of infection, and if there is cross-protection by antibodies directed against seasonal coronaviruses. We addressed these questions and found in accordance with other studies that neutralization is mediated mainly by antibodies directed against the spike protein of SARS-CoV-2 in general and the receptor binding site in particular. In our test system, utilizing human cells for infection experiments, we did not detect ADE. However, using a novel diagnostic test we found that antibodies against the coronavirus 229E might be involved in cross-protection to SARS-CoV-2.

Knowledge, attitude, practice towards COVID-19 pandemic and its prevalence among hospital visitors at Ataye district hospital, Northeast Ethiopia

BACKGROUND

Coronavirus disease 19 (COVID-19) is currently a global health threat and public health emergency of international concern. Africa is the last continent to be hit by this pandemic and the population is still prone to misconceptions and may not take it seriously. In developing countries including Ethiopia, where trained human resources and equipment for the treatment of COVID-19 are scarce, working on prevention of the viral spread should be a priority as a feasible intervention strategy. The aim of this study was to determine the level of knowledge, attitude, practice (KAP) towards COVID-19 and its prevalence among hospital visitors.

METHODS

Health institution based cross sectional study was conducted among 513 hospital visitors who are recruited by using simple random sampling technique at Ataye district hospital, Northeast Ethiopia from June 3, 2020 to August 10, 2020. A pre-tested structured questionnaire was used to obtain information related to socio-demographic characteristics, knowledge (11 questions), attitude (9 questions) and practice (9 questions). Oro-pharyngeal specimen was collected by trained healthcare provider and processed in a molecular laboratory. After extraction of viral nucleic acid, the Real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting novel coronavirus (2019-nCoV). Data was analyzed using bi-variable and multivariable logistic regression model with 95% CI (confidence interval). From the bi-variable analysis, variables having a P-value <0.25 were retained into multivariable analysis. From the multivariable analysis, variables with a P-value <0.05 was declared as associated factors.

RESULTS

Majority (72.9%) of the study participants were male; and most were urban dwellers. From the total study participants, 17 (3.3%) were found to be infected with the virus. The magnitude of low-level of knowledge was 4.9%; and of the analyzed risk factors, female gender, age (category less than 16 years and category between 16 and 65 years), and usual alcohol drinking habit had statistically significant association with low level knowledge. The proportion of study participants who had low level of practice was 75/513 (14.62%). Family size, age category between 16 and 65 years, and low-level knowledge were associated with low-level practice.

CONCLUSION

Limited number of study participants had high-level knowledge and practice towards COVID-19; while majority of the study candidates demonstrated moderate level of knowledge and practice. Good knowledge, positive attitude and good practice can be a guarantee for the prevention and control of COVID-19. Hence, various measurements to combat the pandemic should be taken by different stakeholders including the community members, religious leader, health professionals and others.

Simulation of the COVID-19 epidemic on the social network of Slovenia: Estimating the intrinsic forecast uncertainty

In the article a virus transmission model is constructed on a simplified social network. The social network consists of more than 2 million nodes, each representing an inhabitant of Slovenia. The nodes are organised and interconnected according to the real household and elderly-care center distribution, while their connections outside these clusters are semi-randomly distributed and undirected. The virus spread model is coupled to the disease progression model. The ensemble approach with the perturbed transmission and disease parameters is used to quantify the ensemble spread, a proxy for the forecast uncertainty. The presented ongoing forecasts of COVID-19 epidemic in Slovenia are compared with the collected Slovenian data. Results show that at the end of the first epidemic wave, the infection was twice more likely to transmit within households/elderly care centers than outside them. We use an ensemble of simulations (N = 1000) and data assimilation approach to estimate the COVID-19 forecast uncertainty and to inversely obtain posterior distributions of model parameters. We found that in the uncontrolled epidemic, the intrinsic uncertainty mostly originates from the uncertainty of the virus biology, i.e. its reproduction number. In the controlled epidemic with low ratio of infected population, the randomness of the social network becomes the major source of forecast uncertainty, particularly for the short-range forecasts. Virus transmission models with accurate social network models are thus essential for improving epidemics forecasting.