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Hunter LA, Wyman S, Packel LJ, Facente SN, Li Y, Harte A, Nicolette G, Di Germanio C, Busch MP, Reingold AL, Petersen ML. Monitoring SARS-CoV-2 incidence and seroconversion among university students and employees: a longitudinal cohort study in California, June-August 2020. BMJ Open 2023; 13:e063999. [PMID: 37024253 PMCID: PMC10083519 DOI: 10.1136/bmjopen-2022-063999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES To identify incident SARS-CoV-2 infections and inform effective mitigation strategies in university settings, we piloted an integrated symptom and exposure monitoring and testing system among a cohort of university students and employees. DESIGN Prospective cohort study. SETTING A public university in California from June to August 2020. PARTICIPANTS 2180 university students and 738 university employees. PRIMARY OUTCOME MEASURES At baseline and endline, we tested participants for active SARS-CoV-2 infection via quantitative PCR (qPCR) test and collected blood samples for antibody testing. Participants received notifications to complete additional qPCR tests throughout the study if they reported symptoms or exposures in daily surveys or were selected for surveillance testing. Viral whole genome sequencing was performed on positive qPCR samples, and phylogenetic trees were constructed with these genomes and external genomes. RESULTS Over the study period, 57 students (2.6%) and 3 employees (0.4%) were diagnosed with SARS-CoV-2 infection via qPCR test. Phylogenetic analyses revealed that a super-spreader event among undergraduates in congregate housing accounted for at least 48% of cases among study participants but did not spread beyond campus. Test positivity was higher among participants who self-reported symptoms (incidence rate ratio (IRR) 12.7; 95% CI 7.4 to 21.8) or had household exposures (IRR 10.3; 95% CI 4.8 to 22.0) that triggered notifications to test. Most (91%) participants with newly identified antibodies at endline had been diagnosed with incident infection via qPCR test during the study. CONCLUSIONS Our findings suggest that integrated monitoring systems can successfully identify and link at-risk students to SARS-CoV-2 testing. As the study took place before the evolution of highly transmissible variants and widespread availability of vaccines and rapid antigen tests, further research is necessary to adapt and evaluate similar systems in the present context.
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Affiliation(s)
- Lauren A Hunter
- School of Public Health, University of California, Berkeley, California, USA
| | - Stacia Wyman
- Innovative Genomics Institute, University of California, Berkeley, California, USA
| | - Laura J Packel
- School of Public Health, University of California, Berkeley, California, USA
| | - Shelley N Facente
- School of Public Health, University of California, Berkeley, California, USA
- Facente Consulting, Richmond, California, USA
| | - Yi Li
- School of Public Health, University of California, Berkeley, California, USA
| | - Anna Harte
- University Health Services, University of California, Berkeley, California, USA
| | - Guy Nicolette
- University Health Services, University of California, Berkeley, California, USA
| | | | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Arthur L Reingold
- School of Public Health, University of California, Berkeley, California, USA
| | - Maya L Petersen
- School of Public Health, University of California, Berkeley, California, USA
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Landry M, Bornstein S, Nagaraj N, Sardon GA, Castel A, Vyas A, McDonnell K, Agneshwar M, Wilkinson A, Goldman L. Postacute Sequelae of SARS-CoV-2 in University Setting. Emerg Infect Dis 2023; 29:519-527. [PMID: 36703253 PMCID: PMC9973677 DOI: 10.3201/eid2903.221522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Postacute sequelae of SARS-CoV-2 infection, commonly known as long COVID, is estimated to affect 10% to 80% of COVID-19 survivors. We examined the prevalence and predictors of long COVID from a sample of 1,338 COVID-19 cases among university members in Washington, DC, USA, during July 2021‒March 2022. Cases were followed up after 30 days of the initial positive result with confidential electronic surveys including questions about long COVID. The prevalence of long COVID was 36%. Long COVID was more prevalent among those who had underlying conditions, who were not fully vaccinated, who were female, who were former/current smokers, who experienced acute COVID-19 symptoms, who reported higher symptom counts, who sought medical care, or who received antibody treatment. Understanding long COVID among university members is imperative to support persons who have ongoing symptoms and to strengthen existing services or make referrals to other services, such as mental health, exercise programs, or long-term health studies.
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Blake H, Somerset S, Mahmood I, Mahmood N, Corner J, Ball JK, Denning C. A Qualitative Evaluation of the Barriers and Enablers for Implementation of an Asymptomatic SARS-CoV-2 Testing Service at the University of Nottingham: A Multi-Site Higher Education Setting in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13140. [PMID: 36293719 PMCID: PMC9603241 DOI: 10.3390/ijerph192013140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Asymptomatic testing for SARS-CoV-2 RNA has been used to prevent and manage COVID-19 outbreaks in university settings, but few studies have explored their implementation. The aim of the study was to evaluate how an accredited asymptomatic SARS-CoV-2 testing service (ATS) was implemented at the University of Nottingham, a multi-campus university in England, to identify barriers and enablers of implementation and to draw out lessons for implementing pandemic response initiatives in higher education settings. A qualitative interview study was conducted with 25 ATS personnel between May and July 2022. Interviews were conducted online, audio-recorded, and transcribed. Participants were asked about their experience of the ATS, barriers and enablers of implementation. Transcripts were thematically analysed. There were four overarching themes: (1) social responsibility and innovation, (2) when, how and why people accessed testing, (3) impact of the ATS on the spread of COVID-19, and (4) lessons learned for the future. In establishing the service, the institution was seen to be valuing its community and socially responsible. The service was viewed to be broadly successful as a COVID-19 mitigation approach. Challenges to service implementation were the rapidly changing pandemic situation and government advice, delays in service accreditation and rollout to staff, ambivalence towards testing and isolating in the target population, and an inability to provide follow-up support for positive cases within the service. Facilitators included service visibility, reduction in organisational bureaucracy and red tape, inclusive leadership, collaborative working with regular feedback on service status, flexibility in service delivery approaches and simplicity of saliva testing. The ATS instilled a perception of early 'return to normality' and impacted positively on staff feelings of safety and wellbeing, with wider benefits for healthcare services and local communities. In conclusion, we identified common themes that have facilitated or hindered the implementation of a SARS-CoV-2 testing service at a university in England. Lessons learned from ATS implementation will inform future pandemic response interventions in higher education settings.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Sarah Somerset
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Ikra Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Neelam Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jonathan K. Ball
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
| | - Chris Denning
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
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Landry M, Vyas A, Nagaraj N, Sardon GA, Bornstein S, Latif H, Kucherlapaty P, McDonnell K, Castel A, Goldman L. Characteristics of student SARS-CoV-2 cases on an urban university campus: An Observational Study. Interact J Med Res 2022; 11:e39230. [PMID: 36037255 PMCID: PMC9472507 DOI: 10.2196/39230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Academic institutions are central hubs for young adults, laden with academic and social interactions, and communal living arrangements, heightening the risk of transmission of many communicable diseases, including COVID-19. Shortly after the start of the Fall 2020 academic year, institutions of higher learning were identified as hotspots for rises in COVID-19 incidence among young adults. OBJECTIVE This analysis aims to identify the characteristics of student SARS-CoV-2 cases, identify the extent to which the student population adhered to preventative strategies, and examine behaviors that would put them at higher risk of contracting or spreading COVID-19. METHODS This observational study comprises 1,175 university students at The George Washington University (GWU) in Washington, DC, with a confirmed COVID-19 diagnosis between August 3, 2020, and November 30, 2021. Case investigation and contact tracing tools were developed by the Campus COVID-19 Support Team and captured in REDCap. Trained case investigators were notified of a case and attempted to contact all cases within 24 hours of the case receiving their lab result. Associations between case characteristics and number of contacts were examined using Wilcoxon Rank Sum tests. Knowledge of exposure, behaviors since exposure, and student residence status, and fraternity and sorority life affiliation were examined using Chi-Square tests. RESULTS Positive student cases reported a median of three close contacts and 84.6% reported at least one symptom with a median of four COVID-19 symptoms. Congestion (53.4%), cough (45.1%), and headache (41.2%) were the most frequently reported symptoms. Thirty-six percent reported that they did not know how they were exposed to the virus. Among those aware of contact with a COVID-19 confirmed case, 55.1% reported the contact was a close friend or family member and 25.3% reported that it was someone with whom they lived. Athletes (vs. non-athletes), on-campus (vs. off-campus), and undergraduate (vs. graduate) students all reported a significantly higher number of contacts (P<.01). Students living on campus were more likely to report attending campus events in the two days prior to symptom onset or positive test result (P=.004). Students with fraternity/sorority affiliation were more likely to report attending campus events in the two days prior to symptom onset or positive test result (P<.001). CONCLUSIONS COVID-19 cases have not yet stabilized to a predictable state, but this study provides case characteristics and insights for how academic institutions might prepare to mitigate outbreaks on their campuses as the world plans for the transition from pandemic to endemic COVID-19. CLINICALTRIAL
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Affiliation(s)
- Megan Landry
- Office of the Dean, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 7th Floor, Washington, US
| | - Amita Vyas
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Floor, Washington, US
| | - Nitasha Nagaraj
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Floor, Washington, US
| | - Gary A Sardon
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, US
| | - Sydney Bornstein
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, US
| | - Hannah Latif
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Floor, Washington, US
| | - Padmini Kucherlapaty
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Floor, Washington, US
| | - Karen McDonnell
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Floor, Washington, US
| | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, US
| | - Lynn Goldman
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, US.,Office of the Dean, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 7th Floor, Washington, US
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