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Mori M, Yokoyama K, Sanuki R, Inoue F, Maekawa T, Moriyama T. Analyzing factors affecting positivity in drive-through COVID-19 testing: a cross-sectional study. Virol J 2024; 21:111. [PMID: 38745200 PMCID: PMC11094999 DOI: 10.1186/s12985-024-02388-w] [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: 12/25/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Demand for COVID-19 testing prompted the implementation of drive-through testing systems. However, limited research has examined factors influencing testing positivity in this setting. METHODS From October 2020 to March 2023, a total of 1,341 patients, along with their clinical information, were referred from local clinics to the Sasebo City COVID-19 drive-through PCR center for testing. Association between clinical information or factors related to the drive-through center and testing results was analyzed by Fisher's exact test and logistic regression models. RESULTS Individuals testing positive exhibited higher frequencies of upper respiratory symptoms; cough (OR 1.5 (95% CI 1.2-1.8), p < 0.001, q = 0.005), sore throat (OR 2.4 (95% CI 1.9-3.0), p < 0.001, q < 0.001), runny nose (OR 1.4 (95% CI 1.1-1.8), p = 0.002, q = 0.009), and systemic symptoms; fever (OR 1.5 (95% CI 1.1-2.0), p = 0.006, q = 0.02), headache (OR 1.9 (95% CI 1.4-2.5), p < 0.001, q < 0.001), and joint pain (OR 2.7 (95% CI 1.8-4.1), p < 0.001, q < 0.001). Conversely, gastrointestinal symptoms; diarrhea (OR 0.2 (95% CI 0.1-0.4), p < 0.001, q < 0.001) and nausea (OR 0.3 (95% CI 0.1-0.6), p < 0.001, q < 0.001) were less prevalent among positives. During omicron strain predominant period, higher testing positivity rate (OR 20 (95% CI 13-31), p < 0.001) and shorter period from symptom onset to testing (3.2 vs. 6.0 days, p < 0.001) were observed compared to pre-omicron period. Besides symptoms, contact history with infected persons at home (OR 4.5 (95% CI 3.1-6.5), p < 0.001, q < 0.001) and in office or school (OR 2.9 (95% CI 2.1-4.1), p < 0.001, q < 0.001), as well as the number of sample collection experiences by collectors (B 7.2 (95% CI 2.8-12), p = 0.002) were also associated with testing results. CONCLUSIONS These findings underscore the importance of factors related to drive-through centers, especially contact history interviews and sample collection skills, for achieving higher rates of COVID-19 testing positivity. They also contribute to enhanced preparedness for next infectious disease pandemics.
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Affiliation(s)
- Masahiko Mori
- Department of Internal Medicine, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan.
| | - Kazuaki Yokoyama
- Sasebo city medical association, Sasebo, Nagasaki, 857-0801, Japan
| | - Riri Sanuki
- Department of Health and Welfare, Sasebo city office, Sasebo, Nagasaki, 857-0042, Japan
| | - Fumio Inoue
- Sasebo city Health Center, Sasebo, Nagasaki, 857-0042, Japan
| | - Takafumi Maekawa
- Department of Surgery, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan
- Department of Surgery, Fukuoka Central Hospital, Fukuoka, Fukuoka, 810-0022, Japan
| | - Tadayoshi Moriyama
- Department of Neurosurgery, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan
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2
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Chi H, Chiu NC, Chen CC, Weng SL, Lien CH, Lin CH, Hu YF, Lei WT, Tai YL, Lin LY, Liu LYM, Lin CY. To PCR or not? The impact of shifting policy from PCR to rapid antigen tests to diagnose COVID-19 during the omicron epidemic: a nationwide surveillance study. Front Public Health 2023; 11:1148637. [PMID: 37546311 PMCID: PMC10399748 DOI: 10.3389/fpubh.2023.1148637] [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: 01/20/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) had caused huge impacts worldwide. Polymerase chain reaction (PCR) is the mainstay diagnostic modality. In most hospitals in Taiwan, samples for PCR are collected at emergency department (ER) or outdoor clinics to avoid virus spread inside hospitals. Home rapid antigen test (RAT) is a feasible, low-cost, and convenient tool with moderate sensitivity and high specificity, which can be performed at home to reduce hospital visits. Due to comparably low severity of omicron variant and high vaccine coverage (~80% residents fully vaccinated with AstraZeneca, Moderna, or Pfizer BioNTech COVID-19 vaccines as of March 2022), the policy was shifted from containment to co-existing with COVID-19 in Taiwan. Virus spread rapidly in the community after the ease of social restrictive measurements. To acquire a confirmed diagnosis, PCR testing was requested for people with suspected COVID-19 infection. As a consequence, people with respiratory symptoms or contact history surged into hospitals for PCR testing, thus, the medical capacity was challenged. The diagnostic policy was altered from PCR to RAT, but the impact of diagnostic policy change remains unclear. Objectives We conducted this study to investigate the number of COVID-19 cases, PCR testing, hospitalizations, mortalities, and hospital visits during the epidemic and evaluate the impact of diagnostic policy change on hospital visits. Methods The diagnostic policy change was implemented in late May 2022. We used nationwide and hospital-based data of COVID-19 cases, PCR testing, hospitalizations, mortalities, and hospital visits before and after policy change as of 31 Jul 2022. Results During the omicron epidemic, significant and synchronous increase of COVID-19 patients, PCR testing, hospital visits were observed. COVID-19 cases increased exponentially since April 2022 and the COVID-19 patients peaked in June (1,943, 55,571, and 61,511 average daily new cases in April, May, and June, respectively). The PCR testing peaked in May (85,788 daily tests) with high positive rate (81%). The policy of RAT as confirmatory diagnosis was implemented on 26 May 2022 and a substantial decline of PCR testing numbers occurred (85,788 and 83,113 daily tests in May and June). People hospitalized for COVID-19 peaked in June (821.8 patients per day) and decreased in July (549.5 patients). The mortality cases also peaked in June (147 cases/day). This trend was also validated by the hospital-based data with a significant decrease of emergency department visits (11,397 visits in May while 8,126 visits in June) and PCR testing (21,314 in May and 6,158 in June). The proportion of people purely for PCR testing also decreased (10-26 vs. 5-14%, before and after policy change, respectively). Conclusions The impact of diagnostic policy change was a complicated issue and our study demonstrated the huge impact of diagnostic policy on health seeking behavior. The PCR testing numbers and emergency department visits had substantial decrease after diagnostic policy change, and the plateau of epidemic peak eased gradually in ~1 month later. Widespread RAT application may contribute to the decreased hospital visits and preserve medical capacity. Our study provides some evidences for policy maker's reference.
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Affiliation(s)
- Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, Taipei City, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, Taipei City, Taiwan
| | - Chung-Chu Chen
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shun-Long Weng
- Department of Medicine, MacKay Medical College, Taipei City, Taiwan
- Department of Obsterics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chi-Hone Lien
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yao-Feng Hu
- Department of Laboratory, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
| | - Yu-Lin Tai
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
| | | | - Lawrence Yu-Min Liu
- Department of Medicine, MacKay Medical College, Taipei City, Taiwan
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Medicine, MacKay Medical College, Taipei City, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan
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3
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Mannino RG, Nehl EJ, Farmer S, Peagler AF, Parsell MC, Claveria V, Ku D, Gottfried DS, Chen H, Lam WA, Brand O. The critical role of engineering in the rapid development of COVID-19 diagnostics: Lessons from the RADx Tech Test Verification Core. SCIENCE ADVANCES 2023; 9:eade4962. [PMID: 37027461 PMCID: PMC10081837 DOI: 10.1126/sciadv.ade4962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
Engineering plays a critical role in the development of medical devices, and this has been magnified since 2020 as severe acute respiratory syndrome coronavirus 2 swept over the globe. In response to the coronavirus disease 2019, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx) initiative to help meet the testing needs of the United States and effectively manage the pandemic. As the Engineering and Human Factors team for the RADx Tech Test Verification Core, we directly assessed more than 30 technologies that ultimately contributed to an increase of the country's total testing capacity by 1.7 billion tests to date. In this review, we present central lessons learned from this "apples-to-apples" comparison of novel, rapidly developed diagnostic devices. Overall, the evaluation framework and lessons learned presented in this review may serve as a blueprint for engineers developing point-of-care diagnostics, leaving us better prepared to respond to the next global public health crisis rapidly and effectively.
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Affiliation(s)
- Robert G. Mannino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Eric J. Nehl
- Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA 30322, USA
| | - Sarah Farmer
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Amanda Foster Peagler
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Maren C. Parsell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Viviana Claveria
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - David Ku
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - David S. Gottfried
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hang Chen
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Wilbur A. Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Oliver Brand
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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4
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Farmer S, Razin V, Peagler AF, Strickler S, Fain WB, Damhorst GL, Kempker RR, Pollock NR, Brand O, Seitter B, Heilman SS, Nehl EJ, Levy JM, Gottfried DS, Martin GS, Greenleaf M, Ku DN, Waggoner JJ, Iffrig E, Mannino RG, F. Wang Y, Ortlund E, Sullivan J, Rebolledo PA, Clavería V, Roback JD, Benoit M, Stone C, Esper A, Frank F, Lam WA. Don't forget about human factors: Lessons learned from COVID-19 point-of-care testing. CELL REPORTS METHODS 2022; 2:100222. [PMID: 35527805 PMCID: PMC9061138 DOI: 10.1016/j.crmeth.2022.100222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
During the COVID-19 pandemic, the development of point-of-care (POC) diagnostic testing accelerated in an unparalleled fashion. As a result, there has been an increased need for accurate, robust, and easy-to-use POC testing in a variety of non-traditional settings (i.e., pharmacies, drive-thru sites, schools). While stakeholders often express the desire for POC technologies that are "as simple as digital pregnancy tests," there is little discussion of what this means in regards to device design, development, and assessment. The design of POC technologies and systems should take into account the capabilities and limitations of the users and their environments. Such "human factors" are important tenets that can help technology developers create POC technologies that are effective for end-users in a multitude of settings. Here, we review the core principles of human factors and discuss lessons learned during the evaluation process of SARS-CoV-2 POC testing.
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Affiliation(s)
- Sarah Farmer
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Victoria Razin
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Amanda Foster Peagler
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Samantha Strickler
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - W. Bradley Fain
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Gregory L. Damhorst
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Russell R. Kempker
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nira R. Pollock
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Oliver Brand
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Brooke Seitter
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Stacy S. Heilman
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric J. Nehl
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joshua M. Levy
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - David S. Gottfried
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Greg S. Martin
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Morgan Greenleaf
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - David N. Ku
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jesse J. Waggoner
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Iffrig
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert G. Mannino
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yun F. Wang
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Ortlund
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Sullivan
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Paulina A. Rebolledo
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Viviana Clavería
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - John D. Roback
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - MacArthur Benoit
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Cheryl Stone
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Annette Esper
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Filipp Frank
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Wilbur A. Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
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5
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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6
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Waudby-West R, Parcell BJ, Palmer CNA, Bell S, Chalmers JD, Siddiqui MK. The association between SARS-CoV-2 RT-PCR cycle threshold and mortality in a community cohort. Eur Respir J 2021; 58:13993003.00360-2021. [PMID: 34172468 PMCID: PMC8246006 DOI: 10.1183/13993003.00360-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
A coronavirus disease 2019 (COVID-19) diagnosis is widely made by the use of reverse transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When using RT-PCR, the infectivity of SARS-CoV-2 can be inferred from the threshold cycle (Ct) value [1]. It is best practice to confirm the validity of the standard curve using reference materials or in-house plasmid controls with known viral copy numbers [2]. As the Ct value represents the cycle number at which the signal breaches the threshold for positivity, a lower Ct value is indicative of a higher viral load. Although some studies suggest that viral load is associated with mortality and infectiousness [3, 4], a systematic review has identified little difference in viral load between pre-symptomatic, asymptomatic and symptomatic patients [5]. As a result, the clinical relevance of viral load remains controversial, and it is not used in clinical practice [6]. Here, we report the relationship between the Ct value and all-cause mortality for people who tested positive for SARS-CoV-2 on a combined nasal and pharyngeal swab in the Tayside region of Scotland, UK. This is a community cohort study and includes the local population of the region, as well as symptomatic health and social care workers tested as part of a screening programme [7]. In order to obtain clinical characteristics and outcomes for those who tested positive, anonymised record linkage was conducted between routine healthcare datasets as described previously [8]. All positive PCR tests from 12 March until 1 May, 2020 were included, and all deaths recorded by National Records Scotland until 20 May, 2020. Approval for anonymised data linkage was granted by the local Data Protection Officer (Caldicott Guardian). Ct values from RT-PCR tests are associated with risk of mortality in SARS-CoV-2 infection. Hazards of Ct values <20 compared to >30 were 2.20 (95% CI 1.28–3.76) in a model adjusted for age, sex, comorbidities and hospitalisation.https://bit.ly/3gjuqdU
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Affiliation(s)
- Rupert Waudby-West
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Benjamin J Parcell
- Dept of Medical Microbiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Colin N A Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Moneeza K Siddiqui
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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7
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Abo-Leyah H, Gallant S, Cassidy D, Giam YH, Killick J, Marshall B, Hay G, Snowdon C, Hothersall EJ, Pembridge T, Strachan R, Gallant N, Parcell BJ, George J, Furrie E, Chalmers JD. The protective effect of SARS-CoV-2 antibodies in Scottish healthcare workers. ERJ Open Res 2021; 7:00080-2021. [PMID: 34104643 PMCID: PMC8164012 DOI: 10.1183/23120541.00080-2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare workers (HCWs) are believed to be at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It is not known to what extent the natural production of antibodies to SARS-CoV-2 is protective against re-infection. Methods A prospective observational study of HCWs in Scotland (UK) from May to September 2020 was performed. The Siemens SARS-CoV-2 total antibody assay was used to establish seroprevalence in this cohort. Controls, matched for age and sex to the general local population, were studied for comparison. New infections (up to 2 December 2020) post antibody testing were recorded to determine whether the presence of SARS-CoV-2 antibodies protects against re-infection. Results A total of 2063 health and social care workers were recruited for this study. At enrolment, 300 HCWs had a positive antibody test (14.5%). 11 out of 231 control sera tested positive (4.8%). HCWs therefore had an increased likelihood of a positive test (OR 3.4, 95% CI 1.85–6.16; p<0.0001). Dentists were most likely to test positive. 97.3% of patients who had previously tested positive for SARS-CoV-2 by reverse transcriptase (RT)-PCR had positive antibodies. 18.7% had an asymptomatic infection. There were 38 new infections with SARS-CoV-2 in HCWs who were previously antibody negative, and one symptomatic RT-PCR-positive re-infection. The presence of antibodies was therefore associated with an 85% reduced risk of re-infection with SARS-CoV-2 (hazard ratio 0.15, 95% CI 0.06–0.35; p=0.026). Conclusion HCWs were three times more likely to test positive for SARS-CoV-2 than the general population. Almost all infected individuals developed an antibody response, which was 85% effective in protecting against re-infection with SARS-CoV-2. In this study, healthcare workers were three times more likely to test positive for #SARSCoV2 than the general population. Almost all infected individuals developed an antibody response, and this was 85% effective in protecting against re-infection.https://bit.ly/3mLPUmk
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Affiliation(s)
- Hani Abo-Leyah
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Stephanie Gallant
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Diane Cassidy
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Yan Hui Giam
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Justin Killick
- Dept of Immunology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Beth Marshall
- Dept of Immunology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Gordon Hay
- Dept of Immunology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Caroline Snowdon
- Dept of Public Health, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Eleanor J Hothersall
- Dept of Public Health, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Pembridge
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Rachel Strachan
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Natalie Gallant
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Benjamin J Parcell
- Dept of Microbiology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Elizabeth Furrie
- Dept of Immunology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,These authors contributed equally
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK.,These authors contributed equally
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 PMCID: PMC7544065 DOI: 10.1371/journal.pone.0240205] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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9
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 DOI: 10.1101/2020.05.21.20108746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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10
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Siddiqui MK, Parcell B, Allstaff S, Palmer C, Chalmers JD, Bell S. Characteristics and outcomes of health and social care workers testing positive for SARS-CoV-2 in the Tayside region of Scotland. Eur Respir J 2020; 56:2002568. [PMID: 32675210 PMCID: PMC7366178 DOI: 10.1183/13993003.02568-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/03/2022]
Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and reported outcomes among health and social care workers (HSCWs) is concerning [1–3]. Early in the outbreak it was recommended in the UK that HSCWs experiencing symptoms of a cough or fever remain absent from work for 7 days. In order to address this problem, National Health Service (NHS) Tayside, a health board in Scotland covering a population of 400,000, was the first in Scotland to set up a drive-through testing programme for HSCWs, other key workers and their symptomatic household contacts (including children), with results available within 24 h, allowing staff to return to work following a negative test [4]. As testing for SARS-CoV-2 was limited to hospitalised patients across much of Europe there is limited data on the self-reported clinical characteristics and outcomes of patients in the community with coronavirus disease 2019 (COVID-19). Here, we report characteristics and outcomes of HSCWs presenting to the drive-through testing centre who tested positive for SARS-CoV-2 on a combined nasal and pharyngeal swab. Anonymised record linkage was conducted between routinely collected healthcare datasets in order to ascertain clinical characteristics and outcomes of those who tested positive. All hospitalisations until 25 April and deaths until 20 May, 2020 were recorded. Approval was obtained from the local data protection officer (Caldicott Guardian). Tayside, Scotland was one of the first health boards to institute testing for all symptomatic workers. As expected, there was a high prevalence of SARS-CoV-2 among health and social care workers; however, in most cases disease was mild. https://bit.ly/38JaUmB
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Affiliation(s)
- Moneeza K Siddiqui
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Benjamin Parcell
- Dept of Medical Microbiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Sarah Allstaff
- Tayside Sexual and Reproductive Health Service, Ninewells Hospital and Medical School, Dundee, UK
| | - Colin Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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11
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Parcell BJ, Brechin K, Allstaff S, Park M, Third W, Bean S, Hind C, Farmer R, Chandler D, Chalmers JD. Drive-through testing for SARS-CoV-2 in symptomatic health and social care workers and household members: an observational cohort study. Thorax 2020; 75:1109-1111. [PMID: 32855343 PMCID: PMC7677465 DOI: 10.1136/thoraxjnl-2020-215128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
The requirement for health and social care workers to self-isolate when they or their household contacts develop symptoms consistent with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to critical staff shortages in the context of a pandemic. In this report, we describe the implementation of a drive-through testing service in a single National Health Service region in Scotland. From 17 March 2020 to 11 April 2020, 1890 SARS-CoV-2 reverse transcription PCR assay (RT-PCR) tests were performed. 22% of tests were positive. Allowing the remaining 78% of staff to return to work within 24 hours was estimated to save over 8000 working days during the peak pandemic period.
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Affiliation(s)
- Benjamin J Parcell
- Department of Medical Microbiology, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Sarah Allstaff
- Tayside Sexual and Reproductive Health Service, Ninewells Hospital and Medical School, Dundee, UK
| | - Meg Park
- Department of Medicine and Cardiovascular, Ninewells Hospital and Medical School, Dundee, UK
| | - Wendy Third
- Dundee Health and Social Care Partnership, Dundee, UK
| | - Susan Bean
- Department of Medicine and Cardiovascular, Ninewells Hospital and Medical School, Dundee, UK
| | - Chris Hind
- Department of Medical Microbiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Rajiv Farmer
- Virology Department, Ninewells Hospital and Medical School, Dundee, UK
| | | | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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