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Burton E, Quinn R, Crosbie-Staunton K, Deasy C, Masterson S, O'Donnell C, Merwick Á, Willis D, Kearney PM, Mc Carthy VJC, Buckley CM. Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study. BMJ Open 2024; 14:e078168. [PMID: 38508613 PMCID: PMC10961584 DOI: 10.1136/bmjopen-2023-078168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021. DESIGN We conducted a secondary data analysis with a quasi-experimental design. SETTING We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'. PRIMARY AND SECONDARY OUTCOME MEASURES We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis. PARTICIPANTS We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021. RESULTS 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001). CONCLUSIONS A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork, Ireland
| | - Rory Quinn
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Áine Merwick
- Neurology Department, Cork University Hospital, Cork, Ireland
| | - David Willis
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Espinosa O, Mora L, Sanabria C, Ramos A, Rincón D, Bejarano V, Rodríguez J, Barrera N, Álvarez-Moreno C, Cortés J, Saavedra C, Robayo A, Franco OH. Predictive models for health outcomes due to SARS-CoV-2, including the effect of vaccination: a systematic review. Syst Rev 2024; 13:30. [PMID: 38229123 PMCID: PMC10790449 DOI: 10.1186/s13643-023-02411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The interaction between modelers and policymakers is becoming more common due to the increase in computing speed seen in recent decades. The recent pandemic caused by the SARS-CoV-2 virus was no exception. Thus, this study aims to identify and assess epidemiological mathematical models of SARS-CoV-2 applied to real-world data, including immunization for coronavirus 2019 (COVID-19). METHODOLOGY PubMed, JSTOR, medRxiv, LILACS, EconLit, and other databases were searched for studies employing epidemiological mathematical models of SARS-CoV-2 applied to real-world data. We summarized the information qualitatively, and each article included was assessed for bias risk using the Joanna Briggs Institute (JBI) and PROBAST checklist tool. The PROSPERO registration number is CRD42022344542. FINDINGS In total, 5646 articles were retrieved, of which 411 were included. Most of the information was published in 2021. The countries with the highest number of studies were the United States, Canada, China, and the United Kingdom; no studies were found in low-income countries. The SEIR model (susceptible, exposed, infectious, and recovered) was the most frequently used approach, followed by agent-based modeling. Moreover, the most commonly used software were R, Matlab, and Python, with the most recurring health outcomes being death and recovery. According to the JBI assessment, 61.4% of articles were considered to have a low risk of bias. INTERPRETATION The utilization of mathematical models increased following the onset of the SARS-CoV-2 pandemic. Stakeholders have begun to incorporate these analytical tools more extensively into public policy, enabling the construction of various scenarios for public health. This contribution adds value to informed decision-making. Therefore, understanding their advancements, strengths, and limitations is essential.
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Affiliation(s)
- Oscar Espinosa
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS) & Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Laura Mora
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, Colombia
| | - Cristian Sanabria
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, Colombia
| | - Antonio Ramos
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS) & Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Duván Rincón
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, Colombia
| | - Valeria Bejarano
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS) & Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Jhonathan Rodríguez
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS) & Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Nicolás Barrera
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, Colombia
| | | | - Jorge Cortés
- Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Carlos Saavedra
- Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Adriana Robayo
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, Colombia
| | - Oscar H Franco
- University Medical Center Utrecht, Utrecht University & Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, USA
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3
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Kamiya T, Alvarez-Iglesias A, Ferguson J, Murphy S, Sofonea MT, Fitz-Simon N. Estimating time-dependent contact: a multi-strain epidemiological model of SARS-CoV-2 on the island of Ireland. GLOBAL EPIDEMIOLOGY 2023; 5:100111. [PMID: 37162815 PMCID: PMC10159265 DOI: 10.1016/j.gloepi.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Mathematical modelling plays a key role in understanding and predicting the epidemiological dynamics of infectious diseases. We construct a flexible discrete-time model that incorporates multiple viral strains with different transmissibilities to estimate the changing patterns of human contact that generates new infections. Using a Bayesian approach, we fit the model to longitudinal data on hospitalisation with COVID-19 from the Republic of Ireland and Northern Ireland during the first year of the pandemic. We describe the estimated change in human contact in the context of government-mandated non-pharmaceutical interventions in the two jurisdictions on the island of Ireland. We take advantage of the fitted model to conduct counterfactual analyses exploring the impact of lockdown timing and introducing a novel, more transmissible variant. We found substantial differences in human contact between the two jurisdictions during periods of varied restriction easing and December holidays. Our counterfactual analyses reveal that implementing lockdowns earlier would have decreased subsequent hospitalisation substantially in most, but not all cases, and that an introduction of a more transmissible variant - without necessarily being more severe - can cause a large impact on the health care burden.
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Affiliation(s)
- Tsukushi Kamiya
- HRB Clinical Research Facility, University of Galway, Ireland
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
| | | | - John Ferguson
- HRB Clinical Research Facility, University of Galway, Ireland
| | - Shane Murphy
- HRB Clinical Research Facility, University of Galway, Ireland
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4
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Townsend L, Kelly G, Kenny C, McGrath J, Donohue S, Allen N, Doherty L, Noonan N, Martin G, Fleming C, Bergin C. Healthcare Worker Characteristics Associated with SARS-CoV-2 Vaccine Uptake in Ireland; a Multicentre Cross-Sectional Study. Vaccines (Basel) 2023; 11:1529. [PMID: 37896933 PMCID: PMC10610998 DOI: 10.3390/vaccines11101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
The prevention of SARS-CoV-2 acquisition and transmission among healthcare workers is an ongoing challenge. Vaccination has been introduced to mitigate these risks. Vaccine uptake varies among healthcare workers in the absence of vaccine mandates. We investigated engagement with SARS-CoV-2 vaccination among healthcare workers and identified characteristics associated with lower vaccine uptake. This multi-site cross-sectional study recruited n = 1260 healthcare workers in both clinical and non-clinical roles over a three-month period from November 2022. Participants reported their engagement with the primary SARS-CoV-2 vaccination programme and subsequent booster programmes, as well as providing demographic, occupational and personal medical history information. Multivariable linear regression identified characteristics associated with vaccine uptake. Engagement with vaccination programmes was high, with 88% of participants receiving at least one booster dose after primary vaccination course. Younger age and female sex were associated with reduced vaccine uptake. Healthcare workers in non-clinical roles also had reduced vaccine uptake. These findings should inform vaccination strategies across healthcare settings and target populations with reduced vaccine uptake directly, in particular young, female, and non-clinical healthcare workers, both for SARS-CoV-2 and other healthcare-associated vaccine-preventable infections.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Gavin Kelly
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Claire Kenny
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Jonathan McGrath
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Seán Donohue
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Niamh Allen
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | | | - Noirin Noonan
- Department of Occupational Medicine, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Greg Martin
- Health Protection Surveillance Centre, D01 A4A3 Dublin, Ireland
| | | | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
- Department of Clinical Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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5
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Carroll HK, Broderick A, McCarthy O, Bambury RM, Power DG, Collins DC, Connolly RM, Noonan SA, Collins D, Cunningham E, Kennedy M, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, Lowney AC, O'Leary MJ, O'Reilly S. Room to Improve: An Audit of In-Hospital End-of-Life Care for Oncology Patients in a Tertiary Cancer Centre in Ireland During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231196620. [PMID: 37670454 DOI: 10.1177/00302228231196620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic compounded isolation for patients through social distancing measures and staff shortages. We were concerned about the impact of COVID-19 on the quality of care provided at end-of-life in 2021 in a national cancer centre, and instigated the first ever review of the care of the dying. Quality of care was assessed retrospectively using a validated instrument developed by the United Kingdom's National Quality Board. Sixty-six patient deaths occurred in our cancer centre in 2021. The 'risk of dying' was documented in 65.2% of records. Palliative care services were involved in 77%, and pastoral care in 10.6%. What was important to the patient was documented in 24.2%. The 'quality-of-death' score was satisfactory for most but poor in 21.2%. Our study prompted change, including appointment of an end-of-life coordinator, development of a checklist to ensure comprehensive communication, expansion of the end-of-life committee to include junior doctors, and regular audit.
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Affiliation(s)
| | | | - Orfhlaith McCarthy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Sinead A Noonan
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | | | - Elaine Cunningham
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Kennedy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | - Daniel Nuzum
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | | | | | | | - Aoife C Lowney
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Jane O'Leary
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
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6
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Fitz-Simon N, Ferguson J, Alvarez-Iglesias A, Sofonea MT, Kamiya T. Understanding the role of mask-wearing during COVID-19 on the island of Ireland. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221540. [PMID: 37476519 PMCID: PMC10354478 DOI: 10.1098/rsos.221540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
Non-pharmaceutical interventions have played a key role in managing the COVID-19 pandemic, but it is challenging to estimate their impacts on disease spread and outcomes. On the island of Ireland, population mobility restrictions were imposed during the first wave, but mask-wearing was not mandated until about six months into the pandemic. We use data on mask-wearing, mobility, and season, over the first year of the pandemic to predict independently the weekly infectious contact estimated by an epidemiological model. Using our models, we make counterfactual predictions of infectious contact, and ensuing hospitalizations, under a hypothetical intervention where 90% of the population wore masks from the beginning of community spread until the dates of the mask mandates. Over periods including the first wave of the pandemic, there were 1601 hospitalizations with COVID-19 in Northern Ireland and 1521 in the Republic of Ireland. Under the counterfactual mask-wearing scenario, we estimate 512 (95% CI 400, 730) and 344 (95% CI 266, 526) hospitalizations in the respective jurisdictions during the same periods. This could be partly due to other factors that were also changing over time.
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Affiliation(s)
- Nicola Fitz-Simon
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Republic of Ireland
- HRB Clinical Research Facility, University of Galway, Galway, Republic of Ireland
| | - John Ferguson
- HRB Clinical Research Facility, University of Galway, Galway, Republic of Ireland
| | | | | | - Tsukushi Kamiya
- HRB Clinical Research Facility, University of Galway, Galway, Republic of Ireland
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
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7
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O'Reilly S, Kathryn Carroll H, Murray D, Burke L, McCarthy T, O'Connor R, Kilty C, Lynch S, Feighan J, Cloherty M, Fitzpatrick P, Falvey K, Murphy V, Jane O'Leary M, Gregg S, Young L, McAuliffe E, Hegarty J, Gavin A, Lawler M, Kavanagh P, Spillane S, McWade T, Heffron M, Ryan K, Kelly PJ, Murphy A, Corrigan M, Redmond HP, Redmond P, Walsh PM, Tierney P, Zhang M, Bennett K, Mullooly M. Impact of the COVID-19 pandemic on cancer care in Ireland - Perspectives from a COVID-19 and Cancer Working Group. J Cancer Policy 2023; 36:100414. [PMID: 36841473 PMCID: PMC9951610 DOI: 10.1016/j.jcpo.2023.100414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems.
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Affiliation(s)
- Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland; Cancer Trials Ireland, Dublin, Ireland.
| | - Hailey Kathryn Carroll
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Deirdre Murray
- School of Public Health, University College Cork, Cork, Ireland; National Cancer Registry Ireland, Cork, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital and University College Cork, Cork, Ireland
| | | | | | | | - Sonya Lynch
- PPI Contributor c/o Cancer Research, UCC University College Cork, T12 DCA4 Cork, Ireland
| | - Jennifer Feighan
- Irish Nutrition & Dietetic Institute, Airfield Estate, Overend Ave, Dundrum, Dublin, Ireland
| | - Maeve Cloherty
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; National Screening Service, Dublin, Ireland
| | | | | | - Mary Jane O'Leary
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Sophie Gregg
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Leonie Young
- Endocrine Oncology Research Group, Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eilish McAuliffe
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Mark Lawler
- Faculty of Medicine, Health and Life Sciences, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland, UK; DATA-CAN, the UK's Health Data Research Hub for Cancer, UK
| | - Paul Kavanagh
- National Health Intelligence Unit, Strategy and Research, Jervis House, Jervis St, Health Service Executive, Dublin 1, Ireland
| | - Susan Spillane
- Health Information and Quality Authority, Dublin, Ireland
| | - Terry McWade
- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | - Karen Ryan
- Department of Palliative Medicine, Mater Misericordiae University Hospital and St Francis Hospice Dublin, Ireland
| | - Paul J Kelly
- Bon Secours Radiotherapy Centre, Bon Secours, Cork, Ireland; UPMC Hillman Cancer Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Mark Corrigan
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - H Paul Redmond
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - Patrick Redmond
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Mengyang Zhang
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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8
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Viala VL, Slavov SN, de Lima LPO, Lima ARJ, Ribeiro G, Martins AJ, Petry B, Banho CA, Barros CRDS, Moncau CT, Moretti DB, de La-Roque DGL, Marqueze EC, Mattos EC, da Costa FADS, Fukumasu H, Bernardino JDST, Souza-Neto JA, Lesbon JCC, Kayanoki LP, Bernardo LL, Sacchetto L, Clemente LG, Alcantara LCJ, Coutinho LL, Marques BDC, Giovanetti M, Nogueira ML, Poleti MD, Assato PA, Cattony Neto PDQ, Cassano RDLRC, Neto RM, Grotto RMT, Brassaloti RA, Kashima S, Covas DT, Elias MC, Sampaio SC. The Divergent Pattern of SARS-CoV-2 Variant Predominance and Transmission Dynamics in the Brazilian Island of Ilhabela. Viruses 2022; 14:v14071481. [PMID: 35891460 PMCID: PMC9323713 DOI: 10.3390/v14071481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Our effort in SARS-CoV-2 genomic surveillance in Brazil has detected the Alpha Variant of Concern with a predominance higher than 75% in the population of Ilhabela island (São Paulo State) at a time when the Gamma VOC was already predominating the mainland raised concerns for closer surveillance on this island. Therefore, we intensified the surveillance for 24 weeks by generating data from 34% of local positive cases. Our data show that the patterns of VOC predominance dynamics and infection rates were in general distinct from the mainland. We report here the first known case of Alpha predominance in a Brazilian population, a delay greater than 3 months for the Gamma to dominate the previous variants compared to the mainland, and a faster dispersion rate of Gamma and Delta VOCs compared to the mainland. Phylogenetic analysis revealed the SARS-CoV-2 transmission dynamics in Ilhabela were characterized by multiple independent introduction events of Gamma and Delta, with a few events of Alpha introduction, two of them followed by community transmission. This study evidenced the peculiar behavior of SARS-CoV-2 variants in an isolated population and brought to light the importance of specific programs for SARS-CoV-2 genomic surveillance in isolated populations.
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Affiliation(s)
- Vincent Louis Viala
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
- Correspondence: (V.L.V.); (M.C.E.); (S.C.S.)
| | - Svetoslav Nanev Slavov
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (S.N.S.); (D.G.L.d.L.-R.); (S.K.)
| | - Loyze Paola Oliveira de Lima
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Alex Ranieri Jeronimo Lima
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Gabriela Ribeiro
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Antonio Jorge Martins
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Bruna Petry
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Cecilia Artico Banho
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil; (C.A.B.); (L.S.); (B.d.C.M.); (M.L.N.)
| | - Claudia Renata dos Santos Barros
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Cristina Tschorny Moncau
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Debora Botequio Moretti
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Debora Glenda Lima de La-Roque
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (S.N.S.); (D.G.L.d.L.-R.); (S.K.)
| | - Elaine Cristina Marqueze
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Elisangela Chicaroni Mattos
- Department of Veterinary Medicine, School of Animal Science and Food Engineering, University of Sao Paulo, Pirassununga 13635-900, SP, Brazil; (E.C.M.); (H.F.); (J.C.C.L.); (M.D.P.)
| | - Felipe Allan da Silva da Costa
- Department of Bioprocesses and Biotechnology, School of Agricultural Sciences, São Paulo State University (UNESP), Botucatu 18610-034, SP, Brazil; (F.A.d.S.d.C.); (P.A.A.)
| | - Heidge Fukumasu
- Department of Veterinary Medicine, School of Animal Science and Food Engineering, University of Sao Paulo, Pirassununga 13635-900, SP, Brazil; (E.C.M.); (H.F.); (J.C.C.L.); (M.D.P.)
| | - Jardelina de Souza Todao Bernardino
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Jayme A. Souza-Neto
- School of Agricultural Sciences, São Paulo State University (UNESP), Botucatu 18610-034, SP, Brazil; (J.A.S.-N.); (R.M.T.G.)
| | - Jessika Cristina Chagas Lesbon
- Department of Veterinary Medicine, School of Animal Science and Food Engineering, University of Sao Paulo, Pirassununga 13635-900, SP, Brazil; (E.C.M.); (H.F.); (J.C.C.L.); (M.D.P.)
| | | | | | - Lívia Sacchetto
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil; (C.A.B.); (L.S.); (B.d.C.M.); (M.L.N.)
| | - Luan Gaspar Clemente
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Luiz Carlos Júnior Alcantara
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil;
- Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21040-360, RJ, Brazil
| | - Luiz Lehmann Coutinho
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Beatriz de Carvalho Marques
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil; (C.A.B.); (L.S.); (B.d.C.M.); (M.L.N.)
| | - Marta Giovanetti
- Reference Laboratory of Flavivirus, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, RJ, Brazil;
- Department of Science and Technology for Humans and the Environment, University of Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Maurício Lacerda Nogueira
- Medicine School of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil; (C.A.B.); (L.S.); (B.d.C.M.); (M.L.N.)
| | - Mirele Daiana Poleti
- Department of Veterinary Medicine, School of Animal Science and Food Engineering, University of Sao Paulo, Pirassununga 13635-900, SP, Brazil; (E.C.M.); (H.F.); (J.C.C.L.); (M.D.P.)
| | - Patricia Akemi Assato
- Department of Bioprocesses and Biotechnology, School of Agricultural Sciences, São Paulo State University (UNESP), Botucatu 18610-034, SP, Brazil; (F.A.d.S.d.C.); (P.A.A.)
| | - Pedro De Queiroz Cattony Neto
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Raquel de Lello Rocha Campos Cassano
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Raul Machado Neto
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
| | - Rejane Maria Tommasini Grotto
- School of Agricultural Sciences, São Paulo State University (UNESP), Botucatu 18610-034, SP, Brazil; (J.A.S.-N.); (R.M.T.G.)
- Molecular Biology and Applied Biotechnology Laboratory, Clinical Hospital of the Botucatu Medical School, Botucatu 18610-034, SP, Brazil
| | - Ricardo Augusto Brassaloti
- Centro de Genômica Funcional da ESALQ, University of São Paulo, Piracicaba 13418-900, SP, Brazil; (B.P.); (C.T.M.); (L.G.C.); (L.L.C.); (R.d.L.R.C.C.); (R.A.B.)
| | - Simone Kashima
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (S.N.S.); (D.G.L.d.L.-R.); (S.K.)
| | - Dimas Tadeu Covas
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (S.N.S.); (D.G.L.d.L.-R.); (S.K.)
| | - Maria Carolina Elias
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
- Correspondence: (V.L.V.); (M.C.E.); (S.C.S.)
| | - Sandra Coccuzzo Sampaio
- Butantan Institute, São Paulo 05503-900, SP, Brazil; (L.P.O.d.L.); (A.R.J.L.); (G.R.); (A.J.M.); (C.R.d.S.B.); (D.B.M.); (E.C.M.); (J.d.S.T.B.); (P.D.Q.C.N.); (R.M.N.); (D.T.C.)
- Correspondence: (V.L.V.); (M.C.E.); (S.C.S.)
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9
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O'Reilly S, Murphy V, Mulroe E, Tucker L, Carragher F, Marron J, Shannon AM, Rogan K, Connolly RM, Hennessy BT, McDermott RS. The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy. Cancers (Basel) 2022; 14:2247. [PMID: 35565375 PMCID: PMC9101172 DOI: 10.3390/cancers14092247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.
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Affiliation(s)
- Seamus O'Reilly
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
| | | | | | - Lisa Tucker
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | | | | | | | - Ken Rogan
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | - Roisin M Connolly
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
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10
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Heffernan E, Keegan D, Clarke B, Deasy C, O'Donnell C, Crowley P, Hughes A, Murphy AW, Masterson S. Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic. BMJ Open 2022; 12:e057162. [PMID: 35039304 PMCID: PMC8765025 DOI: 10.1136/bmjopen-2021-057162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has produced radical changes in international health services. In Ireland, the National Ambulance Service established a novel home and community testing service that was central to the national COVID-19 screening programme. This service was overseen by a multidisciplinary response room. This research examined the response room service, particularly areas that performed well and areas requiring improvement, using a quality improvement (QI) framework. DESIGN This was a qualitative study comprising semi-structured, individual interviews. Maximum variation sampling was used. The data were analysed using an established thematic analysis procedure. The analysis was guided by the framework, which comprised six QI drivers. SETTING Response room employees, including clinicians, dispatchers and administrators, were interviewed via telephone. RESULTS Leadership for quality: participants valued person-oriented leadership, including regular, open communication and consultation with staff. Person/family engagement: participants endeavoured to provide patient-centred care. Formal patient feedback mechanisms and shared decision-making could be beneficial in the future. Staff engagement: working in a response room could affect well-being, though it also provided networking and learning opportunities. Staff require support and teambuilding. Use of improvement methods: improvements were made in a relatively informal, ad hoc manner. The use of robust methods based on improvement science was not reported. Measurement for quality: data were collected to improve efficiency and accuracy. More rigorous measurement would be beneficial, especially formally collecting stakeholder feedback. Governance for quality: close alignment with collaborators and clear communication with staff are essential. Information and communications technology for quality: this seventh driver was added because the importance of information technology specially designed for pandemics was frequently highlighted. CONCLUSIONS The study provides insights on what worked well and what required improvement in a pandemic response room. It can inform health services, particularly emergency services, in their preparation for additional COVID-19 waves, as well as future crises.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Dylan Keegan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Bridget Clarke
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Conor Deasy
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Cathal O'Donnell
- Clinical Directorate, National Ambulance Service, Health Service Executive, Limerick, Ireland
| | | | - Angela Hughes
- Quality Improvement Division, Health Service Executive, Dublin, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Clinical Directorate, National Ambulance Service, Health Service Executive, Limerick, Ireland
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11
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Bubar KM, Middleton CE, Bjorkman KK, Parker R, Larremore DB. SARS-CoV-2 Transmission and Impacts of Unvaccinated-Only Screening in Populations of Mixed Vaccination Status.. [PMID: 34909778 PMCID: PMC8669845 DOI: 10.1101/2021.10.19.21265231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractCommunity testing programs focused on the unvaccinated population are being enacted in populations with mixed vaccination status to mitigate SARS-CoV-2 spread. Presumably, these policies assume that the unvaccinated are driving transmission, though it is not well understood how viral spread occurs in mixed-status populations. Here, we analyze a model of transmission in which a variable fraction of the population is vaccinated, with unvaccinated individuals proactively screened for infection. By exploring a range of transmission rates, vaccine effectiveness (VE) scenarios, and rates of prior infection, this analysis reveals principles of viral spread in communities of mixed vaccination status, with implications for screening policies. As vaccination rates increase, the proportion of transmission driven by the unvaccinated population decreases, such that most community spread is driven by breakthrough infections once vaccine coverage exceeds 55% (omicron) or 80% (delta), with additional variation dependent on waning or boosted VE. More broadly, the potential impacts of unvaccinated-only screening fall into three distinct parameter regions: (I) “flattening the curve” with little impact on cumulative infections, (II) effectively suppressing transmission, and (III) negligible impact because herd immunity is reached without screening. By evaluating a wide range of scenarios, this work finds broadly that effective mitigation of SARS-CoV-2 transmission by unvaccinated-only screening is highly dependent on vaccination rate, population-level immunity, screening compliance, and vaccine effectiveness against the current variant.
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12
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Comiskey CM, Snel A, Banka P. First back-calculation and infection fatality multiplier estimate of the hidden prevalence of COVID-19 in Ireland. Eur J Public Health 2021; 31:908-912. [PMID: 34245277 PMCID: PMC8344855 DOI: 10.1093/eurpub/ckab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background To date computer models with multiple assumptions have focussed on predicting the incidence of symptomatic cases of COVID-19. Given emerging vaccines, the aim of this study was to provide simple methods for estimating the hidden prevalence of asymptomatic cases and levels of herd immunity to aid future immunization policy and planning. We applied the method in Ireland. Methods For large scale epidemics, indirect models for estimating prevalence have been developed. One such method is the benchmark multiplier method. A further method is back-calculation, which has been used successfully to produce estimates of the scale of a HIV infected population. The methods were applied from March to October 2020 and are applicable globally. Results Results demonstrated that the number of infected individuals was at least twice and possibly six times the number identified through testing. Our estimates ranged from ∼100 000 to 375 000 cases giving a ratio of 1–6 hidden cases for every known case within the study time frame. While both methods are subject to assumptions and limitations, it was interesting to observe that estimates corroborated government statements noting that 80% of people testing positive were asymptomatic. Conclusions As Europe has now endured several epidemic waves with the emergence globally of new variants, it essential that both policy makers and the public are aware of the scale of the hidden epidemic that may surround them. The need for social distancing is as important as ever as we await global immunization rollout.
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Affiliation(s)
- Catherine M Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Anne Snel
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Prakashini Banka
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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