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Wang Z, Murray TA, Xiao M, Lin L, Alemayehu D, Chu H. Bayesian hierarchical models incorporating study-level covariates for multivariate meta-analysis of diagnostic tests without a gold standard with application to COVID-19. Stat Med 2023; 42:5085-5099. [PMID: 37724773 DOI: 10.1002/sim.9902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/25/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
When evaluating a diagnostic test, it is common that a gold standard may not be available. One example is the diagnosis of SARS-CoV-2 infection using saliva sampling or nasopharyngeal swabs. Without a gold standard, a pragmatic approach is to postulate a "reference standard," defined as positive if either test is positive, or negative if both are negative. However, this pragmatic approach may overestimate sensitivities because subjects infected with SARS-CoV-2 may still have double-negative test results even when both tests exhibit perfect specificity. To address this limitation, we propose a Bayesian hierarchical model for simultaneously estimating sensitivity, specificity, and disease prevalence in the absence of a gold standard. The proposed model allows adjusting for study-level covariates. We evaluate the model performance using an example based on a recently published meta-analysis on the diagnosis of SARS-CoV-2 infection and extensive simulations. Compared with the pragmatic reference standard approach, we demonstrate that the proposed Bayesian method provides a more accurate evaluation of prevalence, specificity, and sensitivity in a meta-analytic framework.
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Affiliation(s)
- Zheng Wang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mengli Xiao
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Demissie Alemayehu
- Global Biometrics and Data Management, Pfizer Inc., New York, New York, USA
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Global Biometrics and Data Management, Pfizer Inc., New York, New York, USA
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Akgun E, Alumur SA, Erenay FS. Determining optimal COVID-19 testing center locations and capacities. Health Care Manag Sci 2023; 26:748-769. [PMID: 37934310 DOI: 10.1007/s10729-023-09656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/17/2023] [Indexed: 11/08/2023]
Abstract
We study the problem of determining the locations and capacities of COVID-19 specimen collection centers to efficiently improve accessibility to polymerase chain reaction testing during surges in testing demand. We develop a two-echelon multi-period location and capacity allocation model that determines optimal number and locations of pop-up testing centers, capacities of the existing centers as well as assignments of demand regions to these centers, and centers to labs. The objective is to minimize the total number of delayed appointments and specimens subject to budget, capacity, and turnaround time constraints, which will in turn improve the accessibility to testing. We apply our model to a case study for locating COVID-19 testing centers in the Region of Waterloo, Canada using data from the Ontario Ministry of Health, public health databases, and medical literature. We also test the performance of the model under uncertain demand and analyze its outputs under various scenarios. Our analyses provide practical insights to the public health decision-makers on the timing of capacity expansions and the locations for the new pop-up centers. According to our results, the optimal strategy is to dynamically expand the existing specimen collection center capacities and prevent bottlenecks by locating pop-up facilities. The optimal locations of pop-ups are among the densely populated areas that are in proximity to the lab and a subset of those locations are selected with the changes in demand. A comparison with a static approach promises up to 39% cost savings under high demand using the developed multi-period model.
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Affiliation(s)
- Esma Akgun
- Department of Management Science and Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Sibel A Alumur
- Department of Management Science and Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - F Safa Erenay
- Department of Management Science and Engineering, University of Waterloo, Waterloo, Ontario, Canada.
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Caixeta DC, Paranhos LR, Blumenberg C, Garcia-Júnior MA, Guevara-Vega M, Taveira EB, Nunes MAC, Cunha TM, Jardim ACG, Flores-Mir C, Sabino-Silva R. Salivary SARS-CoV-2 RNA for diagnosis of COVID-19 patients: a systematic revisew and meta-analysis of diagnostic accuracy. JAPANESE DENTAL SCIENCE REVIEW 2023:S1882-7616(23)00016-9. [PMID: 37360001 PMCID: PMC10284464 DOI: 10.1016/j.jdsr.2023.06.004] [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: 01/10/2023] [Revised: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Accurate, self-collected, and non-invasive diagnostics are critical to perform mass-screening diagnostic tests for COVID-19. This systematic review with meta-analysis evaluated the accuracy, sensitivity, and specificity of salivary diagnostics for COVID-19 based on SARS-CoV-2 RNA compared with the current reference tests using a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS). An electronic search was performed in seven databases to find COVID-19 diagnostic studies simultaneously using saliva and NPS/OPS tests to detect SARS-CoV-2 by RT-PCR. The search resulted in 10,902 records, of which 44 studies were considered eligible. The total sample consisted of 14,043 participants from 21 countries. The accuracy, specificity, and sensitivity for saliva compared with the NPS/OPS was 94.3% (95%CI= 92.1;95.9), 96.4% (95%CI= 96.1;96.7), and 89.2% (95%CI= 85.5;92.0), respectively. Besides, the sensitivity of NPS/OPS was 90.3% (95%CI= 86.4;93.2) and saliva was 86.4% (95%CI= 82.1;89.8) compared to the combination of saliva and NPS/OPS as the gold standard. These findings suggest a similarity in SARS-CoV-2 RNA detection between NPS/OPS swabs and saliva, and the association of both testing approaches as a reference standard can increase by 3.6% the SARS-CoV-2 detection compared with NPS/OPS alone. This study supports saliva as an attractive alternative for diagnostic platforms to provide a non-invasive detection of SARS-CoV-2.
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Affiliation(s)
- Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Luiz Renato Paranhos
- School of Dentistry, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marcelo Augusto Garcia-Júnior
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marco Guevara-Vega
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Elisa Borges Taveira
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marjorie Adriane Costa Nunes
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- School of Dentistry, CEUMA University, Sao Luiz, MA, Brazil
| | - Thúlio Marquez Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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Tuite AR, Ng V, Ximenes R, Diener A, Rafferty E, Ogden NH, Tunis M. Quantifying the economic gains associated with COVID-19 vaccination in the Canadian population: A cost-benefit analysis. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:263-273. [PMID: 38440772 PMCID: PMC10911688 DOI: 10.14745/ccdr.v49i06a03] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Background Vaccination has been a key part of Canada's coronavirus disease 2019 (COVID-19) pandemic response. Although the clinical benefits of vaccination are clear, an understanding of the population-level benefits of vaccination relative to the programmatic costs is of value. The objective of this article is to quantify the economic impact of COVID-19 vaccination in the Canadian population between December 2020 and March 2022. Methods We conducted a model-based cost-benefit analysis of Canada's COVID-19 vaccination program. We used an epidemiological model to estimate the number of COVID-19 symptomatic cases, hospitalizations, post-COVID condition (PCC) cases, and deaths in the presence and absence of vaccination. Median, lower and upper 95% credible interval (95% CrI) outcome values from 100 model simulations were used to estimate the direct and indirect costs of illness, including the value of health. We used a societal perspective and a 1.5% discount rate. Results We estimated that the costs of the vaccination program were far outweighed by the savings associated with averted infections and associated downstream consequences. Vaccination increased the net benefit by CAD $298.1 billion (95% CrI: 27.2-494.6) compared to the no vaccination counterfactual. The largest benefits were due to averted premature mortality, resulting in an estimated $222.0 billion (95% CrI: 31.2-379.0) benefit. Conclusion Our model-based economic evaluation provides a retrospective assessment of COVID-19 vaccination during the first 16 months of the program in Canada and suggests that it was welfare-improving, considering the decreased hospitalizations and use of healthcare resources, deaths averted and lower morbidity from conditions such as PCC.
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Affiliation(s)
- Ashleigh R Tuite
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Victoria Ng
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, QC and Guelph, ON
| | - Raphael Ximenes
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Alan Diener
- Policy Research, Economics, and Analytics Unit, Strategic Policy Branch, Health Canada, Ottawa, ON
| | | | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, QC and Guelph, ON
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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MacLean ELH, Villa-Castillo L, Espinoza-Lopez P, Caceres T, Sulis G, Kohli M, Pai M, Ugarte-Gil C. Integrating tuberculosis and COVID-19 molecular testing in Lima, Peru: a cross-sectional, diagnostic accuracy study. THE LANCET. MICROBE 2023:S2666-5247(23)00042-3. [PMID: 37068500 PMCID: PMC10105319 DOI: 10.1016/s2666-5247(23)00042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/23/2022] [Accepted: 02/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Integrated molecular testing could be an opportunity to detect and provide care for both tuberculosis and COVID-19. Many high tuberculosis burden countries, such as Peru, have existing GeneXpert systems for tuberculosis testing with GeneXpert Xpert MTB/RIF Ultra (Xpert Ultra), and a GeneXpert SARS-CoV-2 assay, GeneXpert Xpert Xpress SARS-CoV-2 (Xpert Xpress), is also available. We aimed to assess the feasibility of integrating tuberculosis and COVID-19 testing using one sputum specimen with Xpert Ultra and Xpert Xpress in Lima, Peru. METHODS In this cross-sectional, diagnostic accuracy study, we recruited adults presenting with clinical symptoms or suggestive history of tuberculosis or COVID-19, or both. Participants were recruited from a total of 35 primary health facilities in Lima, Peru. Participants provided one nasopharyngeal swab and one sputum sample. For COVID-19, we tested nasopharyngeal swabs and sputum using Xpert Xpress; for tuberculosis, we tested sputum using culture and Xpert Ultra. We compared diagnostic accuracy of sputum testing using Xpert Xpress with nasopharyngeal swab testing using Xpert Xpress. Individuals with positive Xpert Xpress nasopharyngeal swab results were considered COVID-19 positive, and a positive culture indicated tuberculosis. To assess testing integration, the proportion of cases identified in sputum by Xpert Xpress was compared with Xpert Xpress on nasopharyngeal swabs, and sputum by Xpert Ultra was compared with culture. FINDINGS Between Jan 11, 2021, and April 26, 2022, we recruited 600 participants (312 [52%] women and 288 [48%] men). In-study prevalence of tuberculosis was 13% (80 participants, 95% CI 11-16) and of SARS-CoV-2 was 35% (212 participants, 32-39). Among tuberculosis cases, 13 (2·2%, 1·2-3·7) participants were concurrently positive for SARS-CoV-2. Regarding the diagnostic yield of integrated testing, Xpert Ultra detected 96% (89-99) of culture-confirmed tuberculosis cases (n=77), and Xpert Xpress-sputum detected 67% (60-73) of COVID-19 cases (n=134). All five study staff reported that integrated molecular testing was easy and acceptable. INTERPRETATION The diagnostic yield of Xpert Xpress on sputum was moderate, but integrated testing for tuberculosis and COVID-19 with GeneXpert was feasible. However, systematic testing for both diseases might not be the ideal approach for everyone presenting with presumptive tuberculosis or COVID-19, as concurrent positive cases were rare during the study period. Further research might help to identify when integrated testing is most worthwhile and its optimal implementation. FUNDING Canadian Institutes of Health Research and International Development Research Centre. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Emily Lai-Ho MacLean
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Luz Villa-Castillo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia Lima, Peru
| | - Patricia Espinoza-Lopez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia Lima, Peru
| | - Tatiana Caceres
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia Lima, Peru
| | - Giorgia Sulis
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
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O'Byrne P, Orser L, Musten A, Ho N, Haines M, Lindsay J. Delivering COVID self-tests through GetaKit.ca: Creating testing access during a pandemic. Public Health Nurs 2023; 40:404-409. [PMID: 36625331 DOI: 10.1111/phn.13168] [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: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine the real-world outcomes associated with using the GetaKit.ca website to distribute COVID self-tests to persons with risk factors, with a focus on facilitating testing for persons who are Black, Indigenous, or of Colour (BIPOC). METHODS GetaKit was an open cohort observational study to distribute free self-tests, starting with HIV self-testings and then adding the Lucira Check-It® COVID self-test. Participants would register on our website and complete a risk assessment, which would calculate their need for each type of testing. RESULTS Focusing on the COVID self-tests, from September to December 2021 (with targeted outreach in winter 2022), we distributed 6474 COVID self-tests to 3653 persons through 4161 unique orders, of which 47% came from BIPOC participants. Compared to white participants, BIPOC participants were more likely to have been a contact of COVID but less likely to be vaccinated. As well, 69% of results were reported back via the GetaKit.ca website, with 5.3% of these being positive. The positivity rate for our 3653 participants was 9.6%. CONCLUSIONS Delivering COVID self-tests via our website provided tests to BIPOC communities and yielded positivity rates that matched local COVID testing centres. This highlights the utility of such systems for delivering testing during future pandemics.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Lauren Orser
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Alexandra Musten
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Nikki Ho
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Marlene Haines
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Jennifer Lindsay
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
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Vilches TN, Rafferty E, Wells CR, Galvani AP, Moghadas SM. Economic evaluation of COVID-19 rapid antigen screening programs in the workplace. BMC Med 2022; 20:452. [PMID: 36424587 PMCID: PMC9686464 DOI: 10.1186/s12916-022-02641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diagnostic testing has been pivotal in detecting SARS-CoV-2 infections and reducing transmission through the isolation of positive cases. We quantified the value of implementing frequent, rapid antigen (RA) testing in the workplace to identify screening programs that are cost-effective. METHODS To project the number of cases, hospitalizations, and deaths under alternative screening programs, we adapted an agent-based model of COVID-19 transmission and parameterized it with the demographics of Ontario, Canada, incorporating vaccination and waning of immunity. Taking into account healthcare costs and productivity losses associated with each program, we calculated the incremental cost-effectiveness ratio (ICER) with quality-adjusted life year (QALY) as the measure of effect. Considering RT-PCR testing of only severe cases as the baseline scenario, we estimated the incremental net monetary benefits (iNMB) of the screening programs with varying durations and initiation times, as well as different booster coverages of working adults. RESULTS Assuming a willingness-to-pay threshold of CDN$30,000 per QALY loss averted, twice weekly workplace screening was cost-effective only if the program started early during a surge. In most scenarios, the iNMB of RA screening without a confirmatory RT-PCR or RA test was comparable or higher than the iNMB for programs with a confirmatory test for RA-positive cases. When the program started early with a duration of at least 16 weeks and no confirmatory testing, the iNMB exceeded CDN$1.1 million per 100,000 population. Increasing booster coverage of working adults improved the iNMB of RA screening. CONCLUSIONS Our findings indicate that frequent RA testing starting very early in a surge, without a confirmatory test, is a preferred screening program for the detection of asymptomatic infections in workplaces.
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Affiliation(s)
- Thomas N Vilches
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Ellen Rafferty
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada.
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Kratzer S, Pfadenhauer LM, Biallas RL, Featherstone R, Klinger C, Movsisyan A, Rabe JE, Stadelmaier J, Rehfuess E, Wabnitz K, Verboom B. Unintended consequences of measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review. Cochrane Database Syst Rev 2022; 6:CD015397. [PMID: 35661990 PMCID: PMC9169532 DOI: 10.1002/14651858.cd015397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND With the emergence of SARS-CoV-2 in late 2019, governments worldwide implemented a multitude of non-pharmaceutical interventions in order to control the spread of the virus. Most countries have implemented measures within the school setting in order to reopen schools or keep them open whilst aiming to contain the spread of SARS-CoV-2. For informed decision-making on implementation, adaptation, or suspension of such measures, it is not only crucial to evaluate their effectiveness with regard to SARS-CoV-2 transmission, but also to assess their unintended consequences. OBJECTIVES To comprehensively identify and map the evidence on the unintended health and societal consequences of school-based measures to prevent and control the spread of SARS-CoV-2. We aimed to generate a descriptive overview of the range of unintended (beneficial or harmful) consequences reported as well as the study designs that were employed to assess these outcomes. This review was designed to complement an existing Cochrane Review on the effectiveness of these measures by synthesising evidence on the implications of the broader system-level implications of school measures beyond their effects on SARS-CoV-2 transmission. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four non-health databases, and two COVID-19 reference collections on 26 March 2021, together with reference checking, citation searching, and Google searches. SELECTION CRITERIA We included quantitative (including mathematical modelling), qualitative, and mixed-methods studies of any design that provided evidence on any unintended consequences of measures implemented in the school setting to contain the SARS-CoV-2 pandemic. Studies had to report on at least one unintended consequence, whether beneficial or harmful, of one or more relevant measures, as conceptualised in a logic model. DATA COLLECTION AND ANALYSIS: We screened the titles/abstracts and subsequently full texts in duplicate, with any discrepancies between review authors resolved through discussion. One review author extracted data for all included studies, with a second review author reviewing the data extraction for accuracy. The evidence was summarised narratively and graphically across four prespecified intervention categories and six prespecified categories of unintended consequences; findings were described as deriving from quantitative, qualitative, or mixed-method studies. MAIN RESULTS Eighteen studies met our inclusion criteria. Of these, 13 used quantitative methods (3 experimental/quasi-experimental; 5 observational; 5 modelling); four used qualitative methods; and one used mixed methods. Studies looked at effects in different population groups, mainly in children and teachers. The identified interventions were assigned to four broad categories: 14 studies assessed measures to make contacts safer; four studies looked at measures to reduce contacts; six studies assessed surveillance and response measures; and one study examined multiple measures combined. Studies addressed a wide range of unintended consequences, most of them considered harmful. Eleven studies investigated educational consequences. Seven studies reported on psychosocial outcomes. Three studies each provided information on physical health and health behaviour outcomes beyond COVID-19 and environmental consequences. Two studies reported on socio-economic consequences, and no studies reported on equity and equality consequences. AUTHORS' CONCLUSIONS We identified a heterogeneous evidence base on unintended consequences of measures implemented in the school setting to prevent and control the spread of SARS-CoV-2, and summarised the available study data narratively and graphically. Primary research better focused on specific measures and various unintended outcomes is needed to fill knowledge gaps and give a broader picture of the diverse unintended consequences of school-based measures before a more thorough evidence synthesis is warranted. The most notable lack of evidence we found was regarding psychosocial, equity, and equality outcomes. We also found a lack of research on interventions that aim to reduce the opportunity for contacts. Additionally, study investigators should provide sufficient data on contextual factors and demographics in order to ensure analyses of such are feasible, thus assisting stakeholders in making appropriate, informed decisions for their specific circumstances.
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Affiliation(s)
- Suzie Kratzer
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | - Carmen Klinger
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia E Rabe
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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9
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Martínez-Cortés M, León-Dominguez CM, Fernandez-Pinero J, Rodriguez M, Almonacid M, Ferrari MJ, Romero R, Antona A, Rivas MD, de La Fuente M, Pérez-Gómez B, Pollán M. SARS-CoV-2 surveillance strategy in essential workers of the Madrid City Council during the first epidemic wave in Spain, March-July 2020. Occup Environ Med 2022; 79:295-303. [PMID: 34599009 PMCID: PMC8492183 DOI: 10.1136/oemed-2021-107654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study prevalence of infection in essential workers of Madrid City Council by occupation, related characteristics, use of protective devices, risk perception, and main concerns about COVID-19 during lockdown. METHODS A total of 30 231 workers were PCR tested for SARS-CoV-2 infection. Information was collected on COVID-19-related symptoms, risk factors, preventive equipment, and risk perception. The crude prevalence was calculated for infection, use of protective devices, perceived risk and main concerns. Additionally, adjusted prevalence and prevalence ratios (PR) were estimated for these variables using logistic regression models with age, gender, occupation, epidemiological week and laboratory as confounding factors. RESULTS Overall prevalence of infection was 3.2% (95% CI 3.0% to 3.4%), being higher among policemen (4.4%) and bus drivers (4.2%), but lower among emergency healthcare personnel, firefighters, food market workers and burial services (<2%). Lower excess risk was observed in workers reporting occupational contact with COVID-19 cases only (PR=1.42; 95% CI 1.18 to 1.71) compared with household exposure only (PR=2.75; 95% CI 2.32 to 3.25). Infection was more frequent in symptomatic workers (PR=1.28; 95% CI 1.11 to 1.48), although 42% of detected infections were asymptomatic. Use of facial masks (78.7%) and disinfectants (86.3%) was common and associated with lower infection prevalence (PRmasks=0.68; 95% CI 0.58 to 0.79; PRdisinfectants=0.75; 95% CI 0.61 to 0.91). Over 50% of workers felt being at high risk of infection and worried about infecting others, yet only 2% considered quitting their work. CONCLUSIONS This surveillance system allowed for detecting and isolating SARS-CoV-2 cases among essential workers, identifying characteristics related to infection and use of protective devices, and revealing specific needs for work-safety information and psychological support.
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Affiliation(s)
| | | | - Jovita Fernandez-Pinero
- Centro de Investigación en Sanidad Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA-CISA, CSIC), Valdeolmos, Comunidad de Madrid, Spain
| | | | | | | | | | | | | | | | - Beatriz Pérez-Gómez
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP, Madrid, Comunidad de Madrid, Spain
| | - Marina Pollán
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP, Madrid, Comunidad de Madrid, Spain
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10
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Campbell JR, Dion C, Uppal A, Yansouni CP, Menzies D. Systematic on-site testing for SARS-CoV-2 infection among asymptomatic essential workers in Montréal, Canada: a prospective observational and cost-assessment study. CMAJ Open 2022; 10:E409-E419. [PMID: 35537749 PMCID: PMC9259431 DOI: 10.9778/cmajo.20210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Essential workers are at increased risk for SARS-CoV-2 infection. We aimed to estimate the yield, acceptability and cost of systematic workplace-based testing of asymptomatic essential workers for SARS-CoV-2 infection. METHODS From Jan. 27 to Mar. 12, 2021, we prospectively recruited non-health care essential businesses in Montréal, Canada, through email or telephone contact. Two trained mobile teams, each composed of 2 non-health care professionals, visited businesses. Consenting asymptomatic employees provided saline gargle samples under supervision. Samples were analyzed by means of reverse transcription polymerase chain reaction (RT-PCR). At businesses with outbreaks (≥ 2 participants with a positive result), we retested all participants with a negative result on initial testing. Our primary outcomes were yield (proportion of test results that were positive), acceptability (proportion of participants estimated to be present at the business who agreed to participate) and costs (including training, sample collection and analysis, and communicating results). Our secondary outcome was identification of factors associated with a positive test result on multivariable logistic regression. RESULTS Of the 366 businesses contacted, 69 (18.8%) agreed to participate. Nineteen businesses (28%) were manufacturers or suppliers, 12 (17%) were in auto sales or repair, and 11 (16%) were in childcare; the corresponding number of employees was 1225, 242 and 113. The median number of participants per business was 13 (interquartile range [IQR] 8-22). Of an estimated 2348 employees on site, 2128 (90.6%) participated (808 [38.0%] female, median age 48 [IQR 37-57] yr). Of the 2626 tests performed, 53 (2.0%) gave a positive result. Self-reported nonwhite ethnicity (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI] 1.4-9.9) and a negative SARS-CoV-2 test result before the study (adjusted OR 0.4, 95% CI 0.2-0.8) were associated with a positive test result. Five businesses were experiencing an outbreak; at these businesses, 40/917 participants (4.4%) had a positive result on the initial test. We repeated testing for employees with initially negative results at 3 of these businesses over 2-3 weeks: 8/350 participants (2.3%) had a positive result on the second test, and none had a positive result on the third and fourth tests; no employer reported new positive results after our final visit (up to Mar. 26, 2021). At the remaining 64 businesses, 1211 participants were tested once, of whom 5 (0.4%) had a positive result. The per-person RT-PCR cost was $34, and all other costs, $8.67. INTERPRETATION On-site saline gargle sampling of essential workers for SARS-CoV-2 testing was acceptable and of modest cost, and appears most useful in the context of outbreaks. This sampling strategy should be evaluated further as a component of efforts to prevent SARS-CoV-2 transmission. PREPRINT: medRxiv - doi:10.1101/2021.05.12.21256956.
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Affiliation(s)
- Jonathon R Campbell
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que.
| | - Cynthia Dion
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Aashna Uppal
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Cedric P Yansouni
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Dick Menzies
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
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11
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Basso D, Aita A, Navaglia F, Mason P, Moz S, Pinato A, Melloni B, Iannelli L, Padoan A, Cosma C, Moretto A, Scuttari A, Mapelli D, Rizzuto R, Plebani M. The University of Padua salivary-based SARS-CoV-2 surveillance program minimized viral transmission during the second and third pandemic wave. BMC Med 2022; 20:96. [PMID: 35197073 PMCID: PMC8865498 DOI: 10.1186/s12916-022-02297-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/11/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The active surveillance of students is proposed as an effective strategy to contain SARS-CoV-2 spread and prevent schools' closure. Saliva for molecular testing is as sensitive as naso-pharyngeal swab (NPS), self-collected and well accepted by participants. This prospective study aimed to verify whether the active surveillance of the Padua University employees by molecular testing of self-collected saliva is an effective and affordable strategy for limiting SARS-CoV-2 spread. METHODS A surveillance program based on self-collection of saliva every 2 weeks (October 2020-June 2021) was conducted. Among 8183 employees of the Padua University, a total of 6284 subjects voluntarily took part in the program. Eight collection points guaranteed the daily distribution and collection of barcoded salivary collection devices, which were delivered to the laboratory by a transport service for molecular testing. Quarantine of positive cases and contact tracing were promptly activated. RESULTS Among 6284 subjects, 206 individuals were SARS-CoV-2 positive (99 by salivary testing; 107 by NPS performed for contact tracing or symptoms). The cumulative SARS-CoV-2 incidence in this cohort was 3.1%, significantly lower than that of employees not in surveillance (8.0%), in Padua (7.1%) and in the Veneto region (7.2%). Employees with positive saliva results were asymptomatic or had mild symptoms. The levels of serum antibodies after 3 months from the infection were correlated with age and Ct values, being higher in older subjects with greater viral loads. CONCLUSIONS Salivary-based surveillance with contact tracing effectively allowed to limit SARS-CoV-2 contagion, also in a population with a high incidence.
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Affiliation(s)
- Daniela Basso
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy. .,Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy.
| | - Ada Aita
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Filippo Navaglia
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Occupational Health Unit, University of Padua, Padua, Italy
| | - Stefania Moz
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Alessio Pinato
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Barbara Melloni
- Environment and Safety Office, University of Padua, Padua, Italy
| | - Luca Iannelli
- Software Development Office - IT Service, University of Padua, Padua, Italy
| | - Andrea Padoan
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Angelo Moretto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Occupational Health Unit, University of Padua, Padua, Italy
| | | | - Daniela Mapelli
- Pro-rector for teaching of the University of Padua, Padua, Italy
| | | | - Mario Plebani
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
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12
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Krishnaratne S, Littlecott H, Sell K, Burns J, Rabe JE, Stratil JM, Litwin T, Kreutz C, Coenen M, Geffert K, Boger AH, Movsisyan A, Kratzer S, Klinger C, Wabnitz K, Strahwald B, Verboom B, Rehfuess E, Biallas RL, Jung-Sievers C, Voss S, Pfadenhauer LM. Measures implemented in the school setting to contain the COVID-19 pandemic. Cochrane Database Syst Rev 2022; 1:CD015029. [PMID: 35037252 PMCID: PMC8762709 DOI: 10.1002/14651858.cd015029] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In response to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the impact of coronavirus disease 2019 (COVID-19), governments have implemented a variety of measures to control the spread of the virus and the associated disease. Among these, have been measures to control the pandemic in primary and secondary school settings. OBJECTIVES To assess the effectiveness of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic, with particular focus on the different types of measures implemented in school settings and the outcomes used to measure their impacts on transmission-related outcomes, healthcare utilisation outcomes, other health outcomes as well as societal, economic, and ecological outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Educational Resources Information Center, as well as COVID-19-specific databases, including the Cochrane COVID-19 Study Register and the WHO COVID-19 Global literature on coronavirus disease (indexing preprints) on 9 December 2020. We conducted backward-citation searches with existing reviews. SELECTION CRITERIA We considered experimental (i.e. randomised controlled trials; RCTs), quasi-experimental, observational and modelling studies assessing the effects of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic. Outcome categories were (i) transmission-related outcomes (e.g. number or proportion of cases); (ii) healthcare utilisation outcomes (e.g. number or proportion of hospitalisations); (iii) other health outcomes (e.g. physical, social and mental health); and (iv) societal, economic and ecological outcomes (e.g. costs, human resources and education). We considered studies that included any population at risk of becoming infected with SARS-CoV-2 and/or developing COVID-19 disease including students, teachers, other school staff, or members of the wider community. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full texts. One review author extracted data and critically appraised each study. One additional review author validated the extracted data. To critically appraise included studies, we used the ROBINS-I tool for quasi-experimental and observational studies, the QUADAS-2 tool for observational screening studies, and a bespoke tool for modelling studies. We synthesised findings narratively. Three review authors made an initial assessment of the certainty of evidence with GRADE, and several review authors discussed and agreed on the ratings. MAIN RESULTS We included 38 unique studies in the analysis, comprising 33 modelling studies, three observational studies, one quasi-experimental and one experimental study with modelling components. Measures fell into four broad categories: (i) measures reducing the opportunity for contacts; (ii) measures making contacts safer; (iii) surveillance and response measures; and (iv) multicomponent measures. As comparators, we encountered the operation of schools with no measures in place, less intense measures in place, single versus multicomponent measures in place, or closure of schools. Across all intervention categories and all study designs, very low- to low-certainty evidence ratings limit our confidence in the findings. Concerns with the quality of modelling studies related to potentially inappropriate assumptions about the model structure and input parameters, and an inadequate assessment of model uncertainty. Concerns with risk of bias in observational studies related to deviations from intended interventions or missing data. Across all categories, few studies reported on implementation or described how measures were implemented. Where we describe effects as 'positive', the direction of the point estimate of the effect favours the intervention(s); 'negative' effects do not favour the intervention. We found 23 modelling studies assessing measures reducing the opportunity for contacts (i.e. alternating attendance, reduced class size). Most of these studies assessed transmission and healthcare utilisation outcomes, and all of these studies showed a reduction in transmission (e.g. a reduction in the number or proportion of cases, reproduction number) and healthcare utilisation (i.e. fewer hospitalisations) and mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 11 modelling studies and two observational studies assessing measures making contacts safer (i.e. mask wearing, cleaning, handwashing, ventilation). Five studies assessed the impact of combined measures to make contacts safer. They assessed transmission-related, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed a reduction in transmission, and a reduction in hospitalisations; however, studies showed mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 13 modelling studies and one observational study assessing surveillance and response measures, including testing and isolation, and symptomatic screening and isolation. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom-based screening and isolation. Outcomes included transmission, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed effects in favour of the intervention in terms of reductions in transmission and hospitalisations, however some showed mixed or negative effects on societal, economic and ecological outcomes (e.g. fewer number of days spent in school). We found three studies that reported outcomes relating to multicomponent measures, where it was not possible to disaggregate the effects of each individual intervention, including one modelling, one observational and one quasi-experimental study. These studies employed interventions, such as physical distancing, modification of school activities, testing, and exemption of high-risk students, using measures such as hand hygiene and mask wearing. Most of these studies showed a reduction in transmission, however some showed mixed or no effects. As the majority of studies included in the review were modelling studies, there was a lack of empirical, real-world data, which meant that there were very little data on the actual implementation of interventions. AUTHORS' CONCLUSIONS Our review suggests that a broad range of measures implemented in the school setting can have positive impacts on the transmission of SARS-CoV-2, and on healthcare utilisation outcomes related to COVID-19. The certainty of the evidence for most intervention-outcome combinations is very low, and the true effects of these measures are likely to be substantially different from those reported here. Measures implemented in the school setting may limit the number or proportion of cases and deaths, and may delay the progression of the pandemic. However, they may also lead to negative unintended consequences, such as fewer days spent in school (beyond those intended by the intervention). Further, most studies assessed the effects of a combination of interventions, which could not be disentangled to estimate their specific effects. Studies assessing measures to reduce contacts and to make contacts safer consistently predicted positive effects on transmission and healthcare utilisation, but may reduce the number of days students spent at school. Studies assessing surveillance and response measures predicted reductions in hospitalisations and school days missed due to infection or quarantine, however, there was mixed evidence on resources needed for surveillance. Evidence on multicomponent measures was mixed, mostly due to comparators. The magnitude of effects depends on multiple factors. New studies published since the original search date might heavily influence the overall conclusions and interpretation of findings for this review.
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Affiliation(s)
- Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia E Rabe
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Suzie Kratzer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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13
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Bulfoni M, Sozio E, Marcon B, De Martino M, Cesselli D, De Carlo C, Martinella R, Migotti A, Vania E, Zanus-Fortes A, De Piero J, Nencioni E, Tascini C, Isola M, Curcio F. Validation of a Saliva-Based Test for the Molecular Diagnosis of SARS-CoV-2 Infection. DISEASE MARKERS 2022; 2022:6478434. [PMID: 35035611 PMCID: PMC8759915 DOI: 10.1155/2022/6478434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since the beginning of the pandemic, clinicians and researchers have been searching for alternative tests to improve the screening and diagnosis of the SARS-CoV-2 infection. Currently, the gold standard for virus identification is the nasopharyngeal (NP) swab. Saliva samples, however, offer clear, practical, and logistical advantages but due to a lack of collection, transport, and storage solutions, high-throughput saliva-based laboratory tests are difficult to scale up as a screening or diagnostic tool. With this study, we aimed to validate an intralaboratory molecular detection method for SARS-CoV-2 on saliva samples collected in a new storage saline solution, comparing the results to NP swabs to determine the difference in sensitivity between the two tests. METHODS In this study, 156 patients (cases) and 1005 asymptomatic subjects (controls) were enrolled and tested simultaneously for the detection of the SARS-CoV-2 viral genome by RT-PCR on both NP swab and saliva samples. Saliva samples were collected in a preservative and inhibiting saline solution (Biofarma Srl). Internal method validation was performed to standardize the entire workflow for saliva samples. RESULTS The identification of SARS-CoV-2 conducted on saliva samples showed a clinical sensitivity of 95.1% and specificity of 97.8% compared to NP swabs. The positive predictive value (PPV) was 81% while the negative predictive value (NPV) was 99.5%. Test concordance was 97.6% (Cohen's Kappa = 0.86; 95% CI 0.81-0.91). The LoD of the test was 5 viral copies for both samples. CONCLUSIONS RT-PCR assays conducted on a stored saliva sample achieved similar performance to those on NP swabs, and this may provide a very effective tool for population screening and diagnosis. Collection of saliva in a stabilizing solution makes the test more convenient and widely available; furthermore, the denaturing properties of the solution reduce the infective risks belonging to sample manipulation.
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Affiliation(s)
- Michela Bulfoni
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Pathology, ASU FC, Udine, Italy
| | - Emanuela Sozio
- Infectious Disease Unit, Department of Medicine, ASU FC, Udine, Italy
| | | | | | - Daniela Cesselli
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Pathology, ASU FC, Udine, Italy
| | - Chiara De Carlo
- Infectious Disease Unit, Department of Medicine, ASU FC, Udine, Italy
| | | | | | - Eleonora Vania
- Infectious Disease Unit, Department of Medicine, ASU FC, Udine, Italy
| | | | - Jessica De Piero
- Infectious Disease Unit, Department of Medicine, ASU FC, Udine, Italy
| | | | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
- Infectious Disease Unit, Department of Medicine, ASU FC, Udine, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine, Udine, Italy
- Department of Laboratory Medicine, ASU FC, Udine, Italy
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14
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Ross AM, Ramlawi S, Fakhraei R, Murphy MSQ, Ducharme R, Dingwall-Harvey ALJ, White RR, Ritchie K, Muldoon K, El-Chaâr D. The psychological impact of the COVID-19 pandemic and a SARS-CoV-2 testing programme on obstetric patients and healthcare workers. WOMEN'S HEALTH 2022; 18:17455057221103101. [PMID: 35686846 PMCID: PMC9189525 DOI: 10.1177/17455057221103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: The aim of this study was to describe the psychological impact of the COVID-19 pandemic and the specific impact of a universal SARS-CoV-2 testing programme on obstetric patients and healthcare workers at The Ottawa Hospital. Methods: This was a follow-up survey study of obstetric healthcare workers and then-pregnant patients who participated in a SARS-CoV-2 testing programme conducted in The Ottawa Hospital obstetrical triage units from 19 October to 17 November 2020. Surveys explored the effects of the COVID-19 pandemic and the testing programme on participants’ psychological well-being. Responses were collected from April to September 2021. Descriptive summary statistics were calculated for both groups. Results: During hospitalization for delivery, obstetric patients (n = 143) worried about giving COVID-19 to their new baby (88.11%), catching COVID-19 (83.22%), and giving COVID-19 to their partner (76.22%). Patients felt relief at being tested for COVID-19 during the universal testing programme (24.65%) and at getting their results (28.87%). Patients also believed that universal SARS-CoV-2 testing was a good way to slow COVID-19 spread (79.72%), reduce anxiety (75.52%), and increase relief (76.22%). In addition, patients felt good about participating in research that could help others (91.61%). Among obstetric healthcare workers (n = 94), job satisfaction decreased and job stress increased during the COVID-19 pandemic. The universal testing programme led to minor increases in healthcare worker job stress and burden, particularly among nurses, but the majority (85.23%) believed it was a valuable research initiative. Conclusion: The COVID-19 pandemic has had a negative psychological impact on obstetric patients and healthcare workers. Universal SARS-CoV-2 testing was generally viewed favourably and may serve as an effective strategy for estimating COVID-19 prevalence without adding undue stress onto patients and healthcare workers during the pandemic.
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Affiliation(s)
- Abigail M Ross
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Serine Ramlawi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Romina Fakhraei
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Malia SQ Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Kerri Ritchie
- Ottawa Hospital Research Institute, Psychiatry, The Ottawa Hospital, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Darine El-Chaâr, Department of Obstetrics, Gynaecology and Newborn care, The Ottawa Hospital, General Campus, CPCR, Box 241, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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15
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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: 68] [Impact Index Per Article: 22.7] [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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16
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Mendoza RP, Bi C, Cheng HT, Gabutan E, Pagaspas GJ, Khan N, Hoxie H, Hanna S, Holmes K, Gao N, Lewis R, Wang H, Neumann D, Chan A, Takizawa M, Lowe J, Chen X, Kelly B, Asif A, Barnes K, Khan N, May B, Chowdhury T, Pollonini G, Gouda N, Guy C, Gordon C, Ayoluwa N, Colon E, Miller-Medzon N, Jones S, Hossain R, Dodson A, Weng M, McGaskey M, Vasileva A, Lincoln AE, Sikka R, Wyllie AL, Berke EM, Libien J, Pincus M, Premsrirut PK. Implementation of a pooled surveillance testing program for asymptomatic SARS-CoV-2 infections in K-12 schools and universities. EClinicalMedicine 2021; 38:101028. [PMID: 34308321 DOI: 10.1101/2021.02.09.21251464v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine COVID-19 testing that may ultimately reduce the overall viral burden in the community. METHODS We implemented a testing program using the SalivaClear࣪ pooled surveillance method that included students, faculty and staff from K-12 schools (student age range 5-18 years) and universities (student age range >18 years) across the country (Mirimus Clinical Labs, Brooklyn, NY). The data analysis was performed using descriptive statistics, kappa agreement, and outlier detection analysis. FINDINGS From August 27, 2020 until January 13, 2021, 253,406 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (Ct) values between pooled and individual samples) measures. The detection of SARS-CoV-2 in saliva was comparable to the nasopharyngeal swab. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. INTERPRETATION By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis for the presence of SARS-CoV-2 enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. We provide strong evidence that pooled testing may be a fundamental component to the reopening of schools by minimizing the risk of in-school transmission among students and faculty. FUNDING Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.
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Affiliation(s)
- Rachelle P Mendoza
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Chongfeng Bi
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Hui-Ting Cheng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elmer Gabutan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nadia Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Helen Hoxie
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Stephen Hanna
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Kelly Holmes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nicholas Gao
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Raychel Lewis
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Huaien Wang
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Daniel Neumann
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Angela Chan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meril Takizawa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - James Lowe
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Xiao Chen
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brianna Kelly
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Aneeza Asif
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Keena Barnes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nusrat Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brandon May
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Tasnim Chowdhury
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nourelhoda Gouda
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Chante Guy
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Candice Gordon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nana Ayoluwa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elvin Colon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Shanique Jones
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Rauful Hossain
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Arabia Dodson
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meimei Weng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Miranda McGaskey
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Ana Vasileva
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Andrew E Lincoln
- MedStar Sports Medicine Research Center, MedStar Health Research Institute, 2900 S Hanover St., Baltimore, MD 21225, USA
- Department of Rehabilitation Medicine, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - Robby Sikka
- Minnesota Timberwolves, 600 Hennepin Ave, Minneapolis, MN 55403, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Ethan M Berke
- OptumLabs, UnitedHealth Group, 12700 Whitewater Dr, Minnetonka, MN 55343 USA
| | - Jenny Libien
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Matthew Pincus
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Prem K Premsrirut
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
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17
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Mendoza RP, Bi C, Cheng HT, Gabutan E, Pagapas GJ, Khan N, Hoxie H, Hanna S, Holmes K, Gao N, Lewis R, Wang H, Neumann D, Chan A, Takizawa M, Lowe J, Chen X, Kelly B, Asif A, Barnes K, Khan N, May B, Chowdhury T, Pollonini G, Gouda N, Guy C, Gordon C, Ayoluwa N, Colon E, Miller-Medzon N, Jones S, Hossain R, Dodson A, Weng M, McGaskey M, Vasileva A, Lincoln AE, Sikka R, Wyllie AL, Berke EM, Libien J, Pincus M, Premsrirut PK. Implementation of a pooled surveillance testing program for asymptomatic SARS-CoV-2 infections in K-12 schools and universities. EClinicalMedicine 2021; 38:101028. [PMID: 34308321 PMCID: PMC8286123 DOI: 10.1016/j.eclinm.2021.101028] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine COVID-19 testing that may ultimately reduce the overall viral burden in the community. METHODS We implemented a testing program using the SalivaClear࣪ pooled surveillance method that included students, faculty and staff from K-12 schools (student age range 5-18 years) and universities (student age range >18 years) across the country (Mirimus Clinical Labs, Brooklyn, NY). The data analysis was performed using descriptive statistics, kappa agreement, and outlier detection analysis. FINDINGS From August 27, 2020 until January 13, 2021, 253,406 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (Ct) values between pooled and individual samples) measures. The detection of SARS-CoV-2 in saliva was comparable to the nasopharyngeal swab. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. INTERPRETATION By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis for the presence of SARS-CoV-2 enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. We provide strong evidence that pooled testing may be a fundamental component to the reopening of schools by minimizing the risk of in-school transmission among students and faculty. FUNDING Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.
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Affiliation(s)
- Rachelle P. Mendoza
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Chongfeng Bi
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Hui-Ting Cheng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elmer Gabutan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nadia Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Helen Hoxie
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Stephen Hanna
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Kelly Holmes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nicholas Gao
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Raychel Lewis
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Huaien Wang
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Daniel Neumann
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Angela Chan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meril Takizawa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - James Lowe
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Xiao Chen
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brianna Kelly
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Aneeza Asif
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Keena Barnes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nusrat Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brandon May
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Tasnim Chowdhury
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nourelhoda Gouda
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Chante Guy
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Candice Gordon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nana Ayoluwa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elvin Colon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Shanique Jones
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Rauful Hossain
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Arabia Dodson
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meimei Weng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Miranda McGaskey
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Ana Vasileva
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Andrew E. Lincoln
- MedStar Sports Medicine Research Center, MedStar Health Research Institute, 2900 S Hanover St., Baltimore, MD 21225, USA
- Department of Rehabilitation Medicine, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - Robby Sikka
- Minnesota Timberwolves, 600 Hennepin Ave, Minneapolis, MN 55403, USA
| | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Ethan M. Berke
- OptumLabs, UnitedHealth Group, 12700 Whitewater Dr, Minnetonka, MN 55343 USA
| | - Jenny Libien
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Matthew Pincus
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Prem K. Premsrirut
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
- Corresponding author at: Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA.
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18
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Mbwogge M. Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review. JMIRX MED 2021; 2:e27254. [PMID: 33857269 PMCID: PMC8045129 DOI: 10.2196/27254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all. OBJECTIVE The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions. METHODS Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included "mass testing," "test and trace," "contact tracing," "COVID-19," "SARS-CoV-2," "effectiveness," "asymptomatic," "symptomatic," "community screening," "UK," and "2020." Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings. RESULTS The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively. CONCLUSIONS There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services.
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Affiliation(s)
- Mathew Mbwogge
- London School of Hygiene & Tropical Medicine London United Kingdom
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19
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Bastos ML, Perlman-Arrow S, Menzies D, Campbell JR. The Sensitivity and Costs of Testing for SARS-CoV-2 Infection With Saliva Versus Nasopharyngeal Swabs : A Systematic Review and Meta-analysis. Ann Intern Med 2021; 174:501-510. [PMID: 33428446 PMCID: PMC7822569 DOI: 10.7326/m20-6569] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nasopharyngeal swabs are the primary sampling method used for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they require a trained health care professional and extensive personal protective equipment. PURPOSE To determine the difference in sensitivity for SARS-CoV-2 detection between nasopharyngeal swabs and saliva and estimate the incremental cost per additional SARS-CoV-2 infection detected with nasopharyngeal swabs. DATA SOURCES Embase, Medline, medRxiv, and bioRxiv were searched from 1 January to 1 November 2020. Cost inputs were from nationally representative sources in Canada and were converted to 2020 U.S. dollars. STUDY SELECTION Studies including at least 5 paired nasopharyngeal swab and saliva samples and reporting diagnostic accuracy for SARS-CoV-2 detection. DATA EXTRACTION Data were independently extracted using standardized forms, and study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). DATA SYNTHESIS Thirty-seven studies with 7332 paired samples were included. Against a reference standard of a positive result on either sample, the sensitivity of saliva was 3.4 percentage points lower (95% CI, 9.9 percentage points lower to 3.1 percentage points higher) than that of nasopharyngeal swabs. Among persons with previously confirmed SARS-CoV-2 infection, saliva's sensitivity was 1.5 percentage points higher (CI, 7.3 percentage points lower to 10.3 percentage points higher) than that of nasopharyngeal swabs. Among persons without a previous SARS-CoV-2 diagnosis, saliva was 7.9 percentage points less (CI, 14.7 percentage points less to 0.8 percentage point more) sensitive. In this subgroup, if testing 100 000 persons with a SARS-CoV-2 prevalence of 1%, nasopharyngeal swabs would detect 79 more (95% uncertainty interval, 5 fewer to 166 more) persons with SARS-CoV-2 than saliva, but with an incremental cost per additional infection detected of $8093. LIMITATION The reference standard was imperfect, and saliva collection procedures varied. CONCLUSION Saliva sampling seems to be a similarly sensitive and less costly alternative that could replace nasopharyngeal swabs for collection of clinical samples for SARS-CoV-2 testing. PRIMARY FUNDING SOURCE McGill Interdisciplinary Initiative in Infection and Immunity. (PROSPERO: CRD42020203415).
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Affiliation(s)
- Mayara Lisboa Bastos
- McGill University and McGill International TB Centre, Montreal, Quebec, Canada, and State University of Rio de Janeiro, Rio de Janeiro, Brazil (M.L.B.)
| | | | - Dick Menzies
- McGill University, McGill International TB Centre, and Montreal Chest Institute, Montreal, Quebec, Canada (D.M.)
| | - Jonathon R Campbell
- McGill University and McGill International TB Centre, Montreal, Quebec, Canada (J.R.C.)
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Butler-Laporte G, Lawandi A, Schiller I, Yao M, Dendukuri N, McDonald EG, Lee TC. Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Intern Med 2021; 181:353-360. [PMID: 33449069 PMCID: PMC7811189 DOI: 10.1001/jamainternmed.2020.8876] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/05/2020] [Indexed: 01/09/2023]
Abstract
Importance Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the noninvasive criterion standard for diagnosis of coronavirus disease 2019 (COVID-19). However, it requires trained personnel, limiting its availability. Saliva NAAT represents an attractive alternative, but its diagnostic performance is unclear. Objective To assess the diagnostic accuracy of saliva NAAT for COVID-19. Data Sources In this systematic review, a search of the MEDLINE and medRxiv databases was conducted on August 29, 2020, to find studies of diagnostic test accuracy. The final meta-analysis was performed on November 17, 2020. Study Selection Studies needed to provide enough data to measure salivary NAAT sensitivity and specificity compared with imperfect nasopharyngeal swab NAAT as a reference test. An imperfect reference test does not perfectly reflect the truth (ie, it can give false results). Studies were excluded if the sample contained fewer than 20 participants or was neither random nor consecutive. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed for the systematic review, with multiple authors involved at each stage of the review. To account for the imperfect reference test sensitivity, we used a bayesian latent class bivariate model for the meta-analysis. Main Outcomes and Measures The primary outcome was pooled sensitivity and specificity. Two secondary analyses were performed: one restricted to peer-reviewed studies, and a post hoc analysis limited to ambulatory settings. Results The search strategy yielded 385 references, and 16 unique studies were identified for quantitative synthesis. Eight peer-reviewed studies and 8 preprints were included in the meta-analyses (5922 unique patients). There was significant variability in patient selection, study design, and stage of illness at which patients were enrolled. Fifteen studies included ambulatory patients, and 9 exclusively enrolled from an outpatient population with mild or no symptoms. In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses. Conclusions and Relevance These results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.
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Affiliation(s)
- Guillaume Butler-Laporte
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
| | - Alexander Lawandi
- Department of Critical Care Medicine, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Mandy Yao
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Emily G. McDonald
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Todd C. Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
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21
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Matukas LM, Dhalla IA, Laupacis A. Trouver, tester, « tracer » et isoler énergiquement pour battre la COVID-19. CMAJ 2021; 192:E1836-E1837. [PMID: 33318103 DOI: 10.1503/cmaj.202120-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Larissa M Matukas
- Départements de médecine de laboratoire et pathobiologie et de médecine (Matukas), Université de Toronto; Division de microbiologie (Matukas), Départements de médecine de laboratoire et de médecine, Hôpital St. Michael's, Unity Health Toronto, Département de médecine et Institut des politiques, de la gestion et de l'évaluation de la santé (Dhalla), Université de Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; rédacteur en chef (Laupacis), CMAJ
| | - Irfan A Dhalla
- Départements de médecine de laboratoire et pathobiologie et de médecine (Matukas), Université de Toronto; Division de microbiologie (Matukas), Départements de médecine de laboratoire et de médecine, Hôpital St. Michael's, Unity Health Toronto, Département de médecine et Institut des politiques, de la gestion et de l'évaluation de la santé (Dhalla), Université de Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; rédacteur en chef (Laupacis), CMAJ
| | - Andreas Laupacis
- Départements de médecine de laboratoire et pathobiologie et de médecine (Matukas), Université de Toronto; Division de microbiologie (Matukas), Départements de médecine de laboratoire et de médecine, Hôpital St. Michael's, Unity Health Toronto, Département de médecine et Institut des politiques, de la gestion et de l'évaluation de la santé (Dhalla), Université de Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; rédacteur en chef (Laupacis), CMAJ
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22
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Thron C, Mbazumutima V, Tamayo LV, Todjihounde L. Cost effective reproduction number based strategies for reducing deaths from COVID-19. JOURNAL OF MATHEMATICS IN INDUSTRY 2021; 11:11. [PMID: 34221823 PMCID: PMC8237561 DOI: 10.1186/s13362-021-00107-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 05/09/2023]
Abstract
In epidemiology, the effective reproduction number R e is used to characterize the growth rate of an epidemic outbreak. If R e > 1 , the epidemic worsens, and if R e < 1 , then it subsides and eventually dies out. In this paper, we investigate properties of R e for a modified SEIR model of COVID-19 in the city of Houston, TX USA, in which the population is divided into low-risk and high-risk subpopulations. The response of R e to two types of control measures (testing and distancing) applied to the two different subpopulations is characterized. A nonlinear cost model is used for control measures, to include the effects of diminishing returns. Lowest-cost control combinations for reducing instantaneous R e to a given value are computed. We propose three types of heuristic strategies for mitigating COVID-19 that are targeted at reducing R e , and we exhibit the tradeoffs between strategy implementation costs and number of deaths. We also consider two variants of each type of strategy: basic strategies, which consider only the effects of controls on R e , without regard to subpopulation; and high-risk prioritizing strategies, which maximize control of the high-risk subpopulation. Results showed that of the three heuristic strategy types, the most cost-effective involved setting a target value for R e and applying sufficient controls to attain that target value. This heuristic led to strategies that begin with strict distancing of the entire population, later followed by increased testing. Strategies that maximize control on high-risk individuals were less cost-effective than basic strategies that emphasize reduction of the rate of spreading of the disease. The model shows that delaying the start of control measures past a certain point greatly worsens strategy outcomes. We conclude that the effective reproduction can be a valuable real-time indicator in determining cost-effective control strategies.
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Affiliation(s)
- Christopher Thron
- Department of Sciences and Mathematics, Texas A&M University-Central Texas, Killeen, TX 76549 USA
| | - Vianney Mbazumutima
- Institute of Mathematics and Physical Sciences, IMSP-Bénin, Abomey Calavi University, Porto-Novo, Bénin
| | - Luis V. Tamayo
- Department of Sciences and Mathematics, Texas A&M University-Central Texas, Killeen, TX 76549 USA
| | - Léonard Todjihounde
- Institute of Mathematics and Physical Sciences, IMSP-Bénin, Abomey Calavi University, Porto-Novo, Bénin
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23
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Krishnaratne S, Pfadenhauer LM, Coenen M, Geffert K, Jung-Sievers C, Klinger C, Kratzer S, Littlecott H, Movsisyan A, Rabe JE, Rehfuess E, Sell K, Strahwald B, Stratil JM, Voss S, Wabnitz K, Burns J. Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review. Cochrane Database Syst Rev 2020; 12:CD013812. [PMID: 33331665 PMCID: PMC9206727 DOI: 10.1002/14651858.cd013812] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In response to the spread of SARS-CoV-2 and the impact of COVID-19, national and subnational governments implemented a variety of measures in order to control the spread of the virus and the associated disease. While these measures were imposed with the intention of controlling the pandemic, they were also associated with severe psychosocial, societal, and economic implications on a societal level. One setting affected heavily by these measures is the school setting. By mid-April 2020, 192 countries had closed schools, affecting more than 90% of the world's student population. In consideration of the adverse consequences of school closures, many countries around the world reopened their schools in the months after the initial closures. To safely reopen schools and keep them open, governments implemented a broad range of measures. The evidence with regards to these measures, however, is heterogeneous, with a multitude of study designs, populations, settings, interventions and outcomes being assessed. To make sense of this heterogeneity, we conducted a rapid scoping review (8 October to 5 November 2020). This rapid scoping review is intended to serve as a precursor to a systematic review of effectiveness, which will inform guidelines issued by the World Health Organization (WHO). This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and was registered with the Open Science Framework. OBJECTIVES To identify and comprehensively map the evidence assessing the impacts of measures implemented in the school setting to reopen schools, or keep schools open, or both, during the SARS-CoV-2/COVID-19 pandemic, with particular focus on the types of measures implemented in different school settings, the outcomes used to measure their impacts and the study types used to assess these. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, the CDC COVID-19 Research Articles Downloadable Database for preprints, and the WHO COVID-19 Global literature on coronavirus disease on 8 October 2020. SELECTION CRITERIA We included studies that assessed the impact of measures implemented in the school setting. Eligible populations were populations at risk of becoming infected with SARS-CoV-2, or developing COVID-19 disease, or both, and included people both directly and indirectly impacted by interventions, including students, teachers, other school staff, and contacts of these groups, as well as the broader community. We considered all types of empirical studies, which quantitatively assessed impact including epidemiological studies, modelling studies, mixed-methods studies, and diagnostic studies that assessed the impact of relevant interventions beyond diagnostic test accuracy. Broad outcome categories of interest included infectious disease transmission-related outcomes, other harmful or beneficial health-related outcomes, and societal, economic, and ecological implications. DATA COLLECTION AND ANALYSIS We extracted data from included studies in a standardized manner, and mapped them to categories within our a priori logic model where possible. Where not possible, we inductively developed new categories. In line with standard expectations for scoping reviews, the review provides an overview of the existing evidence regardless of methodological quality or risk of bias, and was not designed to synthesize effectiveness data, assess risk of bias, or characterize strength of evidence (GRADE). MAIN RESULTS We included 42 studies that assessed measures implemented in the school setting. The majority of studies used mathematical modelling designs (n = 31), while nine studies used observational designs, and two studies used experimental or quasi-experimental designs. Studies conducted in real-world contexts or using real data focused on the WHO European region (EUR; n = 20), the WHO region of the Americas (AMR; n = 13), the West Pacific region (WPR; n = 6), and the WHO Eastern Mediterranean Region (EMR; n = 1). One study conducted a global assessment and one did not report on data from, or that were applicable to, a specific country. Three broad intervention categories emerged from the included studies: organizational measures to reduce transmission of SARS-CoV-2 (n = 36), structural/environmental measures to reduce transmission of SARS-CoV-2 (n = 11), and surveillance and response measures to detect SARS-CoV-2 infections (n = 19). Most studies assessed SARS-CoV-2 transmission-related outcomes (n = 29), while others assessed healthcare utilization (n = 8), other health outcomes (n = 3), and societal, economic, and ecological outcomes (n = 5). Studies assessed both harmful and beneficial outcomes across all outcome categories. AUTHORS' CONCLUSIONS We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic.
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Affiliation(s)
- Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Suzie Kratzer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia E Rabe
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Costs of active COVID-19 testing in Canada. PHARMACOECONOMICS & OUTCOMES NEWS 2020; 863:8. [PMID: 33024406 PMCID: PMC7530347 DOI: 10.1007/s40274-020-7162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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25
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Matukas LM, Dhalla IA, Laupacis A. Aggressively find, test, trace and isolate to beat COVID-19. CMAJ 2020; 192:E1164-E1165. [PMID: 32907821 DOI: 10.1503/cmaj.202120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Larissa M Matukas
- Departments of Laboratory Medicine and Pathobiology, and Medicine (Matukas), University of Toronto; Division of Microbiology (Matukas), Department of Lab Medicine, and Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Department of Medicine and Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; editor-in-chief (Laupacis), CMAJ
| | - Irfan A Dhalla
- Departments of Laboratory Medicine and Pathobiology, and Medicine (Matukas), University of Toronto; Division of Microbiology (Matukas), Department of Lab Medicine, and Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Department of Medicine and Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; editor-in-chief (Laupacis), CMAJ
| | - Andreas Laupacis
- Departments of Laboratory Medicine and Pathobiology, and Medicine (Matukas), University of Toronto; Division of Microbiology (Matukas), Department of Lab Medicine, and Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Department of Medicine and Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto; Unity Health Toronto (Dhalla), Toronto, Ont.; editor-in-chief (Laupacis), CMAJ
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