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Bastuji-Garin S, Brouard L, Bourgeon-Ghittori I, Zebachi S, Boutin E, Hemery F, Fourreau F, Oubaya N, De Roux Q, Mongardon N, Fourati S, Decousser JW. The Relative Contributions of Occupational and Community Risk Factors for COVID-19 among Hospital Workers: The HOP-COVID Cohort Study. J Clin Med 2023; 12:jcm12031208. [PMID: 36769854 PMCID: PMC9917902 DOI: 10.3390/jcm12031208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The relative contributions of occupational and community sources of COVID-19 among health-care workers (HCWs) are still subject to debate. In a cohort study at a 2814-bed tertiary medical center (five hospitals) in the Paris area of France, we assessed the proportion of hospital-acquired cases among staff and identified risk factors. Between May 2020 and June 2021, HCWs were invited to complete a questionnaire on their COVID-19 risk factors. RT-PCR and serology test results were retrieved from the virology department. Mixed-effects logistic regression was used to account for clustering by hospital. The prevalence of COVID-19 was 15.6% (n = 213/1369 respondents) overall, 29.7% in the geriatric hospitals, and 56.8% of the infections were hospital-acquired. On multivariable analyses adjusted for COVID-19 incidence and contact in the community, a significantly higher risk was identified for staff providing patient care (especially nursing assistants), staff from radiology/functional assessment units and stretcher services, and staff working on wards with COVID-19 clusters among patients or HCWs. The likelihood of infection was greater in geriatric wards than in intensive care units. The presence of significant occupational risk factors after adjustment for community exposure is suggestive of a high in-hospital risk and emphasizes the need for stronger preventive measures-especially in geriatric settings. Clinicaltrials.gov NCT04386759.
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Affiliation(s)
- Sylvie Bastuji-Garin
- IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France
- Department of Public Health, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
- Correspondence: (S.B.-G.); (J.-W.D.)
| | - Ludivine Brouard
- Clinical Research Unit (URC Mondor), Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Irma Bourgeon-Ghittori
- IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France
- CARMAS, University Paris Est Creteil, 94010 Créteil, France
- DMU SAPHIRE, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Sonia Zebachi
- Clinical Research Unit (URC Mondor), Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Emmanuelle Boutin
- IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France
- Clinical Research Unit (URC Mondor), Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Francois Hemery
- Département d’Information Médicale, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Frédéric Fourreau
- Equipe Opérationnelle d’Hygiène, Département Prévention, Diagnostic, Traitement des Infections, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Nadia Oubaya
- IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France
- Department of Public Health, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Quentin De Roux
- Service D’Anesthésie-Réanimation Chirurgicale, DMU CARE, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Nicolas Mongardon
- IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France
- Service D’Anesthésie-Réanimation Chirurgicale, DMU CARE, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
- IMRB, EnvA, 94700 Maisons-Alfort, France
| | - Slim Fourati
- Département de Virologie, Bactériologie, Parasitologie-Mycologie, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
| | - Jean-Winoc Decousser
- Equipe Opérationnelle d’Hygiène, Département Prévention, Diagnostic, Traitement des Infections, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France
- DYNAMYC, University Paris Est Creteil, 94010 Créteil, France
- DYNAMYC, EnvA, 94700 Maisons-Alfort, France
- Correspondence: (S.B.-G.); (J.-W.D.)
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Zhang J, Yu Y, Petrovic M, Pei X, Tian QB, Zhang L, Zhang WH. Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis. Age Ageing 2023; 52:6987654. [PMID: 36668818 DOI: 10.1093/ageing/afac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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Affiliation(s)
- Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,The Research Center for Medical Sociology, Tsinghua University, 100084 Beijing, China
| | - Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xiaomei Pei
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 050017 Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 710061 Xi'an, Shaanxi, China
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3800, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 450001 Zhengzhou, Henan, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,School of Public Health, Université libre de Bruxelles (ULB), Bruxelles 1070, Belgium
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3
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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Dyer AH, Fallon A, Noonan C, Dolphin H, O'Farrelly C, Bourke NM, O'Neill D, Kennelly SP. Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update. J Am Med Dir Assoc 2022; 23:1590-1602. [PMID: 35922016 PMCID: PMC9250924 DOI: 10.1016/j.jamda.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Helena Dolphin
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland; Inflammageing Research Group, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Desmond O'Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Despite advances in infection prevention and control and breakthroughs in vaccination development, challenges remain for long-term care facilities (LTCFs) as they face a likely future of emerging infectious diseases. To ensure the safety of LTCF residents from the current and future pandemics, we identify lessons learned from the coronavirus disease 2019 (COVID-19) experience for improving future prevention and response efforts. RECENT FINDINGS In addition to high disease susceptibility among LTCF residents, LTCF vulnerabilities include a lack of pandemic preparedness, a lack of surge capacity in human, material and testing resources, and poorly designed buildings. External sources of vulnerability include staff working in multiple LTCFs and high COVID-19 rates in surrounding communities. Other challenges include poor cooperation between LTCFs and the other components of health systems, inadequately enforced regulations, and the sometimes contradictory interests for-profit LTCFs face between protecting their residents and turning a profit. SUMMARY These challenges can be addressed in the post-COVID-19 period through systemic reforms. Governments should establish comprehensive health networks that normalize mechanisms for prediction/preparedness and response/recovery from disruptive events including pandemics. In addition, governments should facilitate cooperation among public and private sector health systems and institutions while utilizing advanced digital communication technologies. These steps will greatly reduce the threat to LTCFs posed by emerging infectious diseases in future.
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6
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Verbiest MEA, Stoop A, Scheffelaar A, Janssen MM, van Boekel LC, Luijkx KG. Health impact of the first and second wave of COVID-19 and related restrictive measures among nursing home residents: a scoping review. BMC Health Serv Res 2022; 22:921. [PMID: 35841028 PMCID: PMC9286708 DOI: 10.1186/s12913-022-08186-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background and objectives COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves. Research design and methods In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style. Results Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic. Discussion and implications Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods.
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Affiliation(s)
- Marjolein E A Verbiest
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
| | - Annerieke Stoop
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Aukelien Scheffelaar
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Meriam M Janssen
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Leonieke C van Boekel
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Katrien G Luijkx
- Academic Collaborative Centre Older Adults, Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
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7
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Gómez Vázquez JP, García YE, Schmidt AJ, Martínez-López B, Nuño M. Testing and vaccination to reduce the impact of COVID-19 in nursing homes: an agent-based approach. BMC Infect Dis 2022; 22:477. [PMID: 35590305 PMCID: PMC9117861 DOI: 10.1186/s12879-022-07385-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization. METHODS We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission among resident and staff agents in a nursing home. Interactions between 172 residents and 170 staff based on data from a nursing home in Los Angeles, CA. Scenarios were simulated assuming different levels of non-pharmaceutical interventions, testing frequencies, and vaccine efficacy to reduce transmission. RESULTS Under the hypothetical scenario of widespread SARS-CoV-2 in the community, 3-day testing frequency minimized the attack rate and the time to eradicate an outbreak. Prioritization of vaccine among staff or staff and residents minimized the cumulative number of infections and hospitalization, particularly in the scenario of high probability of an introduction. Reducing the probability of a viral introduction eased the demand on testing and vaccination rate to decrease infections and hospitalizations. CONCLUSIONS Improving frequency of testing from 7-days to 3-days minimized the number of infections and hospitalizations, despite widespread community transmission. Vaccine prioritization of staff provides the best protection strategy when the risk of viral introduction is high.
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Affiliation(s)
- José P. Gómez Vázquez
- Center for Animal Disease Modeling and Surveillance, University of California Davis, Davis, CA USA
| | - Yury E. García
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
| | - Alec J. Schmidt
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, University of California Davis, Davis, CA USA
| | - Miriam Nuño
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
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Rauhala AS, Fagerström LM, Lindholst AC, Sinervo TS, Bertelsen TM, Bliksvær T, Lunde BV, Solli R, Wolmesjö MG, Hansen MB. Which factors are associated with COVID-19 infection incidence in care services for older people in Nordic countries? A cross-sectional survey. Scand J Public Health 2022; 50:787-794. [PMID: 35546571 PMCID: PMC9361421 DOI: 10.1177/14034948221085398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To investigate the differences between Sweden, Denmark, Finland and Norway
regarding residential/home care units’ and frontline managers’ background
factors, the resources allocated and measures taken during the initial
phases of the COVID-19 pandemic, and whether and how these differences were
associated with COVID-19 among older people in residential/home units. Methods: Register- and survey-based data. Responses from managers in municipal and
private residential/home units. Number of municipal COVID-19 cases from
national registries. Multilevel logistic multivariate regression analysis
with presence of COVID-19 among older people in residential/home units as
the outcome variable. Results: The proportions of residential/home units with client COVID-19 cases,
mid-March–April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and
Sweden 38.8%, most cases found in clusters. The proportions were similar
among employees. Client likelihood of having COVID-19 was six-fold higher if
the employees had COVID-19. Mean client cases per residential/home unit were
Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same
municipal infection incidence class, Sweden’s mean client infection levels
were three-fold those of other countries. The regression analysis variables
country, municipal COVID-19 incidence proportion, and care type were
associated with client cases at p ⩽ .001. Compared with
Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86,
0.41 and 0.35 respectively. The variable difficulties in preventive testing
had an OR of 1.56, p ⩽ .05. Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing
resources somewhat explained the confirmed COVID-19 cases among older
people in residential/home units. A two- to five-fold unexplained
inter-country difference in ORs in the multivariate analyses was
notable. The level of protection of vulnerable older clients in
municipal and private residential/home units differed between the
included countries.
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Affiliation(s)
- Auvo S Rauhala
- Åbo Akademi University, Turku, Finland.,Vaasa Central Hospital, Finland
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Shimizu K, Maeda H, Sando E, Fujita A, Tashiro M, Tanaka T, Izumikawa K, Motomura K, Morimoto K. Epidemiology of SARS-CoV-2 infection in nursing facilities and the impact of their clusters in a Japanese core city. J Infect Chemother 2022; 28:955-961. [PMID: 35461770 PMCID: PMC9005365 DOI: 10.1016/j.jiac.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/10/2023]
Abstract
Introduction Nursing facilities are vulnerable to coronavirus disease 2019 (COVID-19) due to the congregate nature of their housing, the older age of the residents, and the variety of their geriatric chronic conditions. Little is known about the impact of nursing facility COVID-19 on the local health system. Methods We collected data of COVID-19 cases in Nagasaki city from April 15, 2020 to June 30, 2021. We performed universal screening of the healthcare workers (HCWs) and the users of nursing facilities, once the first case of COVID-19 was detected within that facility. The community-dwelling people received testing if they had symptoms or if they were suspected of having close contact with the positive cases. The epidemiological survey for each COVID-19 case was performed by the public health officers of the local public health center. Results Out of 111,773 community-dwelling older adults (age ≥ 65 years) and 20,668 nursing facility users in Nagasaki city, we identified 358 and 71 COVID-19 cases, and 33 and 12 COVID-19 deaths, respectively, during the study period. The incidence rate ratios (IRRs) for COVID-19 and its deaths among the nursing facility users were 1.07 (95% confidence interval (CI), 0.82–1.39) and 1.97 (95%CI, 0.92–3.91) compared with the community-dwelling older adults. Four clusters, which had more than 10 COVID-19 cases, accounted for 60% (65/109) of the overall cases by the HCWs and the users. Conclusions The prevention of COVID-19 clusters is important to reduce the number of COVID-19 cases and deaths among the nursing facility population.
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Affiliation(s)
- Koki Shimizu
- Nagasaki City Public Health Center, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Haruka Maeda
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eiichiro Sando
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
| | - Ayumi Fujita
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Konosuke Morimoto
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
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Cummings KJ, Beckman J, Frederick M, Harrison R, Nguyen A, Snyder R, Chan E, Gibb K, Rodriguez A, Wong J, Murray EL, Jain S, Vergara X. Disparities in COVID-19 fatalities among working Californians. PLoS One 2022; 17:e0266058. [PMID: 35349589 PMCID: PMC8963556 DOI: 10.1371/journal.pone.0266058] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies. METHODS We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state's COVID-19 case registry. Working status for decedents aged 18-64 years was determined from state employment records, death certificates, and case registry data and classified as "confirmed working," "likely working," or "not working." We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators. RESULTS COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as "confirmed working." The remainder were classified as "likely working" (n = 4,121 [51.2%]) or "not working" (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers. CONCLUSION Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.
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Affiliation(s)
- Kristin J. Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
| | - John Beckman
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Matthew Frederick
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Alyssa Nguyen
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Robert Snyder
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Elena Chan
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Kathryn Gibb
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Andrea Rodriguez
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Jessie Wong
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Erin L. Murray
- Immunization Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Seema Jain
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Ximena Vergara
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Heluna Health, City of Industry, CA, United States of America
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11
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Postvaccination SARS-CoV-2 Infections among Healthcare Professionals: A Real World Evidence Study. Vaccines (Basel) 2022; 10:vaccines10040511. [PMID: 35455260 PMCID: PMC9024651 DOI: 10.3390/vaccines10040511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Due to the COVID-19 pandemic, all countries with a global mobilization started to produce and authorize vaccines, prioritizing healthcare professionals (HCPs) to reduce transmission. The aim of this study was to assess post-vaccination infections’ occurrence among HCPs and their correlation with symptom onset. A retrospective cohort study was carried out in the Campania Region from December 2020 to April 2021. Data were retrieved from the Regional Health Information System of the Campania Region (Sinfonia). The study cohort included subjects that had all received at least one vaccine dose. Risk ratios (RRs) adjusted for age and sex (95% confidence intervals) were performed to assess differences in the prevalence between HCPs who tested positive or negative for COVID-19. Univariate and multivariate logistic regression models were used to evaluate the association between symptoms and vaccination status. Findings revealed that HCPs had a lower risk of contracting COVID-19 after receiving at least one vaccine dose, and this risk decreased with age. Furthermore, not having full vaccination coverage may predict a severe/critical evolution of the disease. This study provides a snapshot of the initial state of the Italian vaccination campaign on HCPs. A surveillance approach using Big Data matched to clinical conditions could offer a real analysis in the categorization of subjects most at risk.
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12
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Dayanand D, Irudhayanathan I, Kundu D, Manesh A, Abraham V, Abhilash KP, Chacko B, Moorthy M, Samuel P, Peerawaranun P, Mukaka M, Joseph J, Sivaprakasam M, Varghese GM. Community seroprevalence and risk factors for SARS CoV-2 infection in different subpopulations in Vellore, India and its implications for future prevention. Int J Infect Dis 2021; 116:138-146. [PMID: 34971822 PMCID: PMC8712712 DOI: 10.1016/j.ijid.2021.12.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study was to inform public health policy decisions through the assessment of IgG antibody seroprevalence in the population and the risk factors for SARS-CoV-2 infection. Methods The seroprevalence of IgG antibodies among different subpopulations at the end of the first and second waves of the pandemic was estimated. Various risk factors associated with seropositivity, including sociodemography, IgG antibodies against endemic human coronavirus, and vaccination status, were also assessed. Results For all 2433 consenting participants, the overall estimated seroprevalences at the end of first and second waves were 28.5% (95% CI 22.3–33.7%) and 71.5% (95% CI 62.8–80.5%), respectively. The accrual of IgG positivity was heterogeneous, with the highest seroprevalences found in urban slum populations (75.1%). Vaccine uptake varied among the subpopulations, with low rates (< 10%) among rural and urban slum residents. The majority of seropositive individuals (75%) were asymptomatic. Residence in urban slums (OR 2.02, 95% CI 1.57–2.6; p < 0.001), middle socioeconomic status (OR 1.77, 95% CI 1.17–2.67; p = 0.007), presence of diabetes (OR 1.721, 95% CI 1.148–2.581; p = 0.009), and hypertension (OR 1.75, 95% CI 1.16–2.64; p = 0.008) were associated with seropositivity in multivariable analyses. Conclusion Although considerable population immunity has been reached, with more than two-thirds seropositive, improved vaccination strategies among unreached subpopulations and high-risk individuals are suggested for better preparedness in future.
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Affiliation(s)
- Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Indhuja Irudhayanathan
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinod Abraham
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Binila Chacko
- Department of Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mahesh Moorthy
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna Samuel
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - Jayaraj Joseph
- Department of Electrical Engineering, Indian Institute of TechnologyMadras, Tamil Nadu, India; Healthcare Technology Innovation Centre (HTIC), Indian Institute of Technology Madras, Tamil Nadu, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering, Indian Institute of TechnologyMadras, Tamil Nadu, India; Healthcare Technology Innovation Centre (HTIC), Indian Institute of Technology Madras, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
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13
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Vogazianos P, Argyropoulos CD, Haralambous C, Mikellidou CV, Boustras G, Andreou M, Silvestros V, Theofanous F, Soteriou S, Gregoriou I, Apostolidou AJ, Demetriou A, Athanasiadou M, Stylianou C, Michael M, Herodotou H, Alexandrou D, Kalakouta O, Pana ZD. Impact assessment of COVID-19 non-pharmaceutical interventions in long term care facilities in Cyprus: Safety improvement strategy. SAFETY SCIENCE 2021; 143:105415. [PMID: 34305320 PMCID: PMC8285258 DOI: 10.1016/j.ssci.2021.105415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/12/2021] [Indexed: 05/11/2023]
Abstract
The current COVID-19 crisis has changed our everyday lives almost in every aspect. Many people worldwide have died or hospitalised due to the severe impact of COVID-19 on the vulnerable population, and in particular to the elderly residents of long term care facilities (LTCF). The problem is amplified due to the fact that many of those occupants also suffer from comorbidities (e.g. respiratory and cardiovascular diseases, hypertension, etc.) and are therefore regarded as a susceptible host to severe COVID-19 disease. Impacts can be felt in the wider societal safety level. The aim of the present study is, therefore, to present the first National multimodal quality and safety improvement strategy plan for the LTCF in the Republic of Cyprus. The current program focused on the intensification of COVID-19 epidemiological surveillance, the promotion of educational training on best practises in infection control and prevention, and the implementation of additional non-pharmaceutical interventions (NPIs), according to the recommendations of ECDC (European Centre for Disease Prevention and Control) and WHO (World Health Organization). This innovative program fostered the interconnectivity and collaboration among the local authorities, academia and the local leaders of the LTCF. In addition, this program reinforced the importance of volunteerism and active participation of medical students in the National initiatives against the COVID-19 pandemic. The effectiveness of the adopted multimodal advanced care-safety planning program is appraised based on the reported new confirmed COVID-19 cases among LTCF healthcare workers and occupants, after the introducing and implementation of the selected NPIs. This multimodal strategy plan seems to be capable of reducing significantly the number of new cases of COVID-19 infections in LTCF and as a result, to also affect the residents' death number.
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Affiliation(s)
- Paris Vogazianos
- Department of Behavioural and Social Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Christos D Argyropoulos
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Christos Haralambous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Cleo Varianou Mikellidou
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - George Boustras
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Michalis Andreou
- Unit for Health Inspections, Ministry of Health, Nicosia, Cyprus
| | - Valentinos Silvestros
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Fani Theofanous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Soteroulla Soteriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Ioanna Gregoriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | | | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | | | - Maria Michael
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | | | - Denise Alexandrou
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | - Olga Kalakouta
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | - Zoi Dorothea Pana
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Department of Medicine, European University Cyprus, Nicosia 2404, Cyprus
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14
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Frazer K, Mitchell L, Stokes D, Lacey E, Crowley E, Kelleher CC. A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19. BMJ Open 2021; 11:e047012. [PMID: 34663652 PMCID: PMC8523961 DOI: 10.1136/bmjopen-2020-047012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/29/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. SETTING Long-term care facilities. PARTICIPANTS Residents, staff and visitors of facilities. PRIMARY AND SECONDARY OUTCOME MEASURES Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. RESULTS The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents. CONCLUSIONS Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF. PROSPERO REGISTRATION NUMBER CRD42020191569.
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Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lachlan Mitchell
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Diarmuid Stokes
- Health Sciences Library, University College Dublin, Dublin, Ireland
| | - Ella Lacey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Eibhlin Crowley
- Office for Health Affairs, College of Health and Agricultural Science, University College Dublin, Dublin, Ireland
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
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15
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Fröberg M, Hassan SS, Pimenoff VN, Akterin S, Conneryd Lundgren K, Elfström KM, Dillner J. Risk for SARS-CoV-2 infection in healthcare workers outside hospitals: A real-life immuno-virological study during the first wave of the COVID-19 epidemic. PLoS One 2021; 16:e0257854. [PMID: 34582483 PMCID: PMC8478233 DOI: 10.1371/journal.pone.0257854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Most COVID-19 related infections and deaths may occur in healthcare outside hospitals. Here we explored SARS-CoV-2 infections among healthcare workers (HCWs) in this setting. DESIGN All healthcare providers in Stockholm, Sweden were asked to recruit HCWs at work for a study of past or present SARS-CoV-2 infections among HCWs. Study participants This study reports the results from 839 HCWs, mostly employees of primary care centers, sampled in June 2020. RESULTS SARS-CoV-2 seropositivity was found among 12% (100/839) of HCWs, ranging from 0% to 29% between care units. Seropositivity decreased by age and was highest among HCWs <40 years of age. Within this age group there was 19% (23/120) seropositivity among women and 11% (15/138) among men (p<0.02). Current infection, as measured using PCR, was found in only 1% and the typical testing pattern of pre-symptomatic potential "superspreaders" found in only 2/839 subjects. CONCLUSIONS Previous SARS-CoV-2 infections were common among younger HCWs in this setting. Pre-symptomatic infection was uncommon, in line with the strong variability in SARS-CoV-2 exposure between units. Prioritizing infection prevention and control including sufficient and adequate personal protective equipment, and vaccination for all HCWs are important to prevent nosocomial infections and infections as occupational injuries during an ongoing pandemic.
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Affiliation(s)
- Maria Fröberg
- Gustavsberg Primary Care Center, Region Stockholm, Gustavsberg, Sweden.,Akademiskt Primärvårdscentrum, Region Stockholm, Stockholm, Sweden
| | | | - Ville N Pimenoff
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | - K Miriam Elfström
- Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
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16
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Gallichotte EN, Nehring M, Young MC, Pugh S, Sexton NR, Fitzmeyer E, Quicke KM, Richardson M, Pabilonia KL, Ehrhart N, Fosdick BK, VandeWoude S, Ebel GD. Durable Antibody Responses in Staff at Two Long-Term Care Facilities, during and Post SARS-CoV-2 Outbreaks. Microbiol Spectr 2021; 9:e0022421. [PMID: 34287058 PMCID: PMC8552744 DOI: 10.1128/spectrum.00224-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 02/08/2023] Open
Abstract
SARS-CoV-2 has had a disproportionate impact on nonhospital health care settings, such as long-term-care facilities (LTCFs). The communal nature of these facilities, paired with the high-risk profile of residents, has resulted in thousands of infections and deaths and a high case fatality rate. To detect presymptomatic infections and identify infected workers, we performed weekly surveillance testing of staff at two LTCFs, which revealed a large outbreak at one of the sites. We collected serum from staff members throughout the study and evaluated it for binding and neutralization to measure seroprevalence, seroconversion, and type and functionality of antibodies. At the site with very few incident infections, we detected that over 40% of the staff had preexisting SARS-CoV-2 neutralizing antibodies, suggesting prior exposure. At the outbreak site, we saw rapid seroconversion following infection. Neutralizing antibody levels were stable for many weeks following infection, suggesting a durable, long-lived response. Receptor-binding domain antibodies and neutralizing antibodies were strongly correlated. The site with high seroprevalence among staff had two unique introductions of SARS-CoV-2 into the facility through seronegative infected staff during the period of study, but these did not result in workplace spread or outbreaks. Together, our results suggest that a high seroprevalence rate among staff can contribute to immunity within a workplace and protect against subsequent infection and spread within a facility. IMPORTANCE Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19 due to their communal nature and high-risk profile of residents. LTCF staff have the ability to introduce SARS-CoV-2 into the facility, where it can spread, causing outbreaks. We tested staff weekly at two LTCFs and collected blood throughout the study to measure SARS-CoV-2 antibodies. One site had a large outbreak and infected individuals rapidly generated antibodies after infection. At the other site, almost half the staff already had antibodies, suggesting prior infection. The majority of these antibodies bind to the receptor-binding domain of the SARS-CoV-2 spike protein and are potently neutralizing and stable for many months. The non-outbreak site had two unique introductions of SARS-CoV-2 into the facility, but these did not result in workplace spread or outbreaks. Our results reveal that high seroprevalence among staff can contribute to immunity and protect against subsequent infection and spread within a facility.
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Affiliation(s)
- Emily N. Gallichotte
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Mary Nehring
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Michael C. Young
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Sierra Pugh
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Nicole R. Sexton
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Emily Fitzmeyer
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kendra M. Quicke
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Megan Richardson
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kristy L. Pabilonia
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Nicole Ehrhart
- Columbine Health Systems Center for Healthy Aging and Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Bailey K. Fosdick
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Sue VandeWoude
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Gregory D. Ebel
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
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17
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Elfström KM, Blomqvist J, Nilsson P, Hober S, Pin E, Månberg A, Pimenoff VN, Arroyo Mühr LS, Lundgren KC, Dillner J. Differences in risk for SARS-CoV-2 infection among healthcare workers. Prev Med Rep 2021; 24:101518. [PMID: 34458081 PMCID: PMC8379088 DOI: 10.1016/j.pmedr.2021.101518] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022] Open
Abstract
Clustering of SARS-CoV-2 exposure among HCWs in specific hospital wards was found. SARS-CoV-2 infection was most common among nurse assistants in COVID-19 wards. HCWs in wards with infectious diseases experience did not have increased risk.
Healthcare workers (HCWs) are a risk group for SARS-CoV-2 infection, but which healthcare work that conveys risk and to what extent such risk can be prevented is not clear. Starting on April 24th, 2020, all employees at work (n = 15,300) at the Karolinska University Hospital, Stockholm, Sweden were invited and 92% consented to participate in a SARS-CoV-2 cohort study. Complete SARS-CoV-2 serology was available for n = 12,928 employees and seroprevalences were analyzed by age, sex, profession, patient contact, and hospital department. Relative risks were estimated to examine the association between type of hospital department as a proxy for different working environment exposure and risk for seropositivity, adjusting for age, sex, sampling week, and profession. Wards that were primarily responsible for COVID-19 patients were at increased risk (adjusted OR 1.95 (95% CI 1.65–2.32) with the notable exception of the infectious diseases and intensive care units (adjusted OR 0.86 (95% CI 0.66–1.13)), that were not at increased risk despite being highly exposed. Several units with similar types of work varied greatly in seroprevalences. Among the professions examined, nurse assistants had the highest risk (adjusted OR 1.62 (95% CI 1.38–1.90)). Although healthcare workers, in particular nurse assistants, who attend to COVID-19 patients are a risk group for SARS-CoV-2 infection, several units caring for COVID-19 patients had no excess risk. Large variations in seroprevalences among similar units suggest that healthcare work-related risk of SARS-CoV-2 infection may be preventable.
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Affiliation(s)
| | | | - Peter Nilsson
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Sophia Hober
- Division of Protein Technology, Department of Protein Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Elisa Pin
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Anna Månberg
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Ville N Pimenoff
- Karolinska Institute, Stockholm, Sweden.,University of Oulu, Oulu, Finland
| | | | | | - Joakim Dillner
- Karolinska University Hospital, Stockholm SE-141 86, Sweden.,Karolinska Institute, Stockholm, Sweden
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18
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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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19
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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20
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Francis ME, Richardson B, Goncin U, McNeil M, Rioux M, Foley MK, Ge A, Pechous RD, Kindrachuk J, Cameron CM, Richardson C, Lew J, Machtaler S, Cameron MJ, Gerdts V, Falzarano D, Kelvin AA. Sex and age bias viral burden and interferon responses during SARS-CoV-2 infection in ferrets. Sci Rep 2021; 11:14536. [PMID: 34267262 PMCID: PMC8282673 DOI: 10.1038/s41598-021-93855-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/17/2021] [Indexed: 12/18/2022] Open
Abstract
SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) hospitalizations and deaths disportionally affect males and older ages. Here we investigated the impact of male sex and age comparing sex-matched or age-matched ferrets infected with SARS-CoV-2. Differences in temperature regulation was identified for male ferrets which was accompanied by prolonged viral replication in the upper respiratory tract after infection. Gene expression analysis of the nasal turbinates indicated that 1-year-old female ferrets had significant increases in interferon response genes post infection which were delayed in males. These results provide insight into COVID-19 and suggests that older males may play a role in viral transmission due to decreased antiviral responses.
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Affiliation(s)
- Magen E Francis
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
| | - Brian Richardson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Una Goncin
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Mara McNeil
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Melissa Rioux
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Mary K Foley
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Anni Ge
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Roger D Pechous
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AK, 72205, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Laboratory of Emerging and Re-emerging Viruses, Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, R3E 0J9, Canada
| | - Cheryl M Cameron
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Christopher Richardson
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Jocelyne Lew
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
| | - Steven Machtaler
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Mark J Cameron
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - Darryl Falzarano
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - Alyson A Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada.
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, NS, B3K 6R8, Canada.
- Canadian Centre for Vaccinology, IWK Health Centre, 5980 University Ave, 4th Floor, R4020, Halifax, NS, B3K 6R8, Canada.
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21
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Foley MK, Searle SD, Toloue A, Booth R, Falkenham A, Falzarano D, Rubino S, Francis ME, McNeil M, Richardson C, LeBlanc J, Oldford S, Gerdts V, Andrew MK, McNeil SA, Clarke B, Rockwood K, Kelvin DJ, Kelvin AA. Centenarians and extremely old people living with frailty can elicit durable SARS-CoV-2 spike specific IgG antibodies with virus neutralization functions following virus infection as determined by serological study. EClinicalMedicine 2021; 37:100975. [PMID: 34222846 PMCID: PMC8235995 DOI: 10.1016/j.eclinm.2021.100975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 165 million COVID-19 cases and >3.4 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities being affected by SARS-CoV-2 and COVID-19, very little is understood about the immune responses and development of humoral immunity in the extremely old person after SARS-CoV-2 infection. Here we conducted a serological study to investigate the development of humoral immunity in centenarians following a SARS-CoV-2 outbreak in a long-term care facility. METHODS Extreme aged individuals and centenarians who were residents in a long-term care facility and infected with or exposed to SARS-CoV-2 were investigated between April and June 2020 for the development of antibodies to SARS-CoV-2. Blood samples were collected from positive and bystander individuals 30 and 60 days after original diagnosis of SARS-CoV-2 infection. Plasma was used to quantify IgG, IgA, and IgM isotypes and subsequent subclasses of antibodies specific for SARS-CoV-2 spike protein. The function of anti-spike was then assessed by virus neutralization assays against the native SARS-CoV-2 virus. FINDINGS Fifteen long-term care residents were investigated for SARS-CoV-2 infection. All individuals had a Clinical Frailty scale score ≥5 and were of extreme older age or were centenarians. Six women with a median age of 98.8 years tested positive for SARS-CoV-2. Anti-spike IgG antibody titers were the highest titers observed in our cohort with all IgG positive individuals having virus neutralization ability. Additionally, 5 out of the 6 positive participants had a robust IgA anti-SARS-CoV-2 response. In all 5, antibodies were detected after 60 days from initial diagnosis.
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Affiliation(s)
- Mary K. Foley
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Samuel D. Searle
- Divsion of Geriatrics, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- MRC Unit for Lifelong Health and Ageing, University College London, London, Gower Street, WC1E 6BT, England United Kingdom
| | - Ali Toloue
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Ryan Booth
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Alec Falkenham
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Darryl Falzarano
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Salvatore Rubino
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, Sassari, Italy
| | - Magen E. Francis
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
| | - Mara McNeil
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Christopher Richardson
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jason LeBlanc
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- Department of Medicine, Faculty of Medicine, Dalhousie University, University, Halifax, Nova Scotia, B3H 4R2, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Nova Scotia, Halifax, B3K 6R8 Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Faculty of Medicine, Dalhousie University, Nova Scotia, Halifax, B3H 4R2, Canada
| | - Sharon Oldford
- Canadian Centre for Vaccinology, IWK Health Centre, Nova Scotia, Halifax, B3K 6R8 Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Faculty of Medicine, Dalhousie University, Nova Scotia, Halifax, B3H 4R2, Canada
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Melissa K. Andrew
- Divsion of Geriatrics, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Shelly A. McNeil
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Nova Scotia, Halifax, B3H 4R2, Canada
| | - Kenneth Rockwood
- Divsion of Geriatrics, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - David J. Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Nova Scotia, Halifax, B3K 6R8 Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd, Jinping, Shantou, China
| | - Alyson A. Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, SK, S7N 5E3, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Nova Scotia, Halifax, B3K 6R8 Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada
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22
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Carnahan JL, Lieb KM, Albert L, Wagle K, Kaehr E, Unroe KT. COVID-19 disease trajectories among nursing home residents. J Am Geriatr Soc 2021; 69:2412-2418. [PMID: 34058012 PMCID: PMC8242389 DOI: 10.1111/jgs.17308] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 12/22/2022]
Abstract
Introduction Older adults are at greater risk of both infection with and mortality from COVID‐19. Many U.S. nursing homes have been devastated by the COVID‐19 pandemic, yet little has been described regarding the typical disease course in this population. The objective of this study is to describe and identify patterns in the disease course of nursing home residents infected with COVID‐19. Setting and Methods This is a case series of 74 residents with COVID‐19 infection in a nursing home in central Indiana between March 28 and June 17, 2020. Data were extracted from the electronic medical record and from nursing home medical director tracking notes from the time of the index infection through August 31, 2020. The clinical authorship team reviewed the data to identify patterns in the disease course of the residents. Results The most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. The duration of symptoms was extended, with an average of over 3 weeks. Of those infected 25 died; 23 of the deaths were considered related to COVID‐19 infection. A subset of residents with COVID‐19 infection experienced a rapidly progressive, fatal course. Discussion/Conclusions Nursing home residents infected with COVID‐19 from the facility we studied experienced a prolonged disease course regardless of the severity of their symptoms, with implications for the resources needed to care for and support of these residents during active infection and post‐disease. Future studies should combine data from nursing home residents across the country to identify the risk factors for disease trajectories identified in this case series.
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Affiliation(s)
- Jennifer L Carnahan
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA.,Regenstrief Institute, IU Center for Aging Research, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Kristi M Lieb
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Lauren Albert
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA
| | - Kamal Wagle
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Community Medicine, Indiana University Health Physicians, Indianapolis, Indiana, USA
| | - Ellen Kaehr
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Kathleen T Unroe
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA.,Regenstrief Institute, IU Center for Aging Research, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
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23
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Malenfant JH, Eslami M, Dao BL, Moore L, Green N, Silver D, OYong K, Ruparelia A, Fisher R, Wood JS, Faisal M, Washburn F, Shvartsblat S, Jewell MP, Romo T, Foo C, Salazar A, Rajagopalan S, Rubin ZA, Gounder P. Seroprevalence of SARS-CoV-2 Among Skilled Nursing Facility Residents and Staff Members - Los Angeles County, August-September 2020. J Infect Dis 2021; 225:367-373. [PMID: 34031692 PMCID: PMC8243593 DOI: 10.1093/infdis/jiab281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence of current/past coronavirus disease 2019 (COVID-19) in skilled
nursing facility (SNF) residents is unknown because of asymptomatic
infection and constrained testing capacity early in the pandemic. We
conducted a seroprevalence survey (SPS) to determine a more comprehensive
prevalence of past COVID-19 in Los Angeles County SNF residents and staff
members. Methods We recruited participants from 24 facilities; participants were requested to
submit a nasopharyngeal (NP) swab for severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) PCR testing and serum for detection of SARS-CoV-2
antibodies. All participants were cross-referenced with our surveillance
database to identify persons with prior positive SARS-CoV-2 results. Results From August 18 to September 24, 2020, we enrolled 3,305 participants (1,340
residents and 1,965 staff members). Among 856 residents providing serum, 362
(42%) had current/past SARS-CoV-2 infection. Of the 346 serology positive
residents, 199 (58%) did not have a documented prior positive SARS-CoV-2 PCR
result. Among 1,806 staff members providing serum, 454 (25%) had
current/past SARS-CoV-2 infection. Of the 447 serology positive staff
members, 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR
result. Conclusions Past testing practices and policies missed a substantial number of SARS-CoV-2
infections in SNF residents and staff members.
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Affiliation(s)
- Jason H Malenfant
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | | | - Bonnie L Dao
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Leo Moore
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Nicole Green
- Public Health Laboratory, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - David Silver
- Rockport Healthcare Services, Los Angeles, CA, USA
| | - Kelsey OYong
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ashutosh Ruparelia
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Rebecca Fisher
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Julia S Wood
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Mohammad Faisal
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Faith Washburn
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Steve Shvartsblat
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Mirna P Jewell
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Tiffany Romo
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Chelsea Foo
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Angela Salazar
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Shobita Rajagopalan
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Zachary A Rubin
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Prabhu Gounder
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
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24
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Viral dynamics and antibody responses in people with asymptomatic SARS-CoV-2 infection. Signal Transduct Target Ther 2021; 6:181. [PMID: 33972497 PMCID: PMC8107204 DOI: 10.1038/s41392-021-00596-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/11/2021] [Accepted: 03/21/2021] [Indexed: 12/24/2022] Open
Abstract
Over 40% of the coronavirus disease 2019 (COVID-19) COVID-19 patients were asymptomatically infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the immune responses of these asymptomatic individuals is a critical factor for developing the strategy to contain the COVID-19 pandemic. Here, we determined the viral dynamics and antibody responses among 143 asymptomatic individuals identified in a massive screening of more than 5 million people in eight districts of Wuhan in May 2020. Asymptomatic individuals were admitted to the government-designated centralized sites in accordance with policy. The incidence rate of asymptomatic infection is ~2.92/100,000. These individuals had low viral copy numbers (peaked at 315 copies/mL) and short-lived antibody responses with the estimated diminish time of 69 days. The antibody responses in individuals with persistent SARS-CoV-2 infection is much longer with the estimated diminish time of 257 days. These results imply that the immune responses in the asymptomatic individuals are not potent enough for preventing SARS-CoV-2 re-infection, which has recently been reported in recovered COVID-19 patients. This casts doubt on the efficacy of forming “herd-immunity” through natural SARS-CoV-2 infection and urges for the development of safe and effective vaccines.
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25
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Tang S, Sanchez Perez M, Saavedra-Campos M, Paranthaman K, Myers R, Fok J, Crawley-Boevey E, Dun-Campbell K, Janarthanan R, Fernandez E, Vusirikala A, Patel B, Ma T, Amin-Chowdhury Z, Shetty N, Zambon M, Bell A, Wynne-Evans E, Chow Y, Ladhani S. Mass testing after a single suspected or confirmed case of COVID-19 in London care homes, April-May 2020: implications for policy and practice. Age Ageing 2021; 50:649-656. [PMID: 33620453 PMCID: PMC7929429 DOI: 10.1093/ageing/afab054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Previous investigations have identified high rates of SARS-CoV-2 infection among residents and staff in care homes reporting an outbreak of COVID-19. We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London. Methods: Between 18–27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by RT-PCR and subsequent whole genome sequencing. Residents and staff in two care homes were re-tested eight days later. Results: Four care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3–59%. Among residents, positivity ranged between 3–76% compared to 3–40% in staff. Half of the SARS-CoV-2 positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introductions of the virus into care homes, and distinct clusters within three of the care homes. Conclusions: We found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. While routine whole home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures.
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Affiliation(s)
- Suzanne Tang
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Marina Sanchez Perez
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | | | - Karthik Paranthaman
- Field Service, National Infection Service, Public Health England, London, UK
| | - Richard Myers
- Bioinformatics Unit, Public Health England, London, UK
| | - Jonathan Fok
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Emma Crawley-Boevey
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Kate Dun-Campbell
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Roshni Janarthanan
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Elena Fernandez
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Amoolya Vusirikala
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Bharat Patel
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Thomas Ma
- Field Service, National Infection Service, Public Health England, London, UK
| | | | - Nandini Shetty
- Virus Reference Department, Public Health England, London, UK
| | - Maria Zambon
- Virus Reference Department, Public Health England, London, UK
| | - Anita Bell
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Edward Wynne-Evans
- London Health Protection Team, National Infection Service, Public Health England, London, UK
- Joint Biosecurity Centre, London, UK
| | - Yimmy Chow
- London Health Protection Team, National Infection Service, Public Health England, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK
- Paediatric Infectious Diseases Research Group, St. George’s University of London, London, UK
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Abstract
BACKGROUND Asymptomatic infection seems to be a notable feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), but the prevalence is uncertain. PURPOSE To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms. DATA SOURCES Searches of Google News, Google Scholar, medRxiv, and PubMed using the keywords antibodies, asymptomatic, coronavirus, COVID-19, PCR, seroprevalence, and SARS-CoV-2. STUDY SELECTION Observational, descriptive studies and reports of mass screening for SARS-CoV-2 that were either cross-sectional or longitudinal in design; were published through 17 November 2020; and involved SARS-CoV-2 nucleic acid or antibody testing of a target population, regardless of current symptomatic status, over a defined period. DATA EXTRACTION The authors collaboratively extracted data on the study design, type of testing performed, number of participants, criteria for determining symptomatic status, testing results, and setting. DATA SYNTHESIS Sixty-one eligible studies and reports were identified, of which 43 used polymerase chain reaction (PCR) testing of nasopharyngeal swabs to detect current SARS-CoV-2 infection and 18 used antibody testing to detect current or prior infection. In the 14 studies with longitudinal data that reported information on the evolution of symptomatic status, nearly three quarters of persons who tested positive but had no symptoms at the time of testing remained asymptomatic. The highest-quality evidence comes from nationwide, representative serosurveys of England (n = 365 104) and Spain (n = 61 075), which suggest that at least one third of SARS-CoV-2 infections are asymptomatic. LIMITATION For PCR-based studies, data are limited to distinguish presymptomatic from asymptomatic infection. Heterogeneity precluded formal quantitative syntheses. CONCLUSION Available data suggest that at least one third of SARS-CoV-2 infections are asymptomatic. Longitudinal studies suggest that nearly three quarters of persons who receive a positive PCR test result but have no symptoms at the time of testing will remain asymptomatic. Control strategies for COVID-19 should be altered, taking into account the prevalence and transmission risk of asymptomatic SARS-CoV-2 infection. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Daniel P Oran
- Scripps Research Translational Institute, La Jolla, California (D.P.O., E.J.T.)
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, California (D.P.O., E.J.T.)
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Roederer T, Mollo B, Vincent C, Nikolay B, Llosa AE, Nesbitt R, Vanhomwegen J, Rose T, Goyard S, Anna F, Torre C, Fourrey E, Simons E, Hennequin W, Mills C, Luquero FJ. Seroprevalence and risk factors of exposure to COVID-19 in homeless people in Paris, France: a cross-sectional study. Lancet Public Health 2021; 6:e202-e209. [PMID: 33556328 PMCID: PMC7993986 DOI: 10.1016/s2468-2667(21)00001-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the COVID-19 lockdown period from March 17 to May 11, 2020, French authorities in Paris and its suburbs relocated people experiencing recurrent homelessness to emergency shelters, hotels, and large venues. A serological survey was done at some of these locations to assess the COVID-19 exposure prevalence in this group. METHODS We did a cross-sectional seroprevalence study at food distribution sites, emergency shelters, and workers' residences that were provided medical services by Médecins Sans Frontières in Paris and Seine-Saint-Denis in the Ile-de-France region. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seropositivity was detected by Luciferase-Linked Immunosorbent Assay and Pseudo Neutralization Test. Sociodemographic and exposure related information was collected via a verbal questionnaire to analyse risk factors and associations with various COVID-19 symptoms. FINDINGS Between June 23 and July 2, 2020, 426 (52%) of 818 individuals recruited tested positive in 14 sites. Seroprevalence varied significantly by type of recruitment site (χ2 p<0·0001), being highest among those living in workers' residences (88·7%, 95% CI 81·8-93·2), followed by emergency shelters (50·5%, 46·3-54·7), and food distribution sites (27·8%, 20·8-35·7). More than two thirds of COVID-19 seropositive individuals (68%, 95% CI 64·2-72·2; 291 of 426) did not report any symptoms during the recall period. COVID-19 seropositivity was strongly associated with overcrowding (medium density: adjusted odds ratio [aOR] 2·7, 95% CI 1·5-5·1, p=0·0020; high density: aOR 3·4, 1·7-6·9, p<0·0001). INTERPRETATION These results show high exposure to SARS-CoV-2 with important variations between those at different study sites. Living in crowded conditions was the strongest factor associated with exposure level. This study underscores the importance of providing safe, uncrowded accommodation, alongside adequate testing and public health information. FUNDING Médecins Sans Frontières, Epicentre, Institut Pasteur's URGENCE nouveau coronavirus fund, Total Foundation.
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Affiliation(s)
| | | | | | | | | | | | - Jessica Vanhomwegen
- Environment and Infectious Risks Research and Expertise Unit, Global Health Department, Institut Pasteur, Paris, France
| | - Thierry Rose
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France
| | - Sophie Goyard
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France
| | - François Anna
- Unit of Molecular Virology and Vaccinology, Virology Department, Institut Pasteur, Paris, France; Theravectys, Paris, France
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Amit S, Beni SA, Biber A, Grinberg A, Leshem E, Regev-Yochay G. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerg Infect Dis 2021; 27:1220-1222. [PMID: 33522478 PMCID: PMC8007324 DOI: 10.3201/eid2704.210016] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease (COVID-19) symptoms can be mistaken for vaccine-related side effects during initial days after immunization. Among 4,081 vaccinated healthcare workers in Israel, 22 (0.54%) developed COVID-19 from 1-10 days (median 3.5 days) after immunization. Clinicians should not dismiss postvaccination symptoms as vaccine-related and should promptly test for COVID-19.
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29
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Alene M, Yismaw L, Assemie MA, Ketema DB, Mengist B, Kassie B, Birhan TY. Magnitude of asymptomatic COVID-19 cases throughout the course of infection: A systematic review and meta-analysis. PLoS One 2021; 16:e0249090. [PMID: 33755688 PMCID: PMC7987199 DOI: 10.1371/journal.pone.0249090] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asymptomatic SARS-CoV-2 infections are responsible for potentially significant transmission of COVID-19. Worldwide, a number of studies were conducted to estimate the magnitude of asymptomatic COVID-19 cases. However, there is a need for more robust and well-designed studies to have a relevant public health intervention. Synthesis of the available studies significantly strengthens the quality of evidences for public health practice. Thus, this systematic review and meta-analysis aimed to determine the overall magnitude of asymptomatic COVID-19 cases throughout the course of infection using available evidences. METHODS We followed the PRISMA checklist to present this study. Two experienced review authors (MA and DBK) were systematically searched international electronic databases for studies. We performed meta-analysis using R statistical software. The overall weighted proportion of asymptomatic COVID-19 cases throughout the course infection was computed. The pooled estimates with 95% confidence intervals were presented using forest plot. Egger's tests were used to assess publication bias, and primary estimates were pooled using a random effects model. Furthermore, a sensitivity analysis was conducted to assure the robustness of the result. RESULTS A total of 28 studies that satisfied the eligibility criteria were included in this systematic review and meta-analysis. Consequently, in the meta-analysis, a total of 6,071 COVID-19 cases were included. The proportion of asymptomatic infections among the included studies ranged from 1.4% to 78.3%. The findings of this meta-analysis showed that the weighted pooled proportion of asymptomatic COVID-19 cases throughout the course of infection was 25% (95%CI: 16-38). The leave-one out result also revealed that the weighted pooled average of asymptomatic SARS-CoV-2 infection was between 28% and 31.4%. CONCLUSIONS In conclusion, one-fourth of SARS-CoV-2 infections are remained asymptomatic throughout the course infection. Scale-up of testing, which targeting high risk populations is recommended to tackle the pandemic.
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Affiliation(s)
- Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Leltework Yismaw
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | | - Belayneh Mengist
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kassie
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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30
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Subramanian R, He Q, Pascual M. Quantifying asymptomatic infection and transmission of COVID-19 in New York City using observed cases, serology, and testing capacity. Proc Natl Acad Sci U S A 2021; 118:e2019716118. [PMID: 33571106 PMCID: PMC7936345 DOI: 10.1073/pnas.2019716118] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The contributions of asymptomatic infections to herd immunity and community transmission are key to the resurgence and control of COVID-19, but are difficult to estimate using current models that ignore changes in testing capacity. Using a model that incorporates daily testing information fit to the case and serology data from New York City, we show that the proportion of symptomatic cases is low, ranging from 13 to 18%, and that the reproductive number may be larger than often assumed. Asymptomatic infections contribute substantially to herd immunity, and to community transmission together with presymptomatic ones. If asymptomatic infections transmit at similar rates as symptomatic ones, the overall reproductive number across all classes is larger than often assumed, with estimates ranging from 3.2 to 4.4. If they transmit poorly, then symptomatic cases have a larger reproductive number ranging from 3.9 to 8.1. Even in this regime, presymptomatic and asymptomatic cases together comprise at least 50% of the force of infection at the outbreak peak. We find no regimes in which all infection subpopulations have reproductive numbers lower than three. These findings elucidate the uncertainty that current case and serology data cannot resolve, despite consideration of different model structures. They also emphasize how temporal data on testing can reduce and better define this uncertainty, as we move forward through longer surveillance and second epidemic waves. Complementary information is required to determine the transmissibility of asymptomatic cases, which we discuss. Regardless, current assumptions about the basic reproductive number of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) should be reconsidered.
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Affiliation(s)
- Rahul Subramanian
- Department of Ecology and Evolution, Biological Sciences Division, University of Chicago, Chicago, IL 60637
| | - Qixin He
- Department of Ecology and Evolution, Biological Sciences Division, University of Chicago, Chicago, IL 60637
| | - Mercedes Pascual
- Department of Ecology and Evolution, Biological Sciences Division, University of Chicago, Chicago, IL 60637;
- Santa Fe Institute, Santa Fe, NM 87501
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31
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Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, Graham J, Booy R, Khandaker G. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100771. [PMID: 33681730 PMCID: PMC7917447 DOI: 10.1016/j.eclinm.2021.100771] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. METHODS We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. FINDINGS We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. INTERPRETATION The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. FUNDING Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.
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Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hannah Ockenden-Muldoon
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Julieanne Graham
- Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Cavanaugh AM, Thoroughman D, Miranda H, Spicer K. Suspected Recurrent SARS-CoV-2 Infections Among Residents of a Skilled Nursing Facility During a Second COVID-19 Outbreak - Kentucky, July-November 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:273-277. [PMID: 33630817 PMCID: PMC8344982 DOI: 10.15585/mmwr.mm7008a3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Reinfection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is believed to be rare (1). Some level of immunity after SARS-CoV-2 infection is expected; however, the evidence regarding duration and level of protection is still emerging (2). The Kentucky Department for Public Health (KDPH) and a local health department conducted an investigation at a skilled nursing facility (SNF) that experienced a second COVID-19 outbreak in October 2020, 3 months after a first outbreak in July. Five residents received positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results during both outbreaks. During the first outbreak, three of the five patients were asymptomatic and two had mild symptoms that resolved before the second outbreak. Disease severity in the five residents during the second outbreak was worse than that during the first outbreak and included one death. Because test samples were not retained, phylogenetic strain comparison was not possible. However, interim period symptom resolution in the two symptomatic patients, at least four consecutive negative RT-PCR tests for all five patients before receiving a positive test result during the second outbreak, and the 3-month interval between the first and the second outbreaks, suggest the possibility that reinfection occurred. Maintaining physical distance, wearing face coverings or masks, and frequent hand hygiene are critical mitigation strategies necessary to prevent transmission of SARS-CoV-2 to SNF residents, a particularly vulnerable population at risk for poor COVID-19-associated outcomes.* Testing, containment strategies (isolation and quarantine), and vaccination of residents and health care personnel (HCP) are also essential components to protecting vulnerable residents. The findings of this study highlight the importance of maintaining public health mitigation and protection strategies that reduce transmission risk, even among persons with a history of COVID-19 infection.
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Belmin J, Lafuente-Lafuente C. The challenge of asymptomatic SARS-CoV-2 transmission in care homes. LANCET REGIONAL HEALTH-EUROPE 2021; 3:100051. [PMID: 33870250 PMCID: PMC7906504 DOI: 10.1016/j.lanepe.2021.100051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Joël Belmin
- Service de Gériatrie, Hôpital Charles Foix, 7 avenue de la République, 94200 Ivry-sur-Seine, France.,Faculté de Médecine, Sorbonne Université, Paris, France
| | - Carmelo Lafuente-Lafuente
- Service de Gériatrie, Hôpital Charles Foix, 7 avenue de la République, 94200 Ivry-sur-Seine, France.,Faculté de Médecine, Sorbonne Université, Paris, France
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Tan X, Letendre JH, Collins JJ, Wong WW. Synthetic biology in the clinic: engineering vaccines, diagnostics, and therapeutics. Cell 2021; 184:881-898. [PMID: 33571426 PMCID: PMC7897318 DOI: 10.1016/j.cell.2021.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
Synthetic biology is a design-driven discipline centered on engineering novel biological functions through the discovery, characterization, and repurposing of molecular parts. Several synthetic biological solutions to critical biomedical problems are on the verge of widespread adoption and demonstrate the burgeoning maturation of the field. Here, we highlight applications of synthetic biology in vaccine development, molecular diagnostics, and cell-based therapeutics, emphasizing technologies approved for clinical use or in active clinical trials. We conclude by drawing attention to recent innovations in synthetic biology that are likely to have a significant impact on future applications in biomedicine.
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Affiliation(s)
- Xiao Tan
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Institute for Medical Engineering and Science, MIT, Cambridge, MA 02139, USA
| | - Justin H Letendre
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Biological Design Center, Boston University, Boston, MA 02215, USA
| | - James J Collins
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Institute for Medical Engineering and Science, MIT, Cambridge, MA 02139, USA; Department of Biological Engineering, MIT, Cambridge, MA 02139, USA; Synthetic Biology Center, MIT, 77 Massachusetts Ave., Cambridge, MA 02139, USA; Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA.
| | - Wilson W Wong
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Biological Design Center, Boston University, Boston, MA 02215, USA.
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Francis ME, Richardson B, McNeil M, Rioux M, Foley MK, Ge A, Pechous RD, Kindrachuk J, Cameron CM, Richardson C, Lew J, Cameron MJ, Gerdts V, Falzarano D, Kelvin AA. Male sex and age biases viral burden, viral shedding, and type 1 and 2 interferon responses during SARS-CoV-2 infection in ferrets. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.01.12.426381. [PMID: 33469587 PMCID: PMC7814824 DOI: 10.1101/2021.01.12.426381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) hospitalizations and deaths disportionally affect males and the elderly. Here we investigated the impact of male sex and age by infecting adult male, aged male, and adult female ferrets with SARS-CoV-2. Aged male ferrets had a decrease in temperature which was accompanied by prolonged viral replication with increased pathology in the upper respiratory tract after infection. Transcriptome analysis of the nasal turbinates and lungs indicated that female ferrets had significant increases in interferon response genes (OASL, MX1, ISG15, etc.) on day 2 post infection which was delayed in aged males. In addition, genes associated with taste and smell such as RTP1, CHGA, and CHGA1 at later time points were upregulated in males but not in females. These results provide insight into COVID-19 and suggests that older males may play a role in viral transmission due to decreased antiviral responses.
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Affiliation(s)
- Magen E. Francis
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
| | - Brian Richardson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA44106
| | - Mara McNeil
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Melissa Rioux
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Mary K. Foley
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Anni Ge
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Roger D. Pechous
- University of Arkansas for Medical Sciences, Department of Microbiology and Immunology, Little Rock, AK, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Laboratory of Emerging and Re-Emerging Viruses, Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Cheryl M. Cameron
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher Richardson
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jocelyne Lew
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark J. Cameron
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA44106
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Darryl Falzarano
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alyson A. Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Vaccine and Infectious Disease Organization - International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, NS B3K 6R8, Canada
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Kronfli N, Akiyama MJ. Prioritizing incarcerated populations for COVID-19 vaccination and vaccine trials. EClinicalMedicine 2021; 31:100659. [PMID: 33385124 PMCID: PMC7772529 DOI: 10.1016/j.eclinm.2020.100659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montreal, Quebec H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Corresponding author at: Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montreal, Quebec H4A 3J1, Canada.
| | - Matthew J. Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Disease, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April-June 2020. Pathogens 2020; 10:pathogens10010008. [PMID: 33374131 PMCID: PMC7824344 DOI: 10.3390/pathogens10010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
Long-term care facilities (LTCFs) have had a disproportionally high mortality rate due to COVID-19. We describe a rapidly escalating COVID-19 outbreak among 116 LTCF residents in Rhode Island, USA. Overall, 111 (95.6%) residents tested positive and, of these, 48 (43.2%) died. The most common comorbidities were hypertension (84.7%) and cardiovascular disease (84.7%). A small percentage (9%) of residents were asymptomatic, while 33.3% of residents were pre-symptomatic, with progression to symptoms within a median of three days following the positive test. While typical symptoms of fever (80.2%) and cough (43.2%) were prevalent, shortness of breath (14.4%) was rarely found despite common hypoxemia (95.5%). The majority of patients demonstrated atypical symptoms with the most common being loss of appetite (61.3%), lethargy (42.3%), diarrhea (37.8%), and fatigue (32.4%). Many residents had increased agitation (38.7%) and anxiety (5.4%), potentially due to the restriction measures or the underlying mental illness. The fever curve was characterized by an intermittent low-grade fever, often the first presenting symptom. Mortality was associated with a disease course beginning with a loss of appetite and lethargy, as well as one more often involving fever greater than 38 °C, loss of appetite, altered mental status, diarrhea, and respiratory distress. Interestingly, no differences in age or comorbidities were noted between survivors and non-survivors. Taking demographic factors into account, treatment with anticoagulation was still associated with reduced mortality (adjusted OR 0.16; 95% C.I. 0.06–0.39; p < 0.001). Overall, the clinical features of the disease in this population can be subtle and the symptoms are commonly atypical. However, clinical decline among those who did not survive was often rapid with patients expiring within 10 days from disease detection. Further studies are needed to better explain the variability in clinical course of COVID-19 among LTCF residents, specifically the factors affecting mortality, the differences observed in symptom presentation, and rate of clinical decline.
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Towards an accurate and systematic characterisation of persistently asymptomatic infection with SARS-CoV-2. THE LANCET. INFECTIOUS DISEASES 2020; 21:e163-e169. [PMID: 33301725 PMCID: PMC7834404 DOI: 10.1016/s1473-3099(20)30837-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023]
Abstract
People with persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience no symptoms throughout the course of infection, and pre-symptomatic individuals become infectious days before they report symptoms. Transmission of SARS-CoV-2 from individuals without symptoms contributes to pandemic spread, but the extent of transmission from persistently asymptomatic individuals remains unknown. We describe three methodological issues that hinder attempts to estimate this proportion. First, incomplete symptom assessment probably overestimates the asymptomatic fraction. Second, studies with inadequate follow-up misclassify pre-symptomatic individuals. Third, serological studies might identify people with previously unrecognised infection, but reliance on poorly defined antibody responses and retrospective symptom assessment might result in misclassification. We provide recommendations regarding definitions, detection, documentation, and follow-up to improve the identification and evaluation of people with persistently asymptomatic SARS-CoV-2 infection and their contacts. Accurate characterisation of the persistently asymptomatic fraction of infected individuals might shed light on COVID-19 pathogenesis and transmission dynamics, and inform public health responses.
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Coronavirus disease 2019 (COVID-19) in long-term care facilities: A review of epidemiology, clinical presentations, and containment interventions. Infect Control Hosp Epidemiol 2020; 43:504-509. [PMID: 33100245 PMCID: PMC7684019 DOI: 10.1017/ice.2020.1292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Long-term care facilities (LTCFs) and their populations have been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. In this review, we summarize the literature to describe the current epidemiology of COVID-19 in LTCFs, clinical presentations and outcomes in the LTCF population with COVID-19, containment interventions, and the role of healthcare workers in SARS-CoV-2 transmission in these facilities.
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40
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 PMCID: PMC7544065 DOI: 10.1371/journal.pone.0240205] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 DOI: 10.1101/2020.05.21.20108746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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Parikh S, O’Laughlin K, Ehrlich HY, Campbell L, Harizaj A, Durante A, Leung V. Point Prevalence Testing of Residents for SARS-CoV-2 in a Subset of Connecticut Nursing Homes. JAMA 2020; 324:1101-1103. [PMID: 32790860 PMCID: PMC7418038 DOI: 10.1001/jama.2020.14984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study describes the point prevalence of polymerase chain reaction tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents of a sample of Connecticut nursing homes in the first half of May 2020.
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Affiliation(s)
- Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Kevin O’Laughlin
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hanna Y. Ehrlich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Lauren Campbell
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Vivian Leung
- Connecticut Department of Public Health, Hartford
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43
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Zhang S, Guo M, Wu F, Xiong N, Ma Y, Wang Z, Duan L, Chen L, Ouyang H, Jin Y. Factors associated with asymptomatic infection in health-care workers with severe acute respiratory syndrome coronavirus 2 infection in Wuhan, China: a multicentre retrospective cohort study. Clin Microbiol Infect 2020; 26:1670-1675. [PMID: 32911080 PMCID: PMC7476563 DOI: 10.1016/j.cmi.2020.08.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the fraction of asymptomatic health-care workers (HCWs) in two designated hospitals for coronavirus disease 2019 (COVID-19) treatment in Wuhan and explore the factors associated with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS All HCWs in Wuhan Union Hospital and Wuhan Red Cross Hospital with either positive SARS-CoV-2 nucleic acid or positive antibody test before 18 April 2020 were included. Exposure, epidemiological and demographic information were retrospectively collected by a structured questionnaire. Medical records were also reviewed for clinical characteristics and CT images of HCWs. RESULTS As of 18 April 2020, a total of 424 HCWs were identified. Among them, 276 (65.1%) were symptomatic and 148 (34.9%) were asymptomatic. Fifty-five (19.9%) families of the symptomatic HCWs and 16 (10.8%) families of the asymptomatic HCWs were infected with SARS-CoV-2. HCWs with infected family members tended to be symptomatic (OR 2.053, 95% CI 1.130-3.730; p 0.018). Multivariable logistic regression analysis exhibited that performing tracheal intubation or extubation (OR 4.057, 95% CI 1.183-13.909; p 0.026) was associated with an increased likelihood of symptomatic SARS-CoV-2 infection, whereas consistent use of N95 respirators (OR 0.369, 95% CI 0.201-0.680; p 0.001) and eye protection (OR 0.217, 95% CI 0.116-0.404; p < 0.001) were associated with an increased likelihood of asymptomatic SARS-CoV-2 infection. CONCLUSIONS Asymptomatic SARS-CoV-2 infection in HCWs comprised a considerable proportion of HCW infections during the pandemic of COVID-19. Those who performed tracheal intubation or extubation were most likely to develop related symptoms, whereas those taking aggressive measures, including consistent use of N95 masks and eye protection, tended to be asymptomatic cases.
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Affiliation(s)
- Shuai Zhang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengfei Guo
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Wu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yanling Ma
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhihui Wang
- Department of Scientific Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Limin Duan
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Chen
- Hospital Infection-Control Department, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Haixia Ouyang
- Department of Human Resources, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Tan F, Wang K, Liu J, Liu D, Luo J, Zhou R. Viral Transmission and Clinical Features in Asymptomatic Carriers of SARS-CoV-2 in Wuhan, China. Front Med (Lausanne) 2020; 7:547. [PMID: 33015099 PMCID: PMC7461982 DOI: 10.3389/fmed.2020.00547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/31/2020] [Indexed: 02/05/2023] Open
Abstract
We report the clinical characteristics, viral shedding duration, and contact tracing for asymptomatic carriers of SARS-CoV-2 in Wuhan, China. The asymptomatic carriers were relatively young (median age: 34.5 years). Chest computed tomography showed no abnormalities. The nasopharyngeal swab was an optimum specimen for RNA testing. The median viral shedding duration was 11.5 days. Notably, 2 months of viral shedding duration were reported in two nurses, which was much longer than previously reported or than usually thought. The transmissibility of SARS-CoV-2 by asymptomatic carriers during the studied period in Wuhan appeared to be weak. Only one patient (1/12) was found to have transmitted the virus to another person. Early asymptomatic carrier detection, isolation, and contact tracing could be useful to mitigate the spread of the disease.
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Affiliation(s)
- Fen Tan
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Respiratory Disease Research Institute of Hunan Province, Central South University, Changsha, China
| | - Kaige Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiasheng Liu
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianfei Luo
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Respiratory Disease Research Institute of Hunan Province, Central South University, Changsha, China
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45
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Birgand G, Blanckaert K, Deschanvres C, Vaudron A, Loury P, King L. Testing strategies for the control of COVID-19 in nursing homes: Universal or targeted screening? J Infect 2020; 82:159-198. [PMID: 32768449 PMCID: PMC7405856 DOI: 10.1016/j.jinf.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Gabriel Birgand
- Regional center for infection control (CPias), University Hospital of Nantes, Nantes, France; NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, UK.
| | - Karine Blanckaert
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - Colin Deschanvres
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - Adrien Vaudron
- Santé Publique France (SpFrance), the French National Public Health Agency, Pays de la Loire regional office, Nantes, France
| | - Pascaline Loury
- Santé Publique France (SpFrance), the French National Public Health Agency, Pays de la Loire regional office, Nantes, France
| | - Lisa King
- Santé Publique France (SpFrance), the French National Public Health Agency, Pays de la Loire regional office, Nantes, France
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