Analysis of a direct access testing system for the detection of SARS-CoV-2 in the paediatric population attending school

Background

During the COVID-19 pandemic, the paediatric population plays a minor role in the spread of the SARS-CoV-2 virus. However, in order to keep schools open and reduce SARS-CoV spreading, it is necessary to identify and isolate early SARS-CoV-2 positive paediatric patients even if they are asymptomatic. The aim of this study was to describe a setting for SARS-CoV 2 testing based on the spontaneous presentation of paediatric patients attending school without a medical prescription and explore its appropriateness.

Study design

Cross-sectional study.

Methods

The study performed between September 2020 and March 2021 among a sample of 13,283 paediatric patients who underwent a swab in four different hospital settings (school hot spot, emergency department, day hospital setting and hospital wards). For each patients we collected: date of swab execution, type of swab, execution setting of the swab, result of the swab, information about community spread of the virus in the 14 days prior to the swab execution, sex and age.

Results

In our sample, females accounted for 45.8%. The median age was 6.8 years (IQR 3.0-11.2) and the most frequent age category was between 6 and 11 years (27.9%). At multivariable models with a swab tested positive as outcome. The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school hot spot setting. Compared with adolescents aged between 14 and 19 years old, new-borns below 3 months (adjOR 1.83, 95% C.I. 1.14-3) and patients aged between 11 and 14 years old (adjOR 1.32, 95% C.I. 1.07-1.63) reported a higher probability of a swab tested positive. Instead, children aged between 3 months and 3 years (adjOR 0.77, 95% C.I. 0.61-0.96) and children aged between 3 years and 6 years (adjOR 0.66, 95% C.I. 0.53-0.83) were less likely to result positive. The higher was the mean of pooled Rt in the 14 days preceding the swab, the higher was the likelihood of resulting positive (adjOR 1.75, 95% C.I. 1.53-1.99).

Conclusion

In conclusion, we found a high incidence of paediatric patients positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings during the period of observation. The free access modality to the nasopharyngeal swab was effective in identifying patients with COVID-19. Public health authorities should implement these testing modality in order to help reduce the spread of SARS-CoV-2 in school settings.

Analysis of a test system for the detection of SARS-CoV-2 in children attending school

Background

During the COVID-19 pandemic, in order to keep schools open and reduce SARS-CoV spreading, SARS-CoV-2 positive paediatric patients (PP) need to be isolated early. The aim of this study was to describe the appropriateness of school hot spot (HS) for SARS-CoV 2 testing based on open access of PP in a paediatric hospital in Turin, Italy.

Methods

A cross-sectional study was performed between September 2020 and March 2021. The data collected included: date of swab execution, type of swab, execution setting of the swab, result of the swab, sex, age of PP and the mean value of the Rt (reproductive number) of pandemic in the Piedmont region. We collected data about PP from four different hospital settings (HS, Emergency department, day hospital and hospital wards) of Regina Margherita Children’s Hospital (Turin, Italy). We analyzed a sample of 13,283 PP (aged 0-19 years) testing for SARS-CoV-2. The main outcome was the likelihood of testing positive in different settings and in different age groups.

Results

In Our sample, females were 45.8%. The median age was 6.8 years (IQR 3.0-11.2). The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school HS setting. Newborns below 3 months (adj OR 1.85, 95%CI 1.14 - 3) and patients aged between 11 and 13 years old (adj OR 1.32, 95%CI 1.07 - 1.63) reported a higher probability of a swab tested positive compared to adolescents. Instead, children aged between 3 months and 2 years (adj OR 0.77, 95%CI 0.61 - 0.96) and aged between 3 years and 5 years (adj OR 0.66, 95%CI 0.53 - 0.83) were less likely to result positive.

Conclusions

We found a high prevalence of PP positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings. The open access modality to the nasopharyngeal swab was effective in identifying PP with COVID-19. Public health authorities should implement this testing modality in order to reduce SARS-CoV-2 infections in PP.

Key messages

• Open access testing system to detect SARS-CoV-2 is important to do as many tests as possible to identify COVID-19 patients and isolate them in the pediatric population.

• The open access testing modality to detect COVID-19 patients saves time for doctors who, instead of carrying out the patient history, can devote themselves to other clinical activities.

Impact of COVID-19 on emergency department use among home care recipients

Background

The impact of COVID-19 pandemic on Emergency Department (ED) was remarkable throughout Europe. We focused upon ED utilization among integrated home care (IHC) recipients comparing ED between pandemic period with pre-pandemic (February -December 2020 and 2019, respectively) in Piedmont, Italy.

Methods

A retrospective observational study was conducted. All recipients of IHC during the two periods studied were enrolled and all ED visits that occurred among IHC recipients were accounted for. Several variables related to IHC admission, reason of ED visits and demographic characteristics were collected. The average of ED visits in pre-pandemic and pandemic periods were calculated. Analyses were stratified by all variables.

Results

Patients enrolled were 11968 in 2019 and 8938 in 2020. In 2019, 3573 patients had at least one ED visit and 1668 patients in 2020. Number of ED visits was 5503 in 2019 and 2197 in 2020. The average of ED visits in 2020 has reduced in comparison with 2019 (0.464 C.I. [0.44-0.489] and 0.24 C.I. [0.227-0.252], p < 0.001 in 2019 and 2020 respectively). This reduction is regardless of sex, age, duration of IHC, presence of a non-family caregiver or reason for ED visits, except for abdominal pain, cardiac rhythm alteration and gynaecological symptoms. The averages of ED visits were significantly lower for IHC recipients with neoplasm (0.549 C.I. [0.513-0.585] and 0.328 C.I. [0.298-0.358], p < 0.001, and with low level of emergency (1.77 C.I. [1.662-1.877] and 1.397 C.I. [1.348-1.447], p < 0.036), but an increase in mortality rate was not registered.

Conclusions

Our results showed a reduction of ED visits among integrated home care recipients in pandemic period in comparison with pre-pandemic period. If the reduction can be the consequence of an unprepared health service that needs of necessary changes in its organization, these results suggest a great potential of the home care system to reduce the use of the hospital especially for low-risk conditions.

Key messages

• The COVID-19 pandemic overwhelmed health services of all European Countries. A reduced utilization of ED has been shown by literature, especially during the early phase of the COVID-19 pandemic.

• We showed a reduction in IHC recipients and a great decrease in ED visits among IHC patients in 2020 versus 2019, mainly in oncological patients, while an increase in mortality rate was not reported.

COVID-19 fake news, conspiracy beliefs and the role of eHealth literacy: an Italian nationwide survey

Background

The pandemic has been accompanied by an infodemic, which includes false information that can lead to harmful consequences. Additionally, conspiracy theories have been linked to lower preventive behaviors. This work mainly aims to explore the skill in identifying COVID-19 fake news and the conspiracies beliefs.

Methods

A cross-sectional study has been conducted amongst a convenience sample throughout Italy, using a Computer-Assisted Web Interview method (from 12 April 2021-ongoing). The survey included the Single-Item Literacy Screener (SILS), the eHealth Literacy Scale (eHEALS), a Fake News Score (FNS: percentage of misclassified news), a Conspiracy Score (CS: score from 1 to 5). Multivariable linear regressions were run (p &lt; 0.05 as significant).

Results

Up to date, participants were 1252. The median FNS and CS were: 25% (IQR=19-44) and 2.8 (IQR=2.2-3.4). For instance, 54% thought ibuprofen worsens COVID-19 symptoms and 50% agreed with “politicians usually do not tell us the motives for their decisions”. The 17% had low health literacy (SILS) and 41% low eHealth literacy (eHEALS). COVID-19 vaccine hesitant people were 13%. The multivariable models identified many significant relationships. Low economic status and vaccine hesitancy were positively associated with FNS and CS. Higher education had a negative association with FNS and CS. Age was positively associated with FNS. Low health and eHealth literacy were positively associated with FNS. Low eHealth literacy had a negative association with CS. FNS was positively associated with CS.

Conclusions

Associations between news misclassification, conspiracy beliefs and vaccine hesitancy might suggest shared determinants. EHealth literacy had a conflicting role. Attention should be paid to the mass media COVID-19 coverage as key information source for the general population. Public health campaigns should be planned to fight beliefs that hinder the reduction of transmission and might cause additional damages.

Key messages

The median percentage of misclassified news was 25% (IQR=19-44) and the median Conspiracy Score was 2.8 (IQR=2.2-3.4). COVID-19 vaccine hesitant people were 13% and 41% had a low eHealth literacy. News misclassification, conspiracy beliefs and vaccine hesitancy were associated. EHealth literacy had conflicting associations with fake news and conspiracy beliefs.