• Beyond COVID-19-will self-sampling and testing become the norm?

      Boum, Y; Eyangoh, S; Okomo, MC (The Lancet, 2021-04-12)
    • Beyond knowledge: Evaluating the practices and precautionary measures towards COVID-19 amongst medical doctors in Jordan.

      Ramadan, M; Hasan, Z; Saleh, T; Jaradat, M; Al-Hazaimeh, M; Bani Hani, O; Al-Tammemi, AB; Shorman, E; Al-Mistarehi, AH; Kheirallah, K (Wiley, 2021-03-17)
      Background Health Care Workers (HCWs), including medical doctors, played a pivotal role as a first-line defence against the COVID-19 pandemic. Because of high exposure, HCWs are at an increased risk of contracting the disease. Aims This study aims to assess the level of precautionary measures, both at home and the workplace, amongst medical doctors who were on duty during the national lockdown in Jordan. Methods A cross-sectional study was conducted between March 23 and May 1, 2020, utilising a self-administered web-based questionnaire to examine a sample of medical doctors (n = 270) working at different healthcare institutions in Jordan. Likert scale was used to code the data and generate means and percentages. Results The most practiced on-duty precautionary measures were cleaning hands with water and disinfectant for more than 20 seconds (47.4%), followed by proper hygiene before and during meals (38.9%). The most practiced off-duty measures were taking off clothes before entering the residential place (65.9%) and prohibiting visitors (58.1%). Overall, the mean work protection percentage score was 73.8% (range: 28%-100%), while the mean home safety percentage score was 71.3% (range: 25%-100%). Work protection score was positively correlated with the home safety score. Female doctors were found to be more precautious at home than males. Doctors with chronic illness(es) were found to be less precautious than their healthier counterparts. Participants who isolated themselves expressed the highest level of home safety practice. Doctors who reported to smoke were found more precautious at home and doctors who preferred to work during lockdowns were more precautious at the workplace. Conclusion The level of precautionary behaviour of medical doctors in Jordan was not optimal. More attention and efforts are needed to enhance the adherence of doctors to precautionary guidance. Strengthening the role of infectious disease and infection control units within healthcare settings remains a necessity.
    • Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review.

      Hayward, SE; Deal, A; Cheng, C; Crawshaw, A; Orcutt, M; Vandrevala, TF; Norredam, M; Carballo, M; Ciftci, Y; Requena-Mendez, A; et al. (Elsevier, 2021-04-22)
      Background: Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. Methods: We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. Results: 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. Conclusions: Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
    • Clinical profile and factors associated with COVID-19 in Cameroon: a prospective cohort study

      Mbarga, NF; Emilienne, E; Mbarga, M; Ouamba, P; Nanda, H; Kengni, A; Joseph, G; Eyong, J; Tossoukpe, S; Sosso, NS; et al. (medRxiv, 2021-02-23)
      Objectives This study explores the clinical profiles and factors associated with COVID-19 in Cameroon. Research design and methods In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. Results A total of 323 patients were admitted during the study period; 262 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (77%; N=204) to moderate (15%; N=40) to severe (7%; N=18); the case fatality rate was 1% (N=4). Dysgusia (46%; N=111) and hyposmia/anosmia (39%; N=89) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; N=53), of which hypertension was the most common (20%; N=48). Participation in a mass gathering (OR=5.47; P=0.03) was a risk factor for COVID-19. Age groups 60 to 69 (OR=7.41; P=0.0001), 50 to 59 (OR=4.09; P=0.03), 40 to 49 (OR=4.54; P=0.01), male gender (OR=2.53; P=0.04), diabetes (OR= 4.05; P= 0.01), HIV infection (OR=5.57; P=0.03), lung disease (OR= 6.29; P=0.01), dyspnoea (OR=3.70; P=0.008) and fatigue (OR=3.35; P=0.02) significantly predicted COVID-19 severity. Conclusion Unlike many high-income settings, most COVID-19 cases in this study were benign with low fatality. Such findings may guide public health decision-making.
    • Coding-Complete Genome Sequence and Phylogenetic Relatedness of a SARS-CoV-2 Strain Detected in March 2020 in Cameroon.

      Njouom, R; Sadueh-Mba, SA; Tchatchueng, J; Diagne, MM; Dia, N; Tagnouokam, PAN; Boum, Y; Hamadou, A; Esso, L; Faye, O; et al. (American Society for Microbiology, 2021-03-11)
      We describe the coding-complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain obtained in Cameroon from a 58-year-old French patient who arrived from France on 24 February 2020. Phylogenetic analysis showed that this virus, named hCoV-19/Cameroon/1958-CMR-YAO/2020, belongs to lineage B.1.5 and is closely related to an isolate from France.
    • CommunityFirst solutions for COVID-19: decolonising health crises responses.

      Kiddell-Monroe, R; Farber, J; Devine, C; Orbinski, J (The Lancet, 2021-08-01)
    • Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19.

      Mateos Gonzalez, M; Garcia de Casasola Sanchez, G; Munoz, FJT; Proud, K; Lourdo, D; Sander, JV; Oritz Jaimes, GE; Mader, M; Lebrato, JC; Restrepo, MI; et al. (MDPI, 2021-02-22)
      Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.
    • Considerations for planning COVID-19 treatment services in humanitarian responses

      Garry, S; Abdelmagid, N; Baxter, L; Roberts, N; de Waroux, OL; Ismail, S; Ratnayake, R; Favas, C; Lewis, E; Checchi, F (BMC, 2020-12-01)
      The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
    • Copan eNAT Transport System to Address Challenges in COVID-19 Diagnostics in Regions with Limited Testing Access.

      Richard-Greenblatt, M; Comar, CE; Flevaud, L; Berti, M; Harris, RM; Weiss, SR; Glaser, L (American Society for Microbiology, 2021-02-12)
      Community-based healthcare clinics and hospital outreach services have the potential to expand coronavirus disease 2019 (COVID-19) diagnostics to rural areas. However, reduced specimen stability during extended transport, the absence of cold chain to centralized laboratories, and biosafety concerns surrounding specimen handling has limited this expansion. In the following study, we evaluated eNAT (Copan Italia, Brescia, Italy) as an alternative transport system to address the biosafety and stability challenges associated with expanding COVID-19 diagnostics to rural and remote regions. In this study, we demonstrated that high titer severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) lysate placed into eNAT medium cannot be propagated in cell culture, supporting viral inactivation. To account for off-site testing in these settings, we assessed the stability of contrived nasopharyngeal (NP) specimens stored for up to 14 days in various transport medium (eNAT, eSwab, viral transport media [VTM], saline and phosphate-buffered saline [PBS]) at 4°C, 22-25°C, and 35°C. Molecular detection of SARS-CoV-2 was unaffected by sample storage temperature over the 2 weeks when stored in eNAT or PBS (change in cycle threshold [ΔCT ] ≤ 1). In contrast, variable stability was observed across test conditions for other transport media. As eNAT can inactivate SARS-CoV-2, it may support COVID-19 diagnostics at the point-of-care (POC). Evaluation of compatibility of eNAT with Cepheid Xpert Xpress SARS-CoV-2 assay demonstrated equivalent diagnostic accuracy and sensitivity compared to VTM. Taken together, these findings suggest that the implementation of eNAT as a collection device has the potential to expand COVID-19 testing to areas with limited healthcare access.
    • Correcting COVID-19 vaccine misinformation: Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members.

      Hotez, P; Batista, C; Ergonul, O; Figueroa, JP; Gilbert, S; Gursel, M; Hassanain, M; Kang, G; Kim, JH; Lall, B; et al. (Elsevier, 2021-03-06)
    • Covid-19 and refugees, asylum seekers, and migrants in Greece

      Kondilis, E; Puchner, K; Veizis, A; Papatheodorou, C; Benos, A (BMJ, 2020-06-01)
    • COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants.

      Greenaway, C; Hargeaves, S; Barkati, S; Coyle, CM; Gobbi, F; Veizis, A; Douglas, P (Oxford University Press, 2020-07-24)
    • Critical changes to services for TB patients during the COVID-19 pandemic

      Cox, V; Wilkinson, L; Grimsrud, A; Hughes, J; Reuter, A; Conradie, F; Nel, J; Boyles, T (International Union Against Tuberculosis and Lung Disease, 2020-05-01)
    • Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean.

      Urrunaga-Pastor, D; Bendezu-Quispe, G; Herrera-Anazco, P; Uyen-Cateriano, A; Toro-Huamanchumo, CJ; Rodriguz-Morales, AJ; Hernandez, AV; Benites-Zapata, VA (Elsevier, 2021-04-16)
      Background: Determinants of vaccine acceptance are multifactorial, complex, and in most cases, context-dependent. We determined the prevalence of COVID-19 vaccination intention (VI) and fear of its adverse effects (FAE) as well as their associated factors in Latin America and the Caribbean (LAC). Methods: We conducted a secondary cross-sectional analysis of a database collected by the University of Maryland and Facebook. We included participants aged 18 and over from LAC surveyed, January 15 to February 1, 2021. We evaluated VI, FAE, sociodemographic characteristics, COVID-19 symptomatology, compliance with community mitigation strategies, food and economic insecurity, mental health evaluation and the influence in VI when recommended by different stakeholders. We calculated crude and adjusted prevalence ratios with their 95%CIs. Results: We analyzed 472,521 responses by Latin American adults, finding a VI and FAE prevalence of 80.0% and 81.2%, respectively. We found that female and non-binary genders were associated with a lower probability of VI and a higher probability of FAE. Besides, living in a town, village or rural area and economic insecurity was associated with a higher FAE probability. The fears of becoming seriously ill, a family member becoming seriously ill from COVID-19 and having depressive symptoms were associated with a higher probability of VI and FAE. Conclusion: Eight out of 10 adults in LAC have VI and FAE. The factors identified are useful for the development of communication strategies to reduce FAE frequency. It is necessary to guarantee mass vaccination and support the return of economic activities.
    • Europe’s migrant containment policies threaten the response to covid-19

      Hargreaves, S; McKee, M; Jones, L; Veizis, A (BMJ Publishing Group, 2020-03-26)
    • Evaluating Ten Commercially-Available SARS-CoV-2 Rapid Serological Tests Using the STARD (Standards for Reporting of Diagnostic Accuracy Studies) Method.

      Dortet, L; Ronat, JB; Vauloup-Fellous, C; Langendorf, C; Mendels, DA; Emeraud, C; Oueslati, S; Girlich, D; Chauvin, A; Afdjei, A; et al. (American Society for Microbiology, 2020-11-25)
      Numerous SARS-CoV-2 rapid serological tests have been developed, but their accuracy has usually been assessed using very few samples, and rigorous comparisons between these tests are scarce. In this study, we evaluated and compared 10 commercially-available SARS-CoV-2 rapid serological tests using the STARD methodology (Standards for Reporting of Diagnostic Accuracy Studies). 250 sera from 159 PCR-confirmed SARS-CoV-2 patients (collected from 0 to 32 days after onset of symptoms) were tested with rapid serological tests. Control sera (N = 254) were retrieved from pre-COVID periods from patients with other coronavirus infections (N = 11), positive rheumatoid factors (N = 3), IgG/IgM hyperglobulinemia (N = 9), malaria (n = 5), or no documented viral infection (N = 226). All samples were tested using rapid lateral flow immunoassays (LFIA) from 10 manufacturers. Only four tests achieved ≥98% specificity, with other tests ranging from 75.7%-99.2%. Sensitivities varied by the day of sample collection, from 31.7%-55.4% (Days 0-9), 65.9%-92.9% (Days 10-14), and 81.0%-95.2% (>14 days) after the onset of symptoms, respectively. Only three tests evaluated met French Health Authorities’ thresholds for SARS-CoV-2 serological tests (≥90% sensitivity + ≥98% specificity). Overall, the performances between tests varied greatly, with only a third meeting acceptable specificity and sensitivity thresholds. Knowing the analytical performance of these tests will allow clinicians and most importantly laboratorians to use them with more confidence, could help determine the general population’s immunological status, and may help to diagnose some patients with false-negative RT-PCR results.
    • Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review.

      Toomey, E; Conway, Y; Burton, C; Smith, S; Smalle, M; Chan, X; Adisesh, A; Tanveer, S; Ross, L; Thomson, I; et al. (Cambridge University Press, 2020-10-08)
      Background: Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. Objectives: To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators. Data sources: We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews. Methods: Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized. Results: In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Conclusions: Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.
    • From China: hope and lessons for COVID-19 control

      Azman, AS; Luquero, FJ (Elsevier, 2020-04-03)