Management of a large outbreak of COVID-19 at a British Army training centre: lessons for the future.

INTRODUCTION: The COVID-19 pandemic has posed major challenges for infection control within training centres, both civilian and military. Here we present a narrative review of an outbreak that occurred at the Royal Military Academy Sandhurst (RMAS) in January-March 2021, in the context of the circulating, highly transmissible SARS-CoV-2 variant B.1.1.7. METHODS: Testing for SARS-CoV-2 was performed using a combination of reverse transcriptase PCR and Lateral Flow Devices (LFDs). Testing and isolation procedures were conducted in line with a pre-established symptom stratification system. Genomic sequencing was performed on 10 sample isolates. RESULTS: By the end of the outbreak, 185 cases (153 Officer Cadets, 32 permanent staff) had contracted confirmed COVID-19. This represented 15% of the total RMAS population. This resulted in 0 deaths and 0 hospitalisations, but due to necessary isolation procedures did represent an estimated 12 959 person-days of lost training. 9 of 10 (90%) of sequenced isolates had a reportable lineage. All of those reported were found to be the Alpha lineage B.1.1.7. CONCLUSIONS: We discuss the key lessons learnt from the after-action review by the Incident Management Team. These include the importance of multidisciplinary working, the utility of sync matrices to monitor outbreaks in real time, issues around Officer Cadets reporting symptoms, timing of high-risk training activities, infrastructure and use of LFDs. COVID-19 represents a vital learning opportunity to minimise the impact of potential future pandemics, which may produce considerably higher morbidity and mortality in military populations.

Prolonged V.v.-Ecmo for Covid-19 Ards with Lung Recovery

There is limited data regarding prolonged use of veno-venous extracorporeal membrane oxygenation (V.V.-ECMO) for novel coronavirus disease 2019 (COVID-19) with the expectations of lung recovery or when to transition goals and consider lung transplant. We present a patient with lung recovery after an eight-month ECMO course for COVID-19. In January 2022 a 33-year-old obese (BMI 43), unvaccinated, Hispanic man presented to the emergency department positive for COVID-19 with profound hypoxia requiring intubation. After failing maximum medical therapy, he was cannulated on V.V.-ECMO with a right internal jugular 31Fr single-access, dual-stage right atrium-to-pulmonary artery cannula. Sedation was weaned and he was extubated to ECMO support. Mobilization was initiated immediately with the use of a vertical mobilization bed and progressed to ambulating on ECMO. He demonstrated persistent bilateral airspace disease with complete opacification of both lung fields for several months. With ongoing ECMO support his lung function improved. He was decannulated following eight months of support to nasal cannula and discharged home. He continues to improve at home and is able to engage in all activities of daily living. We demonstrate lung recovery following COVID 19 infection with severe ARDS after prolonged ECMO support. Liberating the patient from the ventilator, weaning sedation, physical therapy and patience resulted in pulmonary recovery. Prolonged ECMO support was required to achieve lung recovery in this patient. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A pandemic in the age of next-generation sequencing

Since December 2019, the world has found itself rocked by the emergence of a highly contagious novel coronavirus disease, COVID-19,caused by the virus SARS-CoV-2.The global scientificcommunity has rapidly come together to understand the virus and identify potential treatments andvaccine strategies to minimise the impact on public health. Key to this has been the use of cutting-edgetechnological advances in DNA and RNA sequencing, allowing identification of changes in theviral genome sequence as the infection spreads. This approach has allowed a widespread ‘genomicepidemiology’ approach to infection control, whereby viral transmission (e.g. in healthcare settings)can be detected not only by epidemiological assessment, but also by identifying similarities betweenviral sub-typesamong individuals. The UK has been at the forefront of this response, with researcherscollaborating with public health agencies and NHS Trusts across the UK to form the COVID-19GenomicsUK (COG-UK)Consortium. Genomic surveillance at this scale has provided critical insight into thevirulence and transmission of the virus, enabling near real-timemonitoring of variants of concernand informing infection control measures on local, national and global scales. In the future, next-generationsequencing technologies, such as nanopore sequencing, are likely to become ubiquitousin diagnostic and healthcare settings, marking the transition to a new era of molecular medicine © The Authors. Published by Portland Press Limited under the Creative Commons Attribution License 4.0 (CC BY-NC-ND)

Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward.

BACKGROUND: COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC). AIM: To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC. METHODS: Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak. FINDINGS: Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group). CONCLUSION: Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.