ABSTRACT
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Models, Statistical , SARS-CoV-2/genetics , Systems AnalysisABSTRACT
Background The 2012 Neonatal Early Onset Infection Guideline by National Institute for Clinical Excellent (NICE) [CG149], led to an increase in antibiotic use in well newborns. The Kaiser Permanente Sepsis Risk Calculator (KP-SRC) uses the population's background incidence of EOS, objective information at birth and the infant's clinical presentation to evaluate risk of neonatal EOS in infants >34 weeks gestation. This has safely shown to reduce the use of antibiotics. During the COVID-19 pandemic, the local Operational Delivery Network endorsed the use of the KP-SRC. Objectives To show implementation of KP-SRC can safely and effectively reduce the incidence of antibiotic use in well babies over 34 weeks gestation without an increase in missed cases of sepsis. Methods KP-SRC was implemented in 4 neonatal units. KPSRC is used on all babies with risk factors for infection in accordance with the NICE EOS guideline [CG149] and antibiotics are started according to the recommended outcome. There was slight variation in the parameters used by the units in the calculation of KP-SRC (i.e. Infection incidence rate of 0.8/1000 in 2 units and 0.6/1000 in the other 2 units). Blood culture data during the first seven days of life was provided on a monthly basis by the laboratories. Babies < 34 weeks gestation were excluded and clinical details of the remaining babies were reviewed, particularly with respect to positive blood cultures and readmissions following discharge home. Data was reviewed over a consecutive 5 month period prior to implementation of the KP-SRC (1 Sept 2019 - 31 Jan 2020), and post implementation (1 Sept 2020 - 31 Jan 2021). Results There was a percentage reduction in blood cultures taken in the post KP-SRC implementation period between the 4 units of 52 to 85% (mean 60%). There were 5 positive blood cultures, all babies were commenced on antibiotics at birth in accordance with the KP-SRC recommendation. Twenty babies were started on antibiotics after 24 hours of age and received 5 days of antibiotics. Twelve had no risk factors for infection and would not have been picked up by NICE. Of the eight assessed by KP-SRC, two were admitted to the neonatal unit on day 2 with tachypnea but did not require respiratory support. Only one baby was readmitted following discharge and received 5 days of antibiotics. This baby was readmitted on day 7 with apnoea requiring ventilation. There was a history of maternal prolonged rupture of membranes and mild maternal pyrexia but the baby was well in the immediate postnatal period. Blood cultures were negative with normal CRP's. Conclusions The KP-SRC can lead to a safe and consistent reduction in the number of well babies receiving antibiotics post-delivery. All babies with positive blood cultures were on antibiotics as guided by the KP-SRC and there were no missed cases of sepsis.
ABSTRACT
OBJECTIVE: To assist urologists in the management of andrological and sexual medicine pathologies during the COVID-19 crisis. MATERIAL AND METHOD: Use of the formalized consensus method. RESULTS: The medical and surgical management of patients in andrology and sexual medicine must be adapted. Consultations should, as far as possible, be carried out by tele-consultation. For operative procedures, the delay between the operative decision and the date of (re)scheduling of the procedure will depend on: (1) the level of criticality of the clinical situation; (2) the type of intervention; (3) the functional and psychological repercussions, including quality of life while waiting for the procedure; (4) the notion of losing the chance of having an optimal outcome; (5) the risk of potential complications from delaying a procedure for too long; and (6) taking into account the patient's risk factors for severe forms of COVID-19. The protection of urologists from COVID-19 should be considered. Each urologist must make the best decision for the patient, taking into account the acceptable time frame and quality of life impact before surgical management, the COVID risk parameters, the technical and anesthetic feasibility and the structural possibility of the health care institution to ensure a specific dedicated pathway during the COVID-19 health crisis. CONCLUSION: The management of andrological and sexual medicine pathologies must be adapted to the COVID-19 crisis context. Some patients may require surgery, including in emergency. These recommendations are transitional and will end with the COVID-19 crisis.