Spatial assessment of disease surveillance during the first wave of the COVID-19 pandemic

Background: Early surveillance of COVID-19 in Scotland included routine monitoring of positive test rates and COVID-19-related NHS 24 calls. The COVID Symptom Study (CSS) provides another surveillance source, collating self-reported symptoms in the general population and predictions of likely infection. Aim(s): To capture spatial patterns of COVID-19 infection using Spatio-temporal (ST) analyses on three data streams: positive test rates, NHS24 calls, and CSS predicted cases. These were compared to assess which was best for early disease surveillance. Method(s): Data streams recorded weekly counts of activity by postcode district (PCD) during the first wave of the pandemic. ST analyses assessed the relationship between COVID-19 testing, NHS 24 COVID-19 calls, and CSS predicted COVID-19 cases, applying a Leroux conditional auto-regression (CAR) spatial GLM, adjusting for spatial covariates. Result(s): Positive test rates were associated with the proportion of NHS 24 calls related to COVID-19 per PCD (OR=1.038, 95% credible interval, 1.024-1.052) and the proportion of CSS app users predicted as cases, (OR=1.014, 0.974-1.056). A temporal effect was seen between all streams, after adjusting for spatial covariates. Using both NHS24 and the CSS to model COVID-19 positive test rates accounted for more ST variability than with the separate models, implying that combining sources may improve surveillance accuracy. Conclusion(s): NHS 24 and the CSS can identify similar trends/clusters of COVID-19 and gold-standard testing data, particularly when used in parallel. In the early stages of a pandemic, when widespread testing might not be available, alternative sources of data may be used to inform outbreak management.

Hearing and feeling the music in every step: Musical walks and biographical experience of lockdown

The article investigates the ways in which young musicians explored new (unfamiliar) social landscapes and emotions during Covid-19 pandemic lockdowns, through learning to listen to the "music within their steps” while walking on their own or with members of their own families for the inter-disciplinary project ‘The Musical Steps'. The project examines the self-recorded essays, visual materials and reflections by the young musicians and their parents, which reveal new cultural perspectives of sound, space and silence, along with the thoughts about musical repertoire which were inspired by the walks. Methodologically, we applied the walking biographical method that enabled us to explore young musicians' reflections on music and their lives during lockdowns from an inter-disciplinary perspective. The walking biographies approach to research on the move has been specially adapted for young musicians and their families by the authors. This article explores how walking changed young musicians' emotional perceptions of music and what they heard and felt during and after their walks. Questions were raised as to whether the walks affected their physical and mental well-being, both personally and musically, and whether the walks influenced their understanding of their cultural background/origin. © The Author(s) 2022.

Testing and Treatments in Children with Severe Neurologic Manifestations and Sars-Cov-2 Conditions

INTRODUCTION: Our objective was to characterize testing and treatments provided for hospitalized children with and without severe neurologic manifestations with acute SARSCoV- 2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). METHOD(S): Multinational cross-sectional study of children age < 18 y hospitalized with SARS-CoV-2-related condition between January 2020-July 2021. Admission laboratory, neurologic testing, and treatments related to SARS-CoV-2 conditions were analyzed by severe neurologic manifestation status, a composite of those with univariate logistic regression p< 0.05 for unfavorable outcome (Pediatric Cerebral Performance Category Score 3-6 at hospital discharge). Multivariable logistic regression to identify laboratory values associated with severe neurologic manifestation was performed. RESULT(S): Of 3,556 children, 818 (23%) had severe neurologic manifestation. Children with severe neurologic manifestation were younger (median 5 interquartile range [1-12] vs. 9 [1.1-14] y) and had more MIS-C vs. acute SARSCoV- 2 (35% vs. 22%), pre-existing disease (68% vs. 48%), and death (5% vs. 0.5%), all p< 0.001. Blood fibrinogen was lower in children with (341 [230, 500]) vs. without (410 [274, 537] mg/dl) severe neurologic manifestation, p< 0.001. More children with severe neurologic manifestations had electroencephalography (23% vs. 2.7%), head CT (24% vs. 6%), and brain MRI (16% vs. 4%) performed, p< 0.001, but results were not more frequently abnormal between groups. Cerebrospinal fluid was sampled in 19% vs. 9%, p< 0.001, and intracranial pressure monitors were placed in 5 (1%) vs. 14 (0.5%), p=0.179. Children with severe neurologic manifestation received more steroids (25% vs. 16%) and remdesivir (15% vs. 7%), p< 0.001. After adjustment, higher lymphocytes (odds ratio 1.0003 [95% confidence interval 1.00009, 1.0005]) and lower fibrinogen (0.998 [0.996, 0.999]), p< 0.05, were associated with severe neurologic manifestation status. CONCLUSION(S): Modest laboratory signatures of severe neurologic manifestations in children hospitalized with SARSCoV- 2 related conditions were found. Despite association with worse outcomes, relatively few children received contemporary neurological testing and SARS-CoV-2 related treatments.

Neurologic Outcomes in Hospitalized Children with Acute Sars-Cov-2 or Mis-C

INTRODUCTION: We aimed to describe neurologic outcomes in hospitalized children diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). METHOD(S): Multinational (n=50 centers), cross-sectional study of neurologic manifestations in children < 18 y old hospitalized with a positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020-July 2021. Multivariable logistic regression to identify risk factors for unfavorable outcome at hospital discharge (Pediatric Cerebral Performance Category Score 3-6) was performed. Severe neurologic manifestation included those with univariate logistic regression significant to p< 0.05 for unfavorable outcome: dysautonomia, stroke, encephalopathy, cardiac arrest, meningitis/encephalitis, coma, seizures, weakness, and delirium. RESULT(S): Of 3,556 children (46% female), 3333 (94%) had acute SARS-CoV-2 and 223 (6%) had MIS-C. Unfavorable outcome occurred in 368 (11%) children and 39 (1.1%) died. Children with unfavorable outcome were older (median 9 interquartile range [4-14] vs. 8 [1-14] y, p< 0.001), and more likely to have neurologic comorbidity (72% vs. 10%, p< 0.001), worse Glasgow coma scale score (GCS) group (19% with combined GCS 9-15 vs. 1.7% with GCS< 9, p< 0.001), any neurologic manifestation (52% vs. 37%, p< 0.001), and severe neurologic manifestation (48% vs. 20%, p< 0.001) compared to children with favorable outcome. In multivariate logistic regression, older age (odds ratio 1.1 95% confidence interval [1.0, 1.1], total pre-existing conditions (2.1 [1.8, 2.5]), severe neurologic manifestation (3.4 [2.0, 6.0], and worse GCS group (4.0 [2.6, 5.9]) were associated with unfavorable outcome. CONCLUSION(S): Children with severe neurologic manifestation, pre-existing conditions, and children of older age hospitalized with acute SARS-CoV-2 infection or MIS-C have worse hospital discharge outcomes. Follow-up of these children is necessary to identify and manage neurologic and functional impairment.

A PATIENT SURVEY TO UNDERSTAND THE IMPACTS OF COVID-19 ON DELIVERY OF HIV CARE FROM THE PATIENT'S PERSPECTIVE

Introduction Significant changes occurred in delivery of HIV care due to COVID-19. Our department recognised the benefits of some changes but understanding the impact on patients is essential in establishing a plan for recovery. Methods We conducted a survey using Microsoft forms, delivered via text message to approximately 3000 patients across two HIV departments. The patient experience, communications and information governance teams were involved in the design. Patients were given 4 weeks to respond. Results There were 325 responses. Demographics of respondents roughly matched the cohort, excepting a bias towards slightly older patients. Care was reported to be better than prior to the pandemic by 15%, with another 63% saying it was equally as good. A minority (19%) said their care was not as good. Almost half preferred telephone consultations, 48% said they were more convenient and another 33% said they were equally as convenient, 64% were happy to continue with telephone consultations. 37% said they would want to be seen in person at least every 6 months, 39% said every 12 months, and 13% 18 months. Off-site phlebotomy was popular with 42% saying this was more convenient and 71% happy to continue using it. Discussion This feedback is extremely valuable in shaping provision of future care. The department is proud to have maintained high quality care for the vast majority in the face of enormous pressures. However, a minority of patients have experienced negative impacts on their care;patient choice is clearly vital moving forwards. A patient survey to understand the impacts of COVID-19 on delivery of HIV care from the patient's perspective (Table Presented).

GCS-neuro-COVID: Neurologic manifestations and outcomes in children with and without comorbidities

INTRODUCTION: Children with comorbidities are at increased risk of severe disease due to SARS-CoV-2 (COVID-19) infection and Multisystem Inflammatory Syndrome-Children (MIS-C). We hypothesized that children with comorbidities hospitalized with COVID-19 or MIS-C will experience more neurologic manifestations and worse outcomes compared to children without comorbidities. METHODS: Secondary study of the Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID) study, a multinational study enrolling children < 18 years of age hospitalized with confirmed/presumed COVID-19 or MIS-C. Neurological manifestations, lengths of hospital and intensive care unit (ICU) stay, hospital disposition and mortality were analyzed by comorbidity status. A multivariable logistic regression was performed to analyze the association of comorbidity with neurologic manifestation. RESULTS: Overall, 824 (55%) children had any comorbidity and 646 (43%) had any neurologic manifestation. Children with comorbidity were older (median [interquartile range] 9.5 [4-15] vs. 6.4 [0.5-12], had more COVID-19 (58%) vs. MIS-C (32%) and ICU admissions (39% vs. 29%), and longer hospital length of stay (9 [2-9] vs. 5 [2-6] days), all p< .001;mortality was similar (1.5% vs. 0.5%, p=.067). The most common comorbidities were neurologic and respiratory (20% each). Children with comorbidity more frequently had any neurologic manifestation (61% vs. 39%), and seizures/status epilepticus (11% vs. 4%), p< .001). There were no differences between comorbidity vs no comorbidity groups for the most common neurologic manifestations including headache (21% vs. 20%) and acute encephalopathy (17% vs. 15%). Older age (odds ratio 1.1 [95% confidence interval 1.1-1.1]), ICU stay (2.6 [1.9-3.4]), MIS-C (2.2 [1.5-3.2]), and neurologic (2.8 [1.9-4.1]) comorbidity were associated with neurologic manifestation while cardiovascular morbidity was protective for neurologic manifestation (.5 [.3-.8]), all p< .05. CONCLUSIONS: Children with comorbidity, especially neurologic, who are hospitalized with COVID-19 related conditions are at increased risk of neurologic manifestations. Assessment of post-hospital neurodevelopmental outcomes to determine the impact of neurologic manifestations in children with comorbidity and COVID-19 related conditions is critically needed.

Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration.

OBJECTIVES: At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN: We undertook an ecological study using routinely available national data. METHODS: We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS: Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS: These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.

National population prevalence of antibodies to SARS-CoV-2 among pregnant women in Scotland during the second wave of the COVID-19 pandemic: a prospective national serosurvey.

OBJECTIVES: This study aimed to determine SARS-CoV-2 seroprevalence among pregnant women in the Scottish population during the second wave of the COVID-19 pandemic. STUDY DESIGN: Prospective national serosurvey. METHODS: We tested 13,428 residual samples retrieved from pregnant women participating in the first trimester combined ultrasound and biochemical screening for fetal trisomy across Scotland for SARS-CoV-2 antibodies over a 6-month period from November 2020 to April 2021. Seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. RESULTS: Seroprevalence rates in the antenatal samples significantly increased from 5.5% (95% confidence interval [CI] 4.7%-6.5%) in the 5-week period up to and including International Organization for Standardization (ISO) Week 51 (w/b Monday 14 December 2020) to 11.3% (95% CI 10.1%-12.6%) in the 5-week period up to and including ISO Week 14 (w/b Monday 5 April 2021). Increasing seroprevalence trends across the second wave were observed among all age groups. CONCLUSIONS: By the end of the second wave of the COVID-19 pandemic, approximately one in 10 women tested around the end of the first trimester of pregnancy had antibodies to SARS-CoV-2, suggesting that the vast majority were still susceptible to COVID-19 as they progressed to the later stages of pregnancy, when risks from infection are elevated for both mother and baby.

National population prevalence of antibodies to SARS-CoV-2 in Scotland during the first and second waves of the COVID-19 pandemic.

OBJECTIVES: Studies that measure the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('seroprevalence') are essential to understand population exposure to SARS-CoV-2 among symptomatic and asymptomatic individuals. We aimed to measure seroprevalence in the Scottish population over the course of the COVID-19 pandemic - from before the first recorded case in Scotland through to the second pandemic wave. STUDY DESIGN: The study design of this study is serial cross sectional. METHODS: We tested 41,477 residual samples retrieved from primary and antenatal care settings across Scotland for SARS-CoV-2 antibodies over a 12-month period from December 2019-December 2020 (before rollout of COVID-19 vaccination). Five-weekly rolling seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. Temporal trends in seroprevalence estimates and weekly SARS-CoV-2 notifications were compared. RESULTS: Five-weekly rolling seroprevalence rates were 0% until the end of March, when they increased contemporaneously with the first pandemic wave. Seroprevalence rates remained stable through the summer (range: 3%-5%) during a period of social restrictions, after which they increased concurrently with the second wave, reaching 9.6% (95% confidence interval [CI]: 8.4%-10.8%) in the week beginning 28th December in 2020. Seroprevalence rates were lower in rural vs. urban areas (adjusted odds ratio [AOR]: 0.70, 95% CI: 0.61-0.79) and among individuals aged 20-39 years and 60 years and older (AOR: 0.74, 95% CI: 0.64-0.86; AOR: 0.80, 95% CI: 0.69-0.91, respectively) relative to those aged 0-19 years. CONCLUSIONS: After two waves of the COVID-19 pandemic, less than one in ten individuals in the Scottish population had antibodies to SARS-CoV-2. Seroprevalence may underestimate the true population exposure as a result of waning antibodies among individuals who were infected early in the first wave.

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland.

Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.

Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality.

BACKGROUND: Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. METHODS: Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. RESULTS: One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. CONCLUSIONS: The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. REGISTRATION: This review was registered on PROSPERO as CRD42020177714 .

SARS-CoV-2 Positivity in Asymptomatic-Screened Dental Patients.

Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium-containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%-0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.

Enhanced surveillance of COVID-19 in Scotland: population-based seroprevalence surveillance for SARS-CoV-2 during the first wave of the epidemic.

OBJECTIVES: The impact of the COVID-19 pandemic in Scotland has been amongst the most severe in Europe. Serological surveillance is critical to determine the overall extent of infection across populations and to inform the public health response. This study aimed to estimate the proportion of people who have antibodies to SARS-CoV-2 ('seroprevalence') in the general population of Scotland and to see if this changes over time. STUDY DESIGN/METHODS: Between International Organization for Standardization (ISO) week 17 (i.e. week commencing 20th April) and ISO week 25 (week commencing 15 June), 4751 residual blood samples were obtained from regional biochemistry laboratories in six participating regional health authority areas covering approximately 75% of the Scottish population. Samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies using the LIAISON®SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Italy). Seroprevalence rates were adjusted for the sensitivity and specificity of the assay using Bayesian methods. RESULTS: The combined adjusted seroprevalence across the study period was 4.3% (95% confidence interval: 4.2%-4.5%). The proportion varied each week between 1.9% and 6.8% with no difference in antibody positivity by age, sex or geographical area. CONCLUSIONS: At the end of the first wave of the COVID-19 pandemic, only a small fraction of the Scottish population had antibodies to SARS-CoV-2. Control of COVID-19 requires the ability to detect asymptomatic and mild infections that would otherwise remain undetected through existing surveillance systems. This is important to determine the true number of infections within the general population which, in turn, can help to understand transmission, inform control measures and provide a denominator for the estimation of severity measures such as the proportion of infected people who have been hospitalised and/or have died.