ABSTRACT
Background: The perceived risk of coronavirus disease 2019 (COVID-19) infection for healthcare workers (HCWs) is high. Although testing has focused on symptomatic HCWs, asymptomatic testing is considered by some to be an important strategy to limit occupational spread. Evidence on the results of large asymptomatic testing strategies in healthcare is, however, limited. This study examines the uptake and positivity of COVID-19 testing in a voluntary asymptomatic testing campaign at a large Canadian hospital. Method: In addition to testing HCWs with symptoms, all asymptomatic staff were offered a COVID-19 test at Trillium Health Partners, a large Ontario hospital, from May 27 to June 15, 2020. Testing was offered in four waves, corresponding to the likelihood of exposure to COVID-19-positive patients. The mass asymptomatic testing campaign was offered when the hospital's community test positivity rate had declined to 5%. Results: Since March 16, the hospital has tested 51.3% of its 10,143-person workforce at least once. In the asymptomatic testing campaign for HCWs between May 27 and June 15, 27% of clinical and non-clinical staff received testing. No large differences were found in the proportions of clinical HCWs tested by their exposure to COVID-19-positive patients. In this campaign, 0.2% of asymptomatic HCWs tested positive. However, these individuals either had mild symptoms at testing and did not self-identify or became symptomatic after testing. Conclusions: At this large hospital with declining community prevalence, a mass asymptomatic testing campaign of HCWs found they had a very low likelihood of testing positive for COVID-19.
ABSTRACT
Introduction: Nations thorughout the world are imposing mandatory quarantine on those entering the country. While such measures may be effective in reducing the importation of COVID-19, the mental health implications remain unclear. Objective(s): This study sought to assess mental well-being and factors associated with changes in mental health in individuals subject to mandatory quarantine following travel. Method(s): Travellers arriving at a large urban international airport completed online questionnaires on arrival and days 7 and 14 of mandated quarantine. Questionnaire items such as travel history, mental health, attitudes towards COVID-19, and protection behaviours were drawn from the World Health Organization Survey Tool for COVID-19. Result(s): There was a clinically significant decline in mental health over the course of quarantine among the 10,965 eligible participants. Poor mental health was reported by 5.1% of participants on arrival and 26% on day 7 of quarantine. Factors associated with greater decline in mental health were younger age, female gender, negative views towards quarantine measures, and engaging in fewer COVID-19 prevention behaviours. Conclusion(s): While the widespread use of quarantine may be effective in limiting the spread of COVID-19, the mental health implications are profound and have largely been ignored in public policy decision-making. Psychiatry has a role to play in contributing to the public policy debate to ensure that all aspects of health and well-being are reflected in decisions to isolate people from others.
ABSTRACT
The Abbott ID NOW COVID-19 assay is a rapid point-of-care molecular test for SARS-CoV-2 detection. In theory, it has the potential to decrease turnaround times (TATs) and rapidly facilitate patient flow and triage. Reports for its performance have been mixed, likely due to variations in patient cohorts, preanalytical considerations, and study design. We prospectively evaluated the ID NOW performance against reference reverse transcriptase PCR (RT-PCR) tests, using dual swabs. Patients presented at a large multisite academic hospital with the highest volumes of COVID-19 admissions in Canada. From 1,968 valid swabs, 186 were true positive, 1,760 were true negative, 21 were false negatives, and 1 was false positive. At 10.5% positivity rate, the positive and negative predictive values were 99.5% and 98.8%, respectively. This led to a modest increase in the pretest probability in this cohort of individuals presenting <7 days of symptom onset. The mean times from collection to laboratory receipt and receipt to reporting were 31 and 23 min, respectively. This reduced TAT observed in our study may assist with triage of admitted patients and breaking the chain of transmission through immediate notification of status. We also observed how test performance changed with prevalence, and thus, how the test is used to "rule in" or "rule out" disease must be considered. Although the ID NOW is regarded as a rapid test, it is not high throughput and requires rapid transportation times (<1 h) that may not be plausible in large centers. The utility of this test should be considered with the observed TAT and interpreted in the context of limitations discussed. IMPORTANCE Rapid testing for COVID-19 has been recognized as one potentially important measure in managing the pandemic. However, these rapid tests vary grossly in their performance and their applicability. There have been many studies evaluating the performance of rapid tests for SARS-CoV-2 detection. However, they are frequently not prospective, and patients are not simultaneously swabbed to compare the reference standard RT-PCR. Previous ID NOW study findings are mixed, which may be due to various factors, including patient, epidemiological, and preanalytical considerations. It is critical to consider how the pretest and posttest probabilities and epidemiological factors may affect the performance as the community prevalence of disease fluctuates during this highly dynamic pandemic. We consider how the ID NOW may be utilized in different settings, with considerations of public health and infection control and prevention risk tolerance.