Comparing antibiotic prescriptions in primary care between SARS-CoV-2 and influenza: a retrospective observational study.

BACKGROUND: Antibiotics are frequently prescribed during viral respiratory infection episodes in primary care. There is limited information about antibiotic prescription during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in primary care and its association with risk factors for an adverse course. AIM: To compare the proportion of antibiotic prescriptions between patients with COVID-19 and influenza or influenza-like symptoms, and to assess the association between antibiotic prescriptions and risk factors for an adverse course of COVID-19. DESIGN & SETTING: An observational cohort study using pseudonymised and coded routine healthcare data extracted from 85 primary care practices in the Netherlands. METHOD: Adult patients with influenza and influenza-like symptoms were included from the 2017 influenza season to the 2020 season. Adult patients with suspected or confirmed COVID-19 were included from the first (15 February 2020-1 August 2020) and second (1 August 2020-1 January 2021) SARS-CoV-2 waves. Proportions of antibiotic prescriptions were calculated for influenza and COVID-19 patients. Odds ratios (ORs) were used to compare the associations of antibiotic prescriptions in COVID-19 patients with risk factors, hospital admission, intensive care unit (ICU) admission, and mortality. RESULTS: The proportion of antibiotic prescriptions during the first SARS-CoV-2 wave was lower than during the 2020 influenza season (9.6% versus 20.7%), difference 11.1% (95% confidence interval [CI] = 8.7 to 13.5). During the second SARS-CoV-2 wave, antibiotic prescriptions were associated with being aged ≥70 years (OR 2.05; 95% CI = 1.43 to 2.93), the number of comorbidities (OR 1.46; 95% CI = 1.18 to 1.82), and admission to hospital (OR 3.19; 95% CI = 2.02 to 5.03) or ICU (OR 4.64; 95% CI = 2.02 to 10.62). CONCLUSION: Antibiotic prescription was less common during the SARS-CoV-2 pandemic than during influenza seasons, and was associated with an adverse course and its risk factors. The findings suggest a relatively targeted prescription policy of antibiotics in primary care during COVID-19.

Optimizing the Acceptability, Adherence, and Inclusiveness of the COVID Radar Surveillance App: Qualitative Study Using Focus Groups, Thematic Content Analysis, and Usability Testing.

BACKGROUND: The COVID Radar app was developed as a population-based surveillance instrument to identify at-risk populations and regions in response to the COVID-19 pandemic. The app boasts of >8.5 million completed questionnaires, with >280,000 unique users. Although the COVID Radar app is a valid tool for population-level surveillance, high user engagement is critical to the success of the COVID Radar app in maintaining validity. OBJECTIVE: This study aimed to identify optimization targets of the COVID Radar app to improve its acceptability, adherence, and inclusiveness. METHODS: The main component of the COVID Radar app is a self-report questionnaire that assesses COVID-19 symptoms and social distancing behaviors. A total of 3 qualitative substudies were conducted. First, 3 semistructured focus group interviews with end users (N=14) of the app were conducted to gather information on user experiences. The output was transcribed and thematically coded using the framework method. Second, a similar qualitative thematic analysis was conducted on 1080 end-user emails. Third, usability testing was conducted in one-on-one sessions with 4 individuals with low literacy levels. RESULTS: All 3 substudies identified optimization targets in terms of design and content. The results of substudy 1 showed that the participants generally evaluated the app positively. They reported the app to be user-friendly and were satisfied with its design and functionalities. Participants' main motivation to use the app was to contribute to science. Participants suggested adding motivational tools to stimulate user engagement. A larger national publicity campaign for the app was considered potentially helpful for increasing the user population. In-app updates informing users about the project and its outputs motivated users to continue using the app. Feedback on the self-report questionnaire, stemming from substudies 1 and 2, mostly concerned the content and phrasing of the questions. Furthermore, the section of the app allowing users to compare their symptoms and behaviors to those of their peers was found to be suboptimal because of difficulties in interpreting the figures presented in the app. Finally, the output of substudy 3 resulted in recommendations primarily related to simplification of the text to render it more accessible and comprehensible for individuals with low literacy levels. CONCLUSIONS: The convenience of app use, enabling personal adjustments of the app experience, and considering motivational factors for continued app use (ie, altruism and collectivism) were found to be crucial to procuring and maintaining a population of active users of the COVID Radar app. Further, there seems to be a need to increase the accessibility of public health tools for individuals with low literacy levels. These results can be used to improve the this and future public health apps and improve the representativeness of their user populations and user engagement, ultimately increasing the validity of the tools.

Binnensporten tijdens de COVID-19-pandemie: analyse met behulp van data uit de COVID RADAR app Indoor sporting during the COVID-19 pandemic: analysis with data from the COVID RADAR app

Samenvatting Binnensportaccommodaties werden langer gesloten gehouden dan buitensportaccommodaties gedurende de lockdowns tijdens de COVID-19-pandemie. Dit onderzoek beantwoordt de vraag of binnen sporten het risico op besmetting met SARS-CoV‑2 vergroot. Hiervoor werden gegevens gebruikt van de COVID RADAR-app. Er werd gecorrigeerd voor leeftijd, vaccinatiestatus, geslacht, ander risicogedrag, prevalentie van SARS-CoV‑2 en kwaliteit van de leefomgeving. Uit analyses van 1.353 gebruikers, van wie 13,0% een positieve testuitslag rapporteerde, blijkt dat binnensporters significant vaker een positieve test hadden (oddsratio 1,8;95%-betrouwbaarheidsinterval 1,2–2,6;p = 0,003) ten opzichte van gebruikers die buiten sporten. Dit bevestigt de rationale achter het eerdere beleid ten aanzien van het langer gesloten houden van binnensportaccommodaties om het aantal besmettingen te reduceren. Digitaal aanvullende content De online versie van dit artikel (10.1007/s12508-022-00351-0) bevat aanvullend materiaal, toegankelijk voor daartoe geautoriseerde gebruikers.

[Indoor sporting during the COVID-19 pandemic: analysis with data from the COVID RADAR app]. / Binnensporten tijdens de COVID-19-pandemie: analyse met behulp van data uit de COVID RADAR app.

Indoor sporting locations have been forced to stay closed longer than outdoor sporting locations during the lockdowns introduced during the COVID-19 pandemic. This research addresses the question whether exercising indoors does raise one's risk of infection with SARS-CoV­2. This analysis was performed using data from the COVID RADAR app and accounted for user differences in age, vaccine status, sex, other risky behavior, SARS-CoV­2 prevalence and quality of living environment. Analyzing data from 1,353 users, 13.1% of which reported a positive SARS-CoV­2 test, we found that exercising indoors leads to an odds ratio of 1.8 with a positive SARS-CoV­2 test (95%-confidence interval 1.2-2.6, p = 0.003), as compared to users who exercise outdoors. This confirms the justification used in longer closing indoor sporting locations to reduce the number of infections.

COVID RADAR app: Description and validation of population surveillance of symptoms and behavior in relation to COVID-19.

BACKGROUND: Monitoring of symptoms and behavior may enable prediction of emerging COVID-19 hotspots. The COVID Radar smartphone app, active in the Netherlands, allows users to self-report symptoms, social distancing behaviors, and COVID-19 status daily. The objective of this study is to describe the validation of the COVID Radar. METHODS: COVID Radar users are asked to complete a daily questionnaire consisting of 20 questions assessing their symptoms, social distancing behavior, and COVID-19 status. We describe the internal and external validation of symptoms, behavior, and both user-reported COVID-19 status and state-reported COVID-19 case numbers. RESULTS: Since April 2nd, 2020, over 6 million observations from over 250,000 users have been collected using the COVID Radar app. Almost 2,000 users reported having tested positive for SARS-CoV-2. Amongst users testing positive for SARS-CoV-2, the proportion of observations reporting symptoms was higher than that of the cohort as a whole in the week prior to a positive SARS-CoV-2 test. Likewise, users who tested positive for SARS-CoV-2 showed above average risk social-distancing behavior. Per-capita user-reported SARS-CoV-2 positive tests closely matched government-reported per-capita case counts in provinces with high user engagement. DISCUSSION: The COVID Radar app allows voluntarily self-reporting of COVID-19 related symptoms and social distancing behaviors. Symptoms and risk behavior increase prior to a positive SARS-CoV-2 test, and user-reported case counts match closely with nationally-reported case counts in regions with high user engagement. These results suggest the COVID Radar may be a valid instrument for future surveillance and potential predictive analytics to identify emerging hotspots.