ABSTRACT
Policies such as border closures and quarantines have been widely used during the COVID-19 pandemic. Policy modifications and updates, however, must be adjusted as global vaccination rates increase. We calculated the risks of individual travelers based on their expected transmission and benchmarked them against that of an unvaccinated traveler quarantined for 14 days without testing. All individuals with a negative preboarding test can be released with a negative arrival test, when both tests have a sensitivity ≥ 90% and a specificity ≥ 97%, performance characteristics that could be accomplished by rapid antigen tests. This assumption is valid for an incidence rate up to 0.1 (prior to testing) and effective reproduction number (Rt) up to 4 in the arrival country. In a sensitivity analysis scenario where the incidence rate is 0.4 and Rt is 16, a negative preboarding test and a negative arrival test, both with a sensitivity ≥ 98% and a specificity ≥ 97%, can ensure that a traveler has a lower expected transmission than an unvaccinated person who is quarantined for 14 days. In most cases, fully vaccinated travelers (with or without booster) and a negative preboarding test can be released with a negative rapid antigen test upon arrival, allowing travelers to depart the airport within 30 min.
ABSTRACT
INTRODUCTION: Mental health conditions like depression and anxiety are on the rise, but access to care remains a challenge. Immigrants and racialized communities including Chinese Canadians experience high level of access barriers including communication with clinicians. With the aim to facilitate mental health communications, we tested an Interactive Computer-assisted Client Assessment Survey (iCCAS) in Cantonese/Mandarin and English at a nurse practitioner-led primary care clinic in Toronto. The iCCAS offers a touch-screen, pre-consultation survey with questions on depression, anxiety, post-traumatic stress, alcohol abuse, and social context. The program generates point-of-care reports for the clinician and patient. METHODS: A pilot randomized controlled trial examined the intervention impact on mental health discussion and symptom detection, compared with the usual care, followed by clinicians' qualitative interviews. RESULTS: Fifty self-identified Chinese adult patients participated (iCCAS = 26, Usual Care = 24), response rate 79.4%. Participant mean age was 44.8 years and 92% were immigrants. There was an increase of 19% and 15% in the mental health discussion and detection of symptoms in the iCCAS group compared with the usual care. More participants in the iCCAS group were referred to a social worker or psychiatrist. Patients found the use of iCCAS easy and clinicians identified its benefits for themselves (eg, early identification and comfort) and patients (eg, self-awareness and anonymity) and proposed practice-integration. DISCUSSION: The studied tool holds promise for enhancing clinician-patient mental health communications in primary care settings for overseas Chinese. Implications are discussed for in-person and virtual healthcare which could also inform responses to mental health crisis related to COVID-19.