ABSTRACT
Despite the hospital triage system trying to prevent COVID-19 patients from getting admitted to wards other than isolation/quarantine units, COVID-19 patients were accidentally being discovered time to time from non-COVID-19 wards due to atypical or asymptomatic presentations. Consequently, post-exposure risk assessment was carried out for the relevant health care workers (HCW) and the other patients to assess their risk level of acquiring COVID-19, and to quarantine them if concluded as high risk. Hence, the objective of the study was to assess the outcome and the adequacy of COVID-19 post-exposure risk assessment of health care workers which would be useful in future outbreaks. We studied all events of accidental detection of COVID-19 patients happened in non-COVID-19 wards which were leading to subsequent risk assessment using the 5-questions based tool adapted from the WHO recommendations. The 5 questions discussed the protective measures during face to face meetings or in physical contacts, protective measures during aerosol generating procedures, splashes onto the face, and hand hygiene measures. A retrospective cross-sectional study carried out in the Teaching Hospital Karapitiya, Galle, Sri Lanka, for 4 months covering the second wave of the pandemic. Hospital data base of risk assessments was accessed anonymously and the "yes” or "no” responses to the 5-questions assessment tool were analysed. There were 62 events involving 891 health care workers who underwent post-exposure risk assessment. From the responses the highest score of "yes” was recorded against question 3 (25.7% of total "yes” answers for all questions and 5.8% of total answers for the question number 3) revealing inadequate precautions taken by HCWs in aerosol generating procedures. Hundred and sixty two (18.2%) HCWs were quarantined as high risk and only one became positive for COVID-19 during the quarantine period. Though the 5-question based risk assessment tool effectively helps to identify breaches in infection control during an exposure to a positive COVID-19 patient, it may not be adequate at times as the only tool in deciding the assessee's risk level.
ABSTRACT
BACKGROUND: Although active surveillance SARS-CoV-2 variants of concern (VOCs) is required for proper outbreak control measures, many lower income countries find it challenging to detect VOCs by carrying genomic sequencing alone, due to limited resources. METHODS: VOCs can also be identified by the unique mutations in the spike protein by real-time PCR that detect these single nucleotide polymorphisms (SNPs). We used a multiplex, real-time PCR assay for detection of these SNPs for identification of the prevalence of different SARS-CoV-2 VOCs in 16/26 districts in Sri Lanka. RESULTS: Of the 664/934 that were subjected to the multiplex qRT-PCR, 638 (96.1 %) detected L452R and K417 in the channels and were identified as the delta variant. 25 samples (3.9 %) detected N501Y, with K417 were considered as the alpha variant. Of 10/16 districts in Sri Lanka, the delta variant was the only VOC detected. CONCLUSIONS: This multiplex real-time qRT-PCR which identifies certain SNPs specific to the VOCs appears to be a fast, cheaper and less technically demanding method to generate data regarding the spread of different SARS-CoV-2 variants, and is a suitable method for lower income countries, to supplement the data generated by genomic sequencing.