ABSTRACT
ObjectivesTo determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19, and identify risk factors for positive tests. DesignCohort from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry Setting30 acute care hospitals across Canada ParticipantsPatients hospitalized for non-COVID-19 related diagnoses who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 1, and December 29, 2020 Main outcomePositive nucleic acid amplification test (NAAT) for SARS-CoV-2 Outcome measureDiagnostic yield ResultsWe enrolled 15,690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% - 0.92%). Factors associated with a positive test included presence of a fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases. ConclusionsUniversal screening of hospitalized patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence. Trial registrationNCT04702945 SUMMARY BOXESSection 1: Universal screening of admitted patients for SARS-CoV-2 was implemented in many hospitals at the beginning of the pandemic. The Infections Diseases Society of America (IDSA) recommended avoiding universal screening of asymptomatic hospitalized patients in areas and times of low-COVID prevalence (defined as <2% prevalence) with very low certainty of evidence, based on studies of COVID-19 prevalence among asymptomatic individuals in the community. Section 2: This study supports IDSA recommendations to avoid universal screening for COVID-19 in times and areas of low COVID prevalence and identifies patient-level risk factors strongly associated with positive testing that should be considered for screening.
Subject(s)
Fever , Severe Acute Respiratory Syndrome , COVID-19ABSTRACT
Background: During public health emergencies, disruptions to social landscapes and amplification of inequities for people with opioid use disorder raise important questions about reducing harms and providing treatment accountability to support this population during disasters including COVID-19. This research aims to a) identify how disasters impact persons with opioid use disorder (OUD) and their access to healthcare, with specific attention to COVID-19, and b) inform ongoing responses to the pandemic and future disaster-mitigation plans related to healthcare disruptions affecting persons with opioid use disorder (PWOUD). Methods: We conducted knowledge synthesis based on a 6-stage scoping review framework methodology. Stakeholder consultation was completed using a Nominal Group Technique with two groups, each composed of including providers in primary, emergency and community-based care. One group (n=7) represented voices from urban services, and the other (n=4) Indigenous contexts allowing for attention to healing the whole person, beyond OAT. Results: 61 scientific journal articles and 72 grey literature resources were included after full-text screening. Stakeholder NGT process revealed three contextual factors affecting system and service accountability for responsive OUD care during disaster-driven disruptions: (1) disasters focus attention on single risks and generalized solutions; (2) data-poor decision-making perpetuates stigma and produces policy inattentive to social determinants of health; and (3) harm reduction and contextually-tailored care prepare a system for future disasters. Conclusion: COVID-19 public health efforts require a coordinated systemic approach to serving PWOUD, based on accountability to patients and support for providers.
Subject(s)
Gyrate Atrophy , Opioid-Related Disorders , COVID-19ABSTRACT
Objectives: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design: Systematic review Eligibility: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients. Data sources: PubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis: Risk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis. Outcome measures: Primary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores). Results: 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range -51% to -20%), comprising median reductions for visits of 42%(-53% to -32%), admissions, 28%(-40% to -17%), diagnostics, 31%(-53% to -24%), and for therapeutics, 30%(-57% to -19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change. Conclusions: Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery. Funding, Study registration: No funding was required. PROSPERO: CRD42020203729