USE OF Ag-RDTs TO REDUCE SARS-CoV-2 INFECTIONS AT RELIGIOUS GATHERINGS IN LICS & MICS

Background: Throughout the COVID-19 pandemic, it was evident that many SARS-CoV-2 infections occurred at mass gathering events. In many LMICs and LICs, places of worship serve as a venue for mass gatherings, and therefore a potential source of large-scale transmission events. Mass gatherings at places of worship also serve as an opportunity to distribute Ag-RDTs to a significant proportion of the community at regular intervals, disrupting transmission within the event and potentially impacting community spread of SARS-CoV-2. Method(s): We used an agent-based community assessment model, Propelling Action for Testing and Treatment, to estimate how various strategies of asymptomatic Ag-RDT self-testing of a fixed percentage of persons attending large religious gatherings (10%, 20%, 40%, 100%), in addition to the general underlying level of ongoing symptomatic testing in the population, would impact community transmission of SARS-CoV-2 in 3 contexts (Brazil, Georgia, Zambia). These testing strategies were analyzed with bi-weekly and weekly asymptomatic self-testing in a population with varying levels of vaccine efficacy (low/high), vaccine coverage (10%, 50%, 80%), and reproductive numbers (0.9, 1.2, 1.5, and 2.0) to simulate varying stages of the COVID-19 pandemic. We then performed an economical evaluation of the results from the model to understand the impact and cost-effectiveness of each self-testing strategy at places of worship. Result(s): In each of the epidemic conditions modeled, testing of symptomatic persons at weekly and biweekly frequencies can avert 2%-16% of Brazilian community infections and 31%-45% of infections occurring in places of worship in Brazil. The same is true in Georgia (1%-6% of total infections and 28%-45% place of worship-related infections) and Zambia (2%-21% of total infections and 29%-45% of place of worship related infections) despite differences in the proportion of populations regularly attending places of worship in the 3 countries. Asymptomatic self-testing in 100% of places of worship in a country result in the greatest percent of infections averted and consistently lands on the cost-effectiveness frontier yet requires a budget 520- 1550x greater than that of symptomatic testing alone. Conclusion(s): Testing of symptomatic persons attending regular religious gatherings have a significant impact on the spread of SARS-CoV-2 in places of worship and can significantly reduce community spread in contexts where population level attendance at religious gatherings is high. Cost-effectiveness analysis from Brazil, Georgia and Zambia modelling results with infections averted within places of worship and total community infections averted assuming a total cost per self-test of $2.50 USD.

COVID-19 community assessment hubs in Ireland: A study of staff and patient perceptions of their value.

BACKGROUND: Critical care bed capacity per capita in Ireland is among the lowest in Europe. The COVID-19 pandemic has put additional strain on an over-stretched healthcare system. COVID-19 community assessment hubs (CAHs) were established to prevent unnecessary admission to acute hospitals and to reduce infection spread. OBJECTIVE: The aim of this study was to assess the effectiveness and acceptability of CAHs and identify how the service might be improved or adapted for possible future use. DESIGN: This was a mixed methods study, incorporating co-design with clinical stakeholders. Data collection was via an online survey and semistructured telephone interviews with staff and patients conducted between January and May 2021. SETTING AND PARTICIPANTS: Thirty-one patients completed the survey and nine were interviewed. Twenty interviews were conducted with staff. RESULTS: The findings suggest that the CAH model was successful in providing a dedicated pathway for assessing patients with COVID-19 symptoms, whilst mitigating the risk of infection. Patients were particularly positive about the timely, comprehensive and holistic care they received, as well as the accessibility of the clinics and the friendly attitudes of the staff. Staff welcomed the training and clinical protocols which contributed to their feelings of safety and competency in delivering care to this cohort of patients. They also highlighted the benefits of working in a multidisciplinary environment. Both staff and patients felt that the hubs could be repurposed for alternative use, including the treatment of chronic diseases. DISCUSSION: This study describes staff and patients' experiences of these hubs. An unexpected outcome of this study is its demonstration of the true value of effective multidisciplinary working, not only for the staff who were deployed to this service but also for the patients in receipt of care in these hubs. CONCLUSION: This multidisciplinary patient-centred service may provide a useful model for the delivery of other services currently delivered in hospital settings. PATIENT OR PUBLIC CONTRIBUTION: An earlier phase of this study involved interviews with COVID-19-positive patients on a remote monitoring programme. The data informed this phase. Several of the authors had worked in the CAHs and provided valuable input into the design of the staff and patient interviews.

Psychotic-like Experiences during COVID-19 Outbreak: A survey from Pakistan

Introduction: Despite the fact that adolescents have been at higher risk of distress during the COVID-19 pandemic, the effect of pandemic on psychotic-like experiences (PLEs) is not well described. Objective(s): The study's objective is to evaluate if PLEs are induced in young individuals aged 18-24 during the pandemic. Method(s):A total of 201 college students from Pakistan (ages 18-24) were recruited for a cross-sectional research. We investigated the incidence of PLEs in Pakistan during the pandemic, their links to socio-demographic factors, COVID-19-related characteristics, depression, anxiety, and sleep difficulties. Community Assessment of Psychic Experience's positive symptom component (CAPE), Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and IBM SPSS 25 were used. Result(s): CAPE-Frequency and CAPE-stress were positively associated with PHQ total (p<0.0010);GAD total (p<0.001);time spent indoors due to COVID-19 (p<0.001). Psychiatric disorder other than bipolar disorder or psychosis (p<0.001 for CAPE-frequency and stress), family history of psychiatric disorders (p<0.001 for CAPE-frequency and stress), chronic medical disease (p=0.021 CAPE-frequency and p=0.026 CAPE-stress), illegal drug usage (p<0.001 for CAPE-frequency and stress) were associated with CAPE-Frequency and CAPE-stress. In linear stepwise regression analysis, the best model predicted CAPE-Frequency explained 77.4% of variance with the following variables: PHQ total (B=0.552, SE= 0.08, t=6.909, p<0.001), GAD total (p<0.001), duration at home (p<0.001), and psychiatric disorder in family (p<0.001). Conclusion(s): PLEs have been linked with anxiety and depression during the pandemic. Individuals with a mental condition, family history of psychiatric disorder, chronic medical illness, illicit drug use, and increased time spent at home experienced more PLEs and stress.

Navajo Nation Stores Show Resilience During COVID-19 Pandemic.

On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention [CDC]/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access.

Implementing the COVID-19 Rapid Community Assessment on Vaccine Confidence: Lessons Learned From Alabama and Georgia.

Engaging communities is a key strategy to increase COVID-19 vaccination. The Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Confidence Rapid Community Assessment Guide was developed for community partners to obtain insights about barriers to COVID-19 vaccine uptake and to engage community partners in designing interventions to build vaccine confidence. In spring 2021, 3 CDC teams were deployed to Alabama and Georgia to conduct a rapid community assessment in selected jurisdictions. Data collection included interviews, listening sessions, observations, and street intercept surveys. We identified 3 facilitators and barriers to vaccine uptake: (1) planning and coordination, (2) capacity and implementation, and (3) attitudes and beliefs. We found that the use of the rapid community assessment in Alabama and Georgia was feasible to implement, useful in eliciting unique community concerns and dispelling assumptions, and useful in informing intervention strategies. Our results underscore the importance of community engagement in COVID-19 mitigation strategies.

Building the Evidence for a Rights-Based, People-Centered, Gender-Transformative Tuberculosis Response: An Analysis of the Stop TB Partnership Community, Rights, and Gender Tuberculosis Assessment

The global tuberculosis (TB) response has undergone a transformation in recent years. Calls for a paradigm shift have inspired a new focus on the importance of communities, human rights, and gender in the response. This focus has led to new approaches and innovative tools to fight an age-old disease that still affects millions each year. Notable among these tools is the Stop TB Partnership's community, rights, and gender (CRG) assessment. TB civil society and community groups, in partnership with national TB programs and others, have conducted the CRG assessment in 20 countries across four regions. Using the normative right to health framework, this article analyzes the evidence base generated by this assessment to understand the communities, legal environments, and gender dynamics at the heart of the epidemic. It describes an array of issues revealed by the assessment findings, including limited access to health services, disease-based discrimination, lack of privacy protections, and the impact of patriarchal norms on women affected by TB. Finally, this article considers how to strengthen the CRG assessment and how countries affected by TB and their donors and technical partners can leverage its findings in line with the Sustainable Development Goals and the political declaration from the first-ever United Nations High-Level Meeting on Tuberculosis.

Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit.

BACKGROUND: Assessment of possible infection with SARS-CoV-2, the novel coronavirus responsible for COVID-19 illness, has been a major activity of infection services since the first reports of cases in December 2019. OBJECTIVES: We report a series of 68 patients assessed at a Regional Infection Unit in the UK. METHODS: Between 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. RESULTS: Patients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID-19. Microbiological diagnoses included SARS-CoV-2, mycoplasma pneumonia, influenza A, non-SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty-eight received antimicrobials, 15/68 were admitted, 5 due to inability to self-isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials. CONCLUSIONS: The majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID-19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.