Mental health-related healthcare service utilisation and psychotropic drug dispensation trends in British Columbia during COVID-19 pandemic: a population-based study.

Background: The impact of the COVID-19 pandemic on the population's mental health is vital for informing public health policy and decision-making. However, information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is limited. Aims: We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia, Canada, during the COVID-19 pandemic compared with the prepandemic period. Methods: We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits, emergency department visits, hospital admissions and psychotropic drug dispensations. We examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic period). In addition, we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic, stratified by year, sex, age and condition. Results: By late 2020, except for emergency department visits, utilisation of healthcare services recovered to prepandemic levels. Between 2019 and 2021, the monthly average rate for overall mental health-related outpatient physician visits, emergency department visits and psychotropic drug dispensations increased significantly by 24%, 5% and 8%, respectively. Notable and statistically significant increases were observed among 10-14 year-olds (44% in outpatient physician visits, 30% in emergency department visits, 55% in hospital admissions and 35% in psychotropic drug dispensations) and 15-19 year-olds (45% in outpatient physician visits, 14% in emergency department visits, 18% in hospital admissions and 34% in psychotropic drug dispensations). Additionally, these increases were more prominent among females than males, with some variation for specific mental health-related conditions. Conclusions: The increase in mental health-related healthcare service utilisation and psychotropic drug dispensations during the pandemic likely reflects significant societal consequences of both the pandemic and pandemic management measures. Recovery efforts in British Columbia should consider these findings, especially among the most affected subpopulations, such as adolescents.

US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys.

BACKGROUND: Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. OBJECTIVE: This study aimed to define individuals' lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. METHODS: US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. RESULTS: There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). CONCLUSIONS: A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted.

Comparative transmission of SARS-CoV-2 Omicron (B.1.1.529) and Delta (B.1.617.2) variants and the impact of vaccination: national cohort study, England.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (B.1.1.529) rapidly replaced Delta (B.1.617.2) to become dominant in England. Our study assessed differences in transmission between Omicron and Delta using two independent data sources and methods. Omicron and Delta cases were identified through genomic sequencing, genotyping and S-gene target failure in England from 5-11 December 2021. Secondary attack rates for named contacts were calculated in household and non-household settings using contact tracing data, while household clustering was identified using national surveillance data. Logistic regression models were applied to control for factors associated with transmission for both methods. For contact tracing data, higher secondary attack rates for Omicron vs. Delta were identified in households (15.0% vs. 10.8%) and non-households (8.2% vs. 3.7%). For both variants, in household settings, onward transmission was reduced from cases and named contacts who had three doses of vaccine compared to two, but this effect was less pronounced for Omicron (adjusted risk ratio, aRR 0.78 and 0.88) than Delta (aRR 0.62 and 0.68). In non-household settings, a similar reduction was observed only in contacts who had three doses vs. two doses for both Delta (aRR 0.51) and Omicron (aRR 0.76). For national surveillance data, the risk of household clustering, was increased 3.5-fold for Omicron compared to Delta (aRR 3.54 (3.29-3.81)). Our study identified increased risk of onward transmission of Omicron, consistent with its successful global displacement of Delta. We identified a reduced effectiveness of vaccination in lowering risk of transmission, a likely contributor for the rapid propagation of Omicron.

Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021

Background: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.Methods: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.Results: By amending the required changes, we could include a total of 27 874 individuals in the first step of the survey. This number was 27 745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.Conclusion: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

"We need to talk to each other": Crossing traditional boundaries between public health and occupational health to address COVID-19.

Introduction: This study examined how public health (PH) and occupational health (OH) sectors worked together and separately, in four different Canadian provinces to address COVID-19 as it affected at-risk workers. In-depth interviews were conducted with 18 OH and PH experts between June to December 2021. Responses about how PH and OH worked across disciplines to protect workers were analyzed. Methods: We conducted a qualitative analysis to identify Strengths, Weakness, Opportunities and Threats (SWOT) in multisectoral collaboration, and implications for prevention approaches. Results: We found strengths in the new ways the PH and OH worked together in several instances; and identified weaknesses in the boundaries that constrain PH and OH sectors and relate to communication with the public. Threats to worker protections were revealed in policy gaps. Opportunities existed to enhance multisectoral PH and OH collaboration and the response to the risk of COVID-19 and potentially other infectious diseases to better protect the health of workers. Discussion: Multisectoral collaboration and mutual learning may offer ways to overcome challenges that threaten and constrain cooperation between PH and OH. A more synchronized approach to addressing workers' occupational determinants of health could better protect workers and the public from infectious diseases.

[Surveillance for COVID-19 in Japan.]

The COVID-19 pandemic has had a major impact on the approach to global surveillance of infectious diseases. In this paper, among the currently operating surveillance systems in Japan, we focus on the national epidemiological surveillance of infectious diseases（NESID）system and the active epidemiological investigation scheme, both of which operate based the Infectious Diseases Control Law in Japan. This paper also discusses the response to the current pandemic and the future of infectious disease surveillance.

ILLUMINATING THE PATIENT PERSPECTIVE: WHAT HEALTH CARE PROFESSIONALS SHOULD KNOW ABOUT LIVING WITH NONTUBERCULOUS MYCOBACTERIAL LUNG DISEASE

SESSION TITLE: Outcomes in Pneumonia and NTM SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of this survey was to summarize demographic and clinical characteristics and identify patient perspectives in a cohort of people living with nontuberculous mycobacterial (NTM) lung disease to get a better understanding and perspectives of the patient population living with this disease. METHODS: In partnership with the patient advocacy group NTM Info & Research, we created and disseminated a survey to adult patients living with NTM lung disease. Survey participation was voluntary, and no incentives were offered. The survey focused on key clinical characteristics related to NTM lung disease and qualification and ranking of symptoms. Respondents were asked which HCP(s) they accessed for their NTM lung disease care, how their care could be improved, and to what degree the COVID-19 pandemic has affected their care. RESULTS: Respondents’ (N=90) mean age was 61.5 years, and 91.6% identified as female. Two thirds resided in North America. Most 86.4% identified mycobacterium avium complex (MAC) as the strain with which they were infected. Coughing (81.7%) and fatigue (80%) were most frequently reported. Fatigue was ranked as the most bothersome symptom, followed closely by coughing. These data are consistent with previous studies and patient reports, FDA-led Patient-Focused Drug Development (PFDD) meeting data, and a survey conducted by NTM Info & Research in 2019. Nearly all respondents (96.5%) reported accessing a specialty provider for their NTM lung disease. Close to one third (31.6%) accessed care from a respiratory specialist. Approximately half (53.6%) reported that the COVID-19 pandemic did not significantly affect their NTM care. Respondents reported on aspects of their NTM lung disease care that they would like to see improved. Common themes included earlier diagnosis, sooner evaluation by a specialist, shorter treatment courses, and more education about the disease and its treatments. CONCLUSIONS: Fatigue and coughing are both the most reported and the most bothersome symptoms reported by patients with NTM lung disease. Respondents would like to have been diagnosed earlier, have access to more efficacious and shorter courses of treatments, and be provided more information about their disease and the therapies used to treat it. Respondents would also like HCPs to be better educated on these same topics. These data illuminate the patient perspective so that HCPs who treat patients with NTM lung disease may be better informed of patients’ experiences. CLINICAL IMPLICATIONS: Improved understanding of demographics, risk factors, and clinical manifestations of those with NTM lung disease assist in population surveillance and timelier diagnosis of the disease. A better understanding of patients’ concerns, fears, and hopes is crucial for effective shared decision making and creation of individualized care plans. The ultimate goal is to improve outcomes for patients with NTM lung disease. DISCLOSURES: Stock owner relationship with Abbott Laboratories Please note: 10/2018-10/2020 Added 03/16/2022 by Sarah Anderson, value=Stock owner Stock owner relationship with Johnson & Johnson Please note: 10/2018-10/2020 Added 03/16/2022 by Sarah Anderson, value=Stock owner Stock owner relationship with Merck Please note: 10/2018-10/2020 Added 03/16/2022 by Sarah Anderson, value=Stock owner Advisory Committee Member relationship with MannKind Corporation Please note: Feb 2022-Present Added 04/18/2022 by Amy Leitman, value=Travel

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.

COVID-19: National Pandemic Management Strategies and their Efficacies and Impacts on the Number of Secondary Cases and Prognosis: A Systematic Review.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for an acute respiratory disease designated COIVD-19, which has spread throughout the world. Despite all the struggles with this virus, still, the majority of societies are affected by COVID-19, which raises many questions such as are these ways of management enough, which is crucial in order to contain the virus spread, and which is not effective. In this systemic review, we tried to summarize the data on different ways of managing COVID-19 outbreaks. Through understanding the efficacy and downsides of different approaches to manage COVID-19, public health officials, governing bodies, and health care administrators may be better equipped with the tools necessary to best manage COVID-19 and pandemics. Methods: This systematic review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles were selected using several databases PubMed, ScienceDirect, and Google Scholar, all peer-reviewed and published articles from December 1, 2019 to April 23, 2020 that met the inclusion criteria were selected. Results: The majority of the included articles were mathematical modeling, cohort studies (n = 9), cross-sectional (n = 6), and one case series. Most articles originated from China and then Singapore. The measures that have been practiced in these articles consisted of close contact tracing and case isolation, quarantine, strict surveillance, lockdown, and travel surveillance. Conclusions: The most effective approach is at least the combination of case detection and isolation, and contact tracing or containment measures. In the literature, travel controls seem to be ineffective, personal hygiene should be tough and emphasized.

The Performance of Two Rapid Antigen Tests During Population-Level Screening for SARS-CoV-2 Infection.

Background: SARS-CoV-2 antigen assays offer a rapid mean to diagnose and isolate infected individuals. However, their utility in population-level screening is unknown. Objectives: The performance of two antigen tests in detecting SARS-CoV-2 was assessed among individuals randomly selected in the community. Study Design: A prospective study that performed head-to-head comparison of two SARS-CoV-2 antigen assays. Individuals were recruited during community SARS-CoV-2 screening over 10 working days. Demographic and clinical data were collected. Standard Q COVID-19 Ag test, a point-of-care chromatographic assay, was conducted immediately, and then the sample was transported to the virology laboratory to perform PCR and the LIAISON SARS-CoV-2 Ag chemiluminesence immunoassay. Results: respiratory samples from 991 individuals were collected, and 62 were positive by PCR. Inconclusive PCR results were observed in 19 samples and were excluded. The median age of participants was 40.2 years (IQR 32.3-47.8), and 932 (94%) were males. Most (77.4%) of infections were asymptomatic. The sensitivity and the specificity of the LIAISON assay were 43.3% (95%CI 30.6-56.8) and 99.9% (95%CI 99.3-100). The Standard Q assay had lower sensitivity (30.6%, 95%CI 19.6-43.7) but similar specificity (98.8%, 95%CI, 97.8-99.4). Similarly, the LIAISON assay had higher positive predictive value (96.3%, 95%CI 81-99.9% vs. 63.3%, 95%CI, 43.9-80.1%). Both assays performed better in symptomatic patients and among samples with a low-cycle threshold (Ct < 25). Conclusion: In our setting of random community surveillance, rapid antigen testing of nasopharyngeal swabs by either LIAISON SARS-CoV-2 Ag (DiaSorin) or Standard Q COVID-19 Ag (SD Biosensor) was less sensitive to detecting SARS-CoV-2 than the TaqPath COVID-19 RT-PCR.

Changes in the pattern and disease burden of acute respiratory viral infections before and during the COVID-19 pandemic.

OBJECTIVES: We conducted a comparative analysis of the differences in the incidence of 8 acute respiratory viruses and the changes in their patterns before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Three sentinel surveillance systems of the Korea Disease Control and Prevention Agency and data from the Health Insurance Review and Assessment Service were analyzed. The average numbers of reported cases and the related hospital admissions and outpatient data were compared between April 2018-2019 and 2020-2021. Changes in the disease burden and medical expenditures between these 2 time periods were evaluated. RESULTS: During the COVID-19 pandemic, the number of reported cases of all acute respiratory viral infections, except for human bocavirus, decreased significantly. Data from the Health Insurance Review and Assessment Service also showed decreases in the actual amount of medical service usage and a marked reduction in medical expenditures. CONCLUSION: Non-pharmacological interventions in response to COVID-19 showed preventive effects on the transmission of other respiratory viruses, as well as COVID-19. Although COVID-19 had a tremendous impact on society as a whole, with high social costs, there were also positive effects, such as a reduction in the incidence of acute respiratory viral infections.

Precision health diagnostic and surveillance network uses S gene target failure (SGTF) combined with sequencing technologies to track emerging SARS-CoV-2 variants.

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic revealed a worldwide lack of effective molecular surveillance networks at local, state, and national levels, which are essential to identify, monitor, and limit viral community spread. SARS-CoV-2 variants of concern (VOCs) such as Alpha and Omicron, which show increased transmissibility and immune evasion, rapidly became dominant VOCs worldwide. Our objective was to develop an evidenced-based genomic surveillance algorithm, combining reverse transcription polymerase chain reaction (RT-PCR) and sequencing technologies to quickly identify highly contagious VOCs, before cases accumulate exponentially. METHODS: Deidentified data were obtained from 508,969 patients tested for coronavirus disease 2019 (COVID-19) with the TaqPath COVID-19 RT-PCR Combo Kit (ThermoFisher) in four CLIA-certified clinical laboratories in Puerto Rico (n = 86,639) and in three CLIA-certified clinical laboratories in the United States (n = 422,330). RESULTS: TaqPath data revealed a frequency of S Gene Target Failure (SGTF) > 47% for the last week of March 2021 in both, Puerto Rico and US laboratories. The monthly frequency of SGTF in Puerto Rico steadily increased exponentially from 4% in November 2020 to 47% in March 2021. The weekly SGTF rate in US samples was high (>8%) from late December to early January and then also increased exponentially through April (48%). The exponential increase in SGFT prevalence in Puerto Rico was concurrent with a sharp increase in VOCs among all SARS-CoV-2 sequences from Puerto Rico uploaded to Global Influenza Surveillance and Response System (GISAID) (n = 461). Alpha variant frequency increased from <1% in the last week of January 2021 to 51.5% of viral sequences from Puerto Rico collected in the last week of March 2021. CONCLUSIONS: According to the proposed evidence-based algorithm, approximately 50% of all SGTF patients should be managed with VOCs self-quarantine and contact tracing protocols, while WGS confirms their lineage in genomic surveillance laboratories. Our results suggest this workflow is useful for tracking VOCs with SGTF.

First report and genome sequencing of SARS-CoV-2 in a cat (Felis catus) in Colombia

Introduction. SARS-CoV-2 is a virus of zoonotic origin that can bind to ACE2 receptors on the cells of various mammals, including animals such as cats, dogs, ferrets, hyenas, coatis, otters, big cats, non-human primates, white-tailed deer, manatees, hippopotamuses, hamsters, and minks. Studies have shown that the virus can circulate among minks and Syrian hamsters, mutate, lead to animal-to-human zoonotic jump, and further onward spread between humans. The transmission of the virus from humans to cats is evident, but the virus's return to humans has not yet been demonstrated. Infection in pets is unusual, and there are few human-to-pet transmission reports worldwide. Objective. To describe the SARS-CoV-2 infection in Cordoba, Colombian Caribbean, a domestic animal. Methods. A cross-sectional molecular surveillance study was carried out, oral and rectal swabs were taken from cats and dogs living with people diagnosed with COVID-19. Results. SARS-CoV-2 was found in a cat living with a person with COVID-19. Genome sequencing showed that the B.1.111 lineage caused the infection in the cat. The owner's sample could not be sequenced. The lineage is predominant in Colombia, and this variant is characterized by the presence of the D614D and Q57H mutation. Conclusion.This is the first report on sequencing the SARS-CoV-2 genome in a cat in Colombia shows the importance of some interesting SARS-CoV-2 mutations in promoting the transmissibility of this new coronavirus in companion animals. Lack of information Human-to-cat or cat-to-human infection. © 2022, Fundacao Oswaldo Cruz. All rights reserved.

2020 webPOISONCONTROL data summary.

INTRODUCTION: Increasing use of the internet for health information has decreased utilization of traditional telephone-based poison centers in the United States. webPOISONCONTROL®, a browser-based tool and app was launched to meet the growing demand for online, personalized recommendations for human poison exposures. This study was conducted to characterize webPOISONCONTROL cases and highlight its potential for real-time monitoring of poisoning. METHODS: Case data for all completed, nonduplicated public cases entered in 2020 were analyzed using a custom Qlik Sense dashboard. RESULTS: Of the 156,202 cases, 52.9% occurred in children younger than 4 years. Most cases (109,057, 69.8%) were initially triaged to home, 28.4% were advised to call Poison Control, and 1.7% were referred to the ED. Follow-up was available for 33.3% of home-triaged cases; 1.7% of those had a change in triage recommendation. Pharmaceuticals were implicated in 41.5% of cases (nonpharmaceuticals in 58.5%). Ingestion was the most common route (88.4%, 138,012). One-time double dose therapeutic error cases were implicated in 17,901 cases (27.6% of pharmaceutical cases). Cosmetics (13.9%) and cleaning substances (12.9%) were the most frequent substance categories. Melatonin was the most frequently implicated generic substance (4.5% of cases). Most (72.0%) cases had no effect (21.4%), a minor effect (3.9%) or were minimally toxic with unknown outcome (46.7%). There were no deaths, 17 major outcomes (0.01%), and 26.7% of cases had potentially toxic exposures with no outcome determination. In 2020, webPOISONCONTROL handled 7.3% as many human poison exposure cases as were reported to U.S. phone-based poison centers. Online cases are skewed towards younger ages (53% in children younger than 4 years vs 37% of phone-based cases) and towards nonpharmaceuticals (58.5% vs 43.5%). Near real-time data visualizations enabled detection of COVID-19-related increases in exposures to hand sanitizers and cleaners, illustrating the public health surveillance and hazard detection capabilities of webPOISONCONTROL. CONCLUSION: The webPOISONCONTROL tool provides a safe, quick and fully-automated alternative to those who are unable or unwilling to use the telephone to call a traditional poison center.

'Stay at home ': exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK.

OBJECTIVES: The first UK national lockdown began on 23 March 2020, in response to the COVID-19 pandemic, and led to reduced STI/HIV service provision in the UK. We investigated sexual behaviour, use and need for sexual healthcare during the pandemic. METHODS: Participants (N=2018), including men (cis/transgender), transwomen and gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth, completed an online cross-sectional survey (23 June 2020-14 July 2020), in response to adverts on social media and dating apps.Sexual behaviour, service use and unmet need for STI testing (any new male and/or multiple condomless anal sex (CAS) partners without STI testing) in the 3 months since lockdown began were examined and compared using multivariable analyses with an equivalent 3-month period in a 2017 survey (N=1918), conducted by the same research team. RESULTS: Since lockdown began, 36.7% of participants reported one or more new partners, 17.3% reported CAS with multiple partners, 29.7% HIV testing (among 1815 of unknown/negative status), 24.9% STI testing and 15.4% using pre-exposure prophylaxis (PrEP).Since lockdown began, 25.3% of participants had unmet need for STI testing. This was more likely among Asian versus white participants (adjusted OR (aOR)=1.76, (1.14 to 2.72), p=0.01); for participants living in Scotland (aOR=2.02, (1.40 to 2.91), p<0.001) or Northern Ireland (aOR=1.93, (1.02-3.63), p=0.04) versus England; and for those living with HIV (aOR=1.83, (1.32 to 2.53), p<0.001).Compared to 2017, the equivalent 2020 subsample were less likely to report new male partners (46.8% vs 71.1%, p<0.001), multiple CAS partners (20.3% vs 30.8%, p<0.001) and have unmet need for STI testing (32.8% vs 42.5%, p<0.001) in the past 3 months. CONCLUSIONS: We found potential for ongoing STI/HIV transmission among men who have sex with men during the initial UK lockdown, despite reduced sexual activity, and inequalities in service access. These findings will support public health planning to mitigate health risks during and after the COVID-19 response.

Assessing the Electronic Evidence System Needs of Canadian Public Health Professionals: Cross-sectional Study.

BACKGROUND: True evidence-informed decision-making in public health relies on incorporating evidence from a number of sources in addition to traditional scientific evidence. Lack of access to these types of data as well as ease of use and interpretability of scientific evidence contribute to limited uptake of evidence-informed decision-making in practice. An electronic evidence system that includes multiple sources of evidence and potentially novel computational processing approaches or artificial intelligence holds promise as a solution to overcoming barriers to evidence-informed decision-making in public health. OBJECTIVE: This study aims to understand the needs and preferences for an electronic evidence system among public health professionals in Canada. METHODS: An invitation to participate in an anonymous web-based survey was distributed via listservs of 2 Canadian public health organizations in February 2019. Eligible participants were English- or French-speaking individuals currently working in public health. The survey contained both multiple-choice and open-ended questions about the needs and preferences relevant to an electronic evidence system. Quantitative responses were analyzed to explore differences by public health role. Inductive and deductive analysis methods were used to code and interpret the qualitative data. Ethics review was not required by the host institution. RESULTS: Respondents (N=371) were heterogeneous, spanning organizations, positions, and areas of practice within public health. Nearly all (364/371, 98.1%) respondents indicated that an electronic evidence system would support their work. Respondents had high preferences for local contextual data, research and intervention evidence, and information about human and financial resources. Qualitative analyses identified several concerns, needs, and suggestions for the development of such a system. Concerns ranged from the personal use of such a system to the ability of their organization to use such a system. Recognized needs spanned the different sources of evidence, including local context, research and intervention evidence, and resources and tools. Additional suggestions were identified to improve system usability. CONCLUSIONS: Canadian public health professionals have positive perceptions toward an electronic evidence system that would bring together evidence from the local context, scientific research, and resources. Elements were also identified to increase the usability of an electronic evidence system.

Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA.

We aimed to generate an unbiased estimate of the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 4 urban counties in Utah, USA. We used a multistage sampling design to randomly select community-representative participants >12 years of age. During May 4-June 30, 2020, we collected serum samples and survey responses from 8,108 persons belonging to 5,125 households. We used a qualitative chemiluminescent microparticle immunoassay to detect SARS-CoV-2 IgG in serum samples. We estimated the overall seroprevalence to be 0.8%. The estimated seroprevalence-to-case count ratio was 2.5, corresponding to a detection fraction of 40%. Only 0.2% of participants from whom we collected nasopharyngeal swab samples had SARS-CoV-2-positive reverse transcription PCR results. SARS-CoV-2 antibody prevalence during the study was low, and prevalence of PCR-positive cases was even lower. The comparatively high SARS-CoV-2 detection rate (40%) demonstrates the effectiveness of Utah's testing strategy and public health response.