Monitoring the Temporal Trajectory of Sars-Cov-2 in Hong Kong - Daily Antigen Rapid Testing Surveillance (Darts) System

Intro: The number of PCR-confirmed cases may serve poorly as a surveillance data for a representative disease activity, due to its bias towards symptomatic cases or people having an identifiable risk exposure, and the high dependency on changing testing policy. We reported a large-scale ad-hoc community surveillance initiative, Daily Antigen Rapid Testing Surveillance (DARTS) System, using self-performed rapid antigen tests(RAT). Method(s): A representative cohort of 10000+ individuals was enrolled over the territory. Participants were divided into 7 sub-cohorts to achieve a rolling schedule with 1400+ individuals on a daily basis. Participant performed the RAT regularly irrespective of symptom or exposure history, with a self-sampled throat-and-nasal swab. RAT result and photo were reported on the same day of testing through an online platform. Daily point prevalence was disseminated on a real-time dashboard to inform the situation awareness(https://covid19.sph.hku.hk/dashboard). Finding(s): Since its launch during the peak of the fifth wave in March 2022, the system has tracked the changing trajectory of different phases of the Omicron pandemic, including the rapidly subsiding daily prevalence from an initial high value of 12.7% (8.4-18.7) in early March to a baseline of 0.6% (0.2-1.4) in early April, maintained with a non-zero baseline (0.1-0.3%) over May, and subsequent stepwise increase to 0.5% (0.2-1.2) in June. The reproduction number increased from 0.66(0.63,0.70) to 1.23(1.14,1.33) from March to June, signifying the gradual increase of residual Omicron transmission. Conclusion(s): Our DARTS system has demonstrated the feasibility of a participatory surveillance system using self-performed RAT, and its utility as an ad-hoc surveillance to timely reflect the rapidly changing epidemic trajectory. Regular testing irrespective of symptom and exposure risk helps to give more representative picture, including subclinical cases who also carried an implication of disease transmission. The use of RAT also helps to avoid the constraint of manpower and testing capacity, and has been quickly adopted for case definition.Copyright © 2023

Validation of Commercial Kits Using Standard ICMR Protocol

Background: SARS-CoV-2 highlighted worldwide, the need of enhance testing capacity. Government of India, under Atmanirbhar Bharat provided platform to private/public companies to develop and manufacture diagnostic reagents /kits for SARS CoV 2 testing. Objective(s): * Performance evaluation of commercial kits. * Handholding of private/public companies to improve the kits quality for its diagnostic accuracy to use for Covid 19 diagnosis Material(s) and Method(s): The SOP for the validation of diagnostic kits were prepared and approved by ICMR technical committee. The ICMR NIV single tube assay was used as gold slandered. The panels of known positives and negatives were prepared. Validation of commercially developed RT-PCRs, RNA extraction kits and virus transport medium were undertaken. The sensitivity and specificity of the kit were calculated and reported as per ICMR's acceptance. Result(s): Real time RT-PCR kits evaluation: Total 165 kits were evaluated, which includes 12 LAMP assay. Among domestic kits, 31 kits were satisfactory while 83 were not satisfactory. Among the imported kits, 25 kits were satisfactory while 26 were not satisfactory. RNA extraction kits evaluation:- Total 157 kits were evaluated, Among domestic kits, 57 kits were satisfactory while 53 were not satisfactory. Among the imported kits, 31 kits were satisfactory and 17 were not satisfactory. VTM kits evaluated = Total 89 kits were evaluated among which nine kits were imported while 80 kits were of domestic origin. Performance of 10 kits was not satisfactory. Conclusion(s): Kit validation is important to access the quality of commercial kits and to enhanced the testing capacity exponentially in country.

Impact of the COVID-19 pandemic on suspected lungcancer referrals and subsequent lung cancer diagnosis atNorth Bristol NHS Trust

Introduction: COVID-19 posed an unprecedented challenge to NHS services. A report by the UK Lung CancerCoalition in October 2020 suggested lung cancer was disproportionately affected,due to overlapping symptoms withCOVID-19 and pressures on respiratory services during the pandemic. We investigated the impact of COVID-19 onlung cancer diagnoses in our hospital. Method(s): We reviewed all two-week-wait (TWW) suspected lung cancer referrals over two periods;March 2020-February 2021 (pandemic cohort) and January-December 2019 (pre-COVID cohort). Result(s): Overall, there were fewer referrals to the lung cancer TWW service in 12 months of the COVID pandemiccompared with 2019 (469 vs 502). Reductions in referral numbers correlated with local peaks in COVID diagnoses,(see Figure 1, noting reduced COVID testing capacity during the early pandemic). A similar proportion of referralsresulted in a diagnosis of lung cancer in both groups (142/469;30.8% vs 150/502;29.8%, p=0.32). Of peoplediagnosed with lung cancer during the COVID pandemic, more were performance status 2 or higher compared with pre-pandemic (60/142;42.3% vs 35/137;25.6%, p=0.003). Additionally, more stage IV (61/141;61% vs 48/140;34.3%) and fewer stage I (36/141;25.5% vs 43/140;30.7%) tumours were diagnosed (p=0.046) in the pandemic cohort. Conclusion(s): Our observations replicate national patterns and highlight the serious impact the pandemic has had. Several unavoidable factors were responsible: similarity of cancer and COVID symptoms,reduced access to healthcare due to competing pressures, and 'shielding' of people at high risk of lung cancer impacting on number of healthcare interactions.

Improving societal benefit through transformative consumer research: A descriptive review

This paper assesses the societal benefit of transformative consumer research (TCR) through a descriptive review of articles published in the special issues associated with the TCR conferences, held every two years from 2009 to 2021. Frequency analysis and directed content analysis reveal (1) various societal benefits (knowledge, enhanced awareness, capacity building, and recommendations for improvement or redirection), (2) facilitators and barriers for solution implementation (e.g., definition of a problem-solving orientation to research problems, collaboration with practitioners, and testing and refining of solutions), and (3) well-being issues over time (e.g., climate change and sustainability education, food wastage reduction, healthy food consumption and production, and vulnerability during the COVID-19 pandemic). This research contributes to the literature in four ways by (1) synthesizing the types and natures of societal benefits of TCR, (2) identifying the most discussed consumer well-being issues over time, (3) assessing the barriers and facilitators for the implementation of solutions that influence societal benefits, and (4) providing a research agenda for improving consumer well-being and enhancing societal benefit. © 2023 Elsevier Inc.

Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT)

PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHOD(S): We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator;and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test;2) completed test. Results by intervention will be assessed at 12 months. RESULT(S): Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients "engaged" with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening.

Covid-19 X-Ray Scan Images Classification and Detection by Residual Based Deep Learning

Infectious disease Covid-19 is a fast-spreading virus that infects both human beings and animals. As a result of this condition, animals may get infected with the virus. This fatal viral illness has an impact on not only the day-to-day lives of people but also their health and the economy of the nation in which they live. There is currently no vaccination available for COVID-19, regardless of the fact it is a global epidemic that is growing rapidly across the globe. Since then, the virus has swiftly spread over the globe, turning into a pandemic (WHO, 2020), with the number of reported cases and fatalities connected with them continuing to rise on a daily basis. At the moment, more research on an efficient screening technique is necessary in order to diagnose instances of the virus and separate those who have been infected from the rest of the population. To limit the spread of the fatal virus and defend themselves from it, medical practitioners and specialists in many nations across the world are introducing multifunction testingto improve their treatment regimen and testing capacity. This is currently being done to enhance their capacity to detect the infection. When COVID-19-infected patients were studied in a clinical area, it was observed that they were often infected with respiratory illnesses. This conclusion was reached as a result of the findings of the study. Imaging techniques such as chest x- rays (also known as radiography) and chest CT scans are more accurate than other methods when it comes to detecting issues that are connected to the lungs. A thorough chest x-ray is less expensive than a chest CT, albeit. The most successful method of machine learning uses deep learning technologies. This is a great tool for analysing a large number of chest x-ray images, which could significantly affect the Covid-19 screening process. Copyright © 2022, Anka Publishers. All rights reserved.

Feasibility and Acceptability of Public-Private Partnership Model for Combatting COVID-19 in Kisumu, Kenya

Introduction/ Background: The effect of COVID-19 on weak health systems has been devastating, especially in sub-Saharan Africa. The private sector can provide complementary support to address health crises within vulnerable public health systems. This paper provides a qualitative description on the Feasibility and Acceptability of the Public-Private Partnership Model in combating COVID-19. Methods: We carried out a feasibility and acceptability study of a unique Public-Private Partnership Model. COVID-19 samples were collected from participating sites and tested at centralized government referencing laboratory at the Kenya Medical Research Institute. We conducted a qualitative study using an explanatory research design in 5 participating health facilities in Kisumu County. We did in-depth interviews (n=49) with purposively selected key policymakers, health workers and patients. Interviews were audiorecorded. Data was transcribed in verbatim form and analyzed thematically using Nvivo 11 Results: Notable advantages of the Public-Private Partnership Model included: 1. The model helped complement tasks between Kisumu Department of Health and public and private healthcare providers, with support from an NGO (PharmAccess). 2. The model increased testing capacity at the county level by increasing the number of sample collection sites. 3. COVID-19 data digitalization, and semi-real time digital dashboards aided reporting of COVID-19 results needed for immediate contact tracing. 4. The model increased capacity building of the health workers improved adherence to MoH guidelines. Inhibitors included lack of comprehensive policies on communication channels and inadequate financial resources. Impact: The Partnership increased health workers knowledge and testing capacity enabling majority of the Kisumu population to access COVID-19 testing in addition to digitalization of COVID-19 data for real time transmission. Conclusion: A digitally supported Public-Private Partnership Model for combatting COVID-19 is feasible and acceptable by all participating stakeholders. This model is scalable and currently being deployed to 13 additional counties in Kenya.

An evaluation index system for regional mobile SARS-CoV-2 virus nucleic acid testing capacity in China: a modified Delphi consensus study.

BACKGROUND: Large-scale detection has great potential to bring benefits for containing the COVID-19 epidemic and supporting the government in reopening economic activities. Evaluating the true regional mobile severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus nucleic acid testing capacity is essential to improve the overall fighting performance against this epidemic and maintain economic development. However, such a tool is not available in this issue. We aimed to establish an evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity and provide suggestions for improving the capacity level. METHODS: The initial version of the evaluation index system was identified based on massive literature and expert interviews. The Delphi method questionnaire was designed and 30 experts were consulted in two rounds of questionnaire to select and revise indexes at all three levels. The Analytic Hierarchy Process method was used to calculate the weight of indexes at all three levels. RESULTS: The evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity, including 5 first-level indexes, 17 second-level indexes, and 90 third-level indexes. The response rates of questionnaires delivered in the two rounds of consultation were 100 and 96.7%. Furthermore, the authority coefficient of 30 experts was 0.71. Kendall's coordination coefficient differences were statistically significant (P < 0.001). The weighted values of capacity indexes were established at all levels according to the consistency test, demonstrating that 'Personnel team construction' (0.2046) came first amongst the five first-level indexes, followed by 'Laboratory performance building and maintenance' (0.2023), 'Emergency response guarantee' (0.1989), 'Information management system for nucleic acid testing resources' (0.1982) and 'Regional mobile nucleic acid testing emergency response system construction' (0.1959). CONCLUSION: The evaluation system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity puts forward a specific, objective, and quantifiable evaluation criterion. The evaluation system can act as a tool for diversified subjects to find the weak links and loopholes. It also provides a measurable basis for authorities to improve nucleic acid testing capabilities.

Estimating unconfirmed COVID-19 infection cases and multiple waves of pandemic progression with consideration of testing capacity and non-pharmaceutical interventions: A dynamic spreading model.

The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has unique epidemiological characteristics that include presymptomatic and asymptomatic infections, resulting in a large proportion of infected cases being unconfirmed, including patients with clinical symptoms who have not been identified by screening. These unconfirmed infected individuals move and spread the virus freely, presenting difficult challenges to the control of the pandemic. To reveal the actual pandemic situation in a given region, a simple dynamic susceptible-unconfirmed-confirmed-removed (D-SUCR) model is developed taking into account the influence of unconfirmed cases, the testing capacity, the multiple waves of the pandemic, and the use of non-pharmaceutical interventions. Using this model, the total numbers of infected cases in 51 regions of the USA and 116 countries worldwide are estimated, and the results indicate that only about 40% of the true number of infections have been confirmed. In addition, it is found that if local authorities could enhance their testing capacities and implement a timely strict quarantine strategy after identifying the first infection case, the total number of infected cases could be reduced by more than 90%. Delay in implementing quarantine measures would drastically reduce their effectiveness.

ONE HEALTH APPROACHES TO COVID-19 IN SOUTH AFRICA

Among African countries, South Africa has recorded the highest number of cases while also having conducted the highest number of tests. The higher case numbers reported may be a function of the higher testing capacity compared to other African countries. Initially testing capacity was inadequate necessitating the need to co-opt in the National Veterinary Institute at Onderstepoort to cope with the testing requirements. This was a practical demonstration of the One Health approach to handling COVID-19. It is shown how the country has ably managed the disease in humans from testing right through to vaccination. The few occurrences of SARs-CoV-2 infections in animals are also reported. Apart from searching for and discovering new variants of both interest and concern, a number of research focus areas have also been identified.

Simulation models to predict biochemistry test capacity in Covid-19 pandemic surge capacity planning in tertiary care centres

Background-aim: The COVID-19 pandemic has re-emphasized the need for the timely delivery of clinical laboratory results to support optimal patient care. The objective of this study was to determine if current instrumentation in Saskatoon hospital chemistry laboratories could accommodate the anticipated COVID workload in addition to non-COVID testing for the existing acute care hospitals and proposed field hospitals. Methods: A simulation model was utilized to assess workload and turn-around-time (TAT) capacity for pre-analytic, total analytic, chemistry, ion-selective-electrode and immunoassay testing to accommodate an expanded COVID workload. Anticipated COVID patient numbers and a COVID specific test menu were incrementally introduced into a 24 hour pre-COVID testing workload. The impact of field hospital location, courier schedule and daily instrument maintenance schedule were also considered when calculating a TAT from specimen collection to result reporting. Results: Instrumentation throughput, scheduled times for instrument daily maintenance and the time of day when the specimen surge is received in the laboratory were found to be significant predictors of laboratory’s ability to accommodate anticipated COVID workload. Courier schedule and proximity of the field hospital to the laboratory significantly influenced the TAT for field hospital testing. Conclusions: A simulation model is a helpful tool to provide useful information for optimal delivery of multi-site clinical laboratory services during the COVID-19 pandemic.

ANATIONAL SEROPREVALENCE SURVEY of SARS-CoV-2 ANTIBODIES in SOUTH AFRICA: 2020-2021

Background: South Africa is one of the African countries most affected by the COVID-19 pandemic. SARS-CoV-2 seroprevalence surveys provide valuable epidemiological information given the existence of asymptomatic cases. We report the findings of the first nationwide household-based population estimates of SARS-CoV-2 seroprevalence among people aged 12 years and older in South Africa. Methods: The survey used a cross-sectional multi-stage stratified cluster design undertaken over two separate time periods (November 2020-February 2021 and April-June 2021) which coincided with the second and third waves of the pandemic in South Africa. The Abbott® and Euroimmun® ani-SARS CoV-2 antibody assays were used to test for SARS-CoV-2 antibodies, the latter being the final result. The survey data was weighted with final individual weights benchmarked against 2020 mid-year population estimates by age, race, sex, and province. Frequencies were used to describe characteristics of the study population and SARS-CoV-2 seroprevalence. Bivariate and multivariate logistics regression analysis were used to identify factors associated with SARS-CoV-2 seropositivity. Results: 13640 participants gave a blood sample. The SARS-CoV-2 seroprevalence using the Euroimmun assay was 19.6% (95% CI 17.9-21.3) over the study period, translating to an estimated 8 675 265 (95% CI 7 508 393-9 842 137) estimated infections among people aged 12 years and older across South Africa by June 2021. Seroprevalence was higher in the Free State (26.8%), and Eastern Cape (26.0%) provinces (Figure). Increased odds of seropositivity were associated with prior PCR testing [aOR=1.29 (95% CI: 0.99-1.66)], being female [aOR=1.28 (95% CI 1.00-1.64), p=0.048] and hypertension, [aOR=1.28 (95% CI 1.00-1.640, p=0.048]. Conclusion: These findings highlight the burden of infection in South Africa by June 2021, and support testing strategies that focus on individuals with known exposure or symptoms since universal testing is not feasible. Females and younger people were more likely to be infected suggesting need for additional strategies targeting these populations. The estimated number of infections was 6.5 times higher than the number of SARS-CoV-2 cases reported nationally, suggesting that the country's testing strategy and capacity partly explain the dynamics of the pandemic. It is therefore essential to bolster testing capacity and to rapidly scale up vaccinations in order to contain the spread of the virus in the country.

UTILITY of COVID-19 POINT-OF-CARE ANTIGEN TESTS in LOW-MIDDLE INCOME SETTINGS

Background: Access to SARS-CoV-2 polymerase chain reaction (PCR) testing is a bottleneck globally, especially in low-and middle-income countries (LMICs). Reliable point-of-care (POC) diagnostics for coronavirus disease 2019 (COVID-19) are cheaper and easier to scale-up than PCR especially in LMICs, and will facilitate interruption of transmission. We report the field-based effectiveness of rapid point-of-care (POC) antigen COVID-19 tests during the beta and delta waves, in South Africa. Methods: We enrolled symptomatic, ambulatory persons under investigation (PUIs) aged 18 years and older, presenting for SARS-CoV-2 diagnosis at public health facilities in three provinces, South Africa. All patients completed a questionnaire regarding symptoms. Nasopharyngeal swabs were taken and processed for SARS-CoV-2 PCR testing using either GeneXpert (Cepheid, USA), or with a manual assay (ThermoFisher TaqPath assay or Seegene Allplex assay) on a real-time PCR platform at routine, accredited National Health Laboratory Service laboratories, as per routine national protocols. Concomitantly, trained study staff performed three facility-based POC antigen tests on a nasal/nasopharyngeal swab, as recommended by the manufacturer. Asymptomatic contacts of people with confirmed COVID-19 were recruited into the asymptomatic study arm and rapid tests and PCR were performed. The sensitivity (S), specificity (Sp), positive (PPV) and negative predictive (NPV) values of tests for PUIs and contacts were calculated using PCR as the reference standard. Results: Between Oct 2020-2021 1816 participants were enrolled;472 (26%) tested PCR or rapid test positive;235 positives (49.8%) and 532 negatives were followed up at 5-14 days;574 asymptomatic contacts were enrolled, of which 21 (3.7%) were PCR positive. Performance of the three antigen tests are shown in Table 1∗. Conclusion: In a real world setting, during the beta and delta waves, compared with PCR the sensitivity of rapid antigen tests ranged from 35-68%. This may reflect low viral loads at diagnosis. Further work will compare antigen test performance in patients with high versus lower cycle threshold (Ct) values. Meanwhile, PCR testing capacity needs urgent scale-up in LMICs and improved POC diagnostics are needed to facilitate COVID-19 diagnosis in LMICs.

Detection Capability Prediction Based on Broad Learning System during the COVID-19 Pandemic

The greatest threat to global health is the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) currently. COVID-19 was declared as a global pandemic on March 11, 2020. For this highly contagious disease, the way of human-to-human transmission has forced us to implement large-scale COVID-19 testing worldwide. On February 21, 2021, 120 million people have already undergone COVID-19 testing. The large scale of COVID-19 testing has driven innovation in strategies, technologies, and concepts for managing public health testing. It is an unprecedented global testing program. In this study, we describe the role of COVID-19 testing while establishing a comprehensive and validated research dataset that includes data from 189 countries and 893 regions between August 8, 2019, and March 3, 2021. Through our analysis, we observed that the more COVID-19 testings provided, the more confirmed cases were detected. The availability of large-scale COVID-19 testing is indispensable to fully control the outbreak, as it is the main way to cut off the source of COVID-19 transmission. Then we used this dataset to predict the COVID-19 detection capabilities of each country by Machine Learning, Ensemble Learning, and Broad Learning System. Experimental results show that Broad Learning System significantly outperformed the Machine Learning. The R2 of predicted the ability of the COVID-19 testing can reach 0.999921. © 2021 IEEE.

Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations

Purpose: We partnered with a local Federally Qualified Health Center (FQHC) to test implementation of evidence-based interventions (EBI) promoting Fecal Immunochemical Test (FIT) CRC screening in an environment in which colonoscopy has been the prevailing screening strategy. We report on implementation adaptations and preliminary results. Background: Sociocultural and medical concerns are barriers to colonoscopy uptake in some populations. An additional barrier to CRC screening is system level capacity for colonoscopy that results in a back log of cases and long wait times. With Covid-19, the additional backlog in overdue CRC screening has underscored the need to expand FIT testing capacity to address screening needs and to pre-empt further racial/ethnic and SES disparities in CRC outcomes. This trial tests the unique and additive value of multiple EBIs for increasing CRC screening (primarily through FIT testing, but also colonoscopy when indicated) while evaluating the success of implementing these approaches. EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and assistance from community health workers. Methods: Participants (3500), ages 45-75, were identified from a large FQHC in New Haven, CT and determined to be overdue for CRC screening. Participants were randomly assigned to one of the four arms of the study: 1) Provider reminder (overdue for CRC screening) only;2) Provider Reminder + SDOH short message and one-size-fits all link to resources;3) Provider Reminder + SDOH short message and offer for individualized navigation (trained navigators from local community) to address SDOH and other barriers;4) Provider Reminder + offer to participate in a CRC educational program as phase 2 of the NCI's Screen to Save program (not an EBI). Preliminary data on uptake of CRC screening will be presented. Results: With input from stakeholders, we have: 1) lowered age eligibility from 50 to 45 to align with new guidelines;2) expanded the target population to 2 additional satellite clinics, more than doubling the proposed study enrollment;3) incorporated design changes in the patient reminders. The collaboration between research team and clinician stakeholders has been critical in minimizing disruptions to clinical workflow while assuring fidelity to the evidence-based interventions. Preliminary outcomes (within one month of intervention) on uptake of intervention across the 4 arms of the study, i.e., referral for CRC screening and test completion will be presented. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx and/or low socioeconomic status individuals stem from the disproportionate burden of SDOH barriers. Findings will inform primary care setting implementation of EBIs to address the anticipated increase in disparities in CRC screening, exacerbated by COVID-19 changes in health care access and utilization, as well as the increased demand associated with the change in guidelines.

The Impact of COVID-19 Response on Infection Prevention Programs and Practices in Southeastern United States

Background. Early assessments of COVID19 preparedness reported resource shortages, use of crisis capacity strategies, variations in testing, personal protective equipment (PPE), and policies in US hospitals. One year later, we performed a follow-up survey to assess changes in infection prevention practice and policies in our diverse network of community and academic hospitals. Methods. This was a cross-sectional electronic survey of infection preventionists in 58 hospitals within the Duke Infection Control Outreach Network (community) and Duke/UNC Health systems (academic) in April-May 2021 to follow-up our initial survey from April 2020. The follow-up survey included 26 questions related to resource availability, crisis capacity strategies, procedures, changes to PPE and testing, and staffing challenges. Results. We received 54 responses (response rate, 93%). Facilities reported significantly fewer PPE and resource shortages in the follow-up survey compared to our initial survey (Figure 1, P< 0.05). Only 32% of respondents were still reprocessing N95 respirators (compared to 73% in initial survey, P< 0.05). All hospitals performed universal masking, universal symptom screening on entry, and 30% required eye protection. In 2020, most hospitals suspended elective surgical procedures in March-April, and restarted in May-June. Approximately 92% reported in-house testing for SARS-COV-2 by April 2020, at least a third of which had a weekly capacity of >100 tests. Almost 80% performed universal pre-operative testing, while 61% performed universal preadmission testing for SARS-COV-2. Almost all hospitals switched from test-based to time-based strategy for discontinuing isolation precautions, majority in August-September 2020. Twenty-five percent hospitals reported infection prevention furloughs, staffing cuts, and or reassignments, while 81% reported increased use of agency nursing during the pandemic. Conclusion. Our follow-up survey reveals improvement in resource availability, evolution of PPE guidance, increase in testing capacity, and burdensome staffing changes. Our serial surveys suggest increasing uniformity in infection prevention policies, but also highlight the increase in staff turnover and infection prevention staffing shortages.

COVID-19 testing laboratory: Establishment and operation aiming topmost biosafety, quality standards and timeliness at Dr. DY Patil Medical College, Pimpri, Pune

Background:Pandemic situation of SARS CoV-2 has made every country to gear up quickly for the prevention, control and testing. Accordingly, India has developed the guidelines and policies and requested all medical colleges to establish the COVID-19 testing facility under the mentorship of ICMR and NABL. Methods:As we, at our college already having the central research facility, the urgent national need has made us easy to create a testing facility for the COVID-19. As per NABL guidelines to have the requirements, we have worked together with wholehearted support and active participation from Human Resource Department, Central Purchase Department, Dean Office and honourable management excellences. All the requirements like physical lab setup, necessary equip- ment’s with calibration and validation, dedicated biosafety cabinets, PPEs, biomedical waste management, UPS system, SOPs, quality consumables, trained manpower, entry protocol, working protocol, exit protocol, result reporting system made functional systematically. Accordingly, data generated and communicated to AIIMS, Nagpur and NABL, subse- quently auditing by NABL was conducted toughly and thoroughly. Results:Without NC we got the NABL Accreditation. On the basis of recommendations of AIIMS, Nagpur and NABL Ac- creditation, the ICMR has provided the login to us. Afterwards the lab started receiving the samples for COVID -19 testing. With minimum samples we started testing and reporting to ICMR, PCMC and State Govt. following all the bi- osafety measures and necessary guidelines compliances. Due to heavy load of samples in our state, authorities have requested to increase the testing capacity, so we have geared up accordingly by improving biosafety by using powered air-purifying respirator (PAPR), additional biosafety cabinets type II B2, weekly decontamination / fumigation of lab and necessary logistics and trained staff. Till now we have tested more than 6000 samples providing the results / reports within TAT of 24 hrs. We achieved 100% concordance for external quality control.

Implementation and decentralization of the analytical process in molecular biology: The experience of Modena for COVID-19 diagnosis

Background: Real time reverse transcriptase polymerase chain reaction (RT-PCR) on clinical specimens is considered the first line test for the diagnosis of SARS-CoV-2 infection. This test involves different steps: RNA extraction, reverse trancription, PCR setting-up, amplification and analysis of results. To date, several analyzers for extraction and amplification phases are availabe, while few are able to guarantee the automation of the entire workflow. To optimise the allocation of swabs, with the aim of maximising the number of swabs tested and reducing the wait time for results, we applied a decentralysed system.Methods: In Provincia of Modena a network of 5 suburban laboratories referring to central laboratory was developed.The work was focused not only on the implementation of new analyzers, but also on the organization and consolidation of the whole workflow integrating the pre-analytical, analytical and postanalytical phases and including the molecular biology tests report on LIS (Laboratory Information System). Furthermore, all laboratory professionals attended a specific training.Results: Between march 2020 and June 2021 450,000 RT-PCR for RNA of Sars-Cov-2 research were performed. The central laboratory analyzes the majority of swabs (n= 259832, 58%), including those enrolled at drive through (44%). 76% were analyzed with a automated system, and 24% with a manual procedure. The laboratory is open every day including Sunday, from 8:00 a.m. to 8:00 p.m. engaging two biologists and five laboratory technicians per day. Our project allowed to increase significantly the number of swabs tested in a day (from 100 in march 2020 to 4600 in march 2021), guaranteeing their reporting within 3 hours in emergency or 24 hours for routine and drive setting.Conclusions: The employ of automated, user friendly and with a guided interface instrument facilited the entire workflow, reducing the operator work and the reporting time. RT-PCR executed with a manual procedure need of a specific expertise to read the reaction products, but the shorter reporting time makes it useful for swabs made in emergency. However, the presence of the barcode reader and the connectivity with the management LIS facilitated the traceability of the samples for the entire diagnostic pathway and the minimization of human error. The implementation of our workflow has involved an important rationalization and optimization of the staff, while integration of new knowledge about SARSCOV-2 and optimal analytical performance of analyzers has allowed a modern management of the samples maximising the laboratory's test capacity for RT-PCR tests.

African countries established COVID-19 testing in one month: Here's how they did it.

BACKGROUND: As a novel and deadly acute respiratory syndrome, which later became known as coronavirus disease 2019 (COVID-19), spread beyond China in late January 2020, there were no laboratories in Africa that could test for the disease. However, in early March, just over a month later, 42 African countries had developed the expertise and resources to perform COVID-19 testing. Our goal was to document this public health success story, learn from it, and use it to inform future public health action. INTERVENTION: Three groups were primarily responsible for establishing COVID-19 testing capacity in Africa. The first group comprised early test manufacturers who reacted with incredible speed and ingenuity early in the pandemic, such as the German company TIB MolBiol that developed a molecular test for COVID-19 before the SARS-CoV-2 genome sequence was available. The second group included private and public donors such as the Jack Ma Foundation, and the last were the coordinators of the rollout, such as the World Health Organization and the Africa Centres for Disease Control and Prevention (CDC). LESSONS LEARNT: The first lesson was that speed is critical, especially during a crisis. It was also demonstrated that being a predictable and transparent trusted institution opens doors and improves effectiveness. Africa CDC, which was only three years old, was able to secure significant resources from external partners and rapidly build substantial testing capacity within Africa because it is a trusted institution. RECOMMENDATIONS: Low- and middle-income countries must build local trusted institutions to better prepare for public health challenges.