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Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study.
Qiu, Xueting; Miller, Joel C; MacFadden, Derek R; Hanage, William P.
  • Qiu X; Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.
  • Miller JC; School of Engineering at Mathematical Sciences, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia.
  • MacFadden DR; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Hanage WP; Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA whanage@hsph.harvard.edu.
BMJ Open ; 11(3): e044644, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1115143
ABSTRACT

INTRODUCTION:

Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources.

METHODS:

Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies.

RESULTS:

In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources.

CONCLUSION:

These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Infection Control / Infectious Disease Transmission, Patient-to-Professional / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-044644

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Infection Control / Infectious Disease Transmission, Patient-to-Professional / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-044644