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Heterogeneity in testing, diagnosis and outcome in SARS-CoV-2 infection across outbreak settings in the Greater Toronto Area, Canada: an observational study.
Wang, Linwei; Ma, Huiting; Yiu, Kristy C Y; Calzavara, Andrew; Landsman, David; Luong, Linh; Chan, Adrienne K; Kustra, Rafal; Kwong, Jeffrey C; Boily, Marie-Claude; Hwang, Stephen; Straus, Sharon; Baral, Stefan D; Mishra, Sharmistha.
  • Wang L; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Ma H; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Yiu KCY; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Calzavara A; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Landsman D; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Luong L; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Chan AK; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Kustra R; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Kwong JC; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Boily MC; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Hwang S; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Straus S; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Baral SD; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
  • Mishra S; MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnyb
CMAJ Open ; 8(4): E627-E636, 2020.
Article in English | MEDLINE | ID: covidwho-840782
ABSTRACT

BACKGROUND:

Congregate settings have been disproportionately affected by coronavirus disease 2019 (COVID-19). Our objective was to compare testing for, diagnosis of and death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across 3 settings (residents of long-term care homes, people living in shelters and the rest of the population).

METHODS:

We conducted a population-based prospective cohort study involving individuals tested for SARS-CoV-2 in the Greater Toronto Area between Jan. 23, 2020, and May 20, 2020. We sourced person-level data from COVID-19 surveillance and reporting systems in Ontario. We calculated cumulatively diagnosed cases per capita, proportion tested, proportion tested positive and case-fatality proportion for each setting. We estimated the age- and sex-adjusted rate ratios associated with setting for test positivity and case fatality using quasi-Poisson regression.

RESULTS:

Over the study period, a total of 173 092 individuals were tested for and 16 490 individuals were diagnosed with SARS-CoV-2 infection. We observed a shift in the proportion of cumulative cases from all cases being related to travel to cases in residents of long-term care homes (20.4% [3368/16 490]), shelters (2.3% [372/16 490]), other congregate settings (20.9% [3446/16 490]) and community settings (35.4% [5834/16 490]), with cumulative travel-related cases at 4.1% (674/16490). Cumulatively, compared with the rest of the population, the diagnosed cases per capita was 64-fold and 19-fold higher among long-term care home and shelter residents, respectively. By May 20, 2020, 76.3% (21 617/28 316) of long-term care home residents and 2.2% (150 077/6 808 890) of the rest of the population had been tested. After adjusting for age and sex, residents of long-term care homes were 2.4 (95% confidence interval [CI] 2.2-2.7) times more likely to test positive, and those who received a diagnosis of COVID-19 were 1.4-fold (95% CI 1.1-1.8) more likely to die than the rest of the population.

INTERPRETATION:

Long-term care homes and shelters had disproportionate diagnosed cases per capita, and residents of long-term care homes diagnosed with COVID-19 had higher case fatality than the rest of the population. Heterogeneity across micro-epidemics among specific populations and settings may reflect underlying heterogeneity in transmission risks, necessitating setting-specific COVID-19 prevention and mitigation strategies.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Outbreaks / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: CMAJ Open Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Outbreaks / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: CMAJ Open Year: 2020 Document Type: Article