Rapidly adapting primary care sentinel surveillance across seven countries in Europe for COVID-19 in the first half of 2020: strengths, challenges, and lessons learned.

As the COVID-19 pandemic began in early 2020, primary care influenza sentinel surveillance networks within the Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE) consortium rapidly adapted to COVID-19 surveillance. This study maps system adaptations and lessons learned about aligning influenza and COVID-19 surveillance following ECDC / WHO/Europe recommendations and preparing for other diseases possibly emerging in the future. Using a qualitative approach, we describe the adaptations of seven sentinel sites in five European Union countries and the United Kingdom during the first pandemic phase (March-September 2020). Adaptations to sentinel systems were substantial (2/7 sites), moderate (2/7) or minor (3/7 sites). Most adaptations encompassed patient referral and sample collection pathways, laboratory testing and data collection. Strengths included established networks of primary care providers, highly qualified testing laboratories and stakeholder commitments. One challenge was the decreasing number of samples due to altered patient pathways. Lessons learned included flexibility establishing new routines and new laboratory testing. To enable simultaneous sentinel surveillance of influenza and COVID-19, experiences of the sentinel sites and testing infrastructure should be considered. The contradicting aims of rapid case finding and contact tracing, which are needed for control during a pandemic and regular surveillance, should be carefully balanced.

Population perspective comparing COVID-19 to all and common causes of death during the first wave of the pandemic in seven European countries.

OBJECTIVES: Mortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 during the first wave of the pandemic across seven countries in Europe with all and common causes of death, stratifying by age and sex. We also calculated deaths as a proportion of the population by age and sex. STUDY DESIGN: Analysis of population mortality data. METHODS: COVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14-16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia, cardiovascular disease combining ischaemic heart disease and stroke, chronic obstructive pulmonary disease, cancer, road traffic accidents and dementia in 2017. RESULTS: Deaths related to COVID-19, while modest overall, varied considerably by age. Deaths as a percentage of all cause deaths during the time period under study ranged from <0.01% in children in Germany, Portugal and Netherlands, to as high as 41.65% for men aged over 80 years in England and Wales. The percentage of the population who died from COVID-19 was less than 0.2% in every age group under the age of 80. In each country, over the age of 80, these proportions were: England and Wales 1.27% males, 0.87% females; Italy 0.6% males, 0.38% females; Germany 0.13% males, 0.09% females; France 0.39% males, 0.2% females; Portugal 0.2% males, 0.15% females; and Netherlands 0.6% males, 0.4% females. CONCLUSIONS: Mortality rates from COVID-19 during the first wave of the pandemic were low including when compared to other common causes of death and are likely to decline further while control measures are maintained, treatments improve and vaccination is instituted. These data may help people to contextualise their risk and for decision-making by policymakers.

Baseline results of a living systematic review for COVID-19 clinical trial registrations.

Background: Since the coronavirus disease 2019 (COVID-19) outbreak was first reported in December 2019, many independent trials have been planned that aim to answer similar questions. Tools allowing researchers to review studies already underway can facilitate collaboration, cooperation and harmonisation. The Infectious Diseases Data Observatory (IDDO) has undertaken a living systematic review (LSR) to provide an open, accessible and frequently updated resource summarising characteristics of COVID-19 study registrations. Methods: Review of all eligible trial records identified by systematic searches as of 3 April 2020 and initial synthesis of clinical study characteristics were conducted. In partnership with Exaptive, an open access, cloud-based knowledge graph has been created using the results.  Results: There were 728 study registrations which met eligibility criteria and were still active. Median (25 th, 75 th percentile) sample size was 130 (60, 400) for all studies and 134 (70, 300) for RCTs. Eight lower middle and low income countries were represented among the planned recruitment sites. Overall 109 pharmacological interventions or advanced therapy medicinal products covering 23 drug categories were studied. Majority (57%, 62/109) of them were planned only in one study arm, either alone or in combination with other interventions. There were 49 distinct combinations studied with 90% (44/49) of them administered in only one or two study arms. The data and interactive platform are available at https://iddo.cognitive.city/. Conclusions:  Baseline review highlighted that the majority of investigations in the first three months of the outbreak were small studies with unique treatment arms, likely to be unpowered to provide solid evidence.  The continued work of this LSR will allow a more dependable overview of interventions tested, predict the likely strength of evidence generated, allow fast and informative filtering of relevant trials for specific user groups and provide the rapid guidance needed by investigators and funders to avoid duplication of efforts.

The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford.

INTRODUCTION: Male circumcision for religious reasons is not available in the NHS. In this report, we present the results of an investigation conducted by the Thames Valley Health Protection Unit (TVHPU) at an unregulated circumcision 'camp' in Oxford in 2006. METHODS: A detailed investigation was initiated following notification by a general practitioner of two children with circumcision-related complications at a 'camp'. Telephone interviews were conducted with the 'camp' organizers, the operating surgeon, GPs and paediatric surgeons. A field visit was carried out by TVHPU staff to assess implementation of infection control practices. RESULTS: Thirty-two children were circumcised over a 3 day period in the library of an Islamic faith school by a single, medically qualified individual. Among the 29 children with follow-up information, 13 (44.8%) developed complications requiring medical intervention. Information obtained from interviews and the field visit confirmed the lack of implementation of standard infection control practices. CONCLUSION: This incident highlights the harm associated with circumcision in young children by unregulated operators due to lack of compliance with best surgical and infection control guidance. There is an urgent need for commissioning circumcision services for religious reasons in the NHS.

Evacuation and sheltering of hospitals in emergencies: a review of international experience.

OBJECTIVE: A scoping exercise to establish how common hospital evacuations are, identify hospital evacuation policies and review case studies to identify triggers, processes and challenges involved in the evacuation of hospitals globally. DESIGN: A systematic search of PubMed and disaster agency online resources, search of grey literature and media reports. RESULTS: This study showed that hospitals are vulnerable to both natural and man made disasters and that hospital evacuations do occur globally. It highlighted the paucity of published data and policy on hospital evacuation and emphasised the vital need to collect data on triggers, reasons for evacuation, sheltering facilities and the process of evacuation. CONCLUSIONS: This study recommends the collection of case studies and the development of a database to assist with the research and development of well tailored hospital evacuation plans. These recommendations reflect and support the 2008-2009 World Disaster Reduction Campaign on Hospitals Safe from Disasters and the timely 2009 Global Platform priority that, Critical services and infrastructure such as health facilities and schools must be safe from disasters.