RESUMO
BackgroundPolicies and programs that promote positive social environments for young children and their families have the potential to improve early childhood development and long-term health. However, due to the community-wide public health measures implemented to reduce transmission of COVID-19, many families are experiencing health and socio-economic challenges and pre-existing supports and services may no longer be available. In this study, we compared the policies and programs countries have implemented to support maternal and child health during the first wave of COVID-19. MethodsWe compared the policies and programs implemented to support child health and well-being during the first wave of COVID-19 in Australia, Canada, the Netherlands, Singapore, the UK, and the USA. A grey literature review was performed to identify policies, announcements, and guidelines released from governmental and public health organizations within each country related to children, parents, families, early childhood development, adverse childhood experiences, child welfare, pre-school, or daycares. We also performed a manual search of government websites. Both provincial and federal government policies were included for Canada. ResultsThe main policies identified were focused on prenatal care, well-baby visit and immunization schedules, financial supports, domestic violence and housing, childcare supports, child protective services, and food security. All of the included countries implemented some of these policies, but there was a large variation in the number, size, and barriers to access these supports. None of the countries implemented supports in all of the potential areas identified. ConclusionPolitical legacy and previous redistributive policies might have influenced the variation in policies and programs introduced by governments. As the COVID-19 pandemic continues, further opportunity for governments to implement supportive programs and policies for children and families exists.
RESUMO
BackgroundPerformance characteristics of SARS-CoV-2 nucleic acid detection assays are understudied within contexts of low pre-test probability, including screening asymptomatic persons without epidemiological links to confirmed cases, or asymptomatic surveillance testing. SARS-CoV-2 detection without symptoms may represent resolved infection with persistent RNA shedding, presymptomatic or asymptomatic infection, or a false positive test. This study assessed clinical specificity of SARS-CoV-2 real-time reverse transcription polymerase chain reaction (rRT-PCR) assays by retesting positive specimens from five pre-test probability groups ranging from high to low with an alternate assay. Materials and MethodsA total of 122 rRT-PCR positive specimens collected from unique patients between March and July 2020 were retested using a laboratory-developed nested RT-PCR assay targeting the RNA-dependent RNA polymerase (RdRp) gene followed by Sanger sequencing. ResultsSignificantly less positive results in the lowest pre-test probability group (facilities with institution-wide screening having [≤] 3 positive asymptomatic cases) were reproduced with the nested RdRp gene RT-PCR assay than in all other groups combined (5/32, 15{middle dot}6% vs 61/90, 68%; p <0{middle dot}0001), and in each subgroup with higher pre-test probability (individual subgroup range 50{middle dot}0% to 85{middle dot}0%). ConclusionsA higher proportion of false-positive test results are likely with lower pre-test probability. Positive SARS-CoV-2 PCR results should be interpreted within the context of patient history, clinical setting, known exposure, and estimated community disease prevalence. Large-scale SARS-CoV-2 screening testing initiatives among low pre-test probability populations should be evaluated thoroughly prior to implementation given the risk of false positives and consequent potential for harm at the individual and population level.
RESUMO
BackgroundSyndromic surveillance systems for COVID-19 are being increasingly used to track and predict outbreaks of confirmed cases. Seasonal circulating respiratory viruses share syndromic overlap with COVID-19, and it is unknown how they will impact the performance of syndromic surveillance tools. Here we investigated the role of non-SARS-CoV-2 respiratory virus test positivity on COVID-19 two independent syndromic surveillance systems in Ontario, Canada. MethodsWe compared the weekly number of reported COVID-19 cases reported in the province of Ontario against two syndromic surveillance metrics: 1) the proportion of respondents with a self-reported COVID-like illness (CLI) from COVID Near You (CNY) and 2) the proportion of emergency department visits for upper respiratory conditions from the Acute Care Enhanced Surveillance (ACES) system. Separately, we plotted the percent positivity for other seasonal respiratory viruses over the same time period and reported Pearsons correlation coefficients before and after the uncoupling of syndromic tools to COVID-19 cases. ResultsThere were strong positive correlations of both CLI and ED visits for upper respiratory causes with COVID-19 cases up to and including a rise in entero/rhinovirus (r = 0.86 and 0.87, respectively). There was a strong negative correlation of both CLI and ED visits for upper respiratory causes with COVID-19 cases (r = -0.85 and -0.91, respectively) during a fall in entero/rhinovirus. InterpretationTwo methods of syndromic surveillance showed strong positive correlations with COVID-19 confirmed case counts before and during a rise in circulating entero/rhinovirus. However, as positivity for enterovirus/rhinovirus fell in late September 2020, syndromic signals became uncoupled from COVID-19 cases and instead tracked the fall in entero/rhinovirus. This finding provides proof-of-principle that regional transmission of seasonal respiratory viruses may complicate the interpretation of COVID-19 surveillance data. It is imperative that surveillance systems incorporate other respiratory virus testing data in order to more accurately track and forecast COVID-19 disease activity.