Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

AbstractHealthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.

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Rapid antigen testing as a reactive public health response to surges in SARS-CoV-2 outbreak risk in healthcare settings

10.1101/2021.08.13.21261968 ◽

2021 ◽

Author(s):

David RM Smith ◽

Audrey Duval ◽

Jean Ralph Zahar ◽

lulla opatowski ◽

Laura TEMIME

Keyword(s):

Health Economic ◽

Diagnostic Testing ◽

Care Facility ◽

Economic Benefits ◽

Nosocomial Outbreak ◽

Rt Pcr ◽

Public Health Response ◽

Term Care ◽

Healthcare Settings ◽

Containment Measures

Background: Surges in community SARS-CoV-2 incidence increase risk of importation and subsequent transmission in healthcare facilities. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive intervention in healthcare settings are unclear. Methods: We used stochastic, individual-based modelling to simulate SARS-CoV-2 transmission in a long-term care facility with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). In contrast to routine symptomatic testing using reverse-transcriptase polymerase chain reaction (RT-PCR), we evaluated the efficacy and health-economic efficiency of single or repeated population-wide Ag-RDT screening interventions implemented in response to surges in nosocomial outbreak risk. Results: Depending on the baseline containment measures in place, nosocomial SARS-CoV-2 incidence was reduced by up to 40-47% (range of means) with routine RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4 to 5 days between the first and second rounds was optimal for transmission prevention. Efficacy varied depending on test sensitivity, subpopulations targeted, and SARS-CoV-2 incidence in the community. Efficiency, however, varied primarily depending on the other containment measures in place: surveillance costs for a combined strategy of routine RT-PCR testing and reactive Ag-RDT screening ranged from a mean €420-€10,260/infection averted across scenarios (default unit costs: €5/Ag-RDT test, €50/RT-PCR test). Interpretation: Reactive Ag-RDT screening complements routine RT-PCR testing, and systematic two-round screening helps overcome limited, time-varying diagnostic sensitivity. Health-economic gains scale significantly with underlying nosocomial outbreak risk.

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Symptom based and transmission-prevention based testing in long-term care facilities: Symptomatology, clinical course and mortality for residents with COVID-19

10.1101/2020.10.28.20221275 ◽

2020 ◽

Author(s):

Kelly C. Paap ◽

Anouk M. van Loon ◽

Sarian M. van Rijs ◽

Esther Helmich ◽

Bianca M. Buurman ◽

...

Keyword(s):

Oxygen Saturation ◽

Long Term Care ◽

Clinical Symptoms ◽

Rt Pcr ◽

Term Care ◽

Care Facilities ◽

Transmission Prevention ◽

Core Symptoms ◽

Testing Policies

AbstractObjectivesInitially, for preventing COVID-19 transmission in long-term care facilities (LTCF) primarily rely on presence of core symptoms (fever, cough, dyspnea), but LTCF residents may also show an atypical course of a SARS-CoV-2 infection. We described the clinical presentation and course of COVID-19 in LTCF residents who were tested either because of presence of core symptoms (S-based) or because of transmission prevention (TP-based)DesignRetrospective cohort study.Setting and participantsAmsta (Amsterdam, The Netherlands), is a 1185-bed LTCF. All LTCF residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 were included (n = 380).MeasuresClinical symptoms, temperature and oxygen saturation were extracted from medical records, 7 days before testing up to 14 days after testing.ResultsSARS-CoV-2 was confirmed in 81 (21%) residents. Of these 81, 36 (44%) residents were tested S-based and 45 (56%) residents were tested TP-based. Yet, CT-values did not differ between the groups. In the 7 days prior to the test the most common symptoms in both groups were: falling (32%), somnolence (25%) and fatigue (21%). Two days before the test, we observed a stronger decrease in oxygen saturation and an increase in temperature for the S-based group compared to the T-based group that remained up to 10 days after testing. Residents with in the S-based group were 2.5 times more likely to decease within 30 days than residents in the TP-based group (HR, 2.56; 95% 1.3 to 5.2). Even though, 73% of the T-based group did eventually developed core symptoms.Conclusion and implicationsMany LTCF residents with a positive PCR did not have core symptoms when tested but had other signs/symptoms in the week before the positive test. Testing policies should therefore be adjusted to prevent transmission. Daily measures of temperature and oxygen saturation can contribute to earlier detection.

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Evaluation of Screening Tests in Bavarian Healthcare Facilities during the Second Wave of the SARS-CoV-2 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147371 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7371

Author(s):

Christina Tischer ◽

Carolin Stupp ◽

Patrick Janson ◽

Kristina Willeke ◽

Chu-Wei Hung ◽

...

Keyword(s):

Screening Tests ◽

Test Results ◽

Rt Pcr ◽

Term Care ◽

Healthcare Facilities ◽

Infection Surveillance ◽

Antigen Tests ◽

Asymptomatic Subjects ◽

Second Wave

Due to the lack of data on asymptomatic SARS-CoV-2-positive persons in healthcare institutions, they represent an inestimable risk. Therefore, the aim of the current study was to evaluate the first 1,000,000 reported screening tests of asymptomatic staff, patients, residents, and visitors in hospitals and long-term care (LTC) facilities in the State of Bavaria over a period of seven months. Data were used from the online database BayCoRei (Bavarian Corona Screening Tests), established in July 2020. Descriptive analyses were performed, describing the temporal pattern of persons that tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) or antigen tests, stratified by facility. Until 15 March 2021, this database had collected 1,038,146 test results of asymptomatic subjects in healthcare facilities (382,240 by RT-PCR, and 655,906 by antigen tests). Of the RT-PCR tests, 2.2% (n = 8380) were positive: 3.0% in LTC facilities, 2.2% in hospitals, and 1.2% in rehabilitation institutions. Of the antigen tests, 0.4% (n = 2327) were positive: 0.5% in LTC facilities, and 0.3% in both hospitals and rehabilitation institutions, respectively. In LTC facilities and hospitals, infection surveillance using RT-PCR tests, or the less expensive but less sensitive, faster antigen tests, could facilitate the long-term management of the healthcare workforce, patients, and residents.

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A Study on the Social Support, Ego Integration, and Hopes of Elderly Hospitalized in Long-term Care Hospital

The Journal of Humanities and Social sciences 21 ◽

10.22143/hss21.9.1.54 ◽

2018 ◽

Vol 9 (1) ◽

pp. 681-694

Author(s):

Dong Sook Choi ◽

Byoung Sook Lee

Keyword(s):

Social Support ◽

Long Term Care ◽

Care Hospital ◽

Term Care ◽

The Social

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A Study of Patterns of Dying in a Multilevel Geriatric Setting

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800015737 ◽

1983 ◽

Vol 2 (2) ◽

pp. 79-85

Author(s):

Isabel Brown

Keyword(s):

Retrospective Study ◽

Long Term Care ◽

Death And Dying ◽

Chronically Ill ◽

The Elderly ◽

Care Hospital ◽

Term Care ◽

Apartment Complex ◽

General Community

ABSTRACTA retrospective study was conducted in a large multilevel geriatric centre to analyse the deaths reported in the year 1981. This centre provides accommodation for 750 elderly and/or chronically ill persons in three agencies—an apartment complex, a home for the aged, and a long-term care hospital The study revealed that the hospital is the place of death for a high proportion of the elderly residents of the centre. In particular, residents of the home for the aged are unlikely to remain in the “home” to die. It was found that patterns of death and dying for individuals admitted to the hospital from the general community differ in several ways from the patterns of those who are already living in the centre in terms of age and probable cause of death.

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Discharge of pharmaceuticals into municipal sewers from hospitals and long-term care facilities

Water Quality Research Journal ◽

10.2166/wqrjc.2012.015 ◽

2012 ◽

Vol 47 (2) ◽

pp. 140-152 ◽

Cited By ~ 3

Author(s):

Muhammad Riaz ul Haq ◽

Chris Metcalfe ◽

Hongxia Li ◽

Wayne Parker

Keyword(s):

Long Term Care ◽

Treatment Plant ◽

Biological Response ◽

Care Homes ◽

Pharmaceutically Active Compounds ◽

Term Care ◽

Healthcare Facilities ◽

Antibiotic Compounds ◽

Composite Samples

The presence of pharmaceutically active compounds in the aquatic environment has become well established, and their presence is of potential concern because they are designed to produce biological response in the target receptor, may bear intrinsic toxicity (e.g. cytostatic agents, antibiotics) and they possess the potential to foster and maintain drug resistance. For both risk assessment and risk management purposes, it is important to identify the major sources of pharmaceuticals in the environment. Healthcare facilities may be major sources of the discharges of these compounds into municipal sewers. In this study, we investigated the contributions to the wastewater treatment plant (WWTP) influents from two hospitals and two long-term care homes of nine compounds. Twenty-four hour composite samples were collected over 5 consecutive days from the effluents of these facilities. The WWTPs receiving sewage from these facilities were also sampled on the same days to facilitate mass balance calculations. The results showed that the healthcare facilities contributed a greater proportion of the antibiotic compounds to the WWTPs than the other target compounds; with maximum contributions of ciprofloxacin by hospitals and long-term care homes of 26.7 and 37%, respectively.

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