Universal PCR and antibody testing demonstrate little to no transmission of SARS-CoV-2 in a rural community

Abstract Background Limited systematic surveillance for SARS-CoV-2 in the early months of the United States epidemic curtailed accurate appraisal of transmission intensity. Our objective was to perform case detection of an entire rural community to quantify SARS-CoV-2 transmission using PCR and antibody testing. Methods We conducted a cross-sectional survey of SARS-CoV-2 infection in the rural town of Bolinas, California (population 1,620), four weeks following shelter-in-place orders. Participants were tested between April 20 th – 24 th, 2020. Prevalence by PCR and seroprevalence from two forms of antibody testing were performed in parallel (Abbott ARCHITECT IgG and in-house IgG ELISA). Results Of 1,891 participants, 1,312 were confirmed Bolinas residents (>80% community ascertainment). Zero participants were PCR positive. Assuming 80% sensitivity, it would have been unlikely to observe these results (p<0.05) if there were >3 active infections in the community. Based on antibody results, estimated prevalence of prior infection was 0.16% (95% CrI: 0.02%, 0.46%). The positive predictive value (PPV) of a positive result on both tests was 99.11% (95% CrI: 95.75%, 99.94%), compared to PPV 44.19%-63.32% (95% CrI range 3.25%-98.64%) if one test was utilized. Conclusions Four weeks following shelter-in-place, SARS-CoV-2 infection in a rural Northern California community was extremely rare. In this low prevalence setting, use of two antibody tests increased seroprevalence estimate precision. This was one of the first community-wide studies to successfully implement synchronous PCR and antibody testing, particularly in a rural setting. Widespread testing remains an underpinning of effective disease control in conjunction with consistent uptake of public health measures.

Download Full-text

Universal PCR and antibody testing demonstrate little to no transmission of SARS-CoV-2 in a rural community

10.1101/2020.08.15.20175786 ◽

2020 ◽

Author(s):

Ayesha Appa ◽

Saki Takahashi ◽

Isabel Rodriguez-Barraquer ◽

Gabriel Chamie ◽

Aenor Sawyer ◽

...

Keyword(s):

Rural Community ◽

Antibody Testing ◽

Cross Sectional Survey ◽

Community Based ◽

Cross Sectional ◽

Rural Town ◽

Combining Data ◽

Low Prevalence ◽

Prior Infection ◽

Abbott Architect

Background: The absence of systematic surveillance for SARS-CoV-2 has curtailed accurate appraisal of transmission intensity. Our objective was to perform case detection of an entire rural community to quantify SARS-CoV-2 transmission using PCR and antibody testing. Methods: We conducted a cross-sectional survey of the prevalence and cumulative incidence of SARS-CoV-2 infection in the rural town of Bolinas, California (population 1,620), four weeks following shelter-in-place orders. Residents and county essential workers were tested between April 20th-24th, 2020. Prevalence by PCR and seroprevalence combining data from two forms of antibody testing were performed in parallel (Abbott ARCHITECT IgG to nucleocapsid protein and in-house IgG ELISA to the receptor binding domain). Results: Of 1,891 participants, 1,312 were confirmed Bolinas residents (>80% community ascertainment). Zero participants were PCR positive. Assuming 80% sensitivity, it would have been unlikely to observe these results (p<0.05) if there were >3 active infections in the community. Based on antibody results, estimated prevalence of prior infection was 0.16% (95% CrI: 0.02%, 0.46%). Seroprevalence estimates using only one of the two tests would have been higher, with greater uncertainty. The positive predictive value (PPV) of a positive result on both tests was 99.11% (95% CrI: 95.75%, 99.94%), compared to PPV 44.19%-63.32% (95% CrI range 3.25%-98.64%) if only one test was utilized. Conclusions: Four weeks following shelter-in-place, active and prior SARS-CoV-2 infection in a rural Northern California community was extremely rare. In this low prevalence setting, use of two antibody tests increased the PPV and precision of seroprevalence estimates.

Download Full-text

Effects of the COVID-19 Pandemic on Medical Students: A Multicenter Quantitative Study

10.21203/rs.3.rs-49481/v2 ◽

2020 ◽

Author(s):

Aaron Harries ◽

Carmen Lee ◽

Lee Jones ◽

Robert M. Rodriguez ◽

John Davis ◽

...

Keyword(s):

Medical Education ◽

Medical Students ◽

Clinical Training ◽

The United States ◽

Antibody Testing ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Rotations ◽

Medical Education System ◽

National Recommendation

Abstract Background: The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.Methods: The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations. Results: 741 (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved.Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%). Conclusions: The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Download Full-text

Effects of the COVID-19 pandemic on medical students: a multicenter quantitative study

BMC Medical Education ◽

10.1186/s12909-020-02462-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aaron J. Harries ◽

Carmen Lee ◽

Lee Jones ◽

Robert M. Rodriguez ◽

John A. Davis ◽

...

Keyword(s):

Medical Education ◽

Medical Students ◽

Clinical Training ◽

The United States ◽

Antibody Testing ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Rotations ◽

Medical Education System ◽

National Recommendation

Abstract Background The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy. Methods The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students’ perceptions of COVID-19’s impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations. Results Seven hundred forty-one (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%). Conclusions The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Download Full-text

Effects of the COVID-19 Pandemic on Medical Students: A Multicenter Quantitative Study

10.21203/rs.3.rs-49481/v1 ◽

2020 ◽

Author(s):

Aaron Harries ◽

Carmen Lee ◽

Lee Jones ◽

Robert Rodriguez ◽

John Davis ◽

...

Keyword(s):

Medical Education ◽

Medical Students ◽

Clinical Training ◽

The United States ◽

Antibody Testing ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Rotations ◽

Medical Education System ◽

National Recommendation

Abstract Background: The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.Methods: The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations.Results: 741 (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted, as per national recommendations. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%).Conclusions: The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Download Full-text

Analyzing Predictors of Control Measures and Psychosocial Problems Associated with COVID-19 Pandemic: Evidence from Eight Countries

Behavioral Sciences ◽

10.3390/bs11080106 ◽

2021 ◽

Vol 11 (8) ◽

pp. 106

Author(s):

Sheikh Saifur Rahman Jony ◽

Ubydul Haque ◽

Nathaniel J. Webb ◽

Emily Spence ◽

Md. Siddikur Rahman ◽

...

Keyword(s):

Psychological Health ◽

Age Groups ◽

Psychosocial Problems ◽

Relevant Information ◽

The United States ◽

Control Measures ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Primary Determinant

COVID-19 has harshly impacted communities globally. This study provides relevant information for creating equitable policy interventions to combat the spread of COVID-19. This study aims to predict the knowledge, attitude, and practice (KAP) of the COVID-19 pandemic at a global level to determine control measures and psychosocial problems. A cross-sectional survey was conducted from July to October 2020 using an online questionnaire. Questionnaires were initially distributed to academicians worldwide. These participants distributed the survey among their social, professional, and personal groups. Responses were collected and analyzed from 67 countries, with a sample size of 3031. Finally, based on the number of respondents, eight countries, including Bangladesh, China, Japan, Malaysia, Mexico, Pakistan, the United States, and Zambia were rigorously analyzed. Specifically, questionnaire responses related to COVID-19 accessibility, behavior, knowledge, opinion, psychological health, and susceptibility were collected and analyzed. As per our analysis, age groups were found to be a primary determinant of behavior, knowledge, opinion, psychological health, and susceptibility scores. Gender was the second most influential determinant for all metrics except information about COVID-19 accessibility, for which education was the second most important determinant. Respondent profession was the third most important metric for all scores. Our findings suggest that greater encouragement from government health authorities and the promotion of health education and policies are essential in the dissemination of COVID-19-awareness and increased control of the spread of COVID-19.

Download Full-text

Pre-Exposure Prophylaxis Training among Medical Schools in the United States

Journal of Primary Care & Community Health ◽

10.1177/21501327211028713 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110287

Author(s):

Robert L. Cooper ◽

Mohammad Tabatabai ◽

Paul D. Juarez ◽

Aramandla Ramesh ◽

Matthew C. Morris ◽

...

Keyword(s):

United States ◽

Hiv Prevention ◽

Injection Drug Users ◽

Drug Users ◽

Healthcare Providers ◽

Medical Schools ◽

The United States ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.

Download Full-text

Are Future Doctors Prepared to Address Patients’ Nutritional Needs? Cooking and Nutritional Knowledge and Habits in Medical Students

American Journal of Lifestyle Medicine ◽

10.1177/15598276211018165 ◽

2021 ◽

pp. 155982762110181

Author(s):

Sam Sugimoto ◽

Drew Recker ◽

Elizabeth E. Halvorson ◽

Joseph A. Skelton

Keyword(s):

Medical Students ◽

Prior Knowledge ◽

The United States ◽

First Year ◽

Nutritional Knowledge ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nutritional Needs ◽

Second Year ◽

First Year Medical Students

Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students’ prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students’ prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking.

Download Full-text

Strategic Planning in Emergency Management: Evaluating the Impacts on Local Program Quality

Journal of Homeland Security and Emergency Management ◽

10.1515/jhsem-2019-0051 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Scott Robert Manning

Keyword(s):

Strategic Planning ◽

Emergency Management ◽

Survey Design ◽

Management Practice ◽

The United States ◽

Program Quality ◽

County Level ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Local Program

AbstractThis study examined the strategic planning practices of county-level emergency management agencies (EMAs), with a specific focus on strategic planning adoption and its relationship to local program quality. The study utilized a descriptive, cross-sectional survey design to collect planning- and program-related data from more than 300 county-level EMAs across the United States. The study findings revealed that most of the county EMAs included in the final sample had previously engaged in strategic planning activities, with nearly all of them continuing to use strategic planning as part of their general management practice. The study findings further revealed that strategic planning had a direct and significant impact on the overall quality of local emergency management programs, and that the strategic planning EMAs had significantly higher mean quality scores across all program dimensions when compared to the non-strategic planning EMAs.

Download Full-text

Use of diagnostic tests by dermatologists, podiatrists and family practitioners in the United States: pilot data from a cross-sectional survey

Mycoses ◽

10.1111/j.1439-0507.2007.01422.x ◽

2007 ◽

Vol 50 (6) ◽

pp. 463-469 ◽

Cited By ~ 14

Author(s):

Rebecca L. Koshnick ◽

Kia K. Lilly ◽

Katherine St Clair ◽

Mary T. Finnegan ◽

Erin M. Warshaw

Keyword(s):

United States ◽

Diagnostic Tests ◽

The United States ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Pilot Data ◽

Family Practitioners

Download Full-text

COVID-19 and the Risk for Increased Intimate Partner Violence Among Gay, Bisexual and Other Men Who Have Sex With Men in the United States

Journal of Interpersonal Violence ◽

10.1177/0886260521997454 ◽

2021 ◽

pp. 088626052199745

Author(s):

Rob Stephenson ◽

Tanaka M.D. Chavanduka ◽

Matthew T. Rosso ◽

Stephen P. Sullivan ◽

Renée A. Pitter ◽

...

Keyword(s):

United States ◽

Intimate Partner Violence ◽

Partner Violence ◽

Social Contact ◽

The United States ◽

Intimate Partner ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sex With Men ◽

First Time

Stay at home orders–intended to reduce the spread of COVID-19 by limiting social contact–have forced people to remain in their homes. The additional stressors created by the need to stay home and socially isolate may act as triggers to intimate partner violence (IPV). In this article, we present data from a recent online cross-sectional survey with gay, bisexual and other men who have sex with men (GBMSM) in the United States to illustrate changes in IPV risks that have occurred during the U.S. COVID-19 epidemic. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May 2020. GBMSM were recruited through paid banner advertisements featured on social networking platforms, recruiting a sample size of 696 GBMSM. Analysis considers changes in victimization and perpetration of IPV during the 3 months prior to the survey (March-May 2020) that represents the first 3 months of lockdown during the COVID-19 epidemic. During the period March-May 2020, 12.6% of participants reported experiencing any IPV with higher rates of emotional IPV (10.3%) than sexual (2.2%) or physical (1.8%) IPV. Of those who reported IPV victimization during lockdown, for almost half this was their first time experience: 5.3% reported the IPV they experienced happened for the first time during the past 3 months (0.8% physical, 2.13% sexual, and 3.3% emotional). Reporting of perpetration of IPV during lockdown was lower: only 6% reported perpetrating any IPV, with perpetration rates of 1.5% for physical, 0.5% for sexual, and 5.3% for emotional IPV. Of those who reported perpetration of IPV during lockdown, very small percentages reported that this was the first time they had perpetrated IPV: 0.9% for any IPV (0.2% physical, 0.2% sexual, and 0.6% emotional). The results illustrate an increased need for IPV resources for GBMSM during these times of increased stress and uncertainty, and the need to find models of resource and service delivery that can work inside of social distancing guidelines while protecting the confidentiality and safety of those who are experiencing IPV.

Download Full-text