Development and Implementation of a scalable and versatile test for COVID-19 diagnostics in rural communities

ABSTRACTRapid and widespread testing of severe acute respiratory coronavirus 2 (SARS-CoV-2) is essential for an effective public health response aimed at containing and mitigating the coronavirus disease 2019 (COVID-19) pandemic. Successful health policy implementation relies on early identification of infected individuals and extensive contact tracing.However, rural communities, where resources for testing are sparse or simply absent, face distinctive challenges to achieving this success. Accordingly, we report the development of an academic, public land grant University laboratory-based detection assay for the identification of SARS-CoV-2 in samples from various clinical specimens that can be readily deployed in areas where access to testing is limited. The test, which is a quantitative reverse transcription polymerase chain reaction (RT-qPCR)-based procedure, was validated on samples provided by the state laboratory and submitted for FDA Emergency Use Authorization. Our test exhibits comparable sensitivity and exceeds specificity and inclusivity values compared to other molecular assays. Additionally, this test can be re-configured to meet supply chain shortages, modified for scale up demands, and is amenable to several clinical specimens. Test development also involved 3D engineering critical supplies and formulating a stable collection media that allowed samples to be transported for hours over a dispersed rural region without the need for a cold-chain. These two elements that were critical when shortages impacted testing and when personnel needed to reach areas that were geographically isolated from the testing center. Overall, using a robust, easy-to-adapt methodology, we show that an academic laboratory can supplement COVID-19 testing needs and help local health departments assess and manage outbreaks. This additional testing capacity is particularly germane for smaller cities and rural regions that would otherwise be unable to meet the testing demand.

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Development and implementation of a scalable and versatile test for COVID-19 diagnostics in rural communities

Nature Communications ◽

10.1038/s41467-021-24552-4 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

A. Ceci ◽

C. Muñoz-Ballester ◽

A. N. Tegge ◽

K. L. Brown ◽

R. A. Umans ◽

...

Keyword(s):

Rural Communities ◽

Scale Up ◽

Cold Chain ◽

Contact Tracing ◽

Local Health ◽

Public Health Response ◽

Clinical Specimens ◽

Detection Assay ◽

Health Response ◽

Testing Center

AbstractRapid and widespread testing of severe acute respiratory coronavirus 2 (SARS-CoV-2) is essential for an effective public health response aimed at containing and mitigating the coronavirus disease 2019 (COVID-19) pandemic. Successful health policy implementation relies on early identification of infected individuals and extensive contact tracing. However, rural communities, where resources for testing are sparse or simply absent, face distinctive challenges to achieving this success. Accordingly, we report the development of an academic, public land grant University laboratory-based detection assay for the identification of SARS-CoV-2 in samples from various clinical specimens that can be readily deployed in areas where access to testing is limited. The test, which is a quantitative reverse transcription polymerase chain reaction (RT-qPCR)-based procedure, was validated on samples provided by the state laboratory and submitted for FDA Emergency Use Authorization. Our test exhibits comparable sensitivity and exceeds specificity and inclusivity values compared to other molecular assays. Additionally, this test can be re-configured to meet supply chain shortages, modified for scale up demands, and is amenable to several clinical specimens. Test development also involved 3D engineering critical supplies and formulating a stable collection media that allowed samples to be transported for hours over a dispersed rural region without the need for a cold-chain. These two elements that were critical when shortages impacted testing and when personnel needed to reach areas that were geographically isolated from the testing center. Overall, using a robust, easy-to-adapt methodology, we show that an academic laboratory can supplement COVID-19 testing needs and help local health departments assess and manage outbreaks. This additional testing capacity is particularly germane for smaller cities and rural regions that would otherwise be unable to meet the testing demand.

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Italian Public Health Response to the COVID-19 Pandemic: Case Report from the Field, Insights and Challenges for the Department of Prevention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103666 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3666 ◽

Cited By ~ 5

Author(s):

Emanuele Torri ◽

Luca Gino Sbrogiò ◽

Enrico Di Rosa ◽

Sandro Cinquetti ◽

Fausto Francia ◽

...

Keyword(s):

Public Health ◽

Case Report ◽

Organizational Capacity ◽

Public Health Approach ◽

Local Health Authority ◽

Local Health ◽

Public Health Response ◽

Response Strategies ◽

Health Response ◽

Italian National Health Service

The coronavirus disease (COVID-19) outbreak is rapidly progressing globally, and Italy, as one of the main pandemic hotspots, may provide some hard lessons for other countries. In this paper, we summarize the current organizational capacity and provide a pragmatic and narrative account of strategies and activities implemented by the Department of Prevention (Dipartimento di Prevenzione)—the regional entity of the Local Health Authority of the Italian National Health Service in charge of public health—since the beginning of the outbreak. We conduct a preliminary analysis of general strengths, weaknesses, opportunities, and threats (SWOT) of the response strategies from a local perspective. Furthermore, we provide firsthand insights on future directions and priorities to manage this unprecedented pandemic. Our case report gives a qualitative view of the healthcare response, based on the experience of frontline professionals, with the aim to generate hypotheses about factors which may promote or hinder the prevention and management of a pandemic locally. We highlight the importance of a public health approach for responding to COVID-19 and reshaping healthcare systems.

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Training and Incorporating Students in SARS-CoV-2 Case Investigations and Contact Tracing

Public Health Reports ◽

10.1177/0033354920974664 ◽

2020 ◽

pp. 003335492097466

Author(s):

Kristen Pogreba Brown ◽

Erika Austhof ◽

Ayeisha M. Rosa Hernández ◽

Caitlyn McFadden ◽

Kylie Boyd ◽

...

Keyword(s):

Public Health ◽

Call Center ◽

Online Survey ◽

Contact Tracing ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Data Quality Control ◽

Public Health Response ◽

Health Response

Objectives In June 2020, Arizona had the fastest-growing number of cases of coronavirus disease 2019 (COVID-19) worldwide. As part of the growing public health response, the University of Arizona Student Aid for Field Epidemiology Response (SAFER) team was able to modify and increase case investigation efforts to assist local health departments. We outline the recommended logistical and management steps to include students in a public health response of this scope. Methods From April 1 through September 1, 2020, the SAFER team identified key components of a successful student team response: volunteer training, management that allows more senior students to manage newer students, adoption of case-management software, and use of an online survey platform for students to conduct interviews consistently and allow for data quality control and management. Results From April 1 through September 1, 2020, SAFER worked with 3 local health departments to complete 1910 COVID-19 case investigations through a virtual call center. A total of 233 volunteers and 46 hourly student workers and staff members were involved. As of September 2020, students were completing >150 interviews per week, including contact-tracing efforts. Practice Implications Developing relationships between applied public health and academic programs can relieve the burden of low-risk, high-volume case investigations at local and state health departments. Furthermore, by establishing a virtual call center, health sciences faculty and students can volunteer remotely during a pandemic with no additional risk of infection.

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Participatory COVID-19 Surveillance Tool in Rural Appalachia

Public Health Reports ◽

10.1177/0033354921990372 ◽

2021 ◽

pp. 003335492199037

Author(s):

Jennifer D. Runkle ◽

Maggie M. Sugg ◽

Garrett Graham ◽

Bryan Hodge ◽

Terri March ◽

...

Keyword(s):

Public Health ◽

Low Cost ◽

Local Level ◽

Local Health ◽

Public Health Response ◽

Health History ◽

Regional Collaboration ◽

Health Response ◽

Participatory Surveillance ◽

Rural Appalachia

Introduction Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. Methods A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. Results Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non–English-speaking groups. Practical Implications This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

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The challenges of the outbreak: the Italian COVID-19 integrated surveillance system

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.356 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

P Pezzotti ◽

O Punzo ◽

A Bella ◽

M Del Manso ◽

A M Urdiales ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Surveillance System ◽

Ad Hoc ◽

Respiratory Infections ◽

Open Data ◽

Local Health ◽

Public Health Response ◽

Term Care ◽

Health Response

Abstract Background In Italy, the National surveillance of all SARS-CoV-2 laboratory-confirmed cases was established on 27 February 2020, building on a previously existing laboratory network focused on suspected and confirmed COVID-19 severe respiratory infections. Methods The integrated epidemiological and microbiological surveillance systematically collects and analyzes information on all SARS-CoV-2 confirmed cases. Regional reference laboratories analyze samples, inform Local Health Authorities of the results and coordinate data flow between cases, hospitals and GPs. Regions provide data through a web interface connected to a dedicated IT platform or by sending a dataset. The Infectious Diseases Department at Istituto Superiore di Sanità processes and analyzes data, producing reports on a daily and weekly basis, as well as indicator analyses based on the monitoring of “phase 2” (post-lockdown). Moreover, mathematical models are constructed daily on these data. Results Since the beginning of the epidemic, the surveillance system recorded 238.901 COVID-19 cases and 33.369 deaths on 19-6. Main challenges were the coordination of different actors, hampered by the decentralization of health to the Regions, and data interpretation due to the delay in the detection of cases and deaths. Besides the COVID-19 surveillance, we planned ad hoc studies and periodic surveys: health care workers, long term care facilities, clusters and red zones, health system resilience monitoring. Conclusions COVID-19 surveillance is an essential tool to inform the public about the epidemic trend and provide support to public health response. We urge upon all relevant stakeholders a reflection on important issues such as defining ethical boundaries for data scavenging during emergencies, how existing laws on data protection could affect record linkage among different existing datasets to assess diseases and other variables for correlation, or which ethical approaches on open data would apply to our setting. Key messages A strong and adequately funded public health system in place allows an efficient response in times of epidemics both in terms of data collection and public health response, policy and decisions. COVID-19 epidemic showed us all the limits of a regionalized health system which was not entirely coordinated between periphery and central institutions.

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A PUBLIC HEALTH RESPONSE TO CANCER CLUSTERS IN MISSOURI

American Journal of Epidemiology ◽

10.1093/oxfordjournals.aje.a115784 ◽

1990 ◽

Vol 132 (supp1) ◽

pp. 23-31 ◽

Cited By ~ 10

Author(s):

JANICE R. DEVIER ◽

ROSS C. BROWNSON ◽

JOHN R. BAGBY ◽

GALE M. CARLSON ◽

JOHN R. CRELLIN

Keyword(s):

Public Health ◽

Spatial Relations ◽

Problem Definition ◽

Preliminary Review ◽

Local Health ◽

Public Health Response ◽

Incidence Data ◽

Health Response ◽

Cancer Clusters ◽

Two Stages

Abstract A protocol was developed in 1984 by the Missouri Department of Health to provide a systematic method for responding to citizen reports of cancer clusters. This protocol integrates public health and environmental expertise and includes two stages: the preliminary review and the investigation. The preliminary review is focused on problem definition and hypothesis generation. Cancer mortality and incidence data are reviewed. Information is gathered and verified through the efforts of citizens, local health officials, environmental staff, and the cancer program staff. Epidemlologic factors evaluated include type of cancer, temporal and spatial relations, population at risk, community profile, and possible environmental and occupational factors. The investigation is an expanded analytic study. Resources are focused on cancer inquiries that appear most likely to involve manageable common exposures. Program experience and protocol development highlights, including surveillance system improvement and educational programming, are described.

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Field performance and public health response using the BinaxNOW TM Rapid SARS-CoV-2 antigen detection assay during community-based testing

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1890 ◽

2020 ◽

Author(s):

Genay Pilarowski ◽

Carina Marquez ◽

Luis Rubio ◽

James Peng ◽

Jackie Martinez ◽

...

Keyword(s):

Public Health ◽

Community Setting ◽

Field Performance ◽

Rt Pcr ◽

Public Health Response ◽

Public Health Action ◽

Assay Sensitivity ◽

Detection Assay ◽

Health Response ◽

Health Action

Abstract Among 3,302 persons tested for SARS-CoV-2 by BinaxNOW TM and RT-PCR in a community setting, rapid assay sensitivity was 100%/98.5%/89% using RT-PCR Ct thresholds of 30, 35 and none. The specificity was 99.9%. Performance was high across ages and those with and without symptoms. Rapid resulting permitted immediate public health action.

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