Detection of a COVID-19 cluster by universal SARS-CoV-2 testing in a geriatric hospital and implications for infection control management

2021 ◽  
pp. 175717742110333
Author(s):  
Fabian Leo ◽  
Angelika Tsilimi ◽  
Charlotte Hillmann
Keyword(s):  
Malignant Disease ◽  
Geriatric Medicine ◽  
Hospital Level ◽  
Testing Strategies ◽  
Virus Rna ◽  
Geriatric Hospital ◽  
Rapid Changes ◽  
Containment Measures ◽  
Asymptomatic Infections ◽  
Control Management

Hospital-level COVID-19 testing strategies may require rapid changes depending on the dynamics of local epidemiology. A COVID-19 outbreak in a hospital near the authors’ institution, a Geriatric Medicine centre in Berlin, Germany, prompted the implementation of comprehensive SARS-CoV-2 testing. Serial nasopharyngeal swabs were collected from all patients and staff and analysed for SARS-CoV-2 virus RNA using quantitative real-time PCR. In total, 11 of 84 patients (13.1%) and 1 of 147 employees (0.68%) tested positive. Of the 11 positive patients, 9 (81.8%) were asymptomatic at the time of testing. The data were used as the basis for adjusting local COVID-19 containment measures. Only one staff-to-staff transmission was observed, and there was no patient-to-patient, patient-to-staff or staff-to-patient transmission. Three patients infected with SARS-CoV2 died, two deaths being attributable to advanced malignant disease and one to COVID-19–associated myocarditis. In conclusion, universal SARS-CoV-2 testing revealed a cluster of predominantly asymptomatic infections, enabled appropriate local COVID-19 containment decisions and presumably contributed to the prevention of in-hospital SARS-CoV-2 transmission.

Modelling In-Patient Bed Usage Behaviour in a Department of Geriatric Medicine

1993 ◽  
Vol 32 (01) ◽  
pp. 79-81 ◽  
Author(s):  
P. Millard ◽  
S. McClean
Keyword(s):  
Census Data ◽  
Geriatric Medicine ◽  
Temporal Trends ◽  
Exponential Model ◽  
Bed Occupancy ◽  
Lengths Of Stay ◽  
Geriatric Hospital ◽  
Using Data ◽  
Acute Patients

Abstract:The flow of patients through geriatric hospitals has been previously described in terms of acute and long-stay states where the bed occupancy at a census point is modelled by a mixed exponential model. Using data for sixteen years the model was fitted to successive annual census points, in order to provide a description of temporal trends. While the number of acute patients has remained fairly stable during the period, the model shows that there has been a decrease in the number of long-stay patients. Mean lengths of stay in our geriatric hospital before death or discharge have decreased during the study period for both acute and long-stay patients.Using these fits of the mixed exponential model to census data, a method is provided for predicting future turnover of patients. These predictions are reasonably good, except when the turnover patterns go through a period of flux in which assumption of stability no longer holds. Overall, a methodology is presented which relates census analysis to the behaviour of admission cohorts, thus producing a means of predicting future behaviour of patients and identifying where there is a change in patterns.

scholarly journals Sars-CoV-2 attack rate in reception and accommodation centres for asylum seekers: systematic review of outbreak media reports in Germany

2021 ◽  
Author(s):  
Rosa Jahn ◽  
Maren Hintermeier ◽  
Kayvan Bozorgmehr
Keyword(s):  
Special Needs ◽  
Attack Rate ◽  
Asylum Seekers ◽  
Negative Binomial ◽  
Refugee Camps ◽  
Testing Strategies ◽  
Containment Measures ◽  
Media Reports ◽  
Google Search ◽  
The Impact

ABSTRACTObjectivesDespite concerns about the impact of the severe acute respiratory syndrome corona virus (Sars-CoV-2) in refugee camps, data on attack rates and effectiveness of containment measures are lacking. We aimed to (1) quantify the attack rate of Sars-CoV-2 during outbreaks in reception and accommodation centres in Germany, (2) assess differences in the attack rate based on containment measures, and (3) provide an overview of testing strategies, communication, conflicts, and protection measures for refugees with special needs.MethodsSystematic web-based review of outbreak media reports (until June 2020) on confirmed Sars-CoV-2 cases in reception centers for asylum seekers in Germany using the google search engine. Reports were screened for pre-defined inclusion criteria and complemented by snowball searches. Data on facility name, location, confirmed cases, containment measures, communication, protection strategies, and conflicts was extracted for each outbreak and reporting date. Evidence synthesis: meta-analysis and negative binomial regression.FindingsWe identified 337 media reports on 101 Sars-CoV-2 outbreaks in 99 reception and accommodation centers in Germany. The pooled Sars-CoV-2 attack rate was 13.1% (95% confidence interval, CI: 9.8-16.7). Outbreak sites implementing mass quarantine (n=76) showed higher rates (15.7; 95% CI: 11.6 - 20.2) compared to sites using conventional strategies (6.6; 95%CI: 3.1 - 11.2), yielding a rate ratio of 0.44 (95%CI: 0.27-0.72) adjusted for testing strategies, type and size of accommodation. Conflicts occurred in at least 11.8% of all outbreaks. Few sites reported specific measures to protect refugees with special needs.ConclusionMass quarantine is associated with higher attack rates, and appears to be a counter-productive containment measure in overcrowded camps. Although further research with individual-level data is required to rule out residual confounding, reception centers and refugee camps should follow the available guidelines on Covid-19 response and refrain from mass quarantine if physical distancing cannot be guaranteed.

A modelling study across the Italian regions: Lockdown, testing strategy, colored zones, and skew-normal distributions. How a numerical index of pandemic criticality could be useful in tackling the CoViD-19. (Preprint)

2021 ◽  
Author(s):  
Stefano De Leo ◽  
Manoel Araujo
Keyword(s):  
Mortality Rates ◽  
Testing Strategy ◽  
Effective Parameters ◽  
Normal Distributions ◽  
Testing Strategies ◽  
Italian Regions ◽  
Containment Measures ◽  
Skew Normal Distributions ◽  
Second Wave ◽  
Numerical Index

BACKGROUND As Europe is facing the second wave of the CoViD-19 pandemic, each country should carefully review how it dealt with the first wave of outbreak. Lessons from the first experience should be useful to avoid indiscriminate closures and, above all, to determine universal (understandable) parameters to guide the introduction of containment measures to reduce the spreading of the virus. OBJECTIVE The use of few (effective) parameters is indeed of extreme importance to create a link between authorities and population, allowing the latter to understand the reason for some restrictions and, consequently, to allow an active participation in the fight against the pandemic. METHODS Testing strategies, fitting skew parameters (as mean, mode, standard deviation, and skewness), mortality rates, and weekly CoViD-19 spreading data, as more people are getting infected, were used to compare the first wave of the outbreak in the Italian regions and to determine which parameters have to be checked before introducing restrictive containment measures. RESULTS We propose few \textit{universal} parameters that, once appropriately weighed, could be useful to correctly differentiate the pandemic situation in the national territory and to rapidly assign the properly pandemic risk to each region. CONCLUSIONS The numerical index of pandemic criticality introduced in this paper could be useful in tackling the CoViD-19.

scholarly journals COVID-19 Asymptomatic Infection Estimation

2020 ◽  
Author(s):  
Yang Yu ◽  
Yu-Ren Liu ◽  
Fan-Ming Luo ◽  
Wei-Wei Tu ◽  
De-Chuan Zhan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Disease Transmission ◽  
Prediction Models ◽  
Real Data ◽  
Machine Learning Techniques ◽  
Fine Grained ◽  
Asymptomatic Patients ◽  
Containment Measures ◽  
Asymptomatic Infections ◽  
The Government

AbstractBackgroundMounting evidence suggests that there is an undetected pool of COVID-19 asymptomatic but infectious cases. Estimating the number of asymptomatic infections has been crucial to understand the virus and contain its spread, which is, however, hard to be accurately counted.MethodsWe propose an approach of machine learning based fine-grained simulator (ML-Sim), which integrates multiple practical factors including disease progress in the incubation period, cross-region population movement, undetected asymptomatic patients, and prevention and containment strength. The interactions among these factors are modeled by virtual transmission dynamics with several undetermined parameters, which are determined from epidemic data by machine learning techniques. When MLSim learns to match the real data closely, it also models the number of asymptomatic patients. MLSim is learned from the open Chinese global epidemic data.FindingsMLSim showed better forecast accuracy than the SEIR and LSTM-based prediction models. The MLSim learned from the data of China’s mainland reveals that there could have been 150,408 (142,178-157,417) asymptomatic and had self-healed patients, which is 65% (64% – 65%) of the inferred total infections including undetected ones. The numbers of asymptomatic but infectious patients on April 15, 2020, were inferred as, Italy: 41,387 (29,037 – 57,151), Germany: 21,118 (11,484 – 41,646), USA: 354,657 (277,641 – 495,128), France: 40,379 (10,807 – 186,878), and UK: 144,424 (127,215 – 171,930). To control the virus transmission, the containment measures taken by the government were crucial. The learned MLSim also reveals that if the date of containment measures in China’s mainland was postponed for 1, 3, 5, and 7 days later than Jan. 23, there would be 109,039 (129%), 183,930 (218%), 313,342 (371%), 537,555 (637%) confirmed cases on June 12.ConclusionsMachine learning based fine-grained simulators can better model the complex real-world disease transmission process, and thus can help decision-making of balanced containment measures. The simulator also revealed the potential great number of undetected asymptomatic infections, which poses a great risk to the virus containment.FundingNational Natural Science Foundation of China.

CME-Dermatologie 22/Antworten: Masern – Epidemiologie und Klinik

Praxis ◽  
2020 ◽  
Vol 109 (15) ◽  
pp. 1179-1181
Author(s):  
Luc Hari ◽  
Stephan Lautenschlager
Keyword(s):  
Virus Rna ◽  
Sind Eine

Zusammenfassung. Die Masern sind eine hoch ansteckende, akute und febrile Krankheit, die durch eine Infektion mit dem Masernvirus verursacht wird. Gemäss Schätzungen der Weltgesundheitsorganisation (WHO) kommt es bei einer weltweiten Prävalenz von zehn Millionen Patientinnen und Patienten pro Jahr zu rund 142 000 Todesfällen (Mortalitätsrate 1,4 %). Klinisch zeigt sich ein stadienhafter Verlauf: Drei bis vier Tage nach dem initialen katarrhalischen Prodromalstadium mit Fieber und Krankheitsgefühl bildet sich das charakteristische Exanthem aus. Die Diagnosestellung erfolgt primär klinisch, muss aber laborchemisch durch den Nachweis von spezifischen IgM-Antikörpern im Serum oder Virus-RNA im Rachenabstrich bestätigt werden. Die Therapie ist rein supportiv, eine spezifische antivirale Behandlung existiert nicht. Der Prävention kommt daher ein absolut zentraler Stellenwert zu, da es sich bei den Masern um eine durch Impfstoffe vermeidbare Erkrankung handelt.

Psychological Aspects of Malignant Disease in Childhood

1981 ◽  
Vol 26 (2) ◽  
pp. 133-134
Author(s):  
E. James Anthony
Keyword(s):  
Malignant Disease ◽  
Psychological Aspects
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