scholarly journals Assessing the feasibility and effectiveness of household-pooled universal testing to control COVID-19 epidemics

2021 ◽  
Vol 17 (3) ◽  
pp. e1008688
Author(s):  
Pieter J. K. Libin ◽  
Lander Willem ◽  
Timothy Verstraeten ◽  
Andrea Torneri ◽  
Joris Vanderlocht ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Testing Procedure ◽  
Contact Tracing ◽  
Universal Testing ◽  
Initial Control ◽  
Care Systems ◽  
Testing Approach ◽  
Test Pool ◽  
The One ◽  
Pcr Test

Outbreaks of SARS-CoV-2 are threatening the health care systems of several countries around the world. The initial control of SARS-CoV-2 epidemics relied on non-pharmaceutical interventions, such as social distancing, teleworking, mouth masks and contact tracing. However, as pre-symptomatic transmission remains an important driver of the epidemic, contact tracing efforts struggle to fully control SARS-CoV-2 epidemics. Therefore, in this work, we investigate to what extent the use of universal testing, i.e., an approach in which we screen the entire population, can be utilized to mitigate this epidemic. To this end, we rely on PCR test pooling of individuals that belong to the same households, to allow for a universal testing procedure that is feasible with the limited testing capacity. We evaluate two isolation strategies: on the one hand pool isolation, where we isolate all individuals that belong to a positive PCR test pool, and on the other hand individual isolation, where we determine which of the individuals that belong to the positive PCR pool are positive, through an additional testing step. We evaluate this universal testing approach in the STRIDE individual-based epidemiological model in the context of the Belgian COVID-19 epidemic. As the organisation of universal testing will be challenging, we discuss the different aspects related to sample extraction and PCR testing, to demonstrate the feasibility of universal testing when a decentralized testing approach is used. We show through simulation, that weekly universal testing is able to control the epidemic, even when many of the contact reductions are relieved. Finally, our model shows that the use of universal testing in combination with stringent contact reductions could be considered as a strategy to eradicate the virus.

scholarly journals Assessing the feasibility and effectiveness of household-pooled universal testing to control COVID-19 epidemics

2020 ◽  
Author(s):  
Pieter Libin ◽  
Lander Willem ◽  
Timothy Verstraeten ◽  
Andrea Torneri ◽  
Joris Vanderlocht ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Testing Procedure ◽  
Contact Tracing ◽  
Universal Testing ◽  
Sample Extraction ◽  
Care Systems ◽  
Testing Approach ◽  
Test Pool ◽  
The One ◽  
Pcr Test

AbstractCurrent outbreaks of SARS-CoV-2 are threatening the health care systems of several countries around the world. The control of SARS-CoV-2 epidemics currently relies on non-pharmaceutical interventions, such as social distancing, teleworking, mouth masks and contact tracing. However, as pre-symptomatic transmission remains an important driver of the epidemic, contact tracing efforts struggle to fully control SARS-CoV-2 epidemics. Therefore, in this work, we investigate to what extent the use of universal testing, i.e., an approach in which we screen the entire population, can be utilized to mitigate this epidemic. To this end, we rely on PCR test pooling of individuals that belong to the same households, to allow for a universal testing procedure that is feasible with the current testing capacity. We evaluate two isolation strategies: on the one hand pool isolation, where we isolate all individuals that belong to a positive PCR test pool, and on the other hand individual isolation, where we determine which of the individuals that belong to the positive PCR pool are positive, through an additional testing step. We evaluate this universal testing approach in the STRIDE individual-based epidemiological model in the context of the Belgian COVID-19 epidemic. As the organisation of universal testing will be challenging, we discuss the different aspects related to sample extraction and PCR testing, to demonstrate the feasibility of universal testing when a decentralized testing approach is used. We show through simulation, that weekly universal testing is able to control the epidemic, even when many of the contact reductions are relieved. Finally, our model shows that the use of universal testing in combination with stringent contact reductions could be considered as a strategy to eradicate the virus.

A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

2019 ◽  
pp. 1-6
Author(s):  
M. Maggio ◽  
M. Barbolini ◽  
Y. Longobucco ◽  
L. Barbieri ◽  
C. Benedetti ◽  
...  
Keyword(s):  
Primary Care ◽  
Construct Validity ◽  
Predictive Value ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Cross Sectional Study ◽  
Criterion Validity ◽  
Cross Sectional ◽  
Care Systems ◽  
The One

Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: – to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); – to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; – to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

scholarly journals Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries

2018 ◽  
Vol 10 (12) ◽  
pp. 4439 ◽  
Author(s):  
Elio Borgonovi ◽  
Paola Adinolfi ◽  
Rocco Palumbo ◽  
Gabriella Piscopo
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Health Care Systems ◽  
Financial Economic ◽  
Point Of View ◽  
Health Care Environment ◽  
Health Gains ◽  
Care Systems ◽  
The One ◽  
The Individual

Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment.

scholarly journals A prospect on the use of antiviral drugs to control local outbreaks of COVID-19

2020 ◽  
Author(s):  
Andrea Torneri ◽  
Pieter Libin ◽  
Joris Vanderlocht ◽  
Anne-Mieke Vandamme ◽  
Johan Neyts ◽  
...  
Keyword(s):  
Control Measure ◽  
Health Care Systems ◽  
Significant Proportion ◽  
Antiviral Drug ◽  
Control Measures ◽  
Contact Tracing ◽  
Final Size ◽  
Antiviral Compound ◽  
Intervention Measures ◽  
Care Systems

AbstractBackgroundCurrent outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation and quarantine, have been shown to decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modelling work shows that this intervention technique may be inadequate to control local outbreaks, even when perfect isolation is assumed. Furthermore, the effect of infectiousness prior to symptom onset combined with a significant proportion of asymptomatic infectees further complicates the use of contact tracing. Antivirals, which decrease the viral load and reduce the infectiousness, could be integrated in the control measures in order to augment the feasibility of controlling the epidemic.MethodsUsing a simulation-based model of viral transmission we tested the efficacy of different intervention measures for the control of COVID-19. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Moreover, we investigate the effect of a potent antiviral compound on the contact tracing process.FindingsThe use of an antiviral drug, in combination with contact tracing, quarantine and isolation, results in a significant decrease of the final size, the peak incidence, and increases the probability that the outbreak will fade out.InterpretationFor an infectious disease in which presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when realized together with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. In addition, in all tested scenarios, the model highlights the benefits of the administration of an antiviral drug in addition to quarantine, isolation and contact tracing. The resulting control measure, could be an effective strategy to control local and re-emerging out-breaks of COVID-19.

scholarly journals Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan

10.2196/22098 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e22098
Author(s):  
Ichiro Nakamoto ◽  
Ming Jiang ◽  
Jilin Zhang ◽  
Weiqing Zhuang ◽  
Yan Guo ◽  
...  
Keyword(s):  
Close Contact ◽  
Health Care Systems ◽  
Participation Rate ◽  
Peer To Peer ◽  
Mobile App ◽  
Contact Tracing ◽  
Population Mobility ◽  
Excessive Pressure ◽  
Public Authorities ◽  
Care Systems

We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users’ privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19.

scholarly journals Diagnostics for COVID-19: A case for field-deployable, rapid molecular tests for community surveillance

2020 ◽  
Vol 54 (4s) ◽  
pp. 71-76
Author(s):  
Michael Frimpong ◽  
Yaw A. Amoako ◽  
Kwadwo B. Anim ◽  
Hubert S. Ahor ◽  
Richmond Yeboah ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Absolute Number ◽  
Contact Tracing ◽  
Infected People ◽  
Delay In Diagnosis ◽  
Slowing Down ◽  
Molecular Tests ◽  
Care Systems ◽  
Novel Coronavirus

Across the globe, the outbreak of the COVID-19 pandemic is causing distress with governments doing everything in their power to contain the spread of the novel coronavirus (SARS-CoV-2) to prevent morbidity and mortality. Actions are being implemented to keep health care systems from being overstretched and to curb the outbreak. Any policy responses aimed at slowing down the spread of the virus and mitigating its immediate effects on health care systems require a firm basis of information about the absolute number of currently infected people, growth rates, and locations/hotspots of infections. The only way to obtain this base of information is by conducting numerous tests in a targeted way. Currently, in Ghana, there is a centralized testing approach, that takes 4-5 days for samples to be shipped and tested at central reference laboratories with results communicated to the district, regional and nationalstakeholders. This delay in diagnosis increases the risk of ongoing transmission in communities and vulnerable institutions. We have validated, evaluated and deployed an innovative diagnostic tool on a mobile laboratory platform to accelerate the COVID-19 testing. A preliminary result of 74 samples from COVID-19 suspected cases has a positivity rate of 12% with a turn-around time of fewer than 3 hours from sample taking to reporting of results, significantly reducing the waiting time from days to hours, enabling expedient response by the health system for contact tracing to reduce transmission and additionally improving case management.

scholarly journals Isolation and Contact Tracing Can Tip the Scale to Containment of COVID-19 in Populations With Social Distancing

2021 ◽  
Vol 8 ◽  
Author(s):  
Mirjam E. Kretzschmar ◽  
Ganna Rozhnova ◽  
Michiel van Boven
Keyword(s):  
Growth Rates ◽  
Process Model ◽  
Reproduction Number ◽  
Health Care Systems ◽  
Contact Tracing ◽  
Explicit Calculation ◽  
Social Distancing ◽  
Household Contacts ◽  
Care Systems ◽  
Doubling Times

SARS-CoV-2 has established itself in all parts of the world, and many countries have implemented social distancing as a measure to prevent overburdening of health care systems. Here we evaluate whether and under which conditions containment of SARS-CoV-2 is possible by isolation and contact tracing in settings with various levels of social distancing. To this end we use a branching process model in which every person generates novel infections according to a probability distribution that is affected by the incubation period distribution, distribution of the latent period, and infectivity. The model distinguishes between household and non-household contacts. Social distancing may affect the numbers of the two types of contacts differently, for example while work and school contacts are reduced, household contacts may remain unchanged. The model allows for an explicit calculation of the basic and effective reproduction numbers, and of exponential growth rates and doubling times. Our findings indicate that if the proportion of asymptomatic infections in the model is larger than 30%, contact tracing and isolation cannot achieve containment for a basic reproduction number (ℛ0) of 2.5. Achieving containment by social distancing requires a reduction of numbers of non-household contacts by around 90%. If containment is not possible, at least a reduction of epidemic growth rate and an increase in doubling time may be possible. We show for various parameter combinations how growth rates can be reduced and doubling times increased by contact tracing. Depending on the realized level of contact reduction, tracing and isolation of only household contacts, or of household and non-household contacts are necessary to reduce the effective reproduction number to below 1. In a situation with social distancing, contact tracing can act synergistically to tip the scale toward containment. These measures can therefore be a tool for controlling COVID-19 epidemics as part of an exit strategy from lock-down measures or for preventing secondary waves of COVID-19.

The Management of Chronic Diseases in the Netherlands and in Germany

2007 ◽  
Vol 9 (3) ◽  
pp. 243-275
Author(s):  
Markus Sichert ◽  
Christina Walser
Keyword(s):  
Health Care ◽  
The Netherlands ◽  
Chronic Diseases ◽  
Chronic Disease Management ◽  
Health Care Systems ◽  
Chronically Ill ◽  
The Other ◽  
Improve Quality ◽  
Care Systems ◽  
The One

Chronic diseases pose significant challenges to health insurance systems. On the one hand, the supply of medical care to patients suffering from chronic diseases is very costly; on the other hand, more and more people are becoming chronically ill, and many of them suffer from diabetes. Against this background, steering mechanisms that address chronic disease management are needed, not only to cope with cost containment, but also to improve quality and to overcome obstructive interfaces of supply structures. This article analyses how these challenges are being dealt with and how the respective chronic diseases – the focus will be on diabetes – are managed in the Netherlands and in Germany. The approaches taken in each of these countries present examples of how structures for political and legal steering have been established within health care systems that are subject to frequent reform. Each approach is assessed by analysing the priority given to either regulatory or competitive elements, and particular reference will be made to (subordinated) implementation structures, contracts or models.

scholarly journals Demand-based models and market failure in health care: projecting shortages and surpluses in doctors and nurses

2018 ◽  
Vol 14 (2) ◽  
pp. 291-294 ◽  
Author(s):  
Stephen Birch
Keyword(s):  
Health Care ◽  
Market Failure ◽  
Health Care Systems ◽  
Public Intervention ◽  
Care Workers ◽  
Workforce Policy ◽  
Care Systems ◽  
The One ◽  
System Sustainability ◽  
Demand For Health

AbstractModels for projecting the demand for and supply of health care workers are generally based on objectives of meeting demands for health care and assumptions of status quo in all but the demographic characteristics of populations. These models fail to recognise that public intervention in health care systems arises from market failure in health care and the absence of an independent demand for health care. Hence projections of demand perpetuate inefficiencies in the form of overutilisation of services on the one hand and unmet needs for care on the other. In this paper the problems with basing workforce policy on projected demand are identified and the consequences for health care system sustainability explored. Integrated needs-based models are offered as alternative approaches that relate directly to the goals of publicly funded health care systems and represent an important element of promoting sustainability in those systems.

scholarly journals Health Care Organizations: Soft Target during COVID-19 Pandemic

2021 ◽  
Vol 36 (3) ◽  
pp. 344-347
Author(s):  
Harald G. De Cauwer ◽  
Francis Somville
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Behavioral Science ◽  
Health Care Systems ◽  
Health Care Facilities ◽  
The Other ◽  
Contact Tracing ◽  
Cyber Terrorism ◽  
Care Systems ◽  
Soft Target

AbstractHealth care organizations have been challenged by the coronavirus disease 2019 (COVID-19) pandemic for some time, while in January 2020, it was not immediately suspected that it would take such a global expansion. In the past, other studies have already pointed out that health care systems, and more specifically hospitals, can be a so-called “soft target” for terrorist attacks. This report has now examined whether this is also the case in the context of the COVID-19 pandemic.During the lockdown, hospitals turned out to be the only remaining soft targets for attacks, given that the other classic targets were closed during the lockdown. On the other hand, other important factors have limited the risk of such attacks in hospitals. The main delaying and relative risk-reducing factors were the access control on temperature and wearing a mask, no visits allowed, limited consultations, and investigations.But even then, health care systems and hospitals were prone to (cyber)terrorism, as shown by other COVID-19-related institutions, such as pharmaceuticals involved in developing vaccines and health care facilities involved in swab testing and contact tracing. Counter-terrorism medicine (CTM) and social behavioral science can reduce the likelihood and impact of terrorism, but cannot prevent (state-driven) cyberterrorism and actions of lone wolves and extremist factions.

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