Utility of early diagnosis, contact tracing and stakeholder engagement in outbreak response in three COVID-19 outbreak settings in Ghana

Objective: To describe how early case detection, testing and contact tracing measures were deployed by stakeholders in response to the COVID-19 outbreak in Ghana – using three outbreak scenarios.Design: A descriptive assessment of three case studies of COVID-19 outbreaks within three settings that occurred in Ghana from March 13 till the end of June 2020.Setting: A construction camp, a factory and a training institution in Ghana.Participants: Staff of a construction camp, a factory, workers and students of a training institution.Interventions: We described and compared the three COVID-19 outbreak scenarios in Ghana, highlighting identification and diagnosis of cases, testing, contact tracing and stakeholder engagement for each scenario. We also outlined the challenges and lessons learnt in the management of these scenarios.Main outcome measures: Approach used for diagnosis, testing, contact tracing and stakeholder engagement.Results: Index cases of the training institution and construction camp were screened the same day of reporting symptoms, whiles the factory index case required a second visit before the screening. All index cases were tested with RTPCR. The training institution followed and tested all contacts, and an enhanced contact tracing approach was conducted for staff of the other two sites. Multi-sectorial engagement and collaboration with stakeholders enabled effectivehandling of the outbreak response in all sites.Conclusion: Comparing all three settings, early diagnosis and prompt actions taken through multi-sectorial collaborations played a major role in controlling the outbreak. Engaging stakeholders in the COVID-19 response is an effective way to mitigate the challenges in responding to the pandemic.

Tool for estimating the probability of having COVID-19 with one or more negative RT-PCR results

Early case detection and isolation of infected individuals are critical to controlling COVID-19. RT-PCR is considered the gold standard for the diagnosis of SARS-CoV-2 infection, but false-negatives occur. We built a user-friendly online tool to estimate the probability of having COVID-19 with negative RT-PCR results and thus avoid preventable transmission.

Response of Healthcare Workers to COVID-19 Protocols after the Index Case at 37 Military Hospital, Ghana

The diagnosis and management of COVID-19 are much dependent on the adherence to standardized protocols. Healthcare workers play a crucial role in the case management of COVID-19 in many institutions. Globally, the disease burden is increasing, and the mortality has reached over 2 041 426 compared with 323 000 in May 2020. In West Africa, the pandemic has shown a slow but steady rise in many countries. Existing protocols and their utilization are best assessed after the occurrence of the index case. General aim. The study assessed the health worker’s response to COVID-19 protocols at three designated areas of the in-hospital management care triaging, holding area, and treatment centers. Method. A qualitative design was used to assess the response of healthcare workers with regards to early case detection, infection prevention, risk communication to clients and compliance to protocols. The study conducted observational visits and purposively selected healthcare workers comprising of clinicians, nurses, emergency medical technicians, and laboratory technicians who perform routine duties at the triaging, holding, and treatment centers. A total of 41 observations were made over two weeks. Results. Participants comprised 23 males and 18 females. At all observed units, the case definition was being used to screen attendants presenting, and appropriate categorization of patients was ensured. The use of temperature in screening for COVID-19 at the units was generally adhered to. Only 50% of participants used the prescribed PPEs. The physical distancing between healthcare workers and client and between clients and caregivers were not enforced; however, hand hygiene was practiced. Disinfection of working surfaces and equipment with 0.5% chlorine or 70% alcohol-based rubs were used most of the time. It was observed however that no psychological counselling was given to suspected cases or their relatives. Conclusion. Healthcare workers showed discordant response to different parts of the protocols for COVID-19 especially appropriate distancing. There was an enhanced awareness among healthcare workers and improvement in infection prevention protocols. The study also observed that as the risk of infection increased from triaging to holding area and to treatment centers, the response of healthcare workers to COVID-19 protocols also improved. Risk communication is an essential part of the COVID-19 management strategy. At the treatment centers, healthcare workers adhered to this protocol, whereas it was a major gap at the triaging and holding areas.

Assessing asymptomatic, pre-symptomatic and symptomatic transmission risk of SARS-CoV-2

Background The relative contributions of asymptomatic, pre-symptomatic and symptomatic transmission of SARS-CoV-2 have not been clearly measured although control measures may differ in response to the risk of spread posed by different types of cases. Methods We collected detailed information on transmission events and symptom status based on laboratory-confirmed patient data and contact tracing data from four provinces and one municipality in China. We estimated the variation in risk of transmission over time, and the severity of secondary infections, by symptomatic status of the infector. Results There were 393 symptomatic index cases with 3136 close contacts and 185 asymptomatic index cases with 1078 close contacts included into the study. The secondary attack rate among close contacts of symptomatic and asymptomatic index cases were 4.1% (128/3136) and 1.1% (12/1078), respectively, corresponding to a higher transmission risk from symptomatic cases than from asymptomatic cases (OR: 3.79, 95% CI: 2.06, 6.95). Approximately 25% (32/128) and 50% (6/12) of the infected close contacts were asymptomatic from symptomatic and asymptomatic index cases, respectively, while more than one third (38%) of the infections in the close contacts of symptomatic cases were attributable to exposure to the index cases before symptom onset. Infected contacts of asymptomatic index cases were more likely to be asymptomatic and less likely to be severe. Conclusions Asymptomatic and pre-symptomatic transmission play an important role in spreading infection, although asymptomatic cases pose a lower risk of transmission than symptomatic cases. Early case detection and effective test-and-trace measures are important to reduce transmission.

Tool for estimating the probability of having COVID-19 with one or more negative RT-PCR results

Early case detection and isolation of infected individuals are critical to controlling COVID-19. RT-PCR is considered the diagnosis gold standard, but false-negatives occur. Based on previous work, we built a user-friendly online tool to estimate the probability of having COVID-19 with negative RT-PCR results and thus avoid preventable SARS-CoV-2 transmission.

A trend prevalence of visceral Leishmaniasis in West Armachiho District, Amhara Region, Northwest Ethiopia

Background Visceral leishmaniasis (VL) is a disease caused by an obligate intracellular protozoan parasite that affects animals and humans. An estimated 3.2 million people are at risk of VL, and 3700–7400 cases occur annually in Ethiopia. The highest numbers of VL cases have been previously reported from the North Western parts of the country, especially in West Armachiho District. The aim of this study was to determine the trend prevalence of VL at the study area. Methods Health center based retrospective data were collected to determine the trend prevalence of VL among patients who had blood examination from January 2010 to August 2015. The blood samples were collected by finger pricking and the infections were confirmed by using rK39 antibody test. Result Of the 9299 VL suspected cases, 1948 (21%) were positive for rK39 antibody test. Of these, 1757 (90.2%) were primary kala-azar cases, 167 (8.6%) were relapse and the remaining 24 (1.2%) were post kala-azar dermal leishmaniasis cases. Conclusions The prevalence of VL is still high in the study area. Therefore, early case detection, diagnosis, treatment, and timely analysis are essential.

Coronavirus (COVID-19) Symptoms, Treatment, and Recent Medical Challenges to the World: A Review

Coronavirus infections have emerged as epidemic and pandemic threats throughout the world. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread across 203 countries and territories in all 5 major continents. World Health Organization (WHO) declared this as a public health emergency of international concern on January 30, 2020. Subsequently, on February 11, 2020, a new name was given to this disease i.e. COVID-19 by an expert group from WHO. As of 3:37 pm CEST, 14 August 2020, there have been 20,730,456 confirmed cases of COVID-19, including 751,154 deaths, reported to WHO. It possibly originated from a small animal market in Wuhan, China. A cluster of patients was admitted with unusual pneumonia not responding to treatment in various hospitals. Epidemiological, genomic analysis and correlation with other coronaviruses led to the isolation of new coronavirus, closely resembling the bat coronaviruses, from such patients in Wuhan. They were identified as the SARS-CoV-2. This virus infection presents an influenza-like illness in the affected people. Fever, cough, respiratory distress with fatigue, diarrhea, nausea, and vomiting are common symptoms seen in adults. The transmissibility of SARS-CoV-1 was less as compared to SARS-CoV-2 infection, and it was well controlled with good public health efforts. The present COVID-19 epidemic is still in the acceleration phase of 3 and 4 in various countries. Without any effective antiviral agents available at present, the need of the hour is early case detection, isolation of cases, use of good preventive care measures by the household contacts and in the hospital setup. Here, we have placed the symptoms and treatment schemes for the COVID-19 from the practice of different research organizations of the World including WHO.

Detection of imported COVID-19 cases worldwide: early assessment of airport entry screening, 24 January until 17 February 2020

The purpose of this study was to provide an overview of entry screening measures applied at airports in response to the COVID-19 epidemic worldwide. Between 24 January and 17 February 2020, 5.2% (95% CI 3.1–8.5) of the 271 total imported COVID-19 cases worldwide (excluding imported cases arriving in China, Macao, and Hong Kong) with known detection location were captured through airport entry screening. The majority of imported COVID-19 cases (210) were identified by the health care system (77.5%). Efforts should focus on health care system preparedness for early case detection, since according to our and previous studies health care facilities are the actual point of entry of imported cases.

Nutritional status and morbidity profile of children with leprosy contact in a rural community

An observational pilot study was conducted to assess the nutritional status and morbidity profile of childhood contacts of leprosy in an endemic area (Chengalpattu) in India. A total of 70 such children were included in the study. Sociodemographic data were collected using a one-to-one interview method and the children were evaluated by dermatologists qualified in paediatric leprosy. The obtained data were computed. Three children were diagnosed to have leprosy through this study. Nutritional status assessment in these children demonstrated malnutrition, a common finding. Regular contact screening of children in endemic areas for early case detection, disability prevention and thereby prevention of community transmission is mandatory. Further research is needed concerning the role of malnutrition in children and its relation to morbidity in leprosy. The closeness and duration of contact of leprosy is also an important risk factor. Effective strategies to diagnose subclinical infection are needed.