Modelling – reports

European Centre for Disease Prevention and Control

Projected baselines of COVID-19 in the EU/EEA and the UK for assessing the impact of de-escalation of measures
As the UK and EU/EEA countries start to de-escalate lockdown and other social distancing measures, ECDC have published a technical report  setting out a model to provide a 30-day forecast of COVID-19 cases, deaths and hospitalisations under a set of assumptions Their first analysis corresponds to a ‘status quo’ where all control measures will be continued until 7 June – this baseline can be compared (alongside the results of other models) to actual figures, to help assess the impact of lifting current measures in different countries.

Methodology for estimating point prevalence of SARS-CoV-2 infection by pooled RT-PCR testing

ECDC have also published a paper  setting out the proposed methodology to monitor the activity of SARS-CoV-2 in the population, including estimating the asymptomatic population and the prevalence in specific risk groups. It is hoped that following this approach will lead to better and more comparable estimates of the disease’s prevalence.

Clinical and Medical News

Impacts of COVID-19 on care for people with long-term conditions

Admissions to A&E and access to non-COVID-related healthcare in general have declined during the pandemic. The Health Foundation examined the impact of COVID-19 on access to and use of health care services for people with existing conditions. They were asked about their use of health care between January 2020 and the end of February 2020; the same group were then asked if they had accessed any health services since the end of February 2020 and what it was for.

Access to health services by such people was 20% lower during the COVID-19 peak period. Some of the largest falls in the use of health services were for mental health (-25%) and cancer (22%). Reasons given for not using health services: just under half reported that they no longer needed access, 10% that they could not get an appointment, and 22% were concerned about contracting or transmitting the virus.

Remdesivir for the Treatment of Covid-19

Remdesivir, an anti-viral drug, is being investigated for its potential use in treating COVID-19. Latest analysis of a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 examined whether it was effective at reducing the time to recovery .

As of 28 April 2020, a total of 391 patients in the remdesivir group and 340 in the placebo group had completed the trial through to day 29, recovered, or died. Preliminary results of this trial suggest that a 10-day course of remdesivir was superior to placebo in the treatment of hospitalized patients with Covid-19 (median number of days to recovery 11 vs. 15).

Cluster Settings

The types of indoor and outdoor settings where transmission of SARS-CoV-2 has been reported to occur which result in clusters of cases have been the focus of this systematic review.  Unsurprisingly, clusters were linked to a wide range of mostly indoor settings (12/18). Almost all clusters involved fewer than 100 cases (141/152), with the outliers being transmission in hospitals, elderly care, worker dormitories, and ship settings. This could inform post-lockdown strategies by identifying places to be kept under close surveillance and/or should remain closed to avoid a resurgence in transmission.

Treatments Explained

The array of treatment approaches for COVID-19 are clearly explained here in a user-friendly infographic developed by Birmingham Health Partners, (an alliance between the University of Birmingham and two NHS Foundation Trusts – Birmingham Women’s & Children’s, and University Hospitals Birmingham). The infographic illustrates the mode of action of each of the pharmaceutical interventions including anti-virals, monoclonal antibody therapy, and steroids.

Nursing Homes and COVID-19 – Outcomes

Nursing home residents have been particularly vulnerable to COVID-19. The World Health Organization has estimated that as many as half of all COVID-19 deaths in Europe occurred in care homes.

The results of an outbreak investigation published this week are reported here. The study included 394 nursing home residents in four nursing homes in central London. It is reported that many of the residents did not display the typical SARS-CoV-2 symptoms of fever and cough, but died after a short period of becoming acutely unwell.

Very sadly, 26% of the residents died over the two-month period leading to an increase in all-cause mortality of 203%. 43% of those tested were asymptomatic and 18% had atypical symptoms such as confusion and vomiting. Widespread testing of staff was not carried out.

And finally …

Sewage as a predictor of COVID-19 outbreaks?

Forget testing, it appears that SARS-CoV-2 RNA concentrations in sewage may be ‘highly correlated’ with outbreaks of COVID-19 and hospital admissions . Primary sewage sludge in New Haven, Connecticut (CT) was analysed and it was found that the SARS-CoV-2 RNA concentration therein closely followed the epidemiology curves established by compiled COVID-19 testing data and hospital admissions and were a seven-day leading indicator. (This report has attracted significant interest over recent days, but analysis suggests that the correlation may be due to a statistical artefact …)

29 May 2020