Testing in a Pandemic — Improving Access, Coordination, and Prioritization

Botti-Lodovico, Yolanda; Rosenberg, Eric S.; Sabeti, Pardis C.

doi:10.1056/nejmp2025173

Cited by 27 publications

(19 citation statements)

References 1 publication

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“…The rationale for symptom-based classifier as a primary outcome was due to widespread difficulties obtaining testing during the early stages of the pandemic. 21 Secondary outcomes were confirmed COVID-19 based on a self-report of a reverse transcription PCR positive test and COVID-19 severity. COVID-19 severity was ascertained based on a report of the need for a hospital visit which required (1) non-invasive breathing support, (2) invasive breathing support and (3) administration of antibiotics combined with oxygen support (online supplemental methods).…”

Section: Assessment Of Covid-19 Risk and Severitymentioning

confidence: 99%

Diet quality and risk and severity of COVID-19: a prospective cohort study

Merino

Joshi

Nguyen

et al. 2021

Gut

167

123

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ObjectivePoor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation.DesignWe used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively.ResultsOver 3 886 274 person-months of follow-up, 31 815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR 0.91; 95% CI 0.88 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation.ConclusionsA diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

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Section: Assessment Of Covid-19 Risk and Severitymentioning

confidence: 99%

Diet quality and risk and severity of COVID-19: a prospective cohort study

Merino

Joshi

Nguyen

et al. 2021

Gut

167

123

View full text Add to dashboard Cite

show abstract

“…As of 27 July 2021, SARS-COV-2 had resulted in 195,1963,640 infections resulting in 4,180,182 deaths in over 220 countries 3 . Preventing the spread of SARS-COV-2 is a global public health priority requiring multiple interventions such as social distancing, hand hygiene, infection protection devices, vaccination, timely and accurate diagnosis, and treatment of the sick 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Field performance of NowCheck rapid antigen test for SARS-CoV-2 in Kisumu County, western Kenya

Onsongo

Otieno

Duijn

et al. 2021

Preprint

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Background Low- and middle-income countries (LMICs) are increasingly adopting low-cost Coronavirus disease 2019 (COVID-19) rapid antigen tests to meet the high demand for SARS-CoV-2 testing. Whilst testing using real-time polymerase chain reaction (RT-PCR) is the current gold standard, its widespread use in LMICs is limited by high costs, turnaround times and is not readily available in most places. COVID-19 antigen tests (Ag-RDT) provide a suitable alternative due to their low cost, rapid turnaround time and easy to set up and use. This study aimed to assess the field performance of the NowCheck COVID-19 antigen kit (Ag-RDT) as a point of care test (POCT) in select healthcare facilities in western Kenya. Methods We conducted a prospective multi-facility field evaluation study of the NowCheck COVID-19 rapid antigen test (Ag-RDT) compared to SARS-CoV-2 RT-PCR (RT-PCR). After obtaining informed consent, trained laboratory technicians collected two pairs of oropharyngeal and nasopharyngeal swabs, both antigen and RT-PCR testing, first for Ag-RDT and next for RT-PCR. We performed Ag-RDTs on-site and shared the results with both the study participants and their healthcare providers within 15-30 minutes. We carried out all RT-PCR tests in a central referral laboratory. The turnaround time for RT-PCR results was typically 24-48 hours. We captured the results of both methods using an electronic digital application. Findings Between December 2020 and March 2021, we enrolled 997 participants who met the Kenyan Ministry of Health COVID-19 case definition. The median age of study participants was 39 years (range one to 80 years), with 54% male. Ag-RDT had a sensitivity of 84.5% (76.0-90.8) and a specificity of 94.4% (95% CI: 92.7-95.8) with an accuracy of 94.2% (92.5- 95.6) when a cycle threshold value (Ct value) of ≤35 was used. The highest sensitivity of 87.7% (77.2-94.5) was observed in samples with Ct values ≤ 30 and the highest specificity of 97.5% (96.2-98.5) at Ct value of <40. Interpretation The NowCheck COVID-19 Ag-RDT showed good performance in field evaluation in multiple healthcare facilities in a developing country. The sensitivity of the kit exceeded the minimum recommended cut-off of 80% as recommended by WHO1. The high specificity of this kit at 94.4% at Ct values ≤33 and 97.5% at Ct values <40 matched that of real-time PCR, making it a good rule-out test for symptomatic patients with COVID-19- like symptoms. The faster turnaround time to results, lower cost, simple analytical steps requiring no equipment or infrastructure makes antigen testing an attractive field-screening method to meet the high demand for COVID-19 testing.

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“…The rationale for symptom-based classifier as a primary outcome was due to widespread difficulties obtaining testing during the early stages of the pandemic. 20 Secondary outcomes were confirmed COVID-19 based on a self-report of a reverse transcription polymerase chain reaction (RT-PCR) positive test and COVID-19 severity. COVID-19 severity was ascertained based on a report of the need for a hospital visit which required 1) non-invasive breathing support, 2) invasive breathing support, and 3) administration of antibiotics combined with oxygen support (online supplementary methods).…”

Section: Assessment Of Covid-19 Risk and Severitymentioning

confidence: 99%

Diet quality and risk and severity of COVID-19: a prospective cohort study

Merino

Joshi

Nguyen

et al. 2021

Preprint

View full text Add to dashboard Cite

ObjectivePoor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation.DesignWe used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively.ResultsOver 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively.ConclusionsA dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

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Testing in a Pandemic — Improving Access, Coordination, and Prioritization

Cited by 27 publications

References 1 publication

Diet quality and risk and severity of COVID-19: a prospective cohort study

Diet quality and risk and severity of COVID-19: a prospective cohort study

Field performance of NowCheck rapid antigen test for SARS-CoV-2 in Kisumu County, western Kenya

Diet quality and risk and severity of COVID-19: a prospective cohort study

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