Evaluation of a home-based 7-day infection control strategy for healthcare workers following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A cohort study
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Abstract
Objective:
Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy.
Methods:
HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce.
Results:
Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%).
Conclusions:
Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.
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SciScore for 10.1101/2020.11.05.20224618: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the research ethics board of the McGill University Health Centre (2020-6565), and written informed consent was obtained from all participants.
Consent: The study was approved by the research ethics board of the McGill University Health Centre (2020-6565), and written informed consent was obtained from all participants.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog…
SciScore for 10.1101/2020.11.05.20224618: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the research ethics board of the McGill University Health Centre (2020-6565), and written informed consent was obtained from all participants.
Consent: The study was approved by the research ethics board of the McGill University Health Centre (2020-6565), and written informed consent was obtained from all participants.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The present study must be considered in light of its weaknesses. First, the interim analysis resulted in a confidence interval surrounding the NPV estimate and may include unacceptably low values to merit implementation as an infection control strategy. We nevertheless present these interim results due to the lack of prospective data evaluating post exposure HCW testing strategies, and a second wave that threatens this essential workforce. With ongoing data collection and data sharing, we expect the precision of the NPV estimate to increase. Second, while the secondary attack rate in this sample is consistent with earlier close contact estimates,1 evolving HCW personal protective equipment policies may lower secondary attack rates in the second wave. If true, this would make our NPV estimate conservative. Third, SARS-CoV-2 immunity was not assessed but may influence the NPV of the testing strategy and the generalizability of our findings. While not yet peer-reviewed, the prevalence of SARS-CoV-2 IgG antibody detection among HCWs at a Canadian tertiary healthcare center during the same study period was low (1.4-3.4%).15 If immunity can be achieved through infection or vaccination, immunity will likely increase with time, making our NPV estimate conservative. Fourth, we did not perform viral culture to confirm the infectivity of participants with SARS-CoV-2 RNA detected by RT-PCR. While our pragmatic study design aimed to evaluate the testing strategy under ‘real world’ conditi...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a protocol registration statement.
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