Objective: To quantify the utility of RT-PCR and rapid antigen tests in preventing post-arrival transmission based on timing of the pre-departure test.Methods: We derived analytical expressions to compute post-arrival transmission when no test is performed, and when either an RT-PCR or any of 18 rapid antigen tests is performed at specified times before arrival. We determined the diagnostic sensitivity of the rapid antigen tests by propagating their RT-PCR percent positive agreement onto known RT-PCR diagnostic sensitivity.Results: Depending on the rapid antigen test used, conducting a rapid antigen test immediately before departure reduces post-arrival transmission between 37.4% (95% CrI: 28.2%–40.7%) and 46.7% (95% CrI:40.0%–49.3%), compared to a 31.1% (95% CrI: 26.3%–33.5%) reduction using an RT-PCR 12 h before arrival. Performance of each rapid antigen test differed by diagnostic sensitivity over the course of disease. However, these differences were smaller than those engendered by testing too early.Conclusion: Testing closer to arrival—ideally on the day of arrival—is more effective at reducing post-arrival transmission than testing earlier. Rapid antigen tests perform the best in this application due to their short turnaround time.
Quarantine and serial testing strategies for a disease depend principally on its incubation period and infectiousness profile. In the context of COVID-19, these primary public health tools must be modulated with successive SARS CoV-2 variants of concern that dominate transmission. Our analysis shows that 1) vaccination status of an individual makes little difference to the determination of the appropriate quarantine duration of an infected case, whereas vaccination coverage of the population can have a substantial effect on this duration, 2) successive variants can challenge disease control efforts by their earlier and increased transmission in the disease time course relative to prior variants, and 3) sufficient vaccine boosting of a population substantially aids the suppression of local transmission through frequent serial testing. For instance, with Omicron, increasing immunity through vaccination and boosters—for instance with 100% of the population is fully immunized and at least 24% having received a third dose—can reduce quarantine durations by up to two days, as well as substantially aid in the repression of outbreaks through serial testing. Our analysis highlights the paramount importance of maintaining high population immunity, preferably by booster uptake, and the role of quarantine and testing to control the spread of SARS CoV-2.
BackgroundRheumatic diseases such as rheumatoid arthritis (RA) and Systemic lupus erythematosus (SLE) were known for increased prevalence and risk of death from cardiovascular disease (CVD) due to systemic inflammation in conjunction with other environmental risk factors and genetic predispositions.[1]The COVID-19 pandemic is of the leading causes for the increased age-adjusted mortality rate in 2020 due to various unforeseeable conditions including unequitable healthcare resource distribution, decrease access to medical treatment other than for COVID-19 infection.ObjectivesTo investigate if the presence of the COVID-19 had an impact on the mortality outcome of acute myocardial infraction (AMI) and acute heart failure (AHF) in rheumatic diseases (RDs) including patients with RA, SLE, psoriasis/psoriatic arthritis, gout, myositis and vasculitis, and sarcoidosis in the United States using the NIS inpatient database from 2016-2020.MethodsUsing NIS database from 2016-2020, we identified patients with a primary admission diagnosis of AMI or AHF using ICD-10 codes. For each admission, we calculated ascertained mortality risk. The association of RDs with inpatient mortality was calculated using multivariable logistic regression. Mortality outcomes from 2016-2019 was compared to 2020, which was the year COVID-19 pandemic initiated.ResultsWe identified a total of 691,834 AMI/AHF hospitalizations from 2016-2019, of which 39,047 patients had RDs. During the pre-COVID-19 time, the inpatient mortality was significantly higher in the non-RDs group (4.1% vs 3.3%,p=<0.001). In multivariable logistic regression model, after adjusting for age, race, gender, region, income and confounding comorbidities, patients in the RDs group had a lower odd ratio of inpatient mortality in AMI/AHF compared to non-RDs group (OR=0.71,p=<0.001). During the pandemic year, total AMI/AHF hospitalizations were 121,285, and 5,813 of them were patients had RDs. Again the hospitalization mortality was higher in the non-RDs group with clinical significance ofp= <0.001 (4.8% vs. 3.4%). Interestingly, in terms of the COVID-19 infection rate, patients the non-RDs group had a higher infection rate when comparing to RDs (25% vs 23%,p=0.047). The odd ratio for AMI/AHF hospitalization mortality was again significantly lower in RDs groups compared to non-RD’s group (OR=0.65,p=<0.001).ConclusionBased on our analysis, the presence of co-morbid RDs was not associated with an increased mortality in patients hospitalized with AMI/AHF. These results may be attributed to the use of biologic agents in RDs patients in reducing systemic inflammation. The lower COVID-19 infection rate in RDs patients could be related to the early and aggressive implementation of social distancing and telehealth appointments in the US during the COVID-19 pandemic.Reference[1]Alhusain, A., & Bruce, I. N. (2013). Cardiovascular risk and inflammatory rheumatic diseases. Clinical medicine (London, England), 13(4), 395–397.https://doi.org/10.7861/clinmedicine.13-4-395Table 1.Demographic, Outcomes and Adjusted Odd Ratio of Hospital Mortality of Acute Myocardial Infraction and Acute Heart Failure Exacerbation in Patient Without and With Rheumatic Diseases 2016-2020Characteristics/outcome 2016-2019Without RDs 691,834With RDs* 39,047p-valueCharacteristics/outcome 2020Without RDs 121,285With RDs* 5,813p-valueMortality (%)4.13.3<0.001Mortality4.83.4<0.001Age (Year, mean)6871<0.001Age (Year, mean)6770<0.001Female (%)4135<0.001Female (%)3731<0.001Length of Stay (day)34<0.001Length of Stay (day)33<0.001COVID-19 Infection Rate (%) ¥25230.047Characteristics/outcome 2016-2019Odd Ratio95% CIp-valueCharacteristics/outcome 2020Odd Ratio95% CIp-valueMortality0.71(0.60, 0.83)<0.001Mortality0.65(0.56, 0.76)<0.001Length of Stay1.01(1.01, 1.02)<0.001Length of Stay1.01(1.00, 1.01)<0.001Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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