Seattle Flu Study - Swab and Send: Study Protocol for At-Home Surveillance Methods to Estimate the Burden of Respiratory Pathogens on a City-Wide Scale

Abstract

Introduction.While seasonal influenza and other respiratory pathogens cause significant morbidity and mortality each year, the community-based burden of these infections remains incompletely understood. Understanding the prevalence, epidemiology, and transmission dynamics of respiratory pathogen infections among community-dwelling individuals is essential during pandemic and epidemic settings and for developing pandemic-preparedness infrastructure. Methods and Analysis.We present the protocol for a novel, city-wide home-based cross-sectional study in the Seattle Metropolitan area, utilizing rapid delivery systems for self-collection of a nasal swab and return to the laboratory for respiratory pathogen testing. All participation takes place electronically, including recruitment, consent, and data collection. Within 48 hours of participants self-reporting respiratory symptoms, a nasal swab kit is delivered to the household via a courier service. Demographic and illness characteristics are collected at the time of sample collection and recovery and behavioral information collected one week later. Specimens are tested in the laboratory for multiple respiratory pathogens, and results are available on a public website for participants.Ethics and Dissemination. The study was approved by the University of Washington Institutional Review Board (Protocol #00006181). Results will be disseminated through peer-reviewed publications, talks at conferences, and on the Study Website ( www.seattleflu.org ).All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Article Summary:• The findings of this study will inform whether a home-based approach to city-wide respiratory surveillance is possible in epidemic settings • A key strength of this study is that it is conducted across diverse neighborhoods spanning a major metropolitan area • Clinical findings may not be generalizable, as they are reliant on self-report (vaccination status, symptoms, healthcare utilization, etc.) All rights reserved. No reuse allowed without permission.author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

SwabExpress: An end-to-end protocol for extraction-free COVID-19 testing

“…These clinical samples were established to be COVID-19-positive via testing at the University of Washington’s Virology lab ( 3 ). Paired conventional and dry mid-nasal swabs were then self-collected via Seattle Flu Study (SFS) home self-swab kits delivered to participants’ homes within 1-2 days after they had tested positive, and returned via delivery service at ambient temperature ( 4, 5 ).…”

“…Based on identification of a laboratory-confirmed positive through the automated laboratory alert system, individuals were contacted and enrolled into a study to compare performance of various swab types. After providing consent, enrolled participants had a swab and send kit ( 4 ) containing two swabs (Copan FloqSwab 56380CS01) delivered to their home via 2-hour delivery and were provided instructions to self collect mid nasal swabs. Participants placed one swab in UTM (Becton Dickinson PN 220220) and the other in an empty 15 mL conical tube for transport.…”

Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City region

“…Given the logistical, regulatory, and methodological challenges to establishing such surveillance during an outbreak, it is critical to have this infrastructure already in place (Kim et al 2020) for future waves of COVID-19 or other future pandemics.…”

Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City Region

“…Retrospective analysis could illuminate the degree of undetected community spreading on a per-region basis, to assess the efficacy of policy and behavioral changes, and prospectively to inform proactive management of an ongoing outbreak 15 . Two other groups have reported sequencing surveillance of nearby or overlapping regions 16,17 , and monitoring of a hospital system could be complemented by broader population studies 18 . Given the logistical and regulatory hurdles to establishing such surveillance, it is critical to have this infrastructure already in place for future waves of COVID-19 or other future pandemics.…”