COVID-19 – what have we learned?

I did a talk at an IPC conference the other day trying to summarise what we’ve learned from the COVID-19 pandemic. You can see my slides here. I think (hope) we have learned a lot – and still have more to learn – about (in no particular order): PPE, transmission routes, testing and laboratory factors, vaccination, organizational transformation, guidelines and policy development, regulatory framework, outbreaks, non-COVID pathogens, antimicrobial stewardship, digital transformation, applied research, and the mental health of our workforce.

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Lateral flow or PCR?

As England moves away from confirmatory PCR testing following a positive lateral flow test in the absence of COVID-19 symptoms, it’s a good time to look at what these two different testing strategies can offer us. There’s an excellent short review in NEJM combined with a case study to help illustrate the impact of pre-test probability plays out. Both lateral flow testing and PCR testing have their place, and in some ways lateral flow testing is a better correlate for infectivity (as well as being cheaper and easier!).

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What is the evidence for droplet transmission for SARS-CoV-2?

A guest post from Dr Evonne Curran

The disputed airborne mode of transmission in this pandemic requires further scrutiny. Researchers have thus far focused on presenting a case for airborne transmission1 rather than disputing that the ‘primary’ mode of transmission for SARS-CoV-2 is via droplets2.

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Omicron: buckle up for a bumpy ride

I’ve been meaning to write an update on the Omicron variant of concern for a few weeks’ now and it’s now or never, so here we go! The Omicron variant has a host of mutations compared with previous variants, which seems to have given it the ability to spread much more rapidly. This may well be due in part to the ability to side-step antibody mediated immunity obtained through previous infection and vaccination. Omicron is spreading rapidly in the community. We don’t yet know what impact the current rapid community spread will have on hospitalisations and ultimately deaths, so time will tell.  

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Monoclonal antibodies to prevent household transmission of SARS-CoV-2

A remarkable new NEJM study has shown that the prophylactic administration of monoclonal antibodies reduces the risk of household contacts developing symptomatic or asymptomatic infection with SARS-CoV-2. For those who did develop symptomatic infection, monoclonal antibodies reduced to duration of disease and the duration of high viral load. This study opens up the possibility of a new tool to prevent the spread of SARS-CoV-2 to vulnerable patients in our hospitals. Is the future of managing hospital contacts of SARS-CoV-2 the prophylactic administration of monoclonal antibodies?

Visual abstract from the study
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Hospital-onset COVID-19 (HOCI): a systematic review

As we get into gear to prepare for the next epidemic wave of COVID-19 affecting healthcare providers (hoping that it will not come), it’s a good time to review where we have got to with the surveillance of healthcare-associated COVID-19. Colleagues at Imperial have just published a systematic review of the latest literature on this important issue. Whilst uncertainties remain about surveillance definitions and exactly what “healthcare-associated COVID-19 infection” is, the message is clear that healthcare-providers must have in place clear and rapid systems for identifying healthcare-associated COVID-19 to prevent the spread of the SARS-CoV-2 virus in healthcare facilities.

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B.1.617.2: an update

PHE released the latest epidemiological summary of the B.1.617.2 VOC (aka “the variant that was first identified in India”) a few days ago. Evidence is emerging rapidly, and the datasets are far from conclusive. But it now seems clear that B.1.617.2 is more transmissible, causes no more hospitalisation or mortality, and vaccine effectiveness is slightly reduced when compared with other variants.

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The role of ventilation in preventing the transmission of SARS-CoV-2

I gave a talk at the Sussex Infection Prevention Development Week yesterday on ventilation and preventing the spread of SARS-CoV-2. I learnt a lot in putting together the talk, so thought I’d share my slides (here) and some of the key points. Ventilation is a crucial way to prevent the spread of SARS-CoV-2 (and other respiratory viruses), and I hope that improved ventilation in health and social care settings will be one of the good things to come out of this pandemic.

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