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COVID-19 infection rates in patients referred for psychiatric admission during a regional surge: The case for universal testing.

ABSTRACT: Some psychiatric hospitals have instituted mandatory COVID-19 testing for all patients referred for admission. Others have permitted patients to decline testing. Little is known about the rate of COVID-19 infection in acute psychiatric inpatients. Characterizing the proportion of infected patients who have an asymptomatic presentation will help inform policy regarding universal mandatory versus symptom-based or opt-out testing protocols. We determined the COVID-19 infection rate and frequency of asymptomatic presentation in 683 consecutively admitted patients during the surge in the New York City region between April 3rd, 2020 and June 8th, 2020. Among these psychiatric inpatients, there was a 9.8 % overall rate of COVID-19 infection. Of the COVID-19 infected patients, approximately 76.1 % (51/67) either had no COVID-19 symptoms or could not offer reliable history of symptoms at the time of admission. Had they not been identified by testing and triaged to a COVID-19 positive unit, they could have infected others, leading to institutional outbreak. These findings provide justification for psychiatric facilities to maintain universal mandatory testing policies, at least until community infection rates fall and remain at very low levels.

SUBMITTER: Brody BD

PROVIDER: S-EPMC7901369 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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COVID-19 infection rates in patients referred for psychiatric admission during a regional surge: The case for universal testing.

Brody Benjamin D BD Shi Zhenzhen Z Shaffer Charles C Eden Daniel D Wyka Katarzyna K Alexopoulos George S GS Parish Sharon J SJ Kanellopoulos Dora D

Psychiatry research 20210223

Some psychiatric hospitals have instituted mandatory COVID-19 testing for all patients referred for admission. Others have permitted patients to decline testing. Little is known about the rate of COVID-19 infection in acute psychiatric inpatients. Characterizing the proportion of infected patients who have an asymptomatic presentation will help inform policy regarding universal mandatory versus symptom-based or opt-out testing protocols. We determined the COVID-19 infection rate and frequency of ...[more]

PMID: 33657449

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Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted lives across all countries and communities. It significantly reduced the global economic output and dealt health systems across the world a serious blow. There is growing evidence showing the progression of the COVID-19 pandemic and the impact it has on health systems, which should help to draw lessons for further consolidating and realizing universal health coverage (UHC) in all countries, complemented by more substantial government commitment and good governance, and continued full implementation of crucial policies and plans to avert COVID-19 and similar pandemic threats in the future. Therefore, the objective of the study was to assess the impact of good governance, economic growth and UHC on the COVID-19 infection rate and case fatality rate (CFR) among African countries.MethodsWe employed an analytical ecological study design to assess the association between COVID-19 CFR and infection rate as dependent variables, and governance, economic development and UHC as independent variables. We extracted data from publicly available databases (i.e., Worldometer, Worldwide Governance Indicators, Our World in Data and WHO Global Health Observatory Repository). We employed a multivariable linear regression model to examine the association between the dependent variables and the set of explanatory variables. STATA version 14 software was used for data analysis.ResultsAll 54 African countries were covered by this study. The median observed COVID-19 CFR and infection rate were 1.65% and 233.46%, respectively. Results of multiple regression analysis for predicting COVID-19 infection rate indicated that COVID-19 government response stringency index (β = 0.038; 95% CI 0.001, 0.076; P = 0.046), per capita gross domestic product (GDP) (β = 0.514; 95% CI 0.158, 0.87; P = 0.006) and infectious disease components of UHC (β = 0.025; 95% CI 0.005, 0.045; P = 0.016) were associated with COVID-19 infection rates, while noncommunicable disease components of UHC (β = -0.064; 95% CI -0.114; -0.015; P = 0.012), prevalence of obesity among adults (β = 0.112; 95% CI 0.044; 0.18; P = 0.002) and per capita GDP (β = -0.918; 95% CI -1.583; -0.254; P = 0.008) were associated with COVID-19 CFR.ConclusionsThe findings indicate that good governance practices, favourable economic indicators and UHC have a bearing on COVID-19 infection rate and CFR. Effective health system response through a primary healthcare approach and progressively taking measures to grow their economy and increase funding to the health sector to mitigate the risk of similar future pandemics would require African countries to move towards UHC, improve governance practices and ensure economic growth in order to reduce the impact of pandemics on populations.

Project description:BackgroundThe feasibility of reducing the population-level incidence of human immunodeficiency virus (HIV) infection by increasing community coverage of antiretroviral therapy (ART) and male circumcision is unknown.MethodsWe conducted a pair-matched, community-randomized trial in 30 rural or periurban communities in Botswana from 2013 to 2018. Participants in 15 villages in the intervention group received HIV testing and counseling, linkage to care, ART (started at a higher CD4 count than in standard care), and increased access to male circumcision services. The standard-care group also consisted of 15 villages. Universal ART became available in both groups in mid-2016. We enrolled a random sample of participants from approximately 20% of households in each community and measured the incidence of HIV infection through testing performed approximately once per year. The prespecified primary analysis was a permutation test of HIV incidence ratios. Pair-stratified Cox models were used to calculate 95% confidence intervals.ResultsOf 12,610 enrollees (81% of eligible household members), 29% were HIV-positive. Of the 8974 HIV-negative persons (4487 per group), 95% were retested for HIV infection over a median of 29 months. A total of 57 participants in the intervention group and 90 participants in the standard-care group acquired HIV infection (annualized HIV incidence, 0.59% and 0.92%, respectively). The unadjusted HIV incidence ratio in the intervention group as compared with the standard-care group was 0.69 (P = 0.09) by permutation test (95% confidence interval [CI], 0.46 to 0.90 by pair-stratified Cox model). An end-of-trial survey in six communities (three per group) showed a significantly greater increase in the percentage of HIV-positive participants with an HIV-1 RNA level of 400 copies per milliliter or less in the intervention group (18 percentage points, from 70% to 88%) than in the standard-care group (8 percentage points, from 75% to 83%) (relative risk, 1.12; 95% CI, 1.09 to 1.16). The percentage of men who underwent circumcision increased by 10 percentage points in the intervention group and 2 percentage points in the standard-care group (relative risk, 1.26; 95% CI, 1.17 to 1.35).ConclusionsExpanded HIV testing, linkage to care, and ART coverage were associated with increased population viral suppression. (Funded by the President's Emergency Plan for AIDS Relief and others; Ya Tsie ClinicalTrials.gov number, NCT01965470.).

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COVID-19 infection rates in patients referred for psychiatric admission during a regional surge: The case for universal testing.

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COVID-19 infection rates in patients referred for psychiatric admission during a regional surge: The case for universal testing.

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