Centers for Disease Control and Prevention (CDC) recommended that any individuals who develop myocarditis/pericarditis after a dose of an mRNA COVID-19 vaccine should defer receiving a subsequent dose until additional safety data are available.
On 9th November, 2021, the CDC allows mix and match of booster shots in USA.
National Advisory Committee on Immunization (NACI) recommended boosters for other high-risk groups, including people 70 years of age and older and front-line health care workers who had a short period of time between their first two shots.
NACI also recommended boosters for people who received two doses of the Astra Zeneca vaccine, as the mRNA vaccines appear to offer better protection.
On 4th November, 2021, the United Kingdom became the first country to approve Pfizer’s competitorOK competitor Merck's COVID-19 pill, which is already under review at the Food and Drug Administration (FDA) after showing strong initial results. Other antivirals are under consideration including an agent from Pfizer (Paxlovid). While promising, caution should be taken with interpreting data from oral antivirals as currently, no published data exist and much conclusions are drawn off grey literature .
India’s Covaxin covid 19 vaccine by Bharat Biotech reported a vaccine effectiveness of 77.8% from a clinical trial. , 2021, a CDC reported vaccine efficacy of 90.9% with primary data from one phase II/III clinical trial in preventing symptomatic, laboratory-confirmed COVID-19 in children aged 5–11 years with or without evidence of previous SARS-CoV-2 infection.
November 2, 2021
October 21st, 2021 Pfizer Inc. and BioNTech announced results from a Phase 3 randomized, controlled trial evaluating the efficacy and safety of a 30-µg booster dose of the Pfizer-BioNTech COVID-19 with a relative vaccine efficacy of 95.6%.
On 21st October, 2021, the advisory panel for the Centers for Disease Control and Prevention (CDC) said people who received Moderna and Johnson & Johnson (J&J) COVID-19 vaccines should receive a booster dose, and should continue with the original vaccine they recieved.
NACI’s latest guidelines suggest provinces should offer boosters to Canadians who received two doses of the Oxford-AstraZeneca vaccine or one dose of the Johnson & Johnson vaccine.
The US Food and Drug Administration (FDA) vaccine advisory group on 26th October 2021 approved the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 at a reduced dosage from the stanard dosing available for those over 12.
Therapeutic Goods Administration (Australia) has provisionally approved a third dose of the Pfizer (Comirnaty) vaccine for individuals 18 years or older. Pfizer (Comirnaty) is recommended as a single booster dose, irrespective of the primary COVID-19 vaccine used.
On 29th October, 2021, NACI issued new guidance "strongly" recommending booster shots for seniors 80 and older.
A survey at University of Oxford, UK, found that social media played a part in children aged 9 to 18 being more undecided than their older counterparts.
A report by the CDC found that the effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization was 93% during the period of B.1.617.2 (Delta) variant dominance among children and adolescents aged 12–18 years.
Consequences of delayed surgeries have potential patient-level and system-level consequences
Modelling indicates that even complete resumption of services requires additional resources to clear the backlogs caused by service disruptions
Retrospective data analysis indicates that minor delays for most cancer surgeries does not negatively impact patients, however the length of time to safely delay is largely dependent on condition and urgency
Badea, A; Groot, G; Young, C; Mueller, M. What have been the consequences of delayed surgeries due to the COVID-19 pandemic? 2021 Oct 18. Document no.: EOC210903 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Emerging evidence suggesting waning levels of immune markers with time, particularly against more virulent variants. How this will correlate to functional immunity is yet to be documented.
Immunocompromised populations with lower levels of responses to standard 2-dose regimens may benefit from a 3rd dose of mRNA vaccine as a part of the primary series, though their response may still be lower than what is expected in the general population
Current recommendation for populations to receive a 3rd dose include adults over a certain age (depending on jurisdiction), those living in long-term care settings, frontline health and social workers and/or people working in high risk settings, those with immune compromising conditions leading to increased risk of severe disease/poor outcomes if infected
Safety trials have indicated that side effects to 3rd/booster doses are similar to those following the 2nd dose in initial vaccination series
Badea, A; Groot, G; Muhajarine, N; Lee, S; Shumilak, G; Hernandez-Ronquillo, L; Tian, K. What is the current evidence and recommendations regarding COVID-19 vaccine booster shots (exceeding 2 doses) for the general population? 2021 Oct 07, Document no.: EOC210902 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).
Studies conducted before mass vaccination campaigns began have reported proper and consistent facemasking by students and staff in school settings are associated with reduced incidence of school-associated transmission or seropositivity.
Fewer studies have reported efficacy of facemasking in the post-mass vaccination period in school settings. The studies available report, however, school-associated transmission were lower, less than 1% secondary attack rate in schools.
Studies of school-associated COVID-19 cases find community exposure to SARS-CoV-2 and/or noncompliance with multiple mitigation measures (e.g. facemask policies, distancing, non-isolation, etc) are key factors of clusters and outbreaks in children.
Badea, A; Groot, G; Muhajarine, N; Howell-Spooner, B; Young, C. What is the evidence for the effectiveness of universal mask use in the pediatric population? 2021 Sep 30, Document no.: EOC210901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
August 18, 2021
- Proof of vaccine “freebies” to customers are slowing
- Many vaccine “lotteries” have now ended with prizes being given out, retrospective analysis of vaccine numbers and assumptions regarding causality will likely follow in the near future
- More state-sponsored incentives such as partnerships with ride-share companies, childcare centers, etc.
- Post-secondary institutions offering incentives mostly in the form of raffles with grand prizes of cash/scholarships for staff/students with proof of vaccination
- ESN evidence synthesis found 8 systematic reviews providing some evidence of positive impact of financial incentives with or without other interventions for non-COVID-19 vaccines, 3 reviews found no effect
- Several European countries (Greece, France, Italy) mandating vaccination for healthcare workers with refusers facing sanctions/fines/suspensions/job loss
- Ontario requiring hospitals, licensed care homes and other high-risk settings such as post-secondary institutions, women’s shelters, youth care facilities, etc. to establish vaccination policies – while vaccination will not likely be mandatory, those who are not vaccinated will be subject to frequent antigen testing.
- In Pakistan, the government will be blocking the SIM cards of vaccine refusers, and allowing business to resume in areas with a vaccination rate of greater than 20%
- In Indonesia, vaccine refusers will have any social aid suspended and face fines
- In the Philippines, the President is threatening to find ways to legalize arresting and forcing vaccination for refusers
- A retrospective analysis of vaccination data in Israel found a peak of 2nd dose vaccinations correlating with the exemption of quarantine for vaccinated individuals beginning January 17th, and high rates continued following the day with the highest new daily cases as well as the day of highest fatality rates
- Israeli survey of 500 individuals found that 21% of respondents were not intending to vaccinate. The implementation of the ‘Green Pass’ would possibly or definitely convince 31% of respondents, but 46% of respondents indicated that it would not.
May 27, 2021
Vaccine incentives are beginning to emerge in North America in various forms due to a lagging vaccine uptake combined with the threat of SARS-CoV-2 variants
Vaccine incentives range from free items and discounts offered by businesses to customers to financial incentives offered by companies to employees such as paid time off or cash bonuses
Some states/provinces have developed vaccine incentive programs offering large lotteries with cash prizes or scholarship awards, cash incentives or offers for free/discounted entertainment options
Some incentives are specifically geared to high priority populations, for example offering gift cards to anyone within a certain age demographic that receives a vaccine at certain sites, or offering the single-dose Johnson & Johnson vaccine at walk-up vaccination sites in subway stations with the addition of free transit passes
Badea, A; Reeder, B; Groot, G; Ellsworth, C. What are other jurisdictions offering for incentive-based COVID-19? 2021 Aug 24, Document no.: EOC210501v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 10 p. (CEST rapid review report).
New search completed August 17, 2021 containing 8 grey literature sources and 51 published journal articles including preprints.
Review of new search resulted in conformation of previously compiled information, relevant evidences and updates have been added to evidence table to reflect updated review.
Vaccine hesitancy was most commonly found in females and pregnant women as males generally showed greater willingness towards vaccine uptake.
Regardless of country and phase of the pandemic, there were evidences of widespread mistrust in the healthcare system and the governments with speed of vaccine development and approval. The greatest impact was seen in minority groups and people of colour.
Significant uptake of vaccination is due to the tailored recommendation of health provider in hesitant population, this has reinforced the importance of vaccination and also promoted vaccination of children with hesitant parents.
Previous vaccination has a positive influence on covid 19 vaccine uptake, (most popularly with influenza vaccine)
Higher age and underlying conditions/vulnerability to diseases along with employment and retirement had significantly lower vaccine hesitancy.
Greater financial incentives were some of the modifying of attitudes towards vaccination.
Social media and internet had mixed impact on hesitancy- restriction of certain vaccines had a direct impact on vaccination uptake whereas some reinforced confidence.
May 10, 2021
New search completed April 19, 2021 containing 29 grey literature sources and 128 published articles
Review of new search resulted in confirmation of previously compiled information, review update deemed not necessary at this time, relevant evidence has been added to the evidence table to reflect updated review
February 1, 2021
Vaccine hesitancy towards the COVID vaccine varies from 2% to 44% in the general population, depending on country, phase of pandemic and specific population
Vaccine hesitancy tends to be lower in healthcare workers than the general population, but still exists at rates up to 56%, again, dependent on the country of residence and phase of the pandemic
The most commonly cited reasons for vaccine hesitancy are concerns about the efficacy and safety, largely due to the expedited testing/approval process
Country of residence and corresponding trust in government/pharmaceutical industries can have a significant role in vaccine acceptance
Strategies to increase vaccine uptake should range from personal-level interventions such as patient education materials to health system level interventions such as healthcare provider training and targeted population vaccine acceptance campaigns
Jagwani, M; Badea, A; Groot, G; Mueller, M; Young, C. What are the causes of vaccine hesitancy? What programs/approaches have been successful in reducing vaccine hesitancy? 2021 Aug 17 Document no.: EOC012201v3 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 15 p. (CEST evidence search report).
Requiring proof of vaccination for entry into another country is not a new idea. There are regulations that need to be followed to set up a “vaccine passport” in relation to international travel (International Health Regulations (IHR) (2005))
At present the World Health Organization does not recommend vaccine passports for international travel, but they are working on a standard Smart Vaccination Certificate technical specification and standards to allow for harmonised processes to include COVID-19 vaccines into an updated version of the IHR (2005)
Countries around the world are beginning to put vaccine passports into place for international travel, as well as in some countries within country travel and access to services or businesses including Israel, France, Italy, Denmark, and the EU
The Canadian Federal government is supportive of a vaccine passport for international travel but recognize the issuing of vaccine passports will need to be province led
As of May 13, 2021, the province of Quebec has begun issuing a downloadable QR code that individual can keep on their smart phone.
As of June 9, 2021, the Federal government of Canada discussed easing restrictions for fully vaccinated Canadian citizens returning to the country
Ethical considerations in the use of vaccine passports include equitable access to vaccination (domestically and internationally), access to technology (eg. Smartphone passports), marginalization, or stigmatization especially among historically racialized groups, and socially isolated populations
Legal considerations include
o Clarifying who has the legal authority to require proof of vaccination,
o Ensuring that if new legislation is created and implemented it is in line with all pre-existing legislation (Charter of Rights and Freedoms, Human Rights Codes, privacy legislation, employment legislation),
o Ensuring that, if created by the government, there is coordination of the Provincial and Federal governments for international travel with respect to jurisdictional overlap, security of information, fraud
Health care facilities should be able to legally enact vaccination policies for patient-facing employees so long as they allow for exemptions due to medical inability or bona fide religious, or conscientious beliefs
Six in ten Canadians (61%) expect vaccine passports to be widely used in Canada by the end of 2021, the same proportion (61%) of Canadians also agreed that only vaccinated people should be allowed to engage in events involving larger crowds such as public transit, air travel, or attending cultural and sports events
Lashta E, von Tigerstrom B, Reeder B, Groot G; Miller, L; Mueller, M. What are the ethical/legal aspects of vaccine requirements? 2021 Jun 21, Document no.: EOC210503 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 25 p. (CEST rapid review report).
Badea, A; Groot, G; Reeder, B; Young, C; Ellsworth, C. What are legitimate exemptions/contraindications for COVID-19 vaccines from a medical point of view? 2021 Jun 10, Document no.: EOC210502 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).
Cohort studies identified worsening mental health outcomes, including depression, anxiety, scores on the Strengths and Difficulties Questionnaire (SDQ), and other subjective mental health measures.
Cross-sectional studies reported post-pandemic prevalence rates of 7%-44% for depression, 6%-47.5% for anxiety, and 3%-22% for PTSD. Worsening sleep quality and increased frequency of substance use were also reported. Effects on self-harm and suicidality are inconclusive.
Risk factors for worsening mental health included identifying as female, older age or higher school grade, and increased use of technology or social media. Exercise was found to be protective.
Sulaiman, F; Hamid, E; Muhajarine, N; Dalidowicz, M; Miller, L. How has COVID-19 and the public health response to COVID-19 impacted mental health outcomes on children 5 to 18 years (school-age)? 2021 Jun 09, Document no.: PH021701 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 18 p. (CEST rapid review report).
· Tele-ICU services are provided either by existing staff within the network to smaller centers, or outsourced to larger networks or independent firms
· The impact of tele-ICU adoption can result in a decrease in ICU mortality as large as 32%
· The impact of tele-ICU adoption of length of stay is mixed, with some studies reporting a significant decrease, while others report a small, but statistically insignificant decrease
· The degree of impact of tele-ICU adoption is linked to several factors such as yearly admission rates, location (urban vs. rural) and level of authority given to the tele-ICU team leading to increased positive impacts.
Badea, A; Groot, G; Reeder, B; Young, C; Ellsworth, C; Howell-Spooner, B. How to deliver remote ICU care for COVID-19 patients to avoid/prevent transfer from smaller communities to tertiary care hospitals. 2021 Apr 6; Document no.: CC210301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 13p. (CEST rapid review report)
Pediatric cases of COVID-19 constitute between 1% to 10% of all confirmed cases of COVID-19; variation exists by jurisdiction.
Few case reports exist of confirmed child-to-other transmission. Contact tracing studies suggest that children are unlikely to be transmitters of the disease. Households are the most likely environments for transmission.
A recent large South Korean contact tracing study however (in pre-print) found that household COVID-19 transmission rates for children age 10-19 were significantly higher than in adults; transmission rates for children age 0-9 were relatively low.
AUGUST 7th, 2020 UPDATE: No new studies examining secondary attack rates of pediatric index cases were found. Studies continue to suggest low transmission from pediatric cases, and high proportion of pediatric cases being asymptomatic to mildly symptomatic.
MARCH 9th, 2021 UPDATE: Variants of Concerns are an emerging threat, but literature on pediatric prevalence and transmissibility is sparse. The British variant seems more transmissible (secondary attack rate higher) but follows the same age-related distribution of cases seen earlier in the pandemic.
Sulaiman, F; Coomaran, V; Muhajarine, N; Dalidowicz, M; Miller, L. What are the effects of the new COVID variants on transmission and school reopenings in pediatric populations? 2021 Mar 30; Document no.: PH030801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 14p. (CEST rapid review report)
Although evidence is preliminary, vaccines have been effective in decreasing cases of SARSCoV-2 infections (COVID-19) and deaths among long-term care (LTC) residents by 89% and 96% respectively (Brown et al., 2021).
Estimated vaccine uptake among LTC staff in ON has been estimated at 68% as of March 5, 2021. The estimated relative reduction in COVID-19 cases among LTC staff is 79% (Brown et al., 2021).
Vaccination against COVID-19 protects in varying degrees against symptomatic infection and can be expected to have some effect on COVID-19 transmission; however, the extent of the impact on transmission is not fully quantified. In 3 separate small studies, all utilizing Pfizer Bio N Tech™ vaccine, the following results were observed: vaccine efficacy among partially vaccinated residents (n=463) was 63% (Britton et al., 2021), nasopharyngeal viral load was significantly decreased following a single dose (n = 10) (mean -2.4 log10 calculated by Ct value) (McEllistrem et al., 2021) and an immunogenic response was demonstrated following full vaccination (N= 134) as measured by antibody titres (15274 AU/mL) with no associated difference by age, gender, frailty or comorbidity (Salmeron Rios et al., 2021).
It is recommended that both vaccinated and unvaccinated persons in LTC continue to follow infection control measures such as masking, physical distancing, and hand/respiratory hygiene as long as there is community transmission of COVID-19 (European CDC 2021; ON Ministry of Health 2021; AB Ministry of Health 2021; Health Protection Surveillance Ireland, 2021; CDC Mar 5, 2021; WHO 2021; Brown et al., 2021; Centre for Health Policy Evaluation in LTC, 2021; Love et al., 2021; Jaklevic et al., 2020).
Within Canada 5 provinces have currently prioritized designated family care givers for vaccination to facilitate their presence in LTC (British Columbia, Newfoundland, Nova Scotia, Ontario and Prince Edward Island; NIA 2021).
Family and friends provide critical support to residents of LTC homes as partners in care and as visitors, playing an important role in their overall health and well-being (NIA, 2021; Levere et al., 2021; CFHI and CPSI, 2021; WHO, 2021; Ranhoff et al., 2021). Emerging evidence shows that cessation of visiting has had a significantly negative impact on the well-being physical, emotional, and cognitive well-being of LTC residents and on the well-being of their families (WHO, 2021; Levere et al., 2021; Suarez-Gonzalez et al., 2021; NIA, 2021; Dhama et al., 2021).
Policy changes pertaining to COVID-19 should be informed by all impacts on the health and well-being of LTC residents and their families and friends, beyond the direct effects of morbidity and mortality due to COVID-19 (Levere et al., 2021; Suarez-Gonzalez et al., 2021; WHO, 2021; Dhama et al., 2021; NIA, 2021). Policy guidelines for healthcare decision makers have focused attention on the harms of stringent visitor policies and the need to reintegrate family/designated caregivers for every resident (CFHI and CPSI, 2021; NIA, 2021; WHO, 2021; ON Ministry of Health, 2021, BCDC 2021).
Available data to inform policy on the impact of strict visitation policies and social isolation in LTC is limited and ongoing data collection is required (Suarez-Gonzales et al., 2021; WHO, 2021; Levere et al., 2021 ).
Prioritization of family/designated caregivers in vaccine roll out policies is intended to address the balance of a more comprehensive definition of resident safety and well-being inclusive of quality of life and well-being with morbidity and mortality of COVID-19 (NIA, 2021; WHO, 2021; CFHI and CPS, 2021). Policies prioritizing family/designated caregivers may also reduce the enormous burden placed on LTC staff during the remainder of the pandemic (NIA, 2021).
Ward, H; Tupper, S; Boden, C; Dalidowicz, M; Mueller, M. What impact does COVID-19 vaccination have on visitation policies and transmission rates in LTC? 2021 Mar 29; Document no.: LTC012501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 44 p. (CEST rapid review report)
Current recommendations suggest phased distribution of authorized vaccines and prioritization of the recipients (e.g., health care workers, frontline essential workers, and elderly population).
A concern that could exist with using AstraZeneca on critical populations is that it may have little coverage for mild-moderate B.1.351, which may have implications in transmission. This could be a concern in critical workforces if the variant becomes predominant, especially given the potentially higher transmissibility of variant. The literature is mixed but it is possible that AstraZeneca has lower efficacy than the mRNA vaccines.
Canadian National Advisory Committee on Immunization (NACI) recommends that in the context of limited vaccine supply, initial doses of mRNA vaccines should be prioritized for those at highest risk of severe illness and death and highest risk of exposure to COVID-19. On the other hand, US Advisory Committee on Immunization Practices (ACIP) recommends no product preference for the vaccines.
Just recently, NACI has expanded its recommendation for the use of the AstraZeneca vaccine to all people over the age of 18, now including those 65 years of age and over.
While Pfizer and Moderna vaccines are mRNA vaccines and need special logistical and transportation considerations, AstraZeneca and Johnson&Johnson (J&J) vaccines are viral vector vaccines that are easier to transport.
J&J is a single dose vaccine thus may be more appropriate in certain settings (such as homeless shelters and correctional facilities). Of note, there is no empirical evidence yet available to support this use; this suggestion is based simply on the nature of the vaccine.
Azizian, A; Shumilak, G; Lee, S; Reeder, B; Groot, G; Miller, L; Howell-Spooner, B. What are the differences between COVID-19 vaccines and how they should be distributed based on population group(s)? 2021 Mar 18; Document no.: EOC031001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 19 p. (CEST rapid review report)
Vulnerable populations such as those experiencing homelessness are 20 times more likely to be hospitalised due to COVID-19, 10 times more likely to require intensive care for COVID-19 and 5 times more likely to die within 21 days of a positive test for COVID-19
Many organizations advocate for socially vulnerable populations to be considered priority populations due to their oftencomplex health needs and inability to fully execute best practices for infection prevention and control
Past experiences from Hepatitis vaccination (requiring 3 injections) and H1N1 pandemic influenza vaccination indicate that partnering with community organizations to provide vaccinations in shelters, community centers and other frequently accessed places along with education and access to known, trusted healthcare providers greatly increase the uptake of vaccination among socially vulnerable populations
Beyond sheltered populations experiencing homelessness, considerations for equitable vaccination programs for the general population should include plans for accessibility for all, including underserved geographic regions
Badea, A; Reeder, B; Hanson, L; Miller, L; Howell-Spooner, B. What are the vaccination strategies for vulnerable populations? 2021 Mar 12; Document no.: PH030401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
Although rapid antigen point-of-care tests (POCT) to detect SARS-CoV-2 (COVID-19) infection have the advantage of rapid result turn-around time compared to laboratory-based reverse-transcriptase polymerase chain reaction (RT-PCR) test, their sensitivity to correctly detect positive cases is lower (Larremore et al., 2020).
Increased frequency of testing compensates for lower test sensitivity of POCTs (See et al., 2021; Larremore et al., 2020). The majority of policy guidelines and public health directives recommend basing frequency of POCT on rates of community transmission or outbreak status of the setting (Public Health Canada, 2021; Ontario Ministry of Long-term Care [LTC], 2021; CDC, 2021; Arizona Department of Health Services, 2020).
Recommended POCT frequency for screening asymptomatic individuals is 3 times per week of staff, including designated support persons, and residents if the home is in an outbreak situation and once per week of staff and designated support persons in a non-outbreak situation (Ontario Ministry of LTC, 2021; CDC, 2021; Larremore et al., 2020).
Designated support persons (i.e. family caregivers) should be tested at the same frequency as LTC staff (Ontario Ministry of LTC, 2021; Micocci et al., 2020; Vilches et al., 2020; Tennessee Department of Health, 2020).
Recommendations are consistent regarding test interpretation and follow-up actions, with the majority of policies and directives recommending a high degree of caution and follow-up RT-PCR testing after a negative POCT if there is a high pre-test probability for COVID-19 infection (i.e. symptomatic, known contact exposure)(Public Health Canada, 2021; CDC, 2021). All reviewed guidelines recommend confirmatory RT-PCR test following a positive POCT if the individual is asymptomatic in order to avoid unnecessary isolation of residents and work restrictions of staff. Contrary to other guidelines, the Oregon Health Authority (2020) considers all positive antigen tests in a symptomatic individual as a positive test regardless of follow up testing.
Modelling studies consistently show that regular POCT screening of asymptomatic staff and residents in LTC during both outbreak and non-outbreak situations results in significant decreases in projected cases when combined with a multipronged approach to prevent transmission (Larremore et al., 2021; Holmdahl et al., 2020; See et al., 2021; Vilches et al., 2020).
Barriers to frequency of testing are availability of test kits, training of testers, human resources for testing, and a reporting strategy (Micocci et al., 2020).
Prioritization of testing should be given to symptomatic healthcare providers and residents first, then screening for residents and staff during outbreaks (See et al., 2020).
The Saskatchewan Health Authority (SHA) Point of Care COVID Testing: Long Term Care Algorithm contains most of the elements present in other algorithms. Additional information should be added on actions taken for presumptive positive or negative tests in different scenarios. Additional information should be provided on frequency of testing and the context for “high-risk contact”.
Ward, H; Tupper, S; Dalidowicz, M; Mueller, M. What are the efficacies and outcomes of Point-of-Care/Antigen testing in Long Term care? 2021 Feb 26; Document no.: LTC020201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 37 p. (CEST rapid review report)
· Studies suggest that antigen-based rapid diagnostic tests (Ag-RDTs) can be used in a population level with high prevalence of COVID-19 disease where health systems are overwhelmed or where nucleic acid amplification tests (NAATs) such as real time reverse transcription polymerase chain reaction (rRT-PCR) are not available.
· The Canadian COVID-19 Testing and Screening Expert Advisory Panel recommends the use of frequent screening with rapid diagnostic tests in selected groups to limit outbreaks.
· WHO and European Center for Disease Prevention and Control recommend using Ag-RDTs with high sensitivity and specificity when NAATs are not available or turnaround time negatively affects NAATs’ clinical utility. For example, COVID-19 Ag-RDTs can be used to surveil health care workers or residents of congregate dwellings during outbreaks or when community transmission rates are high, to screen at-risk individuals to support outbreak investigations, or to screen suspected COVID-19 outbreaks in early stages in settings where NAATs are not available.
· WHO does not recommend Ag-RDTs usage when expected prevalence is low (e.g., screening at points of entry) unless an Ag-RDT’s specificity is high (>99%).
· Studies have shown that Panbio™ COVID-19 Ag Test (Abbott) can have overall sensitivity of 72.6% to 95.2% and specificity of 98.0% to 100% and suggest that this test is appropriate for contagious case identification and asymptomatic case screening, especially in high prevalence (>5%) settings.
· WHO recommends that iterative Ag-RDT testing or confirmatory rRT-PCR testing be done in symptomatic patients or asymptomatic contacts of COVID-19 cases since a negative Ag-RDT result cannot completely exclude an active COVID-19 infection.
· Challenges of population level testing (whether they succeed or fail) such as required logistics and resources (e.g., immunizers, access to Ag-RDTs and equipment), performance accuracy of Ag-RDTs (e.g., false positive or negative rates in real world settings), and public trust and engagement in testing and future measures (e.g., vaccine uptake) are yet to be considered.
Vanstone, J; Groot, G; Dalidowicz, M; Fox, L. Are there validated clinical prediction tools of which Covid-19 inpatients are most probable to require ICU level care? 2021 Feb 4; Document no.: EOC012001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 15 p. (CEST rapid review report)
Initial findings from RCTs of the two authorized COVID-19 vaccines (Pfizer-BioNTech and Moderna) reported that the vaccines are safe. However, subsequent reports show that the adverse and severe allergic reactions to these vaccines are higher than the general rates for vaccines.
Various regulatory agencies identify the risk for serious allergic reactions as low for the authorized vaccines, and they continue to monitor the vaccines’ safety closely.
Further investigations to make causal relationships with reported severe allergic reactions or deaths are needed.
Risks and benefits of receiving the vaccines should be discussed individually in vulnerable populations including pregnant or breast-feeding women, immunocompromised people, or frail elderly people.
Azizian, A; Groot, G; Mueller, M; Young, C. How safe are the Pfizer and Moderna vaccinations? 2021 Jan 24; Document no.: EOC011901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 30 p. (CEST rapid review report)
· Recommended to use existing vaccination structures and delivery services as much as possible for distribution of the COVID-19 vaccines
· Important to consider cold-chain requirements when developing distribution plans
· Should consider alternate locations for hard-to-reach populations that are easily accessible and familiar
· Consider branching out to mobile vaccination (e.g. home visits, door-to-door), pharmacies, workplaces, congregate living facilities, walk-up/drive-through mechanisms for vaccine delivery
Badea, A; Groot, G; Mueller, M; Howell-Spooner, B. How are other jurisdictions distributing COVID-19 vaccines in non-healthcare worker environments and what is the rationale for those distribution models? 2021 Jan 19; Document no.: PH011401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
Two congregate living situations were identified in the literature: those in correctional facilities and those with mental health issues.
People in correctional facilities are more susceptible to infection and have higher mortality rates due to COVID-19 than the general population. Managing outbreaks in facilities is difficult due to high levels of movement, the inability to physically distance, and limited personal protective equipment.
People with mental illness have higher risk of morbidity and mortality due to COVID-19. Severe mental illness is positively correlated with other environmental risk factors for contracting COVID-19, including living in crowded settings, homelessness, and institutionalization. Furthermore, those with mental illness find it difficult to adhere to changing public health or government guidelines around reducing the spread of COVID-19.
Fick, F; Groot, G; Young, C; Mueller, M. What evidence is available to inform vaccination planning in congregate living? 2021 Jan 15; Document no.: EOC011102 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)