Andiapen, M

Couto-Parada, X

Cutino-Moguel, T

Fontana, M

Jensen, M

Manisty, C

Moon, JC

Noursadeghi, M

Pade, C

Treibel, TA

English

UCL Discovery

  Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.  Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.  Correspondence1394 www.thelancet.com   Vol 396   October 31, 2020Authors’ replyKevin Fennelly and Christopher Whalen emphasise that health-care workers (HCWs) are at a higher risk of severe acute respiratory syndrome coronavirus 2 infection than are the general population. Angela Chow and colleagues describe their experience in Singapore of very low rates of HCW infections and nosocomial transmission when effective personal protective equipment is implemented. We agree with both perspectives, and our Correspondence1 did not contradict either of these viewpoints.Front-line HCWs have a reported hazard ratio of more than 3 compared with the general community.2 This risk is variable between studies, with reported seropositivity rates in the UK ranging from 6% to 43% across different hospital settings.3,4 Explanations for this variation include confounding by sampling time points during an emerging epi-demic wave, participant selection (random vs symptomatic), and rates of self-isolation, and differences in the nature of exposures, policies for infection control, and use of personal protective equipment.Our study was done when symp-tomatic HCWs were already required to quarantine. We sought to address the need for repeated mass screen-ing of staff without disease-defining symptoms to help to reduce trans-mission associated with health care. Therefore, we focused on asymp-tomatic or pauci-symptomatic infec-tion in HCWs at sequential timepoints during the first epidemic wave in London, UK, sampling only HCWs who attended work because they did not meet the symptomatic criteria to self-isolate. PCR-positive results peaked one week before the PCR-positive peak in London (which was at that time reflected mainly by symptomatic patients presenting to hospitals). We inferred from this that the peak of asymptomatic infection in our HCW cohort coincided with the peak of virus circulation in the community.1 Thereafter, the rates of prevalent asymptomatic infection in our cohort reduced in line with the decline in community cases, despite a persistent number of patients with COVID-19 within the hospital. Further serial swabbing of HCWs over 16 weeks to mid-August, 2020, showed no new cases (appendix p 1) and neither did extension to two further hospitals and a total of 731 participants who were studied longitudinally (data not shown). The number of HCWs who were self-isolating fell to nearly zero over this time period. Despite some persistent hospitalised cases, zero cases were identified by PCR and nearly zero HCWs were self-quarantining by approximately 4 weeks after the peak, suggesting that nosocomial transmission had ceased. A key contributor to the absence of ongoing nosocomial transmis sion was likely to be the effective implementation of infection control practices.Our approach to focus on asymp-tomatic infections underestimates the absolute incident rate of infec-tions among HCWs, but it identifies the scale of infection missed by case-definition criteria and is likely to be a fair surrogate for the trend of incident infections. These data suggest that tracking community prevalence to trigger asymptomatic screening of HCWs is more informative than monitoring hospital caseloads.Funding for the work presented in this Correspondence was donated by individuals, charitable Trusts, and corporations including Barts Charity (MRC0281), Goldman Sachs, Citadel and Citadel Securities, The Guy Foundation, GW Pharmaceuticals, Kusuma Trust, and Jagclif Charitable Trust. The funders had no role in study design, data collection, or the decision to publish this Correspondence. The corresponding author had full access to all data and final responsibility for the decision to submit for publication. JCM and CM are directly and indirectly supported by the University College London Hospitals (UCLH), Barts National Institute for Health Research (NIHR) Biomedical Research Centres and the British Heart Foundation (BHF) . TAT is funded by a BHF Intermediate Research Fellowship. MN is supported by a Wellcome Trust Investigator in Science Award and the UCLH NIHR Biomedical Research Centre. All other authors declare no competing interests.patient contacts of HCWs who were confirmed to have COVID-19 also screened negative. No in-hospital clusters resulted from the HCWs with COVID-19. During this period, 35 acute respiratory illness clusters in HCWs were identified, but SARS-CoV-2 was not detected. One-time screening of 1378 asymptomatic housekeeping, facilities, information-technology, and security staff identified one (0·07%) person with COVID-19 infection. Since May 6, 2020, all HCWs with acute respiratory illness have been tested for SARS-CoV-2, further reducing the risk of noso-comial transmission. In hospitals that have staff who are well trained and supplied with personal protective equipment, have comprehensive sickness-surveillance systems, and have a universal mask policy, testing of asymptomatic HCWs would not be indicated.We declare no competing interests.*Angela Chow, Htet Lin Htun, Win Mar Kyaw, Lay Tin Lee, Brenda Angangela_chow@ttsh.com.sgDepartment of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (AC, HLH, WMK), Occupational Health Services (LTL), and Department of Infectious Diseases (BA), Tan Tock Seng Hospital, 308433 Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (AC, BA)1 Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet 2020; 395: 1418–20.2 Hunter E, Price DA, Murphy E, et al. First experience of COVID-19 screening of health-care workers in England. Lancet 2020; 395: e77–78.3 Treibel TA, Manisty C, Burton M, et al. COVID-19: PCR screening of asymptomatic health-care workers at London hospital. Lancet 2020; 395: 1608–10.4 Htun HL, Lim DW, Kyaw WM, et al. Responding to the COVID-19 outbreak in Singapore: staff protection and staff temperature and sickness surveillance systems. Clin Infect Dis 2020; published online April 21. https://doi.org/10.1093/cid/ciaa468.5 Ng Y, Li Z, Chua YX, et al. Evaluation of the effectiveness of surveillance and containment measures for the first 100 patients with COVID-19 in Singapore—January 2–February 29, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 307–11.See Online for appendixCorrespondencewww.thelancet.com   Vol 396   October 31, 2020 1395Thomas A Treibel, Charlotte Manisty, Mervyn Andiapen, Corinna Pade, Melanie Jensen, Marianna Fontana, Xosé Couto-Parada, Teresa Cutino-Moguel, Mahdad Noursadeghi, *James C Moonj.moon@ucl.ac.ukInstitute of Cardiovascular Science (TAT, CM, JCM), Division of Infection and Immunity (MN), and National Amyloidosis Centre, Division of Medicine (MF), University College London, London, UK; Department of Cardiology (TAT, CM, MJ, JCM) and Department of Virology (XC-P, TC-M), St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK; Centre for Cardiovascular Medicine and Devices (MA), William Harvey Research Institute (CP), and The Blizard Institute, Barts and the London School of Medicine and Dentistry (CP), Queen Mary University of London, London, UK; and Royal Free London NHS Foundation Trust, London, UK (MF)1 Treibel TA, Manisty C, Burton M, et al. COVID-19: PCR screening of asymptomatic health-care workers at London hospital. Lancet 2020; 395: 1608–10.2 Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health 2020; 5: e475–83.3 Houlihan CF, Vora N, Byrne T, et al. Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers. Lancet 2020; 396: e6–7.4 Augusto JB, Menacho K, Andiapen M, et al. Healthcare workers bioresource: study outline and baseline characteristics of a prospective healthcare worker cohort to study immune protection and pathogenesis in COVID-19. Wellcome Open Res 2020, 5: 179.robust (appendix).2 Moreover, com-pared with the previous year, the cumulative numbers of deceased organ donors and transplants show no significant reduction. Kidney transplantation numbers were stable, while the numbers of heart, lung, and liver transplantations from deceased donors even increased from January to April, 2020, when compared with the same period of the previous year. In contrast, transplant activities in Italy and Spain were reduced by 30–50%.2We believe that this stability is highly related to adequate intensive care resources and largely benefits from the prophylactic measures and control strategy against COVID-19 in Germany. Elective surgeries were postponed or reduced. Therefore, the intensive care and ventilation resources could be allocated to organ procurement and transplantation during this crisis. In addition, a step-by-step plan and recommenda-tions were applied in the early pandemic with close attention to the development and changes of the epidemic situation. The living donation programmes were only tem-porarily paused, whereas deceased organ donor transplants were con-tinued throughout Germany. As a treatment to end-stage organ failure, transplantation should be regarded as an emergency treatment that should not be discontinued during a pandemic with a careful risk–benefit assessment.We declare no competing interests.*Zhi Qu, Carina Oedingen, Tim Bartling, Harald Schrem, Christian Krauthqu.zhi@mh-hannover.deCHERH, Institute for Epidemiology, Social Medicine, and Health Systems Research (ZQ, CO, TB, HS, CK) and Management Team of the Transplant Center (ZQ), Hannover Medical School, 30625 Hannover, Germany; and General, Visceral and Transplant Surgery, and Transplant Center Graz, Medical University of Graz, Graz, Austria (HS)1 Loupy A, Aubert O, Reese PP, Bastien O, Bayer F, Jacquelinet C. Organ procurement and transplantation during the COVID-19 pandemic. Lancet 2020; 395: e95–96.Organ procurement and transplantation in Germany during the COVID-19 pandemicThe COVID-19 pandemic has intro-duced unique challenges to health-care systems worldwide. Organ procure -ment and trans plantation activities were affected in this con text as previ-ously described by Alexandre Loupy and colleagues.1However, COVID-19 and organ transplant data from Germany,2 the Robert Koch Institute, and Euro transplant paints a different picture. With the increase in the number of COVID-19 cases, organ procure ment and transplanta tion activities in Germany remained 2 Rahmel A. Organspende und Transplantation zu Beginn des Jahres 2020. Erste Erfahrungen zum Einfluss der SARS-CoV-2-Pandemie in Deutschland. April 20, 2020. https://www.dso.de/organspende/news-veranstaltungen/news/Organspende%2520und%2520SARS% 2520COV-2/COVID-19-Epidemie/19 (accessed Oct 21, 2020).For Robert Koch Institute COVID-19 data see https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.htmlFor Eurotransplant statistical data see https://www.eurotransplant.org/statistics/monthly-statistics/See Online for appendixSee Online for appendixTransplant programmes in areas with high SARS-CoV-2 transmissionWe read Alexandre Loupy and col-leagues’ account of a significant reduction in transplant activity in France and the USA with interest.1 The UK also has a high burden of COVID-19 with high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission leading to a significant reduction in organ donation and transplant activity. In the UK, in April, 2020, only five out of 23 kidney transplant centres were active during lockdown.2 According to NHS Blood and Transplant, on May 8, 2020, deceased-donor organ retrieval was down by 63% and kidney transplantation by 57% compared with 2019. The Oxford Transplant Centre is located in a hospital without an emergency department and is main-tained as a COVID-19-free site—any suspected cases are isolated on a designated ward, and if confirmed are rapidly transferred to the main acute hospital. We have made profound system-wide changes to our practice covering donor and recipient selection, hospital logistics, and perioperative management to enable our transplant programme to continue, which are summarised in the appendix (pp 1–2). These changes have been highly effective. Between March 16 and May 12, 2020, we did 38 deceased-donor kidney transplants—27 from donation after brain death and 11 from donation after cardiac death. This compares with 16 kidney-alone transplants For more on NHS Blood and Transplant see https://www.nhsbt.nhs.uk/APHP-St Antoine-Garo/Phanie/Science Photo Library

Asymptomatic health-care worker screening during the COVID-19 pandemic - Authors' reply.

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Asymptomatic health-care worker screening during the COVID-19 pandemic - Authors' reply.

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