Pooled COVID-19 tests could help scale up testing and identify & disease hotspots. Researchers at Texas A&M University, CDDEP, and Princeton found that pooled RT-PCR testing could help identify COVID-19 hotspots. The testing strategy could reduce the time, cost, and resources required to estimate the prevalence of the disease in a population, an estimate that informs targeted public health responses. The researchers used mathematical analysis to explore efficient pooling strategies using this technique. For a population containing 256 sampled individuals, where the maximum number of samples in a single pool is 64 (as pooling more samples may be beyond practical testing limits), with only 7.3 tests on average, it would be possible to distinguish between a prevalence of 1 percent and 5 percent, with a 95 percent probability of detection.The Andaman and Nicobar Islands have implemented this testing strategy.  [CDDEPMedRxiv, The Print]

Evidence of pre-symptomatic COVID-19 transmission in Singapore. In a CDC Morbidity and Mortality Weekly Report, researchers identified seven clusters of reported COVID-19 cases in Singapore where pre-symptomatic transmission of the virus likely occurred. In four of the clusters where the date of exposure was undetermined, pre-symptomatic transmission of COVID-19 occurred one to three days prior to symptom onset in the source patients. The authors note that evidence of pre-symptomatic transmission of the novel virus in this study and others emphasizes the importance of comprehensive physical distancing measures. [CDC MMWR]

Underlying health conditions common among severe COVID-19 cases in the US. Using US data from February 12-March 28, 2020, the CDC COVID-19 Response Team concluded that underlying health conditions including diabetes mellitus, chronic lung disease, and cardiovascular disease are risk factors for severe COVID-19 in the United States. The study found that 78 percent of ICU admissions and 71 percent of non-ICU hospitalizations occurred among patients with a reported underlying medical condition. ICU admissions and non-ICU  hospitalizations were more common among patients ≥19 yearswith underlying conditions (13.3-14.5 percent and 27.3-29.8 percent, respectively) than patients without underlying conditions (2.2-2.4 percent and 7.2-7.8 percent, respectively). [CDC MMWR]

Strict prevention measures interrupted COVID-19 transmission in China, study suggests. A study on the epidemiology and transmission of COVID-19 in 30 Chinese provinces outside Hubei between January 19 and February 17, 2020 suggests that the implementation of strict prevention measures and restrictions successfully interrupted local transmission of the virus. The study found that as the epidemic progressed, the mean time from symptom onset to hospital admission decreased from 4.4 to 2.6 days, and the mean incubation period of the virus was 5.2 days. The net reproduction number of COVID-19 at peak ranged between 1.08 (95% CI 0·74–1·54) in Shenzhen city of Guangdong province and 1·71 (1·32–2·17) in Shandong province. However, after January 30th, the net reproduction number of the virus fell below the epidemic threshold (<1) in all locations studied. The authors note that as COVID-19 cases were isolated more quickly over time, community transmission of the virus decreased. [The Lancet Infectious Diseases]

US school closures may negatively impact COVID-19 response due to healthcare worker absenteeism. Researchers from Colorado State University and Yale conducted a modeling study to weigh the potential benefits of school closures on the impact of COVID-19 against the costs of healthcare worker absenteeism due to childcare obligations. The study found that school closures could lead to a higher number of deaths than they prevent if the mortality rate of COVID-19 increased from 2 to 2.35 percent when the US healthcare workforce decreases by 15 percent due to childcare obligations.  [The Lancet Public Health]

Study reports drop in incidence of MDR infections in US hospitals. Researchers at theUS Centers for Disease Control and Prevention (CDC) conducted a cohort study using data from 890 US hospitals and estimated a 20.5 to 39.2 percent decrease in the incidence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), carbapenem-resistant acinetobacter species, and multidrug-resistant Pseudomonas aeruginosa infections between 2012 and 2017. The study found an insignificant change in the incidence of carbapenem-resistant Enterobacteriaceae infections, and a 53.3 percent increase in the incidence of extended-spectrum beta-lactamase (ESBL) infections during the same time period. [NEJM]

Half of hospitalized newborns in Ghana carry MDR bacteria. In a cross-sectional study of two neonatal intensive care units (NICUs) in Ghana, researchers identified high carriage rates of multidrug-resistant (MDR) gram-negative bacteria among newborns. Of the 228 infants screened, 76.8 percent carried pathogenic gram-negative bacteria, with Klebsiella spp. and Escherichia coli (41.7 and 26.4 percent, respectively) being the most prevalent. Nearly half of all infants screened carried MDR gram-negative bacteria, while 46.1 percent carried 3rd generation cephalosporin-resistant organisms. The study also found that length of hospital stay and antibiotic use were independently associated with neonatal carriage rates. [Open Forum Infectious Diseases]

Studies assessing antimicrobial stewardship programs are limited across Africa. In a systematic literature review, researchers in Nigeria and the United Kingdom reported a lack of data on antimicrobial stewardship programs (ASPs) across Africa. The researchers identified 13 studies that assessed the implementation of ASPs in South Africa (7), Kenya (3), Sudan (1), Tanzania (1), and Egypt (1). Of which, 11 were deemed high quality with a low risk of bias. The included studies linked ASPs toan increase in appropriate antibiotic prescribing, a reduction in antibiotic use, and cost savings. The limited data identified in the review suggests that ASPs can be effective in African countries.  [Journal of Global Antimicrobial Resistance]