Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England
Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England
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DOI：
10.2196/18606
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发表时间：
2020-04-01
影响因子：
8.5
通讯作者：
Hobbs, Richard
中科院分区：
文献类型：
--
作者：
de Lusignan, Simon;Bernal, Jamie Lopez;Hobbs, Richard
背景：皇家全科医生学院（RCGP）研究和监测中心（RSC）和英格兰公共卫生部（PHE）在流感和其他传染病的监测方面已经成功合作了50多年，包括之前的三次大流行。随着新型冠状病毒感染（COVID-19）的国际爆发，英国已经制定了一项全国性的控制措施，对疑似接触过COVID-19的人进行检测。与此同时，RCGP RSC的监测工作已扩大到监测COVID-19感染在社区的时间和地理分布，并评估遏制战略的有效性。目的：对无症状人群和呼吸道感染门诊病例进行COVID-19监测，了解COVID-19的传播率和传播模式，评估疫情防控政策的有效性。方法：RCGP RSC，英国500多家全科医生的网络，每周提取假名数据。这种扩大的监测包括五个部分：(1)在医疗记录中记录任何疑似患有或接触过COVID-19的人。电脑化医疗记录供应商在收到请求的一周内创建了新的代码来支持这一点。(2)扩大目前的病毒学监测，并对流感样疾病或下呼吸道感染患者进行检测，但需要注意的是，疑似感染或曾接触过COVID-19的人应转诊至国家防控途径，不得在初级保健中就诊。(3)各年龄组血清学样本采集。这将是一个额外的血液样本，从参加他们的一般做法，为预定的血液测试的人。目前每年进行流感病毒学监测的100家全科医院将参与扩大的病毒学和血清学监测。(4)采集恢复期血清样本。(5)数据管理。如果需要，我们有机会将数据提取升级为每周两次。拭子和血清将在PHE参考实验室进行分析。结果：全科临床系统提供者已推出一套新的紧急临床代码，以支持COVID-19监测。此外，参与当前病毒学监测的做法现在正在从出现下呼吸道感染的低风险患者身上采集COVID-19监测样本。在建立这一监测的头两周内，我们确定了3例：1例通过新的编码系统，另外2例通过扩展病毒学抽样。结论：我们已迅速将已建立的国家RCGP RSC流感监测系统转变为可以测试COVID-19遏制政策有效性的系统。扩大的监测已经看到使用新的代码，报告了3例病例。快速分享这一协议应该使科学批判和共享学习成为可能。
Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC's surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy.Objectives: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy.Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)-with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories.Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling.Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning.