COVID-19 hotspots through clusters analysis in France (may-October 2020): where should we track the virus to mitigate the spread?

BACKGROUND: In France, the lifting of the lockdown implemented to control the COVID-19 first wave in 2020 was followed by a reinforced contact-tracing (CT) strategy for the early detection of cases and transmission chains. We developed a reporting system of clusters defined as at least three COVID-19 cases, within seven days and belonging to the same community or having participated in the same gathering, whether they know each other or not. The aim of this study was to describe the typology and criticality of clusters reported between the two lockdowns in France to guide future action prioritisation. METHODS: In this study we describe the typology and criticality of COVID-19 clusters between the two lockdowns implemented in France (between May and end of October 2020). Clusters were registered in a national database named "MONIC" (MONItoring des Clusters), established in May 2020. This surveillance system identified the most affected communities in a timely manner. A level of criticality was defined for each cluster to take into consideration the risk of spreading within and outside the community of occurrence, and the health impact within the community. We compared the level of criticality according to the type of community in which the cluster occurred using Pearson's chi-square tests. RESULTS: A total of 7236 clusters were reported over the study period, particularly in occupational environment (25.1%, n = 1813), elderly care structures (21.9%, n = 1586), and educational establishments (15.9%, n = 1154). We show a shift over time of the most affected communities in terms of number of clusters. Clusters reported in occupational environment and the personal sphere had increased during summer while clusters reported in educational environment increased after the start of the school year. This trend mirrors change of transmission pattern overtime according to social contacts. Among all reported clusters, 43.1% had a high level of criticality with significant differences between communities (p < 0.0001). A majority of clusters had a high level of criticality in elderly care structures (82.2%), in disability care centres (56.6%), and health care facilities (51.7%). CONCLUSION: These results highlight the importance of targeting public health action based on timely sustained investigations, testing capacity and targeted awareness campaigns. The emergence of new SARS-CoV-2 variants strengthen these public health recommendations and the need for rapid and prioritise vaccination campaigns.

Interprofessional collaboration and diabetes care in Switzerland: A mixed-methods study.

To face the increasing prevalence of diabetes in Switzerland, a cantonal programme has been implemented. One of its goals is to promote collaborative approaches among healthcare professionals (HCPs). The objectives of the current study were to examine HCPs' perceptions about the collaboration they experience in diabetes care and to determine whether perceptions differed among professional groups. A mixed-methods study was conducted. First, a total of 332 HCPs comprising diabetes specialists and non-specialists participated by completing a questionnaire on interprofessional collaboration. Focus groups were then led in order to deepen the understanding and complement the interpretation of quantitative results. Quantitative results showed a perception of a moderate level of collaboration. Mean scores for specialists were systematically worse than those of non-specialists and more prominently in the "level of conflict dimension," which means that specialists generally perceived a lower level of collaboration and a higher level of possible conflict associated with it. Qualitative results highlighted the vagueness in role definition and emphasised a form of reluctance by general physicians to collaborate with specialists, as the physicians felt that they were losing their responsibilities. The findings suggest that it is not the need to collaborate that encourages HCPs involved in collaborative schemes to desire or to know how to successfully initiate, promote, or conduct interprofessional collaboration. This study highlights the important perceptions about collaboration that could be taken into account when planning future collaborative programmes.