Assessment of an enhanced COVID-19 case and contact management protocol in controlling a SARS-CoV-2 Alpha (B.1.1.7) variant outbreak on a construction site.

BACKGROUND: To control the spread of SARS-CoV-2 variants of concern (VOCs), Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health implemented a more stringent COVID-19 case and contact management (CCM) protocol than what was used across Ontario at the time. We describe epidemiological data and public health measures employed during one of the largest COVID-19 outbreaks in the KFL&A region at the time, caused by the SARS-CoV-2 Alpha (B.1.1.7) VOC, to assess this enhanced protocol. METHODS: We obtained line lists of workers associated with the construction site outbreak, and subsequent cases and contacts from case investigators. Case testing, mutation status, and whole genome sequencing were conducted by Public Health Ontario Laboratories. RESULTS: From 409 high-risk contacts of the outbreak, 109 (27%) developed COVID-19. Three generations of spread were associated with the outbreak, affecting seven public health regions across three provinces. Using an enhanced approach to the CCM, KFL&A Public Health caught 15 cases that could have been missed by standard provincial protocols. CONCLUSIONS: Rapid initial spread within the construction site produced a relatively high attack rate among workers (26%) and their immediate contacts (34%). KFL&A Public Health's implementation of stringent CCM protocols and fast testing turn-around time effectively curbed the spread of the disease in subsequent generations - illustrated by the large reduction in attack rate (34%-14%) and cases (50-10) between the second and third generations. Lessons learned from this analysis may inform guidance on the CCM for future SARS-CoV-2 VOCs as well as other highly transmissible communicable diseases.

HISTORIQUE: Pour contrôler la propagation des variants inquiétants (VOC) du SRAS-CoV-2, la région sociosanitaire de Kingston, Frontenac, Lennox et Addington (KFL&A) a adopté un protocole plus rigoureux de gestion des cas et des contacts (GCC) qui était utilisé partout en Ontario à l'époque. Les auteurs décrivent les données épidémiologiques et les mesures sanitaires employées pendant l'une des plus grosses éclosions de COVID-19 de la région sociosanitaire de KFL&A, causée par le VOC Alpha (B.1.1.7) du SRAS-CoV-2, afin d'évaluer ce protocole amélioré. MÉTHODOLOGIE: Les auteurs ont obtenu les listes des lignes des travailleurs associés à l'éclosion sur le chantier de construction, ainsi que des cas et des contacts subséquents des enquêteurs de cas. Les Laboratoires de Santé publique Ontario ont procédé au dépistage des cas et ont vérifié l'état mutationnel et le séquençage du génome entier. RÉSULTATS: Des 409 contacts à haut risque de l'éclosion, 109 (27%) ont contracté la COVID-19. Trois générations de propagation étaient associées à l'éclosion et touchaient sept régions sociosanitaires réparties dans trois provinces. Au moyen d'une approche améliorée de la GCC, la région sociosanitaire de KFL&A a dépisté 15 cas qui auraient pu être omis par les protocoles provinciaux standards. CONCLUSIONS: Une propagation initiale rapide sur le chantier de construction a produit un taux d'attaque relativement élevé chez les travailleurs (26%) et leurs contacts immédiats (34%). Ladoption de protocoles rigoureux de GCC dans la région sociosanitaire de KFL&A et l'obtention rapide des résultats du dépistage ont enrayé la propagation de la maladie avec efficacité dans les générations suivantes, ce qui est démontré par une forte réduction du taux d'attaque (de 34% à 14%) et de cas (de 50 à 10) entre la deuxiéme génération et la troisiéme. Les leçons tirées de cette analyse pourraient éclairer les conseils sur la GCC des futurs VOC du SRAS-COV-2 et des autres maladies contagieuses hautement transmissibles.

Limited Propagation of SARS-CoV-2 among Children in a Childcare Center, Canada, 2021.

An outbreak of severe acute respiratory syndrome coronavirus 2 with no definitive source and potential exposure to variants of concern was declared at a childcare center in Ontario, Canada, in March 2021. We developed a robust outbreak management approach to detect, contain, and interrupt this outbreak and limit propagation among children.

Sarcopenia and physical function in overweight patients with advanced cancer.

Advanced cancer is associated with numerous metabolic abnormalities that may lead to significant body composition changes, particularly muscle loss or sarcopenia. Sarcopenia in cancer has been associated with poor clinical outcomes, including poor physical function. Accurate tools to assess body composition are expensive and not readily available in clinical settings. Unfortunately, little is known about the efficacy of affordable and portable techniques to assess functional status in patients with cancer. We investigated the prevalence of sarcopenia and its association with different portable and low-cost functional status measurement tools (i.e., handgrip strength testing, a two-minute walking test, and a self-report questionnaire) in overweight/obese patients (body mass index ≥ 25 kg/m²) with advanced cancer. Twenty-eight patients (68% men) aged 64.5 ± 9.5 years with advanced lung or colorectal cancer were included. Sarcopenia was assessed by measuring appendicular skeletal muscle (ASM) adjusted by height (ASM index), using dual energy X-ray absorptiometry. Approximately 36% of patients had sarcopenia. Average handgrip strength was greater in men without sarcopenia than in men with it (p=0.035). In men, ASM index was positively correlated with average (r=0.535, p=0.018) and peak handgrip strength (r=0.457, p=0.049). No differences were observed among female patients. Handgrip strength was associated with sarcopenia in male patients with advanced cancer, and therefore it may be used as a portable and simple nutritional screening tool.