News Release 

COVID-19 news from Annals of Internal Medicine

All coronavirus-related content published in Annals is free

American College of Physicians

Research News

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Active surveillance and routine on-site testing could prevent spread of COVID-19 in homeless shelters

Passive sentinel surveillance for COVID-19 in homeless shelters and other congregate living situations may only detect symptomatic cases while missing milder ones. Active testing is needed to identify cases and potentially prevent outbreaks and further viral spread. Findings from a community-based surveillance study are published in Annals of Internal Medicine.

Researchers from University of Washington School of Medicine conducted COVID-19 case counts across several adult and family homeless shelters in King County, Washington between January and April 2020 to demonstrate how active surveillance and surge testing could identify asymptomatic or mild cases. Routine surveillance involved self-selected participation at staffed kiosks in shelters during standardized days and times. Surge testing was initiated on 30 March 2020 (and continued through 24 April) in collaboration with Public Health--Seattle & King County's Communicable Disease Epidemiology Team to conduct contact tracing at 6 shelters where cases of COVID-19 were previously detected. During these 1-day events, the researchers offered testing to all residents and staff. Among 1434 encounters, 29 cases of SARS-CoV-2 infection were detected across 5 shelters. Most of those cases were detected during surge testing events rather than routine surveillance, and of those, most were asymptomatic at the time of sample collection. Eighty-six percent of persons with positive test results slept in a communal space rather than in a private or shared room.

According to the authors, their findings provide key insights into detection strategies for SARS-CoV-2 in a vulnerable, hard-to-reach population. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-3799.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. To reach the lead author, Helen Y. Chu, MD, MPH, please contact Leila Gray at leilag@uw.edu.

2. Researchers discuss research needs for developing guidelines in the era of COVID-19

The sudden emergence and scale of the COVID-19 pandemic have led to substantial pressure and heightened expectations for accelerated systematic reviews and rapid guidelines. Researchers, systematic reviewers, and guideline developers have been tasked with resolving uncertainty in much shorter time frames, in an emerging field, and with types of evidence that they may not have used previously. The evidence base for COVID-19 is characterized by many studies and systematic reviews that are poorly designed and conducted, presenting numerous complications for guideline developers. In addition to presenting the challenges, authors from the Guidelines International Network, Pitlochry, Scotland, and Joanna Briggs Institute, University of Adelaide, Adelaide, Australia discuss several solutions for those developing guidelines and recommendations related to COVID-19. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4907.

The COVID-NMA Project

In an accompanying article, authors from the Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), Inserm, Cochrane France and international colleagues describe a large collaborative project called the COVID-NMA project. Researchers proposed and implemented an "evidence ecosystem" for COVID-19-related studies that minimizes multiple low-quality reviews and helps connect evidence generation, synthesis, and decision making. The ecosystem consists of living mapping of all trials and a comprehensive living synthesis of all available trial evidence evaluating the effect of interventions for the prevention or treatment of COVID-19. There is a master protocol and subprotocols dedicated to specific questions, which are discussed and agreed on by a steering committee. A search to identify eligible RCTs is performed daily. As soon any trial with results is identified, data are collected, risk of bias fully assessed and forest plots of appropriately pooled data produced. All data are made available on a website (https://covid-nma.com). This ecosystem, called the COVID-NMA Project, is intended to change and improve primary research, evidence synthesis and the guideline development process. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-5261.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. To reach the lead author for the COVID-NMA Project, Isabelle Boutron, MD, PhD, contact her directly at isabelle.boutron@aphp.fr.

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