Abstract
Monitoring transmission is a prerequisite for containing COVID-19. We report on effective potential growth (EPG) as a novel measure for the early identification of local outbreaks based on primary care electronic medical records (EMR) and PCR-confirmed cases. Secondly, we studied whether increasing EPG precedes local hospital and intensive care (ICU) admissions and mortality. Population-based cohort including all Catalan citizens' PCR tests, hospitalization, intensive care (ICU) and mortality between 1/07/2020 and 13/09/2020; linked EMR covering 88.6% of the Catalan population was obtained. Nursing home residents were excluded. COVID-19 counts were ascertained based on EMR and PCRs separately. Weekly empirical propagation (ρ7) and 14-day cumulative incidence (A14) and 95% confidence intervals were estimated at care management area (CMA) level, and combined as EPG = ρ7 × A14. Overall, 7,607,201 and 6,798,994 people in 43 CMAs were included for PCR and EMR measures, respectively. A14, ρ7, and EPG increased in numerous CMAs during summer 2020. EMR identified 2.70-fold more cases than PCRs, with similar trends, a median (interquartile range) 2 (1) days earlier, and better precision. Upticks in EPG preceded increases in local hospital admissions, ICU occupancy, and mortality. Increasing EPG identified localized outbreaks in Catalonia, and preceded local hospital and ICU admissions and subsequent mortality. EMRs provided similar estimates to PCR, but some days earlier and with better precision. EPG is a useful tool for the monitoring of community transmission and for the early identification of COVID-19 local outbreaks.
Highlights
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 started as an outbreak in Wuhan (China) late December and quickly evolved into a worldwide pandemic
We aimed to describe effective potential growth (EPG) and risk diagrams based on primary care electronic medical records (EMR) as well as on PCR-confirmed cases as novel measures to monitor COVID-19 local outbreaks
Data were obtained from the official repository of reverse transcriptase polymerase chain reaction (RT-PCR) tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) linked to hospital admissions, intensive care units (ICU) and mortality registries, covering the whole population of Catalonia (>7.6 million people)
Summary
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 started as an outbreak in Wuhan (China) late December and quickly evolved into a worldwide pandemic. Despite universal healthcare and other advantages, Spain was heavily hit by COVID-19 morbimortality in March to May, motivating public health experts to ask for an independent evaluation of the national response to the pandemic [2]. During the first wave of COVID-19, Spain lacked the capacity to test all cases and contacts, and PCR confirmation was only required when patients were admitted to hospital or if they were healthcare workers. Only 38.5% of clinical COVID-19 cases diagnosed between March 1 and April 24 2020 received a RT-PCR test in Catalonia [3]. On May 11th, Spanish authorities advocated that all clinical diagnoses of COVID-19 should have a test, and the number of RT-PCR performed increased dramatically since in an attempt to reduce the test positivity ratio [4, 5]. In Catalonia, official figures show that testing rates increased from 551 RT-PCR tests per week per 100,000 people the first week of June to 1,352 the first week of September
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