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Table 1. Responses to COVID-19 included in the transmission model.
See Methods for description of how COVID-19 response parameters are implemented in model equations. Rows describing policy responses are shaded blue, and rows describing caseload responses are shaded grey. Symptomatic refers to COVID-19 symptoms among individuals infected with SARS-CoV-2. COVID-19; Coronavirus Disease 2019; HCW, healthcare worker; IPC, infection prevention and control; PPE, personal protective equipment; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2.
| COVID-19 response | Evidence | Model implementation | Category/Cause | Interpretation | ||
|---|---|---|---|---|---|---|
| τ = 0 | τ = 1 | |||||
| τas | Abandoned stewardship | Reduction in antibiotic stewardship activities [17] | Increased proportion of patients exposed to antibiotics (A) | Antibiotics/Caseload | No change in antibiotic use | Large increase in antibiotic use during COVID-19 surges |
| τcp | COVID-19 prescribing | COVID-19 patients receive high rates of antibiotic prescription [18] | Increased proportion of symptomatic COVID-19 patients exposed to antibiotics (AI) | Antibiotics/Policy | No excess antibiotic prescribing among symptomatic patients | All symptomatic patients receive antibiotics |
| τcd | Care disorganization | Compromised ability of HCWs to adhere to IPC best practices (e.g., due to increased workload, PPE shortages) [14] | Increased daily rate of at-risk patient–HCW contact (κpat→hcw) | Contact/Caseload | No change in contact behaviour | Large increase in at-risk patient–HCW contact during COVID-19 surges |
| τpl | Patient lockdown | Social interactions among patients limited or forbidden [19] | Decreased daily rate of patient–patient contact (κpat→pat) | Contact/Policy | No change in contact behaviour | Elimination of all patient–patient contact |
| τum | Universal masking | HCWs and patients wear face masks to prevent transmission [20] | Decreased SARS-CoV-2 transmissibility per contact (πV) | IPC/Policy | No change in SARS-CoV-2 transmissibility | SARS-CoV-2 rendered nontransmissible (perfect mask effectiveness) |
| τhh | Hand hygiene | Increase in HCW handwashing performance [21] | Increased hand hygiene compliance (H) | IPC/Policy | No change in hand hygiene compliance | Perfect hand hygiene compliance |
| τcs | COVID-19 stays | COVID-19 patients remain in healthcare facility until recovered [22] | Decreased discharge rate for symptomatic COVID-19 patients (μI) | Disease/Caseload | No impact of SARS-CoV-2 infection on patient length of stay | All patients remain in hospital while symptomatic |
| τss | Staff sick leave | HCWs with COVID-19 stay home from work [23] | A proportion of symptomatic HCWs removed from population for 7 days (until recovered) | Disease/Caseload | No symptomatic staff go on sick leave | All symptomatic staff go on sick leave after being infectious for 1 day |
| τra | Reduced admission | Decreased number of hospital admissions during COVID-19 surges [24] | Decreased patient admission rate (μ) | Admission/Caseload | No change in patient admissions | Large reduction in patient admissions during COVID-19 surges |
| τsc | Sicker casemix | Elective admissions delayed or cancelled during COVID-19 surges, restricting admissions to more critically ill patients [10] | Increased rate of antibiotic-resistant bacterial carriage among patient admissions () | Admission/Caseload | No change in the probability of colonization upon admission | Large increase in the probability of colonization with resistant bacteria upon admission during COVID-19 surges |
Reference
- 1.Smith DRM, Shirreff G, Temime L, Opatowski L (2023) Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance: A modelling study. PLoS Med 20(6): e1004240. 10.1371/journal.pmed.1004240 [DOI] [PMC free article] [PubMed] [Google Scholar]
