Emergence of a novel coronavirus (COVID-19): Protocol for extending surveillance used by the royal college of general practitioners research and surveillance centre and public health England

Simon de Lusignan*, Jamie Lopez Bernal, Maria Zambon, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Nicholas Andrews, Raymond Borrow, Rachel Byford, Andre Charlett, Gavin Dabrera, Joanna Ellis, Alex Elliot, Michael Feher, Filipa Ferreira, Else Krajenbrink, Jonathan Leach, Ezra Linley, Harshana Liyanage, Cecilia Okusi, Mary RamsayGillian Smith, Julian Sherlock, Nicholas Thomas, Manasa Tripathy, John Williams, Gary Howsam, Mark Joy, Richard Hobbs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Citations (Scopus)
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Abstract

Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. 

Objectives: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. 

Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. 

Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. 

Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning.

Original languageEnglish
Article numbere18606
JournalJMIR Public Health and Surveillance
Volume6
Issue number2
DOIs
Publication statusPublished - 2 Apr 2020

Bibliographical note

Funding Information: SdL has had unrelated projects in influenza and gastroenteritis funded by GSK, Takeda, and Seqirus, and has been a member of Global Advisory Boards for Seqirus and Sanofi. The RCGP RSC surveillance work is funded by PHE.

Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on http://publichealth.jmir.org, as well as this copyright and license information must be included.

Publishers Copyright: ©Simon de Lusignan, Jamie Lopez Bernal, Maria Zambon, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Nick Andrews, Ray Borrow, Rachel Byford, André Charlett, Gavin Dabrera, Joanna Ellis, Alex J Elliot, Michael Feher, Filipa Ferreira, Else Krajenbrink, Jonathan Leach, Ezra Linley, Harshana Liyanage, Cecilia Okusi, Mary Ramsay, Gillian Smith, Julian Sherlock, Nicholas Thomas, Manasa Tripathy, John Williams, Gary Howsam, Mark Joy, Richard Hobbs. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 02.04.2020.

Citation: de Lusignan S, Lopez Bernal J, Zambon M, Akinyemi O, Amirthalingam G, Andrews N, Borrow R, Byford R, Charlett A, Dabrera G, Ellis J, Elliot AJ, Feher M, Ferreira F, Krajenbrink E, Leach J, Linley E, Liyanage H, Okusi C, Ramsay M, Smith G, Sherlock J, Thomas N, Tripathy M, Williams J, Howsam G, Joy M, Hobbs R
Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England JMIR Public Health Surveill 2020;6(2):e18606

DOI: 10.2196/18606

Keywords

  • COVID-19
  • Computerized
  • Coronavirus
  • General practice
  • Infections
  • Medical record systems
  • Pandemic
  • Records as topic
  • SARS-CoV-2
  • Sentinel surveillance
  • Serology
  • Surveillance

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