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. 2020 Apr 2;6(2):e18606.
doi: 10.2196/18606.

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 #  1 , Jamie Lopez Bernal #  2 , Maria Zambon #  2 , Oluwafunmi Akinyemi #  1 , Gayatri Amirthalingam #  2 , Nick Andrews #  2 , Ray Borrow #  3 , Rachel Byford #  1 , André Charlett #  2 , Gavin Dabrera #  2 , Joanna Ellis #  2 , Alex J Elliot #  4 , Michael Feher #  1 , Filipa Ferreira #  1 , Else Krajenbrink #  5 , Jonathan Leach #  5 , Ezra Linley #  3 , Harshana Liyanage #  1 , Cecilia Okusi #  1 , Mary Ramsay #  2 , Gillian Smith #  4 , Julian Sherlock #  1 , Nicholas Thomas #  5 , Manasa Tripathy #  1 , John Williams #  1 , Gary Howsam #  5 , Mark Joy #  1 , Richard Hobbs #  1
Affiliations

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 et al. JMIR Public Health Surveill. .

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.

International registered report identifier (irrid): DERR1-10.2196/18606.

Keywords: COVID-19; SARS-CoV-2; computerized; coronavirus; general practice; infections; medical record systems; pandemic; records as topic; sentinel surveillance; serology; surveillance.

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Conflict of interest statement

Conflicts of Interest: 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.

Figures

Figure 1
Figure 1
RCGP RSC virology sampling sites. Distribution by National Health Service region and by brand of computerized clinical systems supplier. RCGP RSC has 100 virology sampling sites, there are >500 practices in total signed up to RCGP RSC across England. NHS: National Health Service. RCGP: Royal College of General Practitioners; RSC: Research and Surveillance Centre.
Figure 2
Figure 2
Screenshot of the COVID-19 codes activated in EMIS web. “COVID-19” search terms finds the codes. Ada Ant is NOT a real patient.
Figure 3
Figure 3
Screenshot showing coding of public health measures in EMIS web.
Figure 4
Figure 4
Screenshot of codes available in TPP SystemOne. SNOMED: Systematized Nomenclature of Human Medicine; 2019-nCoV: novel coronavirus.
Figure 5
Figure 5
Screenshot of COVID-19 Observatory showing number and rate per 10,000 patients investigated for COVID-19 to date within the RCGP RSC network.
Figure 6
Figure 6
Number of full blood count results in RCGP RSC 2019-2020 virology practices for different child and young adult age groups. Practice unique identifiers have been removed. FBC: full blood count.
Figure 7
Figure 7
Number of blood tests in Adults.
Figure 8
Figure 8
Variation of blood sampling in children and young adults according to age. Data on rate of full blood count sampling per 100,000 registered patients for each children and young adult age groups, per year, by individual virology practice. Practice unique identifiers have been removed.
Figure 9
Figure 9
Variation of blood sampling in adults according to age. Rate of full blood count sampling per 100,000 registered patients for each adult age group, per year, by individual virology practice. Practice unique identifiers have been removed.
See this image and copyright information in PMC

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References

    1. Correa A, Hinton W, McGovern A, van Vlymen J, Yonova I, Jones S, de Lusignan S. Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) sentinel network: a cohort profile. BMJ Open. 2016 Apr 20;6(4):e011092. doi: 10.1136/bmjopen-2016-011092. http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=27098827 - DOI - PMC - PubMed
    1. de Lusignan S, Correa A, Smith GE, Yonova I, Pebody R, Ferreira F, Elliot AJ, Fleming D. RCGP Research and Surveillance Centre: 50 years' surveillance of influenza, infections, and respiratory conditions. Br J Gen Pract. 2017 Oct;67(663):440–441. doi: 10.3399/bjgp17X692645. https://bjgp.org/cgi/pmidlookup?view=long&pmid=28963401 - DOI - PMC - PubMed
    1. Royal College of General Practitioners Research and Surveillance Centre. [2020-03-07]. RCGP Research and Surveillance Centre https://www.rcgp.org.uk/rsc.
    1. de Lusignan S, Correa A, Pathirannehelage S, Byford R, Yonova I, Elliot AJ, Lamagni T, Amirthalingam G, Pebody R, Smith G, Jones S, Rafi I. RCGP Research and Surveillance Centre Annual Report 2014-2015: disparities in presentations to primary care. Br J Gen Pract. 2017 Jan;67(654):e29–e40. doi: 10.3399/bjgp16X688573. https://bjgp.org/cgi/pmidlookup?view=long&pmid=27993900 - DOI - PMC - PubMed
    1. Pebody R, Warburton F, Andrews N, Ellis J, von Wissmann B, Robertson C, Yonova I, Cottrell S, Gallagher N, Green H, Thompson C, Galiano M, Marques D, Gunson R, Reynolds A, Moore C, Mullett D, Pathirannehelage S, Donati M, Johnston J, de Lusignan S, McMenamin J, Zambon M. Effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 end of season results. Euro Surveill. 2015;20(36) doi: 10.2807/1560-7917.ES.2015.20.36.30013. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21237 - DOI - PubMed