Researchers contribute to local infection control

The map shows the proportion of the adult population who have been tested in different districts in Uppsala during the past two weeks.

Photograph: Tove Fall and Mats Martinell

Uppsala is one of the regions that has been particularly hard hit by COVID-19 over recent weeks. Infectious disease specialists and researchers are now collaborating to reverse this trend.

Uppsala and senior lecturer in family medicine

at Uppsala University. Photo: David Naylor

It is a Thursday in early December and regional health authority Region Uppsala is holding a press conference. One of the speakers is Mats Martinell, senior medical advisor to Region Uppsala and senior lecturer in family medicine at Uppsala University. Since October, Mats has been in charge of the CRUSH COVID research project, which is gathering data from various sources to build a picture of the spread of infection.

He shows maps and diagrams describing the current infection situation for COVID-19 and which municipalities and districts are most affected.

"Unlike influenza, COVID differs from one region to another locally. In the latest report we can see that it is increasing in Enköping and in Heby, but all municipalities have a high level of infection," says Mats Martinell.

Differences between various age groups

Another image shows differences between various age groups, both in how many are getting tested and the percentage of those who are found to be infected. Today's report shows a high rate of positive tests in the age group 16-19 years, shown in red.

"The age group 61-69 also has a slightly reddish/amber hue, which is cause for some concern considering that many of these may become seriously ill."

Today, there is positive news on several fronts. Viral levels in wastewater have declined over recent weeks and there has been a downturn in the number of people reporting symptoms to the COVID Symptom Study, a research study that gathers data using a mobile app. There has also been a slight decrease in the number of people calling the national health service helpline 1177 with questions about COVID symptoms.

"We are seeing early signals that we can turn things around and halt the spread of infection but, bear in mind, we must persevere. Reversing this trend will have the turning circle of a large ship. What we do now will have an impact later on," says Mats Martinell.

New report each week

The CRUSH COVID project presents a detailed weekly report that is used to plan various initiatives to reduce infection rates.

"The report provides a useful summary of the data infection trackers gather regarding where someone may have been infected and passed on the infection. It also shows areas where too few people are being tested so that we can take measures to improve information and increase availability there. For example, we use the report when we decide were to station our mobile testing unit," explains Fredrik Settergren, operations manager at Region Uppsala.

Uppsala's four testing stations have been supplemented by a mobile testing unit, which for the past fortnight has been stationed in Stenhagen. The results are clearly visible in the CRUSH COVID report: significantly more residents of Stenhagen have now tested themselves.

Initiatives have also shown positive results in Gottsunda, a district with a high rate of infection where few people have been tested. After considerable media attention and the opening of a new testing station, this situation has been turned around.

A broad project with many branches

A great deal of research is being conducted in parallel with preparing weekly reports, including studies of which initiatives are working and how infection is spreading.

"This is a very broad project with many branches. It is exciting to work with public health in real time," says Tove Fall, professor of molecular epidemiology.

In addition to Tove and Mats, the project also involves limnologists, who are measuring viral levels in wastewater under the leadership of researcher Anna Szekely, IT researchers Stefan Engblom and Alexander Medvedev, who are in the process of developing an infection model that can predict how many hospital beds will be needed one week ahead of time,

and two researchers from the Department of Informatics and Media, Ylva Ekström and Therese Monstad, who have joined the project to study communication initiatives for hard-to-reach groups.

How long will the project last?

"We would like to follow up vaccinations as well, as it would be extremely interesting to evaluate how the vaccination strategy works. Given the nature of this pandemic it is hard to say, but at least until the summer, perhaps longer."

Interest from other regional health authorities

Region Uppsala is in a unique position as its testing is centralised, giving the project access to not only positive tests but also negative. This is one explanation for the project's success.

"Other regions could also learn from what we are doing, such as our research into testing and deviations in the level of testing between different groups. And the infection model being developed within the project is actually applicable throughout Sweden," says Tove Fall.

For Tove and her colleagues, it has been an interesting experience to work so closely with Region Uppsala; a collaboration that was quickly underway in the midst of a crisis characterised by an urgent common goal.

"At the University, we can process large datasets and apply an academic mindset, while the Region is in the thick of it operationally and has all the important questions, but doesn't have the time or methods. This is an entirely new situation so it is important to document and learn from it. We are convinced that this working method could be translated to non-communicable diseases to monitor diabetes treatment or dental care."