Periodic Reporting for period 3 - CORESMA (COVID-19-Outbreak Response combining E-health, Serolomics, Modelling, Artificial Intelligence and Implementation Research)
Période du rapport: 2022-04-01 au 2023-06-30
The primary main objective of CORESMA is to generate the most needed clinical and epidemiological data required for defining targeted public health measures at national and global level to become effective during this pandemic.
The secondary main objective is to develop and establish tools and methodologies to improve the global public health preparedness for outbreaks emerging in the future. Our approach is innovative in combining the unique mHealth technology SORMAS, multiplex serolomics, state of the art modelling, artificial intelligence and implementation research also applying them to particularly vulnerable countries outside Europe.
SORMAS – the Surveillance Outbreak Response Management and Analysis System - is a mobile eHealth System that organizes and facilitates disease control and outbreak management in addition to disease surveillance and epidemiological analysis for all administrative levels of the public health system. In February 2020, we made a specific COVID-19 module in SORMAS available to address particular information for this pandemic.
The specific objectives are:
- To capture and provide real-time data through eHealth approaches on spread, transmission and clinical information of COVID-19 infections from Nepal and Côte d'Ivoire, so to guide risk assessment and targeted interventions in- and outside the EU.
- To measure the sero-prevalence of pre-existing cross or partial immunity against COVID-19 in samples from the general population in Germany and Nepal through multiplex serolomics in order to estimate susceptibility in different populations.
- Enhance the first two objectives through respondent driven sampling, comprehensive modelling and artificial intelligence in order to increase efficiency of intervention measures.
- Improve effectiveness of containment measures in countries particularly vulnerable to the COVID-19 pandemic by harnessing concepts of field implementation research, in order to reduce the societal burden of the pandemic for the EU and globally.
The secondary main objective is to develop and establish tools and methodologies to improve the global public health preparedness for outbreaks emerging in the future. Our approach is innovative in combining the unique mHealth technology SORMAS, multiplex serolomics, state of the art modelling, artificial intelligence and implementation research also applying them to particularly vulnerable countries outside Europe.
SORMAS – the Surveillance Outbreak Response Management and Analysis System - is a mobile eHealth System that organizes and facilitates disease control and outbreak management in addition to disease surveillance and epidemiological analysis for all administrative levels of the public health system. In February 2020, we made a specific COVID-19 module in SORMAS available to address particular information for this pandemic.
The specific objectives are:
- To capture and provide real-time data through eHealth approaches on spread, transmission and clinical information of COVID-19 infections from Nepal and Côte d'Ivoire, so to guide risk assessment and targeted interventions in- and outside the EU.
- To measure the sero-prevalence of pre-existing cross or partial immunity against COVID-19 in samples from the general population in Germany and Nepal through multiplex serolomics in order to estimate susceptibility in different populations.
- Enhance the first two objectives through respondent driven sampling, comprehensive modelling and artificial intelligence in order to increase efficiency of intervention measures.
- Improve effectiveness of containment measures in countries particularly vulnerable to the COVID-19 pandemic by harnessing concepts of field implementation research, in order to reduce the societal burden of the pandemic for the EU and globally.
In WP 1, embedding SORMAS in Nepal's and Cote d'Ivore's surveillance systems will make an important contribution to a long-term eSurveillance strategy enabling early detection and improved response to many endemic and epidemic-prone diseases. SORMAS shall be deployed in two provinces in each country and in strategic entry points and laboratories in Côte d'Ivoire.
In the beginning of the project, preparations for the start of SORMAS piloting have begun in both countries, with a focus on the pilot areas. The speed and impact by which the pandemic has interrupted communication and travels activities. This has led to unforeseeable and unavoidable delays in the first and second reporting period. Meanwhile the piloting of SORMAS is finished in pilot provinces in Côte d'Ivoire since 2021. In Nepal SORMAS piloting is ongoing and user training took place in Surdurpashim and Gandaki provinces in November 2022 and spring 2023.
In WP 2, the assessment of seroprevalence includes previous infections with coronaviruses, examining the corresponding implications for pre-existing cross-immunity or partial immunity to COVID-19. We completed the identification of a suitable antigen set that meets the assay objectives and allows the development of a multiplex seroassay with human coronavirus antigens. Technical and clinical validation of the multiplex serological immunoassay was successfully performed with samples from the German population and published in Nature Communications, https://www.nature.com/articles/s41467-021-20973-3. Additionally, extension of the assay to include antigens for other respiratory pathogens has begun.
In WP3, we conducted interviews and surveys for the sequential exploratory mixed methods study in the Netherlands and are in the process of analyzing them. We collaborated in international groups to contribute to policy making for COVID-19 response. As exploitable results, we published different modelling approaches and strategies to make recommendations for political decision makers, e.g. the impact of delays on effectiveness of contact tracing strategies for COVID-19 and key questions for modelling COVID-19 exit strategies. A request to use data from LEOSS, a prospective European multicentre cohort study, was also successfully conducted. The request was eventually approved. These data from LEOASS were used to train a machine learning algorithm in order to study the clinical expression of biomarkers across disease states (uncomplicated, complicated, critical). We also studied predictors for criticality in healthy and comorbid cohorts.
WP 4 is dedicated to the implementation research examining the piloting process of SORMAS. An initial rapid assessment compares pandemic containment measures applied before the implementation of SORMAS to changes after the implementation of SORMAS. A baseline survey to assess knowledge, acceptability and reporting with future SORMAS users and COVID-19 decision makers, was completed in Côte d’Ivoire showing a high acceptance of SORMAS as surveillance system. The assessment is presently on-going in Nepal prior the implementation of the software in the pilot areas. To explore the various surveillance systems used in the two countries even furhter, a second study was developed. In Nepal users were interviewed after the SORMAS training in Sudurpashim Province in November 2022.
In WP5, several Project Advisory Board (PAB) and Scientific Steering Committee meetings took place and two workshops were held at the HZI in Braunschweig, Germany. We publish all publications on the project website, which is continuously updated (www.coresma.eu) and also distribute information via two social media accounts (Twitter: EUcoresma, Mastodon: @CORESMA@sciences.social).
In WP6 compliance to ethical requirement was confirmed by a report of our external ethics advisor.
In the beginning of the project, preparations for the start of SORMAS piloting have begun in both countries, with a focus on the pilot areas. The speed and impact by which the pandemic has interrupted communication and travels activities. This has led to unforeseeable and unavoidable delays in the first and second reporting period. Meanwhile the piloting of SORMAS is finished in pilot provinces in Côte d'Ivoire since 2021. In Nepal SORMAS piloting is ongoing and user training took place in Surdurpashim and Gandaki provinces in November 2022 and spring 2023.
In WP 2, the assessment of seroprevalence includes previous infections with coronaviruses, examining the corresponding implications for pre-existing cross-immunity or partial immunity to COVID-19. We completed the identification of a suitable antigen set that meets the assay objectives and allows the development of a multiplex seroassay with human coronavirus antigens. Technical and clinical validation of the multiplex serological immunoassay was successfully performed with samples from the German population and published in Nature Communications, https://www.nature.com/articles/s41467-021-20973-3. Additionally, extension of the assay to include antigens for other respiratory pathogens has begun.
In WP3, we conducted interviews and surveys for the sequential exploratory mixed methods study in the Netherlands and are in the process of analyzing them. We collaborated in international groups to contribute to policy making for COVID-19 response. As exploitable results, we published different modelling approaches and strategies to make recommendations for political decision makers, e.g. the impact of delays on effectiveness of contact tracing strategies for COVID-19 and key questions for modelling COVID-19 exit strategies. A request to use data from LEOSS, a prospective European multicentre cohort study, was also successfully conducted. The request was eventually approved. These data from LEOASS were used to train a machine learning algorithm in order to study the clinical expression of biomarkers across disease states (uncomplicated, complicated, critical). We also studied predictors for criticality in healthy and comorbid cohorts.
WP 4 is dedicated to the implementation research examining the piloting process of SORMAS. An initial rapid assessment compares pandemic containment measures applied before the implementation of SORMAS to changes after the implementation of SORMAS. A baseline survey to assess knowledge, acceptability and reporting with future SORMAS users and COVID-19 decision makers, was completed in Côte d’Ivoire showing a high acceptance of SORMAS as surveillance system. The assessment is presently on-going in Nepal prior the implementation of the software in the pilot areas. To explore the various surveillance systems used in the two countries even furhter, a second study was developed. In Nepal users were interviewed after the SORMAS training in Sudurpashim Province in November 2022.
In WP5, several Project Advisory Board (PAB) and Scientific Steering Committee meetings took place and two workshops were held at the HZI in Braunschweig, Germany. We publish all publications on the project website, which is continuously updated (www.coresma.eu) and also distribute information via two social media accounts (Twitter: EUcoresma, Mastodon: @CORESMA@sciences.social).
In WP6 compliance to ethical requirement was confirmed by a report of our external ethics advisor.
Our findings will provide unique and reliable evidence for improving risk assessment and response management for this pandemic and for future emerging public health threats to come. Furthermore, our methodologies are scalable to larger population sizes and other countries. Demonstrating fully digitalized and real-time provision of complex clinical and epidemiological information shall make SORMAS the best practice use case implementing International Health Regulations (IHR) even in countries with weak health information infrastructure. The project will also provide continuously updated evidence for agile risk assessment and thus de-escalation of measures to limit undesired effects on mobility and trade to the least necessary. Highest technical data protection and security standards of SORMAS serve the patient rights, prevent for abuse from third parties while serving the global community and maintaining national sovereignty. SORMAS will significantly reduce work burden for the public health service as already evidenced by systematic analyses in other occasions. Our innovative differential serolomics approach will also support clinical trials for potential novel vaccines and thus accelerate their development. The combination of state of the art modelling and innovative artificial intelligence will result in more accurate disease metrics to improve public health interventions and medical treatment.