Chapter 2 40 central, higher-income city districts of the Centre, West and East districts, with poorer health outcomes being reported in peripheral districts(13). Investigating whether such disparities also exist for COVID-19 burden is crucial to developing targeted prevention strategies. We therefore aimed to examine differences in burden of COVID-19 hospitalisations between city districts and ethnic groups in the city of Amsterdam, using routinely collected surveillance data from 29 February to 31 May 2020. METHODS COVID-19 case definition and test strategy Up to and including 11th March 2020, SARS-CoV-2 testing in the Netherlands was conducted only in individuals who fulfilled a strict case definition: (i) having an epidemiological link to a confirmed case and/or returning from a high-risk region with widespread transmission within 14 days prior to the onset of symptoms, and (ii) the presence of fever with at least one of the following symptoms: coughing, shortness of breath (dyspnoea). Testing was mainly carried out by a home testing team of the PHS, by general practitioners and in hospitals. After restrictions were initiated between 12-15 March 2020, testing no longer required a confirmed epidemiological link or travel history, but instead focussed on mitigating the impact on frontline healthcare services and protecting vulnerable groups. Healthcare workers, residents of long-term care facilities and individuals at high risk of severe disease with COVID-like symptoms were prioritised. For patients, testing was carried out in the hospital setting (including purpose-built COVID-19 triage and testing tents), by family physicians, and by the PHS’s home testing team, who also performed testing in long-term care facilities. Healthcare workers could be tested at a special test location at the PHS site itself or at work (in hospitals) and were prioritised in situations where a staffing shortage was at stake. From 11 May 2020, testing at the PHS site was also made available to teachers and those working in other contact professions with COVID-like symptoms but remained inaccessible for the general public until 1 June 2020. Because of this restrictive test policy during the period analysed, we used hospitalisations as a marker of epidemic progression. Data collection, source and linkage Since 28th January 2020, all persons with a positive PCR test for SARS-CoV-2 are required to be notified to the regional PHS, which subsequently notifies the National Institute for Public
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