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Predi-COVID preliminary results

The Luxembourgish cohort study shows encouraging participation rates and sees its protocol published in international peer-reviewed journal
The Predi-COVID nurse team.

Launched under the aegis of the Research Luxembourg COVID-19 Task Force on April 24th, “Predi-COVID” is a cohort study promoted by the Luxembourg Institute of Health that aims to identify the key risk factors and biomarkers associated with COVID-19 severity and comprehend the long-term health consequences of the disease. Predi-COVID will contribute to a better understanding of the heterogeneity observed in disease severity and prognosis, ultimately enabling the accurate evaluation of patients infected with SARS-CoV-2 and more personalised care recommendations. The protocol of the study was published on November 24th in the ‘British Medical Journal Open’, reinforcing the international visibility and success of this highly collaborative “Made in Luxembourg” project. 

The study goals

Predi-COVID was launched with the goal of defining which patient profiles can be associated with a more severe prognosis. The study aims to identify the clinical, epidemiological and socio-demographic characteristics, as well as specific biomarkers from both the SARS CoV-2 virus and the patient, which can help predict the way the disease will evolve in a given individual, according notably to his immune profile.

Predi-COVID and Predi-COVID-H: patient recruitment and operational aspects

The research team has been establishing a cohort of people over the age of 18 positive for SARS CoV-2. All newly diagnosed individuals in Luxembourg can participate in Predi-COVID, upon agreeing to share their data for research purposes. In parallel to Predi-COVID, the ancillary study “Predi-COVID-H” was launched to include household members of COVID-19 positive participants to study the transmission of the virus in this high-risk population. The recruitment and data/sample collection phase started on May 5th and was initially planned to last until December 2020, although an extension period until late June 2021 is being requested.

The health evolution and symptoms of the enrolled patients are followed daily through different remote digital tools, depending on whether patients are at home or at the hospital, for 14 days from the time of confirmation of diagnosis. Short additional evaluations are also performed monthly for up to 12 months, to assess potential long-term consequences of COVID-19. Innovative digital data, specifically voice recordings, is also collected as part of the study. More detailed clinical and digital data and associated biological samples is gathered from a subset of at least 200 volunteers from the Predi-COVID cohort and from 100 Predi-COVID-H participants, in order to better characterise symptoms and clearly define the different outcomes. Upon inclusion in the study and after three weeks, several biological samples — including blood, nasal and oral swabs, saliva and stool — are collected from participants to identify human and viral predictive markers.

Preliminary results: participant recruitment, data collection, symptoms and vocal biomarkers 

Since May 5th – the date of enrolment of the first participant – and as of November 10th, 1406 and 67 eligible subjects have been contacted by phone for inclusion in Predi-COVID and in Predi-COVID-H, respectively, 556 of which agreed to be included in the former and 48 in the latter. On average, participants are 39 years old.  In terms of biological samples, the team has been establishing a unique biobank to study COVID-19, already boasting 627 specimens collected during the baseline and follow-up visits. This collection includes blood, sputum, swabs, stool and hair samples.

The preliminary findings also indicate that the majority of the enrolled population experienced few or mild symptoms. The most prevalent symptoms at admission included fever (26.2% of participants), cough (23.3%), runny nose (12.2%) and sore throat (10.8%), while the most common comorbidities and risk factors include smoking (18.1% of participants), asthma (5.4%), diabetes (4.7%), chronic heart disease (3.6%) and obesity (3.3%).

Furthermore, a total of 3,290 voice recordings has been made available by 245 participants using the CoLive LIH smartphone app, with multiple recordings per person to allow the study of the evolution of voice characteristics over time. These will enable the identification of “vocal biomarkers” of frequently observed symptoms in COVID-19 patients, such as respiratory syndromes, fatigue, anxiety or negative emotions related to COVID-19, which could subsequently be used for the easy remote monitoring of patients at home.

We are delighted with the results obtained thus far. The greater the number of participants the more accurate the final results. Besides, we are now collaborating with the Centre Hospitalier de Luxembourg to envisage the inclusion of up to 100 COVID-19 positive children in Predi-COVID and up to 30 children from affected households in Predi-COVID-H”, states Prof Markus Ollert, Director of the LIH Department of Infection and Immunity and co-Principal Investigator of Predi-COVID.

We are very grateful to the Health Inspection Department of the Ministry of Health for the unwavering support and excellent collaboration throughout, which are key to the success of the study. The protocol has recently been published in a renowned international journal and will serve as the core publication to cite for all future work based on Predi-COVID data. So far, nine ancillary projects funded by the Luxembourg National Research Fund or by the European Commission’s Horizon 2020 programme are already using Predi-COVID data”, concludes Dr Guy Fagherazzi of the LIH Department of Population Health, co-Principal Investigator of Predi-COVID and first author of the publication.   

The full study protocol was published in the ‘British Medical Journal Open’ on November 24th. It is accessible here

Covid-19 taskforce

Large-scale testing operations: Conclusion of phase 1 and launch of phase 2

Ministry of Health to lead the second phase as of mid-September.
On Monday, September 14th, the Minister of Higher Education and Research, Claude Meisch, the Minister of Health, Paulette Lenert, and the Research Luxembourg (RL) COVID-19 Task Force held a press conference in Dudelange to officially conclude the first phase of the large-scale testing, led by the Luxembourg Institute of Health together with the Research Luxembourg community. The operations of the second phase have been handed over to the Health Directorate of the Ministry of Health and will start mid-September.

As part of the exit strategy, Luxembourg has implemented an extensive and unique nation-wide testing campaign, inviting its residents and cross-border workers to voluntarily get tested for COVID19. The aim of this large-scale testing (LST) initiative was to limit the spread of the novel SARS-CoV-2 virus by identifying positive cases early, including among asymptomatic persons, thereby breaking infection chains. At the same time, LST aims to contribute to the close monitoring of the spread of the virus among our population.

The first phase of the LST, coordinated by the Luxembourg Institute of Health (LIH), ran from 27 May until 27 July and relied on 16 ‘drive-through’ and 1 ‘walk-through’ test stations, with a maximum theoretical capacity of 20,000 tests per day. The population was divided into three main categories. The first category was composed of people exposed to a high infectious risk by their professional activity (such as healthcare professionals) whereas the second category consisted of those having resumed their professional activity or about to get back to work. The third category encompassed representative samples of the general population. The recurring testing of the contingents and the rigorous contact tracing not only aims at avoiding new infection chains but also at providing decision makers with evidence-based data.

An extension period prior to the beginning of Phase II was set up during the summer period until 15 September with the aim of monitoring the evolution of the epidemic also during the summer months with a particular accent on people coming back from holidays, those professions specifically linked to the holiday period (Horesca, seasonal workers) and the school start.

In total, 1,520,445 invitations to LST were sent, and 560,082 tests were conducted covering 307,751 Luxembourg residents, reflecting an overall participation rate of almost 50 % of the resident population.

The second phase of the LST will be coordinated by the Health Directorate of the Ministry of Health and is set to run between 16 September 2020 and March 2021, with a capacity of 53,000 tests per week. Building on the experience gained during the first phase, which showed a relatively low prevalence rate, the second phase of the strategy will narrow the focus of the tests and target specifically the population most exposed to the virus, while at the same time allowing for capacities to be adjusted in a timely manner to the evolution of the situation and over a longer period of time than the first phase. This nuanced approach will foster a more precise meshing of the population and a more efficient reactiveness. More detailed information as to this new phase of the LST will be provided by Health Minister Paulette Lenert during a press conference on 24 September.

The handover press conference, which took place at the premises of the Integrated Biobank of Luxembourg (IBBL) in Dudelange in the presence of the Minister of Higher Education and Research, Claude Meisch and the Minister of Health Paulette Lenert, brought together all relevant stakeholders including the CEOs of Research Luxembourg-member institutions, the spokespersons of the RL Task Force, members of the LST scientific advisory board and representatives of Laboratoires Réunis.

As the work of Research Luxembourg on the large-scale testing campaign draws to a close, we would like to sincerely thank all the partners who contributed to the success of this extraordinary effort, particularly Laboratoires Réunis and the staff of Research Luxembourg member institutes

Prof Ulf Nehrbass, CEO of LIH and spokesman of the RL COVID-19 Task Force.

This unparalleled initiative has been widely recognised at the international level, further strengthening the country’s reputation as a leader in public health and biomedical research

Prof Paul Wilmes from the University of Luxembourg’s Luxembourg Centre of Systems Biomedicine (LCSB), deputy spokesman of the Task Force.

The strength of our response to the pandemic lies in the tight connection between public health initiatives such as the large-scale testing and the outstanding research efforts of Luxembourg’s research institutions. This synergy plays a fundamental role in providing tangible solutions to societal issues

Claude Meisch, Minister for Higher Education and Research.

The large scale testing project has confirmed the high level of resilience, adaptability and reactiveness of our country as we face an unprecedented crisis of international dimension. It will reinforce our preparedness all along the evolution of the epidemic. The second phase will consolidate our position as a leader in large-scale testing and will be part of the government’s efforts to fight the virus, ideally until the crisis ends, while allowing for a particular attention to be put on specific target groups

Paulette Lenert, Minister of Health.

Communicated by the Ministry of Higher Education and Research, the Ministry of Health and the Luxembourg Institute of Health. Originally published on

Covid-19 taskforce

Use of new FFP2 masks – ensuring safety & security in large scale testing stations

In the testing stations, the safety and security of the staff collecting samples has been and is being ensured by redundant protection measures with masks and face shields. These measures are strictly respected at all times.  The compliance of these measures and quality of the material being used in that framework is being closely monitored by Laboratoire Réunis, along with their sub-contracters for the large scale testing.

The masks used on the stations were CE labeled, certified by two testing laboratories and all certificates stating compliance with security & safety requirements had been provided.  However, lab reports recently suggested that the tests of some CE masks, including the masks being used at the stations, were not accurate. 

In light of this information, additional tests have been commissioned in an independent Belgian laboratory.  The results of the test received on 3 July 2020 state that the filtration rate of the tested masks is 93.39 %, as compared to  94% required for FFP2 masks. This means there is a differential of 0,61%.

As a consequence and as a precautionary measure, all masks of this model currently being in circulation are being collected, and will no longer be used by the staff as of this afternoon, 3 July 2020 at 4:00 p.m.  Instead, employees will be given certified 3M FFP2 masks used in the national hospitals.
Regular testing of the staff members working in the stations is also part of the standard security protocol. 

Safety and security are a priority for all partners involved in the large scale testing and all measures will be taken to ensure the highest standards are being maintained.

Covid-19 taskforce

Efficient security concept

All Large Scale Testing (LST) related employees are tested at two-week intervals to ensure maximum safety. As with all working groups, there is a possibility that asymptomatic positives may carry the virus and could be potentially contagious. Some days ago, one laboratory employee was thus actually identified positively. This person was asymptomatic with a low viral load and was immediately sent to quarantine. As the person did not work at the actual test stations but was treating the samples in the laboratory, he was at no point in contact with participants of the Large Scale Testing. A subsequent contact tracing process identified two other infected laboratory employees, also asymptomatic with very low virus titers. The head of the Inspection Sanitaire was immediately informed, and the follow-up was carried out according to the guidelines of the Inspection Sanitaire. 

As the three staff members were at no point in contact with participants of the Large Scale Testing it can be excluded that persons invited to the test were infected by one of these employees. Nevertheless, this case highlights once more the importance of systematic testing even if there are no symptoms apparent at all.

The security measures at the test stations are very high. Employees are equipped with masks, gloves, face shields, special overalls and disinfectants. Persons in the laboratories are also equipped with masks, gloves and laboratory coats (and face shields if necessary). In addition, like all workers who are exposed to a high number of contacts every day (healthcare, hairdressers, etc.), they are tested for the novel coronavirus every two weeks.

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Large-scale testing: FAQ now available

The Research Luxembourg COVID-19 Task Force has created a ‘Frequently Asked Questions’ to address questions regarding Luxembourg’s large-scale testing strategy being rolled out in Luxembourg from 27 May – 28 July 2020.
Covid-19 taskforce

Large scale COVID-19 testing: a public health measure

As part of the deconfinement, Luxembourg is calling on its residents and cross-border workers to get tested for COVID-19. It aims to limit the spread of the novel corona virus by voluntary extensive testing until the end of July. This will allow to break infection chains and thus protect family, friends and colleagues. The more tests are carried out, the more new infections can be prevented and the safer everyday life will be.
©️ Mufid Majnun / Unsplash

From 27 May to 28 July 2020, a total of 17 “drive-through” and 2 “walk-through & bike-through” test stations will become available across the country to carry out up to 20,000 tests per day. Citizens and cross-border workers are divided into representative groups that receive invitations by post to get tested voluntarily.

It is important that as many citizens as possible accept these invitations in the coming weeks, because the majority of those infected do not know that they carry the virus. They show little or no symptoms and pass on the virus unconsciously. The COVID-19 PCR test determines whether a person is contagious. While this is a snapshot, it helps identify positive cases, which will then go into domestic isolation for about two weeks and whose contacts are traced back. This reduces the risk of infection for their fellow citizens and new infection chains can be broken. A large-scale participation in the testing increases the protection of their family, friends, colleagues and, last but not least, the risk groups – and thus helps to keep the spread of the virus under control.

Who will be tested and when?

The testing starts already this week: about 6,000 high school graduates and For the large-scale testing, the population is divided into 3 categories depending on their risk of being exposed to the virus:

Category 1 specifically targets groups who are at work most exposed to the virus and who are in contact with many other people, which may increase the risk of transmission. These are professional groups like nursing staff and doctors; hairdresser and cosmetic services; police officers; staff from nurseries; staff from the HORESCA sector as soon as it is reopened; etc.. This category receives invitations to be tested every two weeks.

Category 2 comprises the groups that are either already working normally again, or for which the lockdown will be lifted in the coming weeks. Within these larger groups, small representative subgroups will be tested for the virus. The results from these subgroups can be seen as an early warning signal for the respective sectors, since they allow to identify any new flare-ups in virus spreading at an early stage. Groups for which the lockdown will be lifted can either be tested completely at once (and then be monitored by regularly testing smaller samples) or be split into randomly selected subgroups which are tested over the entire period.

Category 3. Once the exit restrictions are entirely lifted, the timely detection of an increase in infections is crucial to reduce the risk of a second pandemic wave. Therefore, representative samples of the entire population of Luxembourg including cross-border workers are tested every week. This will facilitate the early detection of infection flare-ups in certain regions or sectors, break infection chains and thus help to reduce the spread of SARS-CoV-2.

Based on this concept, the following sectors will be tested:

From 25 May:

  • Sectors from category 1: hairdressing and cosmetics, childcare personnel.
  • Sectors from category 2: construction sector.

From 1 June 2020:

  • Sectors from category 1: nursing staff and doctors, police officers, prison guards, pharmacy personnel, system-relevant sector personnel.
  • Sectors from category 2: elementary school students and teaching staff, industry and retail.

This multifaceted testing strategy covers all potential points at which the virus spread can flare up again. It should allow to test a large part of Luxembourg’s population once and thus help to continuously monitor and keep the spread of the virus under control. This enables all residents and cross-border workers to return to their social and professional life as safely as possible. Considering the dynamics of infections, flexibility is needed to be able to respond quickly to new developments (regional or sector-specific infection clusters). Accordingly, depending on the circumstances, the test capacities can be adapted on a weekly basis.

Where will the testing take place?

A total of 17 drive-through test stations are spread across the country. They are located in Neudorf, Niederanven, Ersange, Frisange, Dippach, Steinfort Windhof, Steinfort P&R, Machtum, Junglinster, Schieren, Schinkert, Luxembourg-Bouillon, Kirchberg, Howald, Bascharage, Belval and Esch-sur-Alzette. In addition, walk-throughs are planned in Belval, Kirchberg and at the Rotonde close to the train station in Luxembourg city. A total of 400 people will be working at these stations in the next two and a half months. These are nurses, security and cleaning staff, administrators, logisticians and coordinators.

Figure 1: Drive-through (blue) and Bike-through/walk-through stations (green) with their maximal testing capacity (red). A) Black dots mark all stations in the whole country. B) Zoom of the Centre and South of Luxembourg.  

How does the testing work?

Citizens and cross-border workers will receive an invitation per post, which will allow them book a test appointment online at one of the testing stations. On the selected date, the person goes to the testing site, where they present their invitation, ID card and their insurance card. A throat swab is then carried out and sent to the laboratory. The tested person leaves the test site and receives the test result via SMS within two days. If the result of the test is positive, the person is contacted personally by the Inspection Sanitaire and will be asked to spend two weeks at home in self-isolation. If the test result is negative, the person must continue to follow the usual protective measures and can return to everyday life.

Who are the partners within this project?

The project has been developed by Research Luxembourg’s COVID-19 Task Force and is led by the Luxembourg Institute of Health. The tests are carried out by its contractual partner Laboratoire Réunis, who is logistically supported by Ecolog.

What is the COVID-19 Task Force?

Efficient measures in the context of the COVID-19 pandemic require close cooperation between research, hospitals and the Government in Luxembourg. For this reason, Research Luxembourg (LIH, LISER, LIST, LNS, Luxinnovation, University of Luxembourg and FNR, under the coordination of the Ministry of Higher Education and Research) has set up the COVID-19 Task Force in order to better implement relevant initiatives. Based on a list of priorities elaborated by ministries and other partners, a number of work packages have been defined, which the COVID-19 Task Force will work on in the coming weeks and months. In cooperation with the government, the COVID-19 Task Force sees its role in providing scientific input to enable the government to work on a fact-based EXIT strategy. To this end, the COVID-19 Task Force is continuously working on updates on the development of the pandemic in Luxembourg and submits concepts and recommendations from a scientific perspective so that they can be incorporated into the political decision-making process.

Communicated by the Luxembourg Institute of Health and Research Luxembourg

Covid-19 taskforce

The concept behind Luxembourg’s testing strategy: Why large scale testing helps with the exit

Research Luxembourg has developed a large-scale testing strategy, which should make the current lockdown-easing measures safer and faster. The project is unique in the world: the goal is to test the entire Luxembourg population. The main aim is to prevent new chains of infection so that the most important elements of everyday life can be guaranteed without endangering the health of individuals or overburdening the health system. spoke with the spokesperson and deputy spokesperson of the Covid-19 Task Force, Ulf Nehrbass (LIH) and Paul Wilmes (University of Luxembourg).

Das Konzept hinter Luxemburgs Teststrategie: Weshalb viele Tests beim Exit helfen

LIH, ScienceRelations Die Covid-19 Task Force ist ein Zusammenschluss aus Forschern in Luxemburg, die seit Wochen in Zusammenarbeit mit den Gesundheitsämtern und Krankenhäusern an Projekten, Simulationen und Strategien arbeitet, um die Ausbreitung des Virus faktisch zu begleiten und die Lage zu überwachen, mit dem Ziel die Ausbreitung des neuartigen Coronavirus jederzeit unter Kontrolle zu behalten.

Covid-19 taskforce

A deconfinement strategy framed by health and research measures

As part of its exit strategy, the Luxembourg government can count on the support of Luxembourg research, namely the Research Luxembourg COVID-19 Task Force. In close cooperation with the Ministry of Higher Education and Research and the Ministry of Health, the COVID-19 Task Force has developed a “Large Scale Testing Strategy” based on a voluntary diagnostic test accessible to the population, including cross-border commuters of the Greater Region. This will ensure that Luxembourg can better and in an informed manner accompany the lifting of restrictions from the lockdown. The more people participate, the more protection this will mean for the entire population.

“Due to the size of Luxembourg and its limited number of residents, we have a great opportunity: we can test the entire population for the novel coronavirus within a short period of time. This makes us the first country in the world to have a complete overview of the number of infected citizens”

Minister of Higher Education and Research Claude Meisch.

By shortening the lockdown period, psychological, economic and social problems will be kept to a minimum.

The overall objective is to avoid a second wave of infected people in the context of exit measures and thus the introduction of a new lockdown.

8,500 tests for students and teachers this week, 20,000 tests per day in a later phase

The testing starts already this week: about 6,000 high school graduates and 2,500 teachers have the opportunity to get tested before they go back to school from May 4th, 2020. They will be informed by letter. The tests are voluntary: everyone can get tested, no one has to.

The testing strategy consists of expanding the capacity to 20,000 tests per day. The objective is to be able to test the entire population, progressively and in contingents, in some cases several times.  

Breaking the infection chain

“The high number of tests carried out will help to assess the extent of the spread of the virus and to detect for the first time asymptomatic cases, which are currently estimated to account for up to 80% of cases. This means that we can detect many more infected people than before, put them in isolation and track their contacts, thus breaking the infection chain”

“As the protection is greater the more people are tested, we want to encourage all residents of the country to participate in this unique public health measure”

Minister of Health Paulette Lenert

In the next few days and weeks, up to 17 test stations will be set up in the country, where the inhabitants of Luxembourg, but also cross-border commuters, can be tested.

“We are pleased that the government has confidence in Research Luxembourg to support it at this historic stage. The aim is to effectively accompany the spread of the virus and to keep it under control at all times”

Ulf Nehrbass, spokesman of the COVID-19 Task Force and CEO of the Luxembourg Institute of Health (LIH).
The core elements of the large-scale testing strategy

Testing and segmentation of the population into contingents

The Research Luxembourg large-scale testing strategy is based on large-scale virus testing, in which the population is not considered as a whole, but divided into different contingents. The tests per contingent are carried out in 3 stages:

  • Stage 1: a representative population of a contingent is tested. The results of these tests give an indication of when the contingent can be freed from restrictions and when it should be tested on a large scale
  • Stage 2: All persons in the contingent are invited to be tested on a voluntary basis.
  • Stage 3: A representative group is selected shortly after the exit measures in order to be tested a second time. This allows monitoring of whether and how the virus is spreading within the contingent.

For people tested negative, the restrictions of the lockdown are lifted. Positive tested people must enter isolation. Their contacts are traced, tested and quarantined to break the chain of infection.

Projections to better guide the deconfinement strategy

“The projections we make on the basis of the test results help policymakers to make decisions on the exit strategy and to adapt measures to the situation at any time. Important indicators include, for example, the ability to trace contacts and the capacity of the health system”

Prof. Rudi Balling, Director of the Luxembourg Centre for Systems Biomedicine at the University of Luxembourg.

The COVID-19 Task Force is well organised for this. In collaboration with the Ministry of Health, researchers, statisticians and doctors work together on a daily basis to produce projections for Luxembourg that are as accurate as possible, based on which the decision-makers can then decide on the measures to be taken. This project, which primarily serves a public health objective, will also enable research to gain a better understanding of the virus in the medium term – which is important in order to learn how we can better live with the virus in the future. In addition, the experience gained now will in the long term also serve to be better prepared as a country in the event of another pandemic.

Ease the path towards normality

“What we do here in Luxembourg is unique. Luxembourg can test more extensively than any other country to date. This enables us to take the difficult path out of the COVID-19 crisis towards normality in the most controlled way possible. On the one hand, this minimises risks and on the other hand, provides a solid basis for the government to make decisions” 

– Ulf Nehrbass
The strategy at a glance

The large-scale testing strategy developed by the COVID-19 Task Force is based on the following 5 elements:

  • Consistent monitoring of key parameters – to monitor the evolution of the COVID 19 pandemic in Luxembourg at all times and to provide a basis for decisions on the scope of testing and the introduction of relaxation or restriction measures
  • Segmentation of the population into contingents
  • High testing capacity: test each contingent, with the aim of gradually and on a voluntary basis testing the largest possible part of the population and then exempting those who test negative from restrictive measures
  • Isolation of positive tested people
  • Efficient and fast tracing of positive tested people and subsequent quarantine-measures
What is the COVID-19 Task Force?

Efficient measures in the context of the COVID-19 pandemic require close cooperation between research, hospitals and the Government in Luxembourg. For this reason, Research Luxembourg (LIH, LISER, LIST, LNS, Luxinnovation, University of Luxembourg and FNR, under the coordination of the Ministry of Higher Education and Research) has set up the COVID-19 Task Force in order to better implement relevant initiatives. Based on a list of priorities elaborated by ministries and other partners, a number of work packages have been defined, which the COVID-19 Task Force will work on in the coming weeks and months. In cooperation with the government, the COVID-19 Task Force sees its role in providing scientific input to enable the government to work on a fact-based EXIT strategy. To this end, the COVID-19 Task Force is continuously working on updates on the development of the pandemic in Luxembourg and submits concepts and recommendations from a scientific perspective so that they can be incorporated into the political decision-making process.

Communicated by Ministry of Health, Ministry of Higher Education and Research and Research Luxembourg