S1 File -

Appendix A. Study protocol including the initial statistical analysis plan (SAP) as submitted to French data authorities, the final SAP, a summary of the changes in the SAP, and the DEPIST-COVID questionnaire. Appendix B. Figure Geographical location of the 18 emergency departments involved in the DEPIST-COVID trial (Paris metropolitan area). Fig B1. Geographical location of the 18 emergency departments involved in the DEPIST-COVID trial (Paris metropolitan area). References: R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/. Hijmans, R.J. (2022). raster: Geographic Data Analysis and Modeling. R package version 4.1.3. https://CRAN.R-project.org/package=raster. Appendix C. Table Emergency department characteristics and study period duration. Table C1. Emergency department characteristics and study period duration. Data are presented as numbers or No 0/Yes 1. ED: Emergency department. ^aAnnual patient admissions included pediatric admissions. ^bDuration of the intervention, control, and wash-out periods (days), median [first quartile, third quartile]: 34.5 [30.0, 36.0]; 34.5 [30.0, 36.0]; 1.5 [1.0, 2.0]. Appendix D. Table Characteristics of patients who underwent and declined SARS-CoV-2 screening for asymptomatic/paucisymptomatic patients during the intervention period. Table D1. Characteristics of patients who underwent and declined SARS-CoV-2 screening for asymptomatic/paucisymptomatic patients during the intervention period. * Patients who accepted the rapid test but did not have a test performed were not included in this table. In univariate analysis, factors associated with performing screening for asymptomatic/paucisymptomatic patients were the following: older age, male sex, having mild symptoms, not being from France, being unemployed, being followed up for a chronic disease, not being screened previously, and self-assessment of a high risk of infection. ** Chronic diseases: diabetes, arterial hypertension, angina pectoris, chronic bronchitis, asthma or chronic respiratory disease. *** For this variable of the DEPIST-COVID questionnaire, data were collected in 8 centers, and it was not possible to collect them later in the remaining 10 centers. Findings are presented for 8 centers (n = 2,226 patients, missing data: 19.5% in the 8 centers). Q1: first quartile; Q3: third quartile; CI: confidence interval. Appendix E. Table Characteristics of patients tested through SARS-CoV-2 screening for asymptomatic/paucisymptomatic patients. Table E1. Characteristics of patients tested through SARS-CoV-2 screening for asymptomatic/paucisymptomatic patients. * Patients with indeterminate results or a known positive SARS-CoV-2 status were not included in this table. In univariate analysis, factors associated with new infections diagnosed through nurse-driven screening for asymptomatic/paucisymptomatic patients were mainly older age, having mild symptoms, not being from France, particularly being from sub-Saharan Africa, being unemployed, not having medical coverage, living in a community, being a case contact and not being previously screened. ** Among patients who underwent a rapid molecular SARS-CoV-2 test, 258 (7.4%) reported having symptoms. Among patients who underwent a rapid multiplex respiratory virus test, 508 (90.1%) reported having symptoms. *** Chronic diseases: diabetes, arterial hypertension, angina pectoris, chronic bronchitis, asthma, or chronic respiratory disease. **** For this variable of the DEPIST-COVID questionnaire, data were collected in 8 centers, and it was not possible to collect them later in the remaining 10 centers. Findings are presented for 8 centers (n = 1,510 patients, missing data: 12.1% in the 8 centers). ***** Rhinovirus/Enterovirus: n = 29 (37.7%), Coronavirus OC43: n = 12 (15.6%), Coronavirus NL63: n = 10 (13.0%), Human Metapneumovirus A+B: n = 10 (13.0%), Respiratory Syncytial Virus A+B: n = 6 (7.8%), Parainfluenza virus 3: n = 3 (3.9%), Bocavirus: n = 2 (2.6%), Parainfluenza virus 4: n = 2 (2.6%), Bocavirus | Coronavirus HKU1: n = 1 (1.3%), Coronavirus 229E: n = 1 (1.3%), Influenza A: n = 1 (1.3%). Among SARS-CoV-2+ patients: Rhinovirus/Enterovirus: n = 2, Bocavirus: n = 1, Parainfluenza virus 4: n = 1, Respiratory Syncytial Virus A+B: n = 1. Q1: first quartile; Q3: third quartile; CI: confidence interval. Appendix F. Figure Newly diagnosed SARS-CoV-2-positive patients per emergency department and strategy. Fig F1. Newly diagnosed SARS-CoV-2–positive patients per emergency department and strategy. Appendix G. Figure SARS-CoV-2 incidence rate in the Paris metropolitan area and per geographical department (75, 77, 92, 93, 95) of the emergency departments involved in the study. Fig G1. SARS-CoV-2 incidence rate in the Paris metropolitan area and per geographical department (75, 77, 92, 93, 95) of the emergency departments involved in the study. y.o.: years old. Appendix H. Table Characteristics of patients newly diagnosed with SARS-CoV-2 infection. Table H1. Characteristics of patients newly diagnosed with SARS-CoV-2 infection. Q1: first quartile; Q3: third quartile; CI: confidence interval. Appendix I. Primary outcome modelling, sensitivity analyses, and intercluster and intracluster correlation coefficients. Table I1. Coefficient estimates from the generalized linear mixed model with a Poisson distribution including the center as a random intercept, the center-by-weekly period interaction as a random effect and the strategy, weekly period and incidence rate-by-weekly period interaction as fixed effects (SAS PROC Glimmix). Table I2. Significant random effects. Table I3. Analysis considering a binarized period (0/1). Table I4. Analysis including variables used for randomization (screening equipment in emergency departments and flow in emergency departments). Table I5. Analysis including strategy * week_since_roll_out interaction. Table I6. Analysis at the center level. Appendix J. Comparison of the proportions of new SARS-CoV-2 diagnoses through screening in emergency departments and of positive tests through community screening for individuals aged 18+ of the geographical departments of the Paris metropolitan area screened during the same period. Table J1. New SARS-CoV-2 infections diagnosed through screening in emergency departments for asymptomatic/paucisymptomatic patients and positive tests through community screening for asymptomatic adults in the geographical departments of the Paris metropolitan area during the same period.* Source: Community screening data were provided by Santé Publique France on May 20, 2022. Table J2. New SARS-CoV-2 infections diagnosed through screening in emergency departments (EDs) for asymptomatic/paucisymptomatic patients per ED and positive tests through community screening for asymptomatic adults tested in the corresponding geographical department.* Source: Community screening data were provided by Santé Publique France on May 20, 2022. Table J3. New SARS-CoV-2 diagnoses through screening in emergency departments and positive tests through community screening for adults in the geographical departments of the Paris metropolitan area during the same period.* Source: Community screening data were provided by Santé Publique France on May 20, 2022. Appendix K. Figures Visits in the 18 emergency departments during the study period in 2021 and during the same period in 2019. Fig K1. Visits to the 18 emergency departments during the same period of the year in 2019 and 2021. Source: Observatoire Régional des Soins Non Programmés (ORNSP). Activité des services d’urgences en Ile-de-France 2021 [Available from: https://orsnp-idf.fr/wp-content/uploads/2022/06/20220606_rapport_annuel_urgences_2021_VF.pdf. Published: June 2022. Accessed date: 07/06/2023]. Fig K2. Proportion of emergency department visits without hospital admission per week in the 18 emergency departments during the same period in 2019 and in 2021. Source: Observatoire Régional des Soins Non Programmés (ORNSP). Activité des services d’urgences en Ile-de-France 2021 [Available from: https://orsnp-idf.fr/wp-content/uploads/2022/06/20220606_rapport_annuel_urgences_2021_VF.pdf. Published: June 2022. Accessed date: 07/06/2023]. Appendix L. Cluster randomised trials extension of the Consolidated Standards of Reporting Trials (CONSORT) checklist. Appendix M. Study group.

(PDF)