The COVID-19-wildfire smoke paradox: Reduced risk of all-cause mortality due to wildfire smoke in Colorado during the first year of the COVID-19 pandemic.

BACKGROUND: In 2020, the American West faced two competing challenges: the COVID-19 pandemic and the worst wildfire season on record. Several studies have investigated the impact of wildfire smoke (WFS) on COVID-19 morbidity and mortality, but little is known about how these two public health challenges impact mortality risk for other causes. OBJECTIVES: Using a time-series design, we evaluated how daily risk of mortality due to WFS exposure differed for periods before and during the COVID-19 pandemic. METHODS: Our study included daily data for 11 counties in the Front Range region of Colorado (2010-2020). We assessed WFS exposure using data from the National Oceanic and Atmospheric Administration and used mortality counts from the Colorado Department of Public Health and Environment. We estimated the interaction between WFS and the pandemic (an indicator variable) on mortality risk using generalized additive models adjusted for year, day of week, fine particulate matter, ozone, temperature, and a smoothed term for day of year. RESULTS: WFS impacted the study area on 10% of county-days. We observed a positive association between the presence of WFS and all-cause mortality risk (incidence rate ratio (IRR) = 1.03, 95%CI: 1.01-1.04 for same-day exposures) during the period before the pandemic; however, WFS exposure during the pandemic resulted in decreased risk of all-cause mortality (IRR = 0.90, 95%CI: 0.87-0.93 for same-day exposures). DISCUSSION: We hypothesize that mitigation efforts during the first year of the pandemic, e.g., mask mandates, along with high ambient WFS levels encouraged health behaviors that reduced exposure to WFS and reduced risk of all-cause mortality. Our results suggest a need to examine how associations between WFS and mortality are impacted by pandemic-related factors and that there may be lessons from the pandemic that could be translated into health-protective policies during future wildfire events.

Epidemiology and Transmission Dynamics of COVID-19 in an Urban Pediatric US Population.

OBJECTIVE: This analysis summarizes observational epidemiologic data and transmission dynamics of SARS-CoV-2 among people aged <18 years to better characterize the pediatric COVID-19 pandemic. METHODS: We conducted a retrospective study of public health surveillance data among children in Denver, Colorado, who were reported to have COVID-19 from March 1, 2020, through September 30, 2021. We used descriptive statistics and bivariate rate ratios (RRs) to describe demographic and clinical characteristics, transmission dynamics, case trends, and ecological associations. RESULTS: A total of 9815 children and adolescents who had COVID-19 were reported during the study period. Adolescents aged 14-17 years had the highest incidence rate (IR) per 1000 people (IR = 107.5; 3021 of 28 108). Hispanic/Latino children had a 1.6 times higher rate of infection than non-Hispanic White children (RR = 1.57; 95% CI, 1.50-1.65; P < .001). Few hospitalizations (n = 138, 1.4%) and deaths (n = 3, 0%) occurred. Most children were symptomatic (4487 of 5499, 81.6%). Within household clusters, a large proportion of pediatric cases (n = 6136) were a secondary case (n = 3959, 64.5%), followed by index case (n = 1170, 19.1%) and co-index case (n = 1007, 16.4%). Non-Hispanic White children had an increased risk of being an index or co-index case (RR = 1.14; 95% CI, 1.06-1.23; P < .001), while Hispanic/Latino children had an increased risk of being a secondary case (RR = 1.07; 95% CI, 1.03-1.11; P < .001). From 2020 to 2021, the association between pediatric case rates and neighborhoods with higher poverty and households with ≥3 people decreased. CONCLUSIONS: Older children and those identifying as Hispanic/Latino had a disproportionate incidence of disease. A sizable proportion of children were considered index cases or co-index cases. Pediatric prevention strategies, especially vaccinations, are vital for pandemic control.

Missed appointments during COVID-19: The impact of telehealth for persons experiencing homelessness with substance use disorders.

We examined the impact of telehealth on appointment retention among individuals with substance use disorder (SUD) by housing status. We evaluated appointment status using multivariate logistic regression with primary predictor variables of visit modality, patient's housing status and interaction between these two variables. Between March 1 and September 30, 2020, there were 18,206 encounters among 1,626 clients with SUD. For telehealth encounters, the probability of an appointment no-show was significantly higher for persons experiencing homelessness compared to stably housed (37% versus 25%, p < 0.001). Housing status influences the effectiveness of telehealth as a modality of healthcare delivery for individuals with SUD.

Disproportionate Incidence of COVID-19 Infection, Hospitalizations, and Deaths Among Persons Identifying as Hispanic or Latino - Denver, Colorado March-October 2020.

Persons identifying as Hispanic or Latino (Hispanic) represent the second largest racial/ethnic group in the United States (1), yet understanding of the impact of coronavirus disease 2019 (COVID-19) in this population is limited. To evaluate COVID-19 health disparities in the community and inform public health, health system, and community-based interventions, local public health authorities analyzed the sociodemographic characteristics of persons who were diagnosed, hospitalized, and who died with COVID-19 in Denver, Colorado. During the first 7 months of the COVID-19 epidemic in Denver (March 6-October 6, 2020) the majority of adult COVID-19 cases (54.8%), hospitalizations (62.1%), and deaths (51.2%) were among persons identifying as Hispanic, more than double the proportion of Hispanic adults in the Denver community (24.9%) (1). Systemic drivers that influence how Hispanic persons live and work increase their exposure risks: compared with non-Hispanic persons, Hispanic persons with COVID-19 in Denver reported larger household sizes and were more likely to report known exposures to household and close contacts with COVID-19, working in an essential industry, and working while ill. Reducing the disproportionate incidence of COVID-19 morbidity and mortality among Hispanic persons will require implementation of strategies that address upstream social and environmental factors that contribute to an increased risk for both infection and transmission and that facilitate improved access to culturally congruent care.