COVID-19 Autopsies, Oklahoma, USA.

OBJECTIVES: To report the methods and findings of two complete autopsies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals who died in Oklahoma (United States) in March 2020. METHODS: Complete postmortem examinations were performed according to standard procedures in a negative-pressure autopsy suite/isolation room using personal protective equipment, including N95 masks, eye protection, and gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcriptase polymerase chain reaction testing on postmortem swabs. RESULTS: A 77-year-old obese man with a history of hypertension, splenectomy, and 6 days of fever and chills died while being transported for medical care. He tested positive for SARS-CoV-2 on postmortem nasopharyngeal and lung parenchymal swabs. Autopsy revealed diffuse alveolar damage and chronic inflammation and edema in the bronchial mucosa. A 42-year-old obese man with a history of myotonic dystrophy developed abdominal pain followed by fever, shortness of breath, and cough. Postmortem nasopharyngeal swab was positive for SARS-CoV-2; lung parenchymal swabs were negative. Autopsy showed acute bronchopneumonia with evidence of aspiration. Neither autopsy revealed viral inclusions, mucus plugging in airways, eosinophils, or myocarditis. CONCLUSIONS: SARS-CoV-2 testing can be performed at autopsy. Autopsy findings such as diffuse alveolar damage and airway inflammation reflect true virus-related pathology; other findings represent superimposed or unrelated processes.

Evaluation of WIC Online Ordering during the COVID-19 Pandemic: Evidence from an Oklahoma Grocery Store Chain.

The COVID-19 pandemic is worsening the disparities in food access in the United States. As consumers have been increasingly using grocery online ordering services to limit their exposure to the COVID-19 virus, participants of federal nutrition assistance programs lack the online benefit redemption option. With the support of the US Department of Agriculture (USDA), retailers are pilot-testing online food benefit ordering in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). By combining the Oklahoma WIC administrative data, the online ordering data from a grocery store chain in Oklahoma, and the COVID-19 data in Oklahoma, this study examines how WIC participants responded to the online food benefit ordering option and how their adoption of online ordering was associated with the COVID-19 incidence. Results show that from July to December 2020, 15,171 WIC households redeemed WIC benefits at an Oklahoma chain store, but only 819 of them adopted online ordering. They together completed 102,227 online orders, which accounted for 2.7% of the store visits and 2.6% of the monetary value of WIC redemptions at these stores. There was no significant relationship between WIC online ordering adoption and COVID-19 incidence in Oklahoma.

The Epidemiology of COVID-19 by Race/Ethnicity in Oklahoma City-County, Oklahoma (12 March 2020-31 May 2021).

We aimed to better understand the racially-/ethnically-specific COVID-19-related outcomes, with respect to time, to respond more effectively to emerging variants. Surveillance data from Oklahoma City-County (12 March 2020-31 May 2021) were used to summarize COVID-19 cases, hospitalizations, deaths, and COVID-19 vaccination status by racial/ethnic group and ZIP code. We estimated racially-/ethnically-specific daily hospitalization rates, the proportion of cases hospitalized, and disease odds ratios (OR) adjusting for sex, age, and the presence of at least one comorbidity. Hot spot analysis was performed using normalized values of cases, hospitalizations, and deaths generated from incidence rates per 100,000 population. During the study period, there were 103,030 confirmed cases, 3457 COVID-19-related hospitalizations, and 1500 COVID-19-related deaths. The daily 7-day average hospitalization rate for Hispanics peaked earlier than other groups and reached a maximum (3.0/100,000) in July 2020. The proportion of cases hospitalized by race/ethnicity was 6.09% among non-Hispanic Blacks, 5.48% among non-Hispanic Whites, 3.66% among Hispanics, 3.43% among American Indians, and 2.87% among Asian/Pacific Islanders. COVID-19 hot spots were identified in ZIP codes with minority communities. The Hispanic population experienced the first surge in COVID-19 cases and hospitalizations, while non-Hispanic Blacks ultimately bore the highest burden of COVID-19-related hospitalizations and deaths.

Impact of local mask mandates upon COVID-19 case rates in Oklahoma.

Use of face coverings has been shown to reduce transmission of SARS-CoV-2. Despite encouragements from the CDC and other public health entities, resistance to usage of masks remains, forcing government entities to create mandates to compel use. The state of Oklahoma did not create a state-wide mask mandate, but numerous municipalities within the state did. This study compares case rates in communities with mandates to those without mandates, at the same time and in the same state (thus keeping other mitigation approaches similar). Diagnosed cases of COVID-19 were extracted from the Oklahoma State Department of Health reportable disease database. Daily case rates were established based upon listed city of residence. The daily case rate difference between each locality with a mask mandate were compared to rates for the portions of the state without a mandate. All differences were then set to a d0 point of reference (date of mandate implementation). Piecewise linear regression analysis of the difference in SARS-CoV-2 infection rates between mandated and non-mandated populations before and after adoption of mask mandates was then done. Prior to adopting mask mandates, those municipalities that eventually adopted mandates had higher transmission rates than the rest of the state, with the mean case rate difference per 100,000 people increasing by 0.32 cases per day (slope of difference = 0.32; 95% CI 0.13 to 0.51). For the post-mandate time period, the differences are decreasing (slope of -0.24; 95% CI -0.32 to -0.15). The pre- and post- mandate slopes differed significantly (p<0.001). The change in slope direction (-0.59; 95% CI -0.80 to -0.37) shows a move toward reconvergence in new case diagnoses between the two populations. Compared to rates in communities without mask mandates, transmission rates of SARS-CoV-2 slowed notably in those communities that adopted a mask mandate. This study suggests that government mandates may play a role in reducing transmission of SARS-CoV-2, and other infectious respiratory conditions.

Characterization of persons with reported SARS-CoV-2 infection in the Oklahoma City tri-county area: Evidence from the first 12 months of transmission.

BACKGROUND: To describe characteristics, hospitalization, and death for reported cases of SARS-CoV-2 infection in the Oklahoma City tri-county area. METHODS: We extracted notified cases of SARS-CoV-2 infection for our study area and used descriptive statistics and modeling to examine case characteristics and calculate the odds of hospitalization and death in relation to a range of explanatory variables. RESULTS: Between March 12th, 2020 and February 28th, 2021, 124,925 cases of SARS-CoV-2 infection were reported from the study region. Being male, White or Black/African American, aged 50 years or older, presenting with apnea, cough, and shortness of breath, and having diabetes was associated with increased odds of hospitalization. The odds of dying were significantly associated with being Black/African American, presenting with cough and fever, having kidney disease and diabetes and being aged 70 years or older. CONCLUSIONS: The first cohort analysis of SARS-CoV-2 positive individuals in the Oklahoma City tri-county area confirms comorbidities and age as important predictors of COVID-19 hospitalization or death. As a novel aspect, we show that early symptoms of breathing difficulties in particular are associated with hospitalization and death. Initial case assessment and SARS-CoV-2 guidelines should continue to focus on age, comorbidities, and early symptoms.

The Online Ordering Behaviors among Participants in the Oklahoma Women, Infants, and Children Program: A Cross-Sectional Analysis.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the United States (U.S.). Participants in the program redeem their prescribed food benefits in WIC-authorized grocery stores. Online ordering is an innovative method being pilot-tested in some stores to facilitate WIC participants' food benefit redemption, which has become especially important in the COVID-19 pandemic. The present research aimed to examine the online ordering (OO) behaviors among 726 WIC households who adopted WIC OO in a grocery chain, XYZ (anonymous) store, in Oklahoma (OK). These households represented approximately 5% of WIC households who redeemed WIC benefits in XYZ stores during the study period, which was 1 July to 31 December 2020. This period was during the COVID-19 pandemic but after the temporary lockdown in Oklahoma had been lifted. Descriptive statistics were estimated for WIC OO households' adoption behaviors and their orders. The Cox proportional hazard model and zero-truncated negative binomial regression were applied to examine the relationship between participants' socio-demographics and the length of time between 1 July 2020, and their first OO, as well as the number of WIC online orders. About 80% of these online orders were picked up without any changes. Minority households had a significantly longer time before adopting their first OO (hazard ratio (HR) < 1, p < 0.001), while households with a child or a woman participant, or more participants, had a shorter time before adopting OO (HR > 1, p < 0.05). Non-Hispanic black households had a fewer number of OOs than non-Hispanic white households (B = -0.374, p = 0.007). OO adoption varied across socio-demographics. More efforts are needed to ensure equal access and adoption of WIC OO.

Predicting COVID-19 cases in diverse population groups using SARS-CoV-2 wastewater monitoring across Oklahoma City.

SARS-CoV-2 was discovered among humans in late 2019 and rapidly spread across the world. Although the virus is transmitted by respiratory droplets, most infected persons also excrete viral particles in their feces. This fact prompted a range of studies assessing the usefulness of wastewater surveillance to determine levels of infection and transmission and produce early warnings of outbreaks in local communities, independently of human testing. In this study, we collected samples of wastewater from 13 locations across Oklahoma City, representing different population types, twice per week from November 2020 to end of March 2021. Wastewater samples were collected and analyzed for the presence and concentration of SARS-CoV-2 RNA using RT-qPCR. The concentration of SARS-CoV-2 in the wastewater showed notable peaks, preceding the number of reported COVID-19 cases by an average of one week (ranging between 4 and 10 days). The early warning lead-time for an outbreak or increase in cases was significantly higher in areas with larger Hispanic populations and lower in areas with a higher household income or higher proportion of persons aged 65 years or older. Using this relationship, we predicted the number of cases with an accuracy of 81-92% compared to reported cases. These results confirm the validity and timeliness of using wastewater surveillance for monitoring local disease transmission and highlight the importance of differences in population structures when interpreting surveillance outputs and planning preventive action.

Twins Separated at Birth: Across a Country and Around the World/Twin Research: Memorial Tribute to Isaac Blickstein, MD; Infanticide and Sacrifice of Archaic-Aged Twins and Triplets; Prehistoric Twin Burials; Highlights from a Conference on Three Identical Strangers/Media Reports: An Atypical Twin Father; An Actor's Twin Brother; Twin Link to Tulsa, Oklahoma Massacre; Superfetated Twins; Twin Comedians and Script Writers; Indian Twins' Loss to COVID-19.

Every reared-apart monozygotic (MZ) twin pair offers a fresh perspective on human developmental questions. This is true regardless of whether the co-twins were raised in the same country or across the globe. The members of two pairs of separated MZ female twins have recently come to attention. In one case the twins were raised by different families in Argentina; in the other case the twins were raised by different families in Sweden and Vietnam. The perceptions and perspectives of these twins are insightful. The twin research section that follows begins with a tribute to our late esteemed colleague, Dr Isaac Blickstein (1953-2020). Research concerning the infanticide and sacrifice of Archaic-aged twins and triplets and prehistoric twin burials is reviewed next. Highlights from a conference focused on the 2018 film Three Identical Strangers are also included in this portion. The final section of this article includes media reports of an atypical twin father, an actor's twin brother, a twin link to the 1921 Tulsa, Oklahoma massacre, the birth of superfetated twins, twin comedians and script writers and Indian twins' tragic loss to COVID-19.

Referrals for Cryptorchidism: Analyzing for Quality from a Pre-COVID Dataset.

OBJECTIVE: To identify risk factors associated with an inaccurate diagnosis, delayed referral, and/or inappropriate ultrasound in consecutive referrals for an undescended testicle (UDT). METHODS: This study was approved by the institutional review board. Data was prospectively collected for all children referred to University of Oklahoma's pediatric urology service from August 2019 to February 2020. The data was imported into SAS vs 9.4 for analysis. We categorized the "quality" of referral by a point system using 3 factors (no previous ultrasound, ≤18 months, correct location). An optimal referral had an accurate testicular examination, was referred by 18 months of age, and no diagnostic ultrasound. RESULTS: We collected 75 referrals. Thirty-nine (52.0%) had confirmed UDT, requiring surgery. Twenty-seven (69.2%) had an accurate initial examination. Forty-one (54.7%) were outside the optimal age. Thirty-four were considered low quality (0-1 qualities) and 41 were high quality (2-3 qualities). Seven (9.3%) were optimal (3/3 qualities). Referrals that needed intervention were statistically more likely to be higher quality. CONCLUSION: Increased quality of UDT referrals directly correlated with the likelihood for treatment. This study reveals a need for more education on UDT referral in the community. By improving referring provider knowledge and skills, we can minimize unnecessary referrals.

SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility - Oklahoma, April-May 2021.

The B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, was identified in India in late 2020 and has subsequently been detected in approximately 60 countries (1). The B.1.617.2 variant has a potentially higher rate of transmission than other variants (2). During May 12-18, 2021, the Oklahoma State Department of Health (OSDH) Acute Disease Service (ADS) was notified by the OSDH Public Health Laboratory (PHL) of 21 SARS-CoV-2 B.1.617.2 specimens temporally and geographically clustered in central Oklahoma. Public health surveillance data indicated that these cases were associated with a local gymnastics facility (facility A). OSDH ADS and local health department staff members reinterviewed persons with B.1.617.2 variant-positive laboratory results and conducted contact tracing. Forty-seven COVID-19 cases (age range = 5-58 years), including 21 laboratory-confirmed B.1.617.2 variant and 26 epidemiologically linked cases, were associated with this outbreak during April 15-May 3, 2021. Cases occurred among 10 of 16 gymnast cohorts* and three staff members; secondary cases occurred in seven (33%) of 26 interviewed households with outbreak-associated cases. The overall facility and household attack rates were 20% and 53%, respectively. Forty (85%) persons with outbreak-associated COVID-19 had never received any COVID-19 vaccine doses (unvaccinated); three (6%) had received 1 dose of Moderna or Pfizer-BioNTech ≥14 days before a positive test result but had not received the second dose (partially vaccinated); four persons (9%) had received 2 doses of Moderna or Pfizer-BioNTech or a single dose of Janssen (Johnson & Johnson) vaccine ≥14 days before a positive test result (fully vaccinated). These findings suggest that the B.1.617.2 variant is highly transmissible in indoor sports settings and within households. Multicomponent prevention strategies including vaccination remain important to reduce the spread of SARS-CoV-2, including among persons participating in indoor sports† and their contacts.

Racial and ethnic differences in family planning telehealth use during the onset of the COVID-19 response in Arkansas, Kansas, Missouri, and Oklahoma.

OBJECTIVES: To explore racial/ethnic disparities in family planning telehealth use. STUDY DESIGN: We analyzed telehealth and in-clinic visits (n = 3142) from ten family planning clinics (April 1-July 31, 2020) by race/ethnicity and month. RESULTS: Telehealth comprised 1257/3142 (40.0%) of overall visits. Telehealth was used by 242/765 (31.6%) of Black/African American and 31/106 (29.2%) multiracial patients. Patients with unknown (162/295, 54.9%), White (771/1870, 41.2%), and other (51/106, 48.1%) identities comprised the majority of telehealth visits. CONCLUSIONS: Our study found differences in telehealth use during the COVID-19 pandemic response. IMPLICATIONS: Understanding barriers and facilitators to telehealth is critical to reducing disparities in access.

The Impact and Implications of The COVID-19 Pandemic on Organ Procurement Outside of an Epicenter.

The COVID-19 pandemic has been well-documented to have a variable impact on individual communities and health care systems. We describe the experience of a single organ procurement organization (OPO), located in an area without a large cluster of cases during the initial phase of the COVID-19 pandemic. A review of community health data describing the impact of COVID-19 nationally and in Oklahoma was conducted. Additionally, a retrospective review of available OPO data from March 2019-May 2020 was performed. While the amount of donor referrals received and organs recovered by the OPO remained stable in the initial months of the pandemic, the observed organs transplanted vs. expected organs transplanted (O:E) decreased to the lowest number in the 15-month period and organs transplanted decreased as well. Fewer organs from Oklahoma donors were accepted for transplant despite staff spending more time allocating organs.

Deviations in criminal filings of child abuse and neglect during COVID-19 from forecasted models: An analysis of the state of Oklahoma, USA.

BACKGROUND: The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. OBJECTIVE: The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. PARTICIPANTS AND SETTING: This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. METHODS: Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. RESULTS: Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. CONCLUSIONS: Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.