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1.
Emerg Infect Dis ; 28(7): 1520-1522, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1875361

ABSTRACT

We investigated a university-affiliated cohort of SARS-CoV-2 Omicron BA.2 infections in Arizona, USA. Of 44 cases, 43 were among students; 26 persons were symptomatic, 8 sought medical care, but none were hospitalized. Most (55%) persons had completed a primary vaccine series; 8 received booster vaccines. BA.2 infection was mild in this young cohort.


Subject(s)
COVID-19 , Viral Vaccines , Arizona/epidemiology , COVID-19/epidemiology , Humans , SARS-CoV-2 , Universities
2.
Am J Public Health ; 112(2): 216-219, 2022 02.
Article in English | MEDLINE | ID: covidwho-1817592

ABSTRACT

The Maricopa County Department of Public Health in Arizona investigated three COVID-19 outbreaks associated with club sports, two in tournaments and one in a hockey league. During September through November 2020, 195 team-associated and 69 secondary household contact cases were identified among 2093 athletes, coaches, and staff members; the team attack rate ranged from 6% to 72%. Outbreaks occurred during high community transmission periods in Maricopa County. Identification of contacts and characterization of prevention strategies were challenging because of limited cooperation from athletes, families, and staff. (Am J Public Health. 2022;112(2):216-219. https://doi.org/10.2105/AJPH.2021.306579).


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Youth Sports , Arizona/epidemiology , Humans , Incidence , SARS-CoV-2 , Surveys and Questionnaires
3.
Public Health Rep ; 137(2): 213-219, 2022.
Article in English | MEDLINE | ID: covidwho-1643031

ABSTRACT

From May through July 2020, Arizona was a global hotspot for new COVID-19 cases. In response to the surge of cases, local public health departments looked for innovative ways to form external partnerships to address their staffing needs. In collaboration with the Maricopa County Department of Public Health, the Arizona State University Student Outbreak Response Team (SORT) created and implemented a virtual call center to conduct public health case investigations for COVID-19. SORT officially launched a dedicated COVID-19 case investigation program after 3 weeks of program design and training. From June 29 through November 8, 2020, SORT recruited and trained 218 case investigators, completed 5000 case patient interviews, and closed 10 000 cases. Our team also developed process improvements to address disparities in case investigation timeliness. A strong infrastructure designed to accommodate remote case investigations, paired with a large workforce, enabled SORT to provide additional surge capacity for the county's high volume of cases. University-driven multidisciplinary case investigator teams working in partnership with state, tribal, and local public health staff members can be an effective tool for supporting a diverse and growing public health workforce. We discuss the essential design factors involved in building a university program to complement local COVID-19 response efforts, including workflows for case management, volunteer case investigator recruitment and training, secure technology platforms for conducting case investigations remotely, and robust data-tracking procedures for maintaining quality control and timely case reporting.


Subject(s)
COVID-19/epidemiology , Call Centers/organization & administration , Contact Tracing/methods , Disease Outbreaks/prevention & control , Intersectoral Collaboration , Program Development , Program Evaluation , Arizona/epidemiology , Humans , Public Health Practice , SARS-CoV-2 , Students , Universities , Volunteers , Workforce/organization & administration
4.
BMJ Open ; 12(1): e053403, 2022 01 17.
Article in English | MEDLINE | ID: covidwho-1633982

ABSTRACT

OBJECTIVE: To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study. SETTING AND DESIGN: This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. PARTICIPANTS: Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. RESULTS: Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. CONCLUSION: When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.


Subject(s)
COVID-19 , Arizona/epidemiology , Cohort Studies , Humans , Longitudinal Studies , Prospective Studies , SARS-CoV-2
5.
Public Health Rep ; 137(2): 220-225, 2022.
Article in English | MEDLINE | ID: covidwho-1622161

ABSTRACT

The COVID-19 pandemic has disproportionately affected tribal populations, including the San Carlos Apache Tribe. Universal screening testing in a community using rapid antigen tests could allow for near-real-time identification of COVID-19 cases and result in reduced SARS-CoV-2 transmission. Published experiences of such testing strategies in tribal communities are lacking. Accordingly, tribal partners, with support from the Centers for Disease Control and Prevention, implemented a serial testing program using the Abbott BinaxNOW rapid antigen test in 2 tribal casinos and 1 detention center on the San Carlos Apache Indian Reservation for a 4-week pilot period from January to February 2021. Staff members at each setting, and incarcerated adults at the detention center, were tested every 3 or 4 days with BinaxNOW. During the 4-week period, 3834 tests were performed among 716 participants at the sites. Lessons learned from implementing this program included demonstrating (1) the plausibility of screening testing programs in casino and prison settings, (2) the utility of training non-laboratory personnel in rapid testing protocols that allow task shifting and reduce the workload on public health employees and laboratory staff, (3) the importance of building and strengthening partnerships with representatives from the community and public and private sectors, and (4) the need to implement systems that ensure confidentiality of test results and promote compliance among participants. Our experience and the lessons learned demonstrate that a serial rapid antigen testing strategy may be useful in work settings during the COVID-19 pandemic as schools and businesses are open for service.


Subject(s)
COVID-19 Serological Testing , COVID-19/diagnosis , Diagnostic Screening Programs , Indigenous Peoples , Arizona/epidemiology , Humans , Pilot Projects , Program Evaluation , SARS-CoV-2
6.
MMWR Morb Mortal Wkly Rep ; 70(5152): 1761-1765, 2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1595557

ABSTRACT

The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed <14 days earlier), and 66 contributed unvaccinated person-time. Using the Cox proportional-hazards model, the estimated VE of full Pfizer-BioNTech vaccination for preventing SARS-CoV-2 infection was 92% (95% CI = 79%-97%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. These findings from a real-world setting indicate that 2 doses of Pfizer-BioNTech vaccine are highly effective in preventing SARS-CoV-2 infection among Arizona adolescents. CDC recommends COVID-19 vaccination for all eligible persons in the United States, including persons aged 12-17 years.


Subject(s)
/administration & dosage , COVID-19/prevention & control , /statistics & numerical data , Adolescent , Arizona/epidemiology , COVID-19/epidemiology , COVID-19 Testing , Child , Female , Humans , Male
7.
Am J Public Health ; 112(1): 38-42, 2022 01.
Article in English | MEDLINE | ID: covidwho-1594448

ABSTRACT

We conducted a community seroprevalence survey in Arizona, from September 12 to October 1, 2020, to determine the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the seroprevalence estimate to predict SARS-CoV-2 infections in the jurisdiction by applying the adjusted seroprevalence to the county's population. The estimated community seroprevalence of SARS-CoV-2 infections was 4.3 times greater (95% confidence interval = 2.2, 7.5) than the number of reported cases. Field surveys with representative sampling provide data that may help fill in gaps in traditional public health reporting. (Am J Public Health. 2022;112(1):38-42. https://doi.org/10.2105/AJPH.2021.306568).


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing , COVID-19/diagnosis , COVID-19/epidemiology , Adolescent , Adult , Aged , Arizona/epidemiology , Child , Family Characteristics , Female , Humans , Male , Middle Aged , Public Health Practice , SARS-CoV-2 , Seroepidemiologic Studies
8.
Am J Public Health ; 111(11): 1939-1941, 2021 11.
Article in English | MEDLINE | ID: covidwho-1526717

ABSTRACT

Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. 2021;111(11):1939-1941. https://doi.org/10.2105/AJPH.2021.306472).


Subject(s)
COVID-19 , Contact Tracing , Indigenous Peoples , Rural Population , Aged , Arizona/epidemiology , COVID-19/epidemiology , COVID-19/mortality , Female , House Calls , Humans , Interdisciplinary Communication , Male , Middle Aged , Public Health , United States , United States Indian Health Service
9.
Emerg Infect Dis ; 27(10): 2718-2720, 2021 10.
Article in English | MEDLINE | ID: covidwho-1486739

ABSTRACT

Genomic surveillance can provide early insights into new circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. While conducting genomic surveillance (1,663 cases) from December 2020-April 2021 in Arizona, USA, we detected an emergent E484K-harboring variant, B.1.243.1. This finding demonstrates the importance of real-time SARS-CoV-2 surveillance to better inform public health responses.


Subject(s)
COVID-19 , SARS-CoV-2 , Arizona/epidemiology , Genomics , Humans , Public Health
10.
MMWR Morb Mortal Wkly Rep ; 70(39): 1372-1373, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1444554

ABSTRACT

CDC recommends universal indoor masking by students, staff members, faculty, and visitors in kindergarten through grade 12 (K-12) schools, regardless of vaccination status, to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Schools in Maricopa and Pima Counties, which account for >75% of Arizona's population (2), resumed in-person learning for the 2021-22 academic year during late July through early August 2021. In mid-July, county-wide 7-day case rates were 161 and 105 per 100,000 persons in Maricopa and Pima Counties, respectively, and 47.6% of Maricopa County residents and 59.2% of Pima County residents had received at least 1 dose of a COVID-19 vaccine. School districts in both counties implemented variable mask policies at the start of the 2021-22 academic year (Table). The association between school mask policies and school-associated COVID-19 outbreaks in K-12 public noncharter schools open for in-person learning in Maricopa and Pima Counties during July 15-August 31, 2021, was evaluated.


Subject(s)
COVID-19/prevention & control , Disease Outbreaks/statistics & numerical data , Masks/statistics & numerical data , Organizational Policy , Schools/organization & administration , Adolescent , Arizona/epidemiology , COVID-19/epidemiology , Child , Child, Preschool , Humans
11.
Sci Rep ; 11(1): 18635, 2021 09 20.
Article in English | MEDLINE | ID: covidwho-1428895

ABSTRACT

Containing the COVID-19 pandemic while balancing the economy has proven to be quite a challenge for the world. We still have limited understanding of which combination of policies have been most effective in flattening the curve; given the challenges of the dynamic and evolving nature of the pandemic, lack of quality data etc. This paper introduces a novel data mining-based approach to understand the effects of different non-pharmaceutical interventions in containing the COVID-19 infection rate. We used the association rule mining approach to perform descriptive data mining on publicly available data for 50 states in the United States to understand the similarity and differences among various policies and underlying conditions that led to transitions between different infection growth curve phases. We used a multi-peak logistic growth model to label the different phases of infection growth curve. The common trends in the data were analyzed with respect to lockdowns, face mask mandates, mobility, and infection growth. We observed that face mask mandates combined with mobility reduction through moderate stay-at-home orders were most effective in reducing the number of COVID-19 cases across various states.


Subject(s)
COVID-19/epidemiology , Data Mining , Arizona/epidemiology , Humans , Incidence , Logistic Models , United States/epidemiology
14.
Viruses ; 13(9)2021 09 10.
Article in English | MEDLINE | ID: covidwho-1411079

ABSTRACT

We used wastewater-based epidemiology and amplicon-based long-read high-throughput sequencing for surveillance of enteroviruses (EVs) in Maricopa County, Arizona, Southwest United States. We collected 48 samples from 13 sites in three municipalities between 18 June and 1 October 2020, and filtered (175 mL each; 0.45 µm pore size) and extracted RNA from the filter-trapped solids. The RNA was converted to cDNA and processed through two workflows (Sanger sequencing (SSW) and long-read Illumina sequencing (LRISW)) each including a nested polymerase chain reaction (nPCR) assay. We subjected the ~350 bp amplicon from SSW to Sanger sequencing and the ~1900-2400 bp amplicon from LRISW to Illumina sequencing. We identified EV contigs from 11 of the 13 sites and 41.67% (20/48) of screened samples. Using the LRISW, we detected nine EV genotypes from three species (Enterovirus A (CVA4, EV-A76, EV-A90), Enterovirus B (E14) and Enterovirus C (CVA1, CVA11, CVA13, CVA19 and CVA24)) with Enterovirus C representing approximately 90% of the variants. However, the SSW only detected the five Enterovirus C types. Similarity and phylogenetic analysis showed that multiple Enterovirus C lineages were circulating, co-infecting and recombining in the population during the season despite the SARS-CoV-2 pandemic and the non-pharmaceutical public health measures taken to curb transmission.


Subject(s)
Enterovirus Infections/epidemiology , Enterovirus Infections/virology , Enterovirus/genetics , Waste Water/microbiology , Water Microbiology , Arizona/epidemiology , Enterovirus/isolation & purification , Enterovirus Infections/history , High-Throughput Nucleotide Sequencing , History, 21st Century , Humans , Phylogeny , RNA, Viral , Seasons , Wastewater-Based Epidemiological Monitoring
15.
Public Health Rep ; 137(1): 120-127, 2022.
Article in English | MEDLINE | ID: covidwho-1410773

ABSTRACT

OBJECTIVES: Frontline essential workers face elevated risks of exposure to COVID-19 because of the interactive nature of their jobs, which require high levels of interaction with the general public and coworkers. The impact of these elevated risks on the mental health of essential workers, especially outside the health care sector, is not well studied. To address this knowledge gap, we examined correlations between perceptions of workplace risks and mental health distress among grocery store workers in Arizona. METHODS: We collected the first statewide sample of essential workers outside the health care sector focused on mental health and well-being. A total of 3344 grocery store workers in Arizona completed an online survey in July 2020. We used multiple regression models to identify demographic and work-based correlates of mental health distress. RESULTS: Levels of mental health distress among respondents were high: 557 of 3169 (17.6%) reported severe levels and 482 of 3168 (15.2%) reported moderate levels. Perceptions of workplace safety were strongly correlated with significantly reduced levels of mental health distress (ß = -1.44; SE = 0.20) and reduced perceived stress (ß = -0.97; SE = 0.16). Financially disadvantaged workers and employees aged <55 reported high levels of mental health distress. Perceptions of safety and protection in the workplace were significantly correlated with availability of safety trainings, social distancing, and policies governing customer behaviors. CONCLUSIONS: Lacking sufficient workplace protections, grocery store employees in Arizona experienced high levels of mental health distress during the COVID-19 pandemic. Providing clear federal and state policies to employers to guide implementation of workplace protections may help reduce sources of mental health distress.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Occupational Health/statistics & numerical data , Stress, Psychological/epidemiology , Supermarkets , Adolescent , Adult , Arizona/epidemiology , Female , Humans , Infection Control/organization & administration , Male , Mental Health , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2 , Safety , Young Adult
16.
Viruses ; 13(1)2021 Jan 07.
Article in English | MEDLINE | ID: covidwho-1389524

ABSTRACT

We describe the complete capsid of a genotype C1-like Enterovirus A71 variant recovered from wastewater in a neighborhood in the greater Tempe, Arizona area (Southwest United States) in May 2020 using a pan-enterovirus amplicon-based high-throughput sequencing strategy. The variant seems to have been circulating for over two years, but its sequence has not been documented in that period. As the SARS-CoV-2 pandemic has resulted in changes in health-seeking behavior and overwhelmed pathogen diagnostics, our findings highlight the importance of wastewater-based epidemiology (WBE ) as an early warning system for virus surveillance.


Subject(s)
Capsid Proteins/genetics , Enterovirus A, Human/genetics , Enterovirus A, Human/isolation & purification , High-Throughput Nucleotide Sequencing/methods , Waste Water/virology , Wastewater-Based Epidemiological Monitoring , Arizona/epidemiology , Capsid/chemistry , Enterovirus Infections/epidemiology , Enterovirus Infections/virology , Humans , Molecular Epidemiology , Pandemics , Phylogeny
17.
PLoS One ; 16(8): e0254347, 2021.
Article in English | MEDLINE | ID: covidwho-1341497

ABSTRACT

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.


Subject(s)
COVID-19/complications , Adolescent , Adult , Aged , Aged, 80 and over , Arizona/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/pathology , COVID-19/rehabilitation , Child , Cohort Studies , Disease Progression , Female , Home Care Services/statistics & numerical data , Humans , Male , Middle Aged , Prevalence , Prognosis , SARS-CoV-2/physiology , Young Adult
18.
JAMA Netw Open ; 4(7): e2117049, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1316186

ABSTRACT

Importance: Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. Objective: To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. Design, Setting, and Participants: In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Main Outcomes and Measures: Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. Results: A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). Conclusions and Relevance: In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.


Subject(s)
COVID-19/prevention & control , Emigration and Immigration/trends , /statistics & numerical data , Adult , Arizona/epidemiology , COVID-19/epidemiology , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Chicago/epidemiology , Cross-Sectional Studies , Emigration and Immigration/statistics & numerical data , Female , Humans , Los Angeles/epidemiology , Male , Mass Screening/methods , Middle Aged , Qualitative Research , Surveys and Questionnaires
20.
West J Emerg Med ; 22(3): 561-564, 2021 May 17.
Article in English | MEDLINE | ID: covidwho-1266891

ABSTRACT

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, a reduction in emergency department (ED) visits was seen nationally according to the US Centers for Disease Control and Prevention. However, no data currently exists for the impact of ED transfers to a higher level of care during this same time period. The primary objective of the study was to determine whether the COVID-19 pandemic affected the rate of non-COVID-19 transfers from a rural community ED. METHODS: We completed a retrospective chart review of all ED patients who presented to Kingman Regional Medical Center in Kingman, Arizona, from March 1-June 31, 2019 and March 1-June 31, 2020. To ensure changes were not due to seasonal trends, we examined transfer rates from the same four-month period in 2019 and 2020. Patients were included in the study if they were transferred to an outside facility for a higher level of care not related to COVID-19. RESULTS: Between the time periods studied there was a 25.33% (P = 0.001) reduction in total ED volume and a 21.44% (P = 0.009) reduction in ED transfers to a higher level of care. No statistical difference was noted in ED transfer volume following adjustment for decreased ED volumes. Transfers for gastroenterology (45%; P = 0.021), neurosurgery (29.2%; P = 0.029), neurology (76.3%; P < 0.001), trauma (37.5%; P = 0.039), urology (41.8%; P = 0.012), and surgery (56.3%; P = 0.028) all experienced a decrease in transfer rates during the time period studied. When gender was considered, males exhibited an increased rate of transfers to psychiatric facilities (P = 0.018). CONCLUSION: Significant reductions in both ED volume and transfers have coincided with the emergence of the COVID-19 pandemic. Further research is needed to determine how the current pandemic has affected patient care.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Patient Transfer/statistics & numerical data , Adult , Arizona/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Rural Population , SARS-CoV-2
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