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1.
JAMA Netw Open ; 4(12): e2140602, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1597867

ABSTRACT

Importance: During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized polymerase chain reaction or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact, and Connecticut colleges and universities used a variety of approaches to reopen campuses to residential students. Objective: To characterize institutional reopening strategies and COVID-19 outcomes in 18 residential college and university campuses across Connecticut. Design, Setting, and Participants: This retrospective cohort study used data on COVID-19 testing and cases and social contact from 18 college and university campuses in Connecticut that had residential students during the 2020-2021 academic year. Exposures: Tests for COVID-19 performed per week per residential student. Main Outcomes and Measures: Cases per week per residential student and mean (95% CI) social contact per week per residential student. Results: Between 235 and 4603 residential students attended the fall semester across each of 18 institutions of higher education in Connecticut, with fewer residential students at most institutions during the spring semester. In census block groups containing residence halls, the fall student move-in resulted in a 475% (95% CI, 373%-606%) increase in mean contact, and the spring move-in resulted in a 561% (95% CI, 441%-713%) increase in mean contact compared with the 7 weeks prior to move-in. The association between test frequency and case rate per residential student was complex; institutions that tested students infrequently detected few cases but failed to blunt transmission, whereas institutions that tested students more frequently detected more cases and prevented further spread. In fall 2020, each additional test per student per week was associated with a decrease of 0.0014 cases per student per week (95% CI, -0.0028 to -0.00001). Conclusions and Relevance: The findings of this cohort study suggest that, in the era of available vaccinations and highly transmissible SARS-CoV-2 variants, colleges and universities should continue to test residential students and use mitigation strategies to control on-campus COVID-19 cases.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Universities , Adolescent , COVID-19/diagnosis , Connecticut/epidemiology , Female , Housing , Humans , Male , Mass Screening/methods , Retrospective Studies , SARS-CoV-2 , Social Interaction , Young Adult
2.
Am J Disaster Med ; 16(3): 195-202, 2021.
Article in English | MEDLINE | ID: covidwho-1572827

ABSTRACT

Connecticut was impacted severely and early on by the COVID-19 pandemic due to the state's proximity to New York City. Hartford Healthcare (HHC), one of the largest healthcare systems in New England, became integral in the state's response with a robust emergency management system already in place. In this manuscript, we review HHC's prepandemic emergency operations as well as the response of the system-wide Office of Emergency Management to the initial news of the virus and throughout the evolving pandemic. Additionally, we discuss the unique acquisition of vital critical care resources and personal protective equipment, as well as the hospital personnel distribution in response to the shifting demands of the virus. The public testing and vaccination efforts, with early consideration for at risk populations, are described as well as ethical considerations of scarce resources. To date, the vaccination effort resulted in over 70 percent of the adult population being vaccinated and with 10 percent of the population having been infected, herd immunity is eminent. Finally, the preparation for reestablishing elective procedures while experiencing a second wave of the pandemic is discussed. These descriptions may be useful for other healthcare systems in both preparation and response for future catastrophic emergencies of all types.


Subject(s)
COVID-19 , Pandemics , Adult , Connecticut/epidemiology , Delivery of Health Care , Humans , SARS-CoV-2
3.
Emerg Infect Dis ; 27(10): 2669-2672, 2021.
Article in English | MEDLINE | ID: covidwho-1486740

ABSTRACT

In fall 2020, a coronavirus disease cluster comprising 16 cases occurred in Connecticut, USA. Epidemiologic and genomic evidence supported transmission among persons at a school and fitness center but not a workplace. The multiple transmission chains identified within this cluster highlight the necessity of a combined investigatory approach.


Subject(s)
COVID-19 , Fitness Centers , Connecticut/epidemiology , Genomics , Humans , SARS-CoV-2
4.
BMC Public Health ; 21(1): 1509, 2021 08 04.
Article in English | MEDLINE | ID: covidwho-1477365

ABSTRACT

BACKGROUND: Light at night (LAN) as a circadian disruption factor may affect the human immune system and consequently increase an individual's susceptibility to the severity of infectious diseases, such as COVID-19. COVID-19 infections spread differently in each state in the United States (US). The current analysis aimed to test whether there is an association between LAN and COVID-19 cases in 4 selected US states: Connecticut, New York, California, and Texas. METHODS: We analyzed clustering patterns of COVID-19 cases in ArcMap and performed a multiple linear regression model using data of LAN and COVID-19 incidence with adjustment for confounding variables including population density, percent below poverty, and racial factors. RESULTS: Hotspots of LAN and COVID-19 cases are located in large cities or metro-centers for all 4 states. LAN intensity is associated with cases/1 k for overall and lockdown durations in New York and Connecticut (P < 0.001), but not in Texas and California. The overall case rates are significantly associated with LAN in New York (P < 0.001) and Connecticut (P < 0.001). CONCLUSIONS: We observed a significant positive correlation between LAN intensity and COVID-19 cases-rate/1 k, suggesting that circadian disruption of ambient light may increase the COVID-19 infection rate possibly by affecting an individual's immune functions. Furthermore, differences in the demographic structure and lockdown policies in different states play an important role in COVID-19 infections.


Subject(s)
COVID-19 , Circadian Rhythm , Communicable Disease Control , Connecticut/epidemiology , Humans , Incidence , SARS-CoV-2 , United States/epidemiology
5.
Sci Rep ; 11(1): 20271, 2021 10 12.
Article in English | MEDLINE | ID: covidwho-1467133

ABSTRACT

To support public health policymakers in Connecticut, we developed a flexible county-structured compartmental SEIR-type model of SARS-CoV-2 transmission and COVID-19 disease progression. Our goals were to provide projections of infections, hospitalizations, and deaths, and estimates of important features of disease transmission and clinical progression. In this paper, we outline the model design, implementation and calibration, and describe how projections and estimates were used to meet the changing requirements of policymakers and officials in Connecticut from March 2020 to February 2021. The approach takes advantage of our unique access to Connecticut public health surveillance and hospital data and our direct connection to state officials and policymakers. We calibrated this model to data on deaths and hospitalizations and developed a novel measure of close interpersonal contact frequency to capture changes in transmission risk over time and used multiple local data sources to infer dynamics of time-varying model inputs. Estimated epidemiologic features of the COVID-19 epidemic in Connecticut include the effective reproduction number, cumulative incidence of infection, infection hospitalization and fatality ratios, and the case detection ratio. We conclude with a discussion of the limitations inherent in predicting uncertain epidemic trajectories and lessons learned from one year of providing COVID-19 projections in Connecticut.


Subject(s)
COVID-19 , Models, Statistical , Pandemics , Public Health Surveillance/methods , COVID-19/epidemiology , COVID-19/transmission , Connecticut/epidemiology , Forecasting , Humans , Pandemics/prevention & control , Pandemics/statistics & numerical data
6.
JAMA Netw Open ; 4(10): e2128575, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1465511

ABSTRACT

Importance: Black and Latinx communities have faced disproportionate harm from the COVID-19 pandemic. Increasing COVID-19 vaccine acceptance and access has the potential to mitigate mortality and morbidity from COVID-19 for all communities, including those most impacted by the pandemic. Objective: To investigate and understand factors associated with facilitating and obstructing COVID-19 vaccine access and acceptance among Black and Latinx communities. Design, Setting, and Participants: This community-partnered qualitative study conducted semistructured, in-depth focus groups with Black and Latinx participants from March 17 to March 29, 2021, using a secure video conferencing platform. Participants were recruited through emails from local community-based organizations, federally qualified health centers, social service agencies, the New Haven, Connecticut, Health Department, and in-person distribution of study information from community health workers. A total of 8 focus groups were conducted, including 4 in Spanish and 4 in English, with 72 participants from a diverse range of community roles, including teachers, custodial service workers, and health care employees, in New Haven, Connecticut. Data were analyzed from March 17 to July 30, 2021. Main Outcomes and Measures: Interviews were audio-recorded, transcribed, translated, and analyzed using an inductive content analysis approach. Themes and subthemes were identified on the acceptability and accessibility of the COVID-19 vaccine among participants who identified as Black and/or Latinx. Results: Among 72 participants, 36 (50%) identified as Black, 28 (39%) as Latinx, and 8 (11%) as Black and Latinx and 56 (78%) identified as women and 16 (22%) identified as men. Participants described 3 major themes that may represent facilitators and barriers to COVID-19 vaccinations: pervasive mistreatment of Black and Latinx communities and associated distrust; informing trust via trusted messengers and messages, choice, social support, and diversity; and addressing structural barriers to vaccination access. Conclusions and Relevance: The findings of this qualitative study may impact what health care systems, public health officials, policy makers, health care practitioners, and community leaders can do to facilitate equitable uptake of the COVID-19 vaccine. Community-informed insights are imperative to facilitating COVID-19 vaccine access and acceptance among communities hardest hit by the pandemic. Preventing the further widening of inequities and addressing structural barriers to vaccination access are vital to protecting all communities, especially Black and Latinx individuals who have experienced disproportionate death and loss from COVID-19.


Subject(s)
African Americans , COVID-19 Vaccines , Health Services Accessibility , Patient Acceptance of Health Care , Adolescent , Adult , Connecticut , Female , Focus Groups , Humans , Male , Middle Aged , Trust , Young Adult
7.
Accid Anal Prev ; 162: 106399, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1437362

ABSTRACT

INTRODUCTION: Recent research suggests that COVID-19 associated stay-at-home orders, or shelter-in-place orders, have impacted intra-and-interstate travel as well as motor vehicle crashes (crashes). We sought to further this research and to understand the impact of the stay-at-home order on crashes in the post order period in Connecticut. METHODS: We used a multiple-comparison group, interrupted time-series analysis design to compare crashes per 100 million vehicle miles traveled (VMT) per week in 2020 to the average of 2017-2019 from January 1-August 31. We stratified crash rate by severity and the number of vehicles involved. We modeled two interruption points reflecting the weeks Connecticut implemented (March 23rd, week 12) and rescinded (May 20th, week 20) its stay-at-home order. RESULTS: During the initial week of the stay-at-home order in Connecticut, there was an additional 28 single vehicle crashes compared to previous years (95% confidence interval (CI): [15.8, 36.8]). However, the increase at the order onset was not seen throughout the duration. Rescinding the stay-at-home order by and large did not result in an immediate increase in crash rates. Crash rates steadily returned to previous year averages during the post-stay-at-home period. Fatal crash rates were unaffected by the stay-at-home order and remained similar to previous year rates throughout the study duration. DISCUSSION: The initial onset of the stay-at-home order in Connecticut was associated with a sharp increase in the single vehicle crash rate but that increase was not sustained for the remainder of the stay-at-home order. Likely changes in driver characteristics during and after the order kept fatal crash rates similar to previous years.


Subject(s)
Automobile Driving , COVID-19 , Accidents, Traffic , Connecticut/epidemiology , Humans , Motor Vehicles , SARS-CoV-2
8.
PLoS One ; 16(9): e0257608, 2021.
Article in English | MEDLINE | ID: covidwho-1416907

ABSTRACT

BACKGROUND: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION: Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. RESULTS: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION: Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.


Subject(s)
COVID-19 , Organ Dysfunction Scores , Pandemics , Adolescent , Adult , COVID-19/ethnology , COVID-19/mortality , Connecticut/epidemiology , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
9.
PLoS One ; 16(9): e0256763, 2021.
Article in English | MEDLINE | ID: covidwho-1416875

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes. METHODS: We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics. RESULTS: Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races. CONCLUSION: While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hospitals, University , Organ Dysfunction Scores , Triage/statistics & numerical data , Adolescent , Adult , African Americans/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Connecticut , Female , Healthcare Disparities/ethnology , Hospital Mortality/ethnology , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2/physiology , Triage/methods , Young Adult
10.
PLoS One ; 16(9): e0257423, 2021.
Article in English | MEDLINE | ID: covidwho-1406754

ABSTRACT

Health Care Leaders (HCLs) faced unprecedented challenges during the initial phases of the COVID-19 pandemic. Leaders played an important role in shaping the experiences of Health Care Workers (HCWs) during this time. However, research is needed on how HCWs experienced and characterized HCLs' response and support. The aim of our study was to examine HCWs' experiences with leadership and to identify aspects of HCLs' response that were effective in supporting HCWs in their roles during the early phases of the pandemic. This was a qualitative study based on open-ended semi-structured interviews conducted (June 1- July 18, 2020) with frontline HCWs during the first wave of the COVID-19 pandemic in Connecticut, USA. Participants (N = 45) included physicians, nurses, respiratory therapists and patient care assistants who worked in inpatient and outpatient settings in various specialties, roles and 3 health systems across Connecticut, USA during the COVID-19 pandemic. Participants were offered a $25 gift card as an incentive for participation. We used inductive techniques derived from grounded theory to develop themes. We identified 6 main themes related to leadership response and support of HCWs during the pandemic namely: 1) Effective communication and transparency; 2) Prioritizing their health and safety; 3) Employee scheduling considerations: autonomy, assignment support and respite; 4) Appreciation- financial and nonfinancial; 5) Showing up and listening and 6) Stepping up with resources. Our findings can inform leadership responses to future pandemics and other unanticipated crises leading to strengthening of the health care system as a whole.


Subject(s)
COVID-19 , Delivery of Health Care , Health Personnel , Leadership , Pandemics , Communication , Connecticut/epidemiology , Delivery of Health Care/economics , Delivery of Health Care/organization & administration , Humans
12.
PLoS One ; 16(7): e0254453, 2021.
Article in English | MEDLINE | ID: covidwho-1329135

ABSTRACT

BACKGROUND: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. RESEARCH QUESTION: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? STUDY DESIGN AND METHODS: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. RESULTS: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. INTERPRETATION: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.


Subject(s)
COVID-19/therapy , Adult , Aged , COVID-19/epidemiology , COVID-19/metabolism , Cohort Studies , Connecticut/epidemiology , Female , Hospital Mortality/trends , Humans , Immunization, Passive/methods , Inpatients , Length of Stay/statistics & numerical data , Male , Middle Aged , Propensity Score , Randomized Controlled Trials as Topic , SARS-CoV-2/isolation & purification , Treatment Outcome
13.
J Infect Public Health ; 14(10): 1563-1565, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1322219

ABSTRACT

BACKGROUND: In the United States, distribution plans for the COVID-19 vaccination were established at the state level. However, some states, such as Connecticut, followed an age-based strategy without considering occupations or co-morbid conditions due to its simplicity in implementation. This strategy raised concerns about exacerbating health inequities because it did not prioritize vulnerable communities, specifically, minorities and low-income groups. The study aims to examine the vaccination inequities among different population groups for people aged 65+. METHODS: A cross-sectional analysis of quantile-based independent sample t-test was employed to examine the relationship between eight social vulnerability indices (SVIs, i.e., below poverty, unemployed, without high school diploma, disability, minority, speaks English less than well, no vehicle, and mobile homes) and vaccination rates at the town level in Connecticut during the second phase of the vaccine distribution plan when individuals aged 65 and over were eligible. Negative binomial regressions were employed to further justify the relationships between SVIs and vaccination rates. RESULTS: The report shows that the differences in vaccination rates were statistically significant between the most vulnerable and the least vulnerable towns with respect to six SVIs (i.e., below poverty, without high school diploma, disability, minority, speaks English less than well, and no vehicle). The vaccination gap was greater for people aged 75+ than people aged 65-74. Among the selected SVIs, below poverty was negatively correlated with the vaccination rate for 75+, and without high school diploma was negatively correlated with both rates. CONCLUSIONS: This report reveals the significant health inequities in COVID-19 vaccination among the elderly population at the early vaccination phase. It can shed insights into health policy initiatives to improve vaccination coverage in the elderly communities, such as promoting onsite scheduling and increasing at-home vaccination services.


Subject(s)
COVID-19 Vaccines , COVID-19 , Aged , Connecticut , Cross-Sectional Studies , Humans , SARS-CoV-2 , United States , Vaccination
14.
JSLS ; 25(2)2021.
Article in English | MEDLINE | ID: covidwho-1305863

ABSTRACT

Background and Objectives: Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area. Methods: We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data. Results: Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk (P > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both P < .05). Discharges home reduced the risk to one-sixth of community spread (P = .03). Risk of infection doubled in hospitalizations > 5 days (P = .05) and quadrupled in discharges to extended care facilities (P = .01). Discussion: Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Elective Surgical Procedures/adverse effects , Patient Discharge/statistics & numerical data , Postoperative Complications/epidemiology , Aged , Aged, 80 and over , COVID-19/transmission , Connecticut/epidemiology , Cross Infection/virology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Operating Rooms , Postoperative Complications/virology , Retrospective Studies , SARS-CoV-2
15.
PLoS One ; 16(7): e0254252, 2021.
Article in English | MEDLINE | ID: covidwho-1304469

ABSTRACT

Increasing cases, insufficient amount of personal protection equipment, extremely demanding workloads, and lack of adequate therapies to save lives can contribute to a psychological burden directly related to working during disease outbreaks. Healthcare workers (HCWs) are at a high risk of contracting COVID-19 due to its ability to spread efficiently through asymptomatic and symptomatic individuals. There are limited studies assessing the pandemic's psychological impact on HCWs, specifically those in close proximity to hospitalized patients with COVID-19. Our study explored the emotions, perceived stressors, and coping strategies of front-line HCWs at high risk of exposure to COVID-19 during the first surge at our community-based teaching hospital, the epicenter of COVID-19 in Connecticut. A validated comprehensive questionnaire derived and modified from previous epidemics was used to inquire about staff feelings, factors that caused stress and factors that mitigated stress. Personal coping strategies and factors that can increase staff's motivation to work during future events of similar nature were also asked. Emotional reactions, coping mechanisms, and stressors varied by healthcare role, while some experiences and reactions were similar among groups. Willingness to participate in a second wave of the pandemic or future outbreaks is strongly driven by adequate personal protective equipment, financial recognition, and recognition from management, similarly reported in previous disease outbreaks. All groups felt a reduction in stress due to a sense of camaraderie and teamwork, as well as when sharing jokes or humor with colleagues. Our HCWs at high risk of exposure experienced significant emotional distress during the first wave of the COVID-19 pandemic. By understanding the needs and experiences of our HCWs at highest risk, we can improve our psychological support using targeted interventions during future waves of this pandemic or similar devastating events.


Subject(s)
Adaptation, Psychological , COVID-19/epidemiology , Health Personnel/psychology , Psychological Distress , SARS-CoV-2 , Adult , COVID-19/therapy , Connecticut/epidemiology , Female , Humans , Male , Middle Aged , Pandemics
16.
Clin Infect Dis ; 72(12): e1004-e1009, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1269561

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in December 2019, with subsequent worldwide spread. The first US cases were identified in January 2020. METHODS: To determine if SARS-CoV-2-reactive antibodies were present in sera prior to the first identified case in the United States on 19 January 2020, residual archived samples from 7389 routine blood donations collected by the American Red Cross from 13 December 2019 to 17 January 2020 from donors resident in 9 states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at the Centers for Disease Control and Prevention for anti-SARS-CoV-2 antibodies. Specimens reactive by pan-immunoglobulin (pan-Ig) enzyme-linked immunosorbent assay (ELISA) against the full spike protein were tested by IgG and IgM ELISAs, microneutralization test, Ortho total Ig S1 ELISA, and receptor-binding domain/ACE2 blocking activity assay. RESULTS: Of the 7389 samples, 106 were reactive by pan-Ig. Of these 106 specimens, 90 were available for further testing. Eighty-four of 90 had neutralizing activity, 1 had S1 binding activity, and 1 had receptor-binding domain/ACE2 blocking activity >50%, suggesting the presence of anti-SARS-CoV-2-reactive antibodies. Donations with reactivity occurred in all 9 states. CONCLUSIONS: These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to 19 January 2020.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Blood Donors , China , Connecticut , Enzyme-Linked Immunosorbent Assay , Humans , Immunoglobulin G , Iowa , Massachusetts , Michigan , Oregon , Rhode Island , Spike Glycoprotein, Coronavirus , Washington , Wisconsin
17.
J Am Dent Assoc ; 152(7): 535-541.e1, 2021 07.
Article in English | MEDLINE | ID: covidwho-1237579

ABSTRACT

BACKGROUND: COVID-19 has created barriers to the delivery of health care services, including dental care. This study sought to quantify the change in dental visits in 2020 compared with 2019. METHODS: This retrospective, observational study examined the percentage change in weekly visits to dental offices by state (inclusive of the District of Columbia), nationally, and by county-level COVID-19 incidence using geographic information from the mobile applications of 45 million smartphones during 2019 and 2020. RESULTS: From March through August 2020, weekly visits to dental offices were 33% lower, on average, than in 2019. Weekly visits were 34% lower, on average, in counties with the highest COVID-19 rates. The greatest decline was observed during the week of April 12, 2020, when there were 66% fewer weekly visits to dental offices. The 5 states (inclusive of the District of Columbia) with the greatest declines in weekly visits from 2019 through 2020, ranging from declines of 38% through 53%, were California, Connecticut, District of Columbia, Massachusetts, and New Jersey. CONCLUSIONS: Weekly visits to US dental offices declined drastically during the early phases of the COVID-19 pandemic. Although rates of weekly visits rebounded substantially by June 2020, rates remain about 20% lower than the prior year as of August 2020. These findings highlight the economic challenges faced by dentists owing to the pandemic. PRACTICAL IMPLICATIONS: States exhibited widespread variation in rates of declining visits during the pandemic, suggesting that dental practices may need to consider different approaches to reopening and encouraging patients to return depending on location.


Subject(s)
COVID-19 , Pandemics , Connecticut , Dental Offices , Humans , Office Visits , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
18.
Infect Control Hosp Epidemiol ; 42(5): 625-626, 2021 05.
Article in English | MEDLINE | ID: covidwho-1233675

ABSTRACT

Mass asymptomatic SARS-CoV-2 nucleic acid amplified testing of healthcare personnel (HCP) was performed at a large tertiary health system. A low period-prevalence of positive HCP was observed. Of those who tested positive, half had mild symptoms in retrospect. HCP with even mild symptoms should be isolated and tested.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Health Personnel/statistics & numerical data , COVID-19/diagnosis , COVID-19/transmission , Connecticut/epidemiology , Humans , SARS-CoV-2/isolation & purification
19.
JAMA Dermatol ; 157(6): 716-720, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1224947

ABSTRACT

Importance: In response to the coronavirus disease 2019 (COVID-19) pandemic, 2 mRNA vaccines (Pfizer-BioNTech and Moderna) received emergency use authorization from the US Food and Drug Administration in December 2020. Some patients in the US have developed delayed localized cutaneous vaccine reactions that have been dubbed "COVID arm." Objective: To describe the course of localized cutaneous injection-site reactions to the Moderna COVID-19 vaccine, subsequent reactions to the second vaccine dose, and to characterize the findings of histopathologic examination of the reaction. Design, Setting, and Participants: This retrospective case series study was performed at Yale New Haven Hospital, a tertiary medical center in New Haven, Connecticut, with 16 patients referred with localized cutaneous injection-site reactions from January 20 through February 12, 2021. Main Outcomes and Measures: We collected each patient's demographic information, a brief relevant medical history, clinical course, and treatment (if any); and considered the findings of a histopathologic examination of 1 skin biopsy specimen. Results: Of 16 patients (median [range] age, 38 [25-89] years; 13 [81%] women), 14 patients self-identified as White and 2 as Asian. The delayed localized cutaneous reactions developed in a median (range) of 7 (2-12) days after receiving the Moderna COVID-19 vaccine. These reactions occurred at or near the injection site and were described as pruritic, painful, and edematous pink plaques. None of the participants had received the Pfizer-BioNTech vaccine. Results of a skin biopsy specimen demonstrated a mild predominantly perivascular mixed infiltrate with lymphocytes and eosinophils, consistent with a dermal hypersensitivity reaction. Of participants who had a reaction to first vaccine dose (15 of 16 patients), most (11 patients) developed a similar localized injection-site reaction to the second vaccine dose; most (10 patients) also developed the second reaction sooner as compared with the first-dose reaction. Conclusions and Relevance: Clinical and histopathologic findings of this case series study indicate that the localized injection-site reactions to the Moderna COVID-19 vaccine are a delayed hypersensitivity reaction. These reactions may occur sooner after the second dose, but they are self-limited and not associated with serious vaccine adverse effects. In contrast to immediate hypersensitivity reactions (eg, anaphylaxis, urticaria), these delayed reactions (dubbed "COVID arm") are not a contraindication to subsequent vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Drug Eruptions/epidemiology , Injection Site Reaction/epidemiology , Adult , Aged , Aged, 80 and over , Connecticut/epidemiology , Drug Eruptions/diagnosis , Drug Eruptions/drug therapy , Drug Eruptions/immunology , Female , Histamine Antagonists/therapeutic use , Humans , Injection Site Reaction/diagnosis , Injection Site Reaction/drug therapy , Injection Site Reaction/immunology , Male , Middle Aged , Retrospective Studies , Skin/immunology , Skin/pathology
20.
Epidemiology ; 32(4): 518-524, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1211432

ABSTRACT

BACKGROUND: Serology tests can identify previous infections and facilitate estimation of the number of total infections. However, immunoglobulins targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to wane below the detectable level of serologic assays (which is not necessarily equivalent to the duration of protective immunity). We estimate the cumulative incidence of SARS-CoV-2 infection from serology studies, accounting for expected levels of antibody acquisition (seroconversion) and waning (seroreversion), and apply this framework using data from New York City and Connecticut. METHODS: We estimated time from seroconversion to seroreversion and infection fatality ratio (IFR) using mortality data from March to October 2020 and population-level cross-sectional seroprevalence data from April to August 2020 in New York City and Connecticut. We then estimated the daily seroprevalence and cumulative incidence of SARS-CoV-2 infection. RESULTS: The estimated average time from seroconversion to seroreversion was 3-4 months. The estimated IFR was 1.1% (95% credible interval, 1.0%, 1.2%) in New York City and 1.4% (1.1, 1.7%) in Connecticut. The estimated daily seroprevalence declined after a peak in the spring. The estimated cumulative incidence reached 26.8% (24.2%, 29.7%) at the end of September in New York City and 8.8% (7.1%, 11.3%) in Connecticut, higher than maximum seroprevalence measures (22.1% and 6.1%), respectively. CONCLUSIONS: The cumulative incidence of SARS-CoV-2 infection is underestimated using cross-sectional serology data without adjustment for waning antibodies. Our approach can help quantify the magnitude of underestimation and adjust estimates for waning antibodies.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Connecticut/epidemiology , Cross-Sectional Studies , Humans , Incidence , New York City , Seroepidemiologic Studies
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