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1.
MMWR Morb Mortal Wkly Rep ; 69(29): 960-964, 2020 07 24.
Article in English | MEDLINE | ID: covidwho-1389848

ABSTRACT

Population prevalence of persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), varies by subpopulation and locality. U.S. studies of SARS-CoV-2 infection have examined infections in nonrandom samples (1) or seroprevalence in specific populations* (2), which are limited in their generalizability and cannot be used to accurately calculate infection-fatality rates. During April 25-29, 2020, Indiana conducted statewide random sample testing of persons aged ≥12 years to assess prevalence of active infection and presence of antibodies to SARS-CoV-2; additional nonrandom sampling was conducted in racial and ethnic minority communities to better understand the impact of the virus in certain racial and ethnic minority populations. Estimates were adjusted for nonresponse to reflect state demographics using an iterative proportional fitting method. Among 3,658 noninstitutionalized participants in the random sample survey, the estimated statewide point prevalence of active SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing was 1.74% (95% confidence interval [CI] = 1.10-2.54); 44.2% of these persons reported no symptoms during the 2 weeks before testing. The prevalence of immunoglobulin G (IgG) seropositivity, indicating past infection, was 1.09% (95% CI = 0.76-1.45). The overall prevalence of current and previous infections of SARS-CoV-2 in Indiana was 2.79% (95% CI = 2.02-3.70). In the random sample, higher overall prevalences were observed among Hispanics and those who reported having a household contact who had previously been told by a health care provider that they had COVID-19. By late April, an estimated 187,802 Indiana residents were currently or previously infected with SARS-CoV-2 (9.6 times higher than the number of confirmed cases [17,792]) (3), and 1,099 residents died (infection-fatality ratio = 0.58%). The number of reported cases represents only a fraction of the estimated total number of infections. Given the large number of persons who remain susceptible in Indiana, adherence to evidence-based public health mitigation and containment measures (e.g., social distancing, consistent and correct use of face coverings, and hand hygiene) is needed to reduce surge in hospitalizations and prevent morbidity and mortality from COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Health Surveillance/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Child , Coronavirus Infections/ethnology , Female , Humans , Indiana/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , Prevalence , Young Adult
4.
AIDS ; 34(12): 1789-1794, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-1301407

ABSTRACT

BACKGROUND: There are limited data describing the presenting characteristics and outcomes among US persons with HIV (PWH) requiring hospitalization for coronavirus disease 2019 (COVID-19). METHODS: We performed a case series of all PWH sequentially admitted with COVID-19 from 8 March 2020 to 23 April 2020 at three hospitals in Atlanta, Georgia. Sociodemographic, clinical and HIV-associated characteristics were collected. RESULTS: Of 530 confirmed COVID-19 cases hospitalized during this period, 20 occurred among PWH (3.8%). The median age was 57 (Q1-Q3, 48-62) years, 65% were men, and 85% were non-Hispanic Black. Presenting median symptom duration was 5 (Q1-Q3, 3-7) days; cough (90%), fever (65%), malaise (60%) and dyspnea (60%) were most common. On admission, 40% of patients required oxygenation support and 65% had an abnormal chest radiograph. Median length of hospitalization was 5 (Q1-Q3, 4-12) days, 30% required intensive care, 15% required intubation, and 15% died. Median CD4 cell count prior to admission was 425 (Q1-Q3, 262-815) cells/µl and 90% of patients had HIV-1 RNA less than 200 copies/ml. Half of the patients had at least five comorbidities; hypertension (70%), dyslipidemia (60%) and diabetes (45%) were most prevalent. All three patients who died had CD4 cell count more than 200, HIV suppression and each had a total of five comorbidities. CONCLUSION: The multisite series in the Southern United States provides characteristics and early outcomes of hospitalized PWH with COVID-19. Nearly all patients had controlled HIV and a high comorbidity burden. Additional study of COVID-19 among PWH is needed to determine the role of age, comorbidities and HIV control in mediating COVID-19 presentation and its sequelae.


Subject(s)
Coronavirus Infections/epidemiology , HIV Infections/epidemiology , Pneumonia, Viral/epidemiology , African Americans/statistics & numerical data , CD4 Lymphocyte Count , COVID-19 , Comorbidity , Coronavirus Infections/ethnology , Coronavirus Infections/therapy , Female , Georgia/epidemiology , HIV Infections/ethnology , HIV Infections/therapy , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , Pneumonia, Viral/therapy , Retrospective Studies
5.
JMIR Public Health Surveill ; 7(4): e24288, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1170047

ABSTRACT

BACKGROUND: There is an urgent need for consistent collection of demographic data on COVID-19 morbidity and mortality and sharing it with the public in open and accessible ways. Due to the lack of consistency in data reporting during the initial spread of COVID-19, the Equitable Data Collection and Disclosure on COVID-19 Act was introduced into the Congress that mandates collection and reporting of demographic COVID-19 data on testing, treatments, and deaths by age, sex, race and ethnicity, primary language, socioeconomic status, disability, and county. To our knowledge, no studies have evaluated how COVID-19 demographic data have been collected before and after the introduction of this legislation. OBJECTIVE: This study aimed to evaluate differences in reporting and public availability of COVID-19 demographic data by US state health departments and Washington, District of Columbia (DC) before (pre-Act), immediately after (post-Act), and 6 months after (6-month follow-up) the introduction of the Equitable Data Collection and Disclosure on COVID-19 Act in the Congress on April 21, 2020. METHODS: We reviewed health department websites of all 50 US states and Washington, DC (N=51). We evaluated how each state reported age, sex, and race and ethnicity data for all confirmed COVID-19 cases and deaths and how they made this data available (ie, charts and tables only or combined with dashboards and machine-actionable downloadable formats) at the three timepoints. RESULTS: We found statistically significant increases in the number of health departments reporting age-specific data for COVID-19 cases (P=.045) and resulting deaths (P=.002), sex-specific data for COVID-19 deaths (P=.003), and race- and ethnicity-specific data for confirmed cases (P=.003) and deaths (P=.005) post-Act and at the 6-month follow-up (P<.05 for all). The largest increases were race and ethnicity state data for confirmed cases (pre-Act: 18/51, 35%; post-Act: 31/51, 61%; 6-month follow-up: 46/51, 90%) and deaths due to COVID-19 (pre-Act: 13/51, 25%; post-Act: 25/51, 49%; and 6-month follow-up: 39/51, 76%). Although more health departments reported race and ethnicity data based on federal requirements (P<.001), over half (29/51, 56.9%) still did not report all racial and ethnic groups as per the Office of Management and Budget guidelines (pre-Act: 5/51, 10%; post-Act: 21/51, 41%; and 6-month follow-up: 27/51, 53%). The number of health departments that made COVID-19 data available for download significantly increased from 7 to 23 (P<.001) from our initial data collection (April 2020) to the 6-month follow-up, (October 2020). CONCLUSIONS: Although the increased demand for disaggregation has improved public reporting of demographics across health departments, an urgent need persists for the introduced legislation to be passed by the Congress for the US states to consistently collect and make characteristics of COVID-19 cases, deaths, and vaccinations available in order to allocate resources to mitigate disease spread.


Subject(s)
COVID-19 , Coronavirus Infections , Data Collection , Public Health Surveillance , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Coronavirus Infections/epidemiology , Coronavirus Infections/ethnology , Data Interpretation, Statistical , District of Columbia , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Time Factors , United States/epidemiology , Young Adult
6.
Rev. Nutr. (Online) ; 33: e200171, 2020.
Article in English | LILACS (Americas) | ID: covidwho-1105900

ABSTRACT

ABSTRACT In Brazil, indigenous peoples present a complex reality characterized by a marked social vulnerability that is manifested in health and nutritional indicators. In this scenario, poor sanitary conditions prevail, with a high burden of chronic noncommunicable diseases; infectious/parasitic diseases; and nutritional disorders, including malnutrition and anemia. This situation is reflected in numerous aspects of food insecurity, placing this population in a position of particular vulnerability to the coronavirus disease 2019 pandemic and its effects. The objective of our study was to present a set of preliminary reflections on food insecurity and indigenous protagonism in times of Covid-19. The pandemic has deepened the inequalities that affect the indigenous peoples, with a direct impact on food security conditions. Amid the effects of the pandemic, indigenous protagonism has played a fundamental role in guaranteeing these peoples' rights and access to food, denouncing the absent and slow official responses as acts of institutional violence, which will have serious and lasting effects on the lives of indigenous peoples.


RESUMO No Brasil, os povos indígenas apresentam uma realidade complexa e caracterizada por uma acentuada vulnerabilidade social, manifesta em indicadores de saúde e de nutrição. Neste cenário prevalecem condições sanitárias precárias, com elevada carga de doenças crônicas não transmissíveis, doenças infecto-parasitárias e agravos nutricionais diversos, incluindo desnutrição e anemia. Esse quadro se reflete em inúmeras faces da insegurança alimentar, situando-os em uma posição particularmente vulnerável à pandemia e seus efeitos. O objetivo deste trabalho é apresentar um conjunto de reflexões, em caráter preliminar, sobre a insegurança alimentar e o protagonismo indígena em tempos de Covid-19. A pandemia vem aprofundando as iniquidades que os atingem, com impactos diretos nas condições de segurança alimentar. O protagonismo indígena tem tido um papel fundamental na garantia de seus direitos e acesso à alimentação, denunciando a ausência e a lentidão das respostas oficiais como ações de violência institucional, que terão graves e duradouros efeitos nas trajetórias destes povos.


Subject(s)
Humans , Coronavirus Infections/ethnology , Food Security , Indigenous Peoples , Social Organization
7.
AIDS ; 34(12): 1771-1774, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-1105050

ABSTRACT

: We performed an observational prospective monocentric study in patients living with HIV (PLWH) diagnosed with COVID-19. Fifty-four PLWH developed COVID-19 with 14 severe (25.9%) and five critical cases (9.3%), respectively. By multivariate analysis, age, male sex, ethnic origin from sub-Saharan Africa and metabolic disorder were associated with severe or critical forms of COVID-19. Prior CD4 T cell counts did not differ between groups. No protective effect of a particular antiretroviral class was observed.


Subject(s)
Coronavirus Infections/epidemiology , HIV Infections/complications , Pneumonia, Viral/epidemiology , Adult , Africa South of the Sahara/ethnology , Anti-Retroviral Agents/therapeutic use , CD4 Lymphocyte Count , COVID-19 , Coronavirus Infections/ethnology , Female , France/epidemiology , HIV Infections/drug therapy , Humans , Logistic Models , Male , Metabolic Diseases/complications , Middle Aged , Multivariate Analysis , Pandemics , Pneumonia, Viral/ethnology , Prospective Studies , Risk Assessment , Risk Factors
10.
Ann Epidemiol ; 52: 46-53.e2, 2020 12.
Article in English | MEDLINE | ID: covidwho-1023435

ABSTRACT

PURPOSE: The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally. METHODS: We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (≥17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. RESULTS: COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11-1.84, and aRR: 1.70, 95% CI: 1.57-1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo). CONCLUSIONS: COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition.


Subject(s)
Coronavirus Infections/mortality , Health Status Disparities , Pneumonia, Viral/mortality , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/ethnology , Coronavirus Infections/transmission , Humans , Local Government , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , Pneumonia, Viral/transmission , Population Surveillance , Residence Characteristics , SARS-CoV-2 , United States/epidemiology
12.
J Infect Dis ; 222(6): 890-893, 2020 08 17.
Article in English | MEDLINE | ID: covidwho-990713

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has unveiled unsettling disparities in the outcome of the disease among African Americans. These disparities are not new but are rooted in structural inequities that must be addressed to adequately care for communities of color. We describe the historical context of these structural inequities, their impact on the progression of COVID-19 in the African American (black) community, and suggest a multifaceted approach to addressing these healthcare disparities. (Of note, terminology from survey data cited for this article varied from blacks, African Americans, or both; for consistency, we use African Americans throughout.).


Subject(s)
African Americans , Betacoronavirus , Coronavirus Infections/epidemiology , Healthcare Disparities/ethnology , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus , Coronavirus Infections/ethnology , Health Services Accessibility , Health Status Disparities , Humans , Pandemics , Pneumonia, Viral/ethnology , Risk Factors , SARS-CoV-2 , Social Determinants of Health/ethnology , Socioeconomic Factors , United States/epidemiology
13.
Am J Public Health ; 110(11): 1628-1634, 2020 11.
Article in English | MEDLINE | ID: covidwho-982652

ABSTRACT

Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults.Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10-16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire.Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress.Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Stress, Psychological/epidemiology , Adolescent , Adult , Alcohol Drinking/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/ethnology , Depression/epidemiology , Female , Humans , Insurance, Health , Male , Marijuana Smoking/epidemiology , Medically Uninsured , Middle Aged , Pneumonia, Viral/ethnology , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology , Young Adult
14.
Am J Public Health ; 110(11): 1624-1627, 2020 11.
Article in English | MEDLINE | ID: covidwho-982651

ABSTRACT

Anti-Asian discrimination and assaults have increased significantly during the Coronavirus disease 2019 (COVID-19) pandemic, contributing to a "secondary contagion" of racism. The United States has a long and well-documented history of both interpersonal and structural anti-Asian discrimination, and the current pandemic reinforces longstanding negative stereotypes of this rapidly growing minority group as the "Yellow Peril."We provide a general overview of the history of anti-Asian discrimination in the United States, review theoretical and empirical associations between discrimination and health, and describe the associated public health implications of the COVID-19 pandemic, citing relevant evidence from previous disasters in US history that became racialized.Although the literature suggests that COVID-19 will likely have significant negative effects on the health of Asian Americans and other vulnerable groups, there are reasons for optimism as well. These include the emergence of mechanisms for reporting and tracking incidents of racial bias, increased awareness of racism's insidious harms and subsequent civic and political engagement by the Asian American community, and further research into resilience-promoting factors that can reduce the negative health effects of racism.


Subject(s)
Asian Americans , Coronavirus Infections/ethnology , Pneumonia, Viral/ethnology , Racism/statistics & numerical data , Asian Americans/history , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Pandemics , Pneumonia, Viral/epidemiology , Public Health/trends , Racism/history , SARS-CoV-2 , United States/epidemiology
16.
MMWR Morb Mortal Wkly Rep ; 69(28): 923-929, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-981648

ABSTRACT

During January 1, 2020-May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19-associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19-associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).


Subject(s)
Coronavirus Infections/mortality , Health Status Disparities , Pneumonia, Viral/mortality , Public Health Surveillance , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Chronic Disease , Coronavirus Infections/ethnology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , Risk Factors , United States/epidemiology , Young Adult
18.
Ethn Dis ; 30(3): 429-432, 2020.
Article in English | MEDLINE | ID: covidwho-937791

ABSTRACT

The randomized clinical trial (RCT) has long been recognized as the 'gold standard' for developing evidence for clinical treatments and vaccines; however, the successful implementation and translation of these findings is predicated upon external validity. The generalization of RCT findings are jeopardized by the lack of participation of at-risk groups such as African Americans, with long-recognized disproportional representation. Distinct factors that deter participation in RCTs include distrust, access, recruitment strategies, perceptions of research, and socioeconomic factors. While strategies have been implemented to improve external validity with greater participation among all segments of the population in RCTs, the coronavirus disease 2019 (COVID-19) pandemic may exacerbate disparities in RCT participation with the potential impact of delaying treatment development and vaccine interventions that are applicable and generalizable. Thus, it is essential to include diverse populations in such strategies and RCTs. This Perspective aims to direct attention to the additional harm from the pandemic as well as a refocus on the unresolved lack of inclusion of diverse populations in conducting RCTs.


Subject(s)
Coronavirus Infections , Pandemics , Patient Selection , Pneumonia, Viral , Randomized Controlled Trials as Topic , African Americans , Betacoronavirus , COVID-19 , Coronavirus Infections/ethnology , Coronavirus Infections/therapy , Health Status Disparities , Humans , Male , Patient Participation , Pneumonia, Viral/ethnology , Pneumonia, Viral/therapy , Randomized Controlled Trials as Topic/methods , Randomized Controlled Trials as Topic/standards , SARS-CoV-2 , Socioeconomic Factors , Vulnerable Populations/ethnology
19.
Medicine (Baltimore) ; 99(46): e22828, 2020 Nov 13.
Article in English | MEDLINE | ID: covidwho-922433

ABSTRACT

BACKGROUND: The Corona Virus Disease, 2019 (COVID-19) pandemic revealed many social disparities that already exist in countries that have social inequalities in their historical context. Studies have already been published on the epidemiological and clinical characteristics of population groups considered to be at risk where they reveal that Black people are at greater risk of becoming ill and dying from this cause. In this context, this protocol describes a systematic review that aims to analyze the association of race as the higher risk for illness and death due to COVID-19. METHODS: This protocol will be developed based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P). For this, we will conduct searches in the PubMed, Web of Science, Scopus, Lilacs, and ScienceDirect databases in the search for cross-sectional studies. All cross-sectional studies that analyzed hospitalization and death by COVID-19 as race in its determinant will be included. The search will be carried out by 2 independent researchers who will carry out the selection of articles, then the duplicate studies will be removed and screened using the Rayyan QCRI application. To assess the risk of bias, the instrument proposed by Downs and Black will be used. Meta-analyzes and subgroup analyzes will be carried out according to included data conditions. RESULTS: Based on this review, it will be possible to carry out a high-quality synthesis of available evidence that brings race as a factor for illness and death by COVID-19 and to verify which race is most affected by this disease. CONCLUSION: The relevance of this systematic review to the current context is considered, as it has a high potential to assist in the development of public health strategies and policies that address existing racial differences.Record of systematic review: CRD42020208767.


Subject(s)
Coronavirus Infections/ethnology , Pneumonia, Viral/ethnology , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Cross-Sectional Studies , Humans , Pandemics , Pneumonia, Viral/mortality , Research Design , Risk Factors , SARS-CoV-2
20.
Int J Environ Res Public Health ; 17(21)2020 Nov 03.
Article in English | MEDLINE | ID: covidwho-921200

ABSTRACT

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.


Subject(s)
Coronavirus Infections/ethnology , Pneumonia, Viral/ethnology , Social Determinants of Health , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Cross-Sectional Studies , Humans , Pandemics , Pneumonia, Viral/mortality , SARS-CoV-2 , United States/epidemiology
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