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1.
PLoS One ; 16(9): e0257693, 2021.
Article in English | MEDLINE | ID: covidwho-1430551

ABSTRACT

BACKGROUND: LGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas. METHODS: Utilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach. RESULTS: Sixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services. CONCLUSION: Our study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.


Subject(s)
COVID-19/epidemiology , Homeless Persons/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adolescent , Female , Housing/statistics & numerical data , Humans , Male , Pandemics
2.
PLoS One ; 16(9): e0255498, 2021.
Article in English | MEDLINE | ID: covidwho-1410655

ABSTRACT

BACKGROUND: Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation. METHODS: A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to have a validated rapid antibody assay for immunoglobulins M (IgM) and G (IgG) and to answer a questionnaire on medical health conditions, comorbidities, and previous COVID-19 symptoms. Information on their housing conditions since the COVID-19 crisis was also collected from the participants. RESULTS: From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. The overall seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3-7.0), ranging from 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P = 0.009). Around one third of the seropositive participants reported COVID-19 symptoms. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced a significantly increased risk of SARS-CoV-2 infection (|z| = 3.65 > 1.96). CONCLUSION: These findings highlight the need for regular screening among the homeless to prevent clustering in overcrowded or inadequate accommodations. It is also necessary to provide essential resources to keep homeless people healthy, the vast majority of whom have cumulative risk factors for SARS-CoV-2 infection.


Subject(s)
Antibodies, Viral/immunology , COVID-19/diagnosis , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , SARS-CoV-2/immunology , Surveys and Questionnaires/statistics & numerical data , Adult , Aged , Antibodies, Viral/blood , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Epidemics/prevention & control , Female , France/epidemiology , Geography , Housing/standards , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Immunoglobulin M/blood , Immunoglobulin M/immunology , Male , Middle Aged , Population Surveillance/methods , SARS-CoV-2/physiology , Seroepidemiologic Studies
3.
PLoS One ; 16(9): e0256921, 2021.
Article in English | MEDLINE | ID: covidwho-1410627

ABSTRACT

Using a nationwide survey of primary grocery shoppers conducted in August 2020, we examine household food spending when the economy had partially reopened and consumers had different spending opportunities in comparison to when the Covid-19 lockdown began. We estimate the impact of Covid-19 on household spending using interval and Order Probit regressions. Income levels, age, access to grocery stores and farmers markets, household demographic information, along with other independent variables are controlled in the model. Findings show that middle-class households (with income below $50,000, or with income between $50,000 and $99,999) are less likely to increase their grocery expenditures during the pandemic. Households with children or elderlies that usually require higher food quality and nutrition intakes had a higher probability of increasing their spending during Covid-19 than before. Furthermore, consumers' spending behaviors were also significantly affected by their safe handing levels and the Covid-19 severity and food accessibility in their residences.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/economics , Family Characteristics , Food/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/virology , Child , Consumer Behavior/statistics & numerical data , Costs and Cost Analysis , Epidemics/prevention & control , Housing/standards , Housing/statistics & numerical data , Humans , Income/statistics & numerical data , SARS-CoV-2/physiology , Time Factors , United States
4.
MMWR Morb Mortal Wkly Rep ; 69(17): 521-522, 2020 May 01.
Article in English | MEDLINE | ID: covidwho-1389843

ABSTRACT

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , Pneumonia, Viral/epidemiology , Boston/epidemiology , COVID-19 , Cities , Georgia/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2 , San Francisco/epidemiology , Washington/epidemiology
5.
PLoS One ; 16(7): e0254954, 2021.
Article in English | MEDLINE | ID: covidwho-1319521

ABSTRACT

BACKGROUND: Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. METHODS: The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software. RESULTS: The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection. CONCLUSION: Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.


Subject(s)
COVID-19/epidemiology , Food Insecurity , Income/statistics & numerical data , Pandemics/economics , Vulnerable Populations/statistics & numerical data , Adult , Aged , Female , Housing/statistics & numerical data , Humans , Male , Middle Aged , Nepal/epidemiology , Surveys and Questionnaires , Young Adult
6.
Sci Rep ; 11(1): 11616, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-1253992

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the world's largest public health concern. This study evaluated COVID-19 transmission risks in people in group living environments. A total of 4550 individuals with a history of recent contact with patients at different places (dormitory/home/outside the residences) and levels (close/lower-risk) were tested for SARS-CoV-2 viral RNA using a nasopharyngeal swab test between July 2020 and May 2021. The test-positive rate was highest in individuals who had contact in dormitories (27.5%), but the rates were largely different between dormitories with different infrastructural or lifestyle features and infection control measures among residents. With appropriate infection control measures, the secondary transmission risk in dormitories was adequately suppressed. The household transmission rate (12.6%) was as high as that of close contact outside the residences (11.3%) and accounted for > 60% of the current rate of COVID-19 transmission among non-adults. Household transmission rates synchronized to local epidemics with changed local capacity of quarantining infectious patients. In conclusion, a group living environment is a significant risk factor of secondary transmission. Appropriate infection control measures and quarantine of infectious residents will decrease the risk of secondary transmission in group living environments.


Subject(s)
COVID-19/transmission , Adolescent , Adult , Aged , COVID-19/epidemiology , Child , Child, Preschool , Contact Tracing , Family Characteristics , Female , Housing/statistics & numerical data , Humans , Infant , Japan/epidemiology , Logistic Models , Male , Middle Aged , Young Adult
7.
BMC Med ; 19(1): 116, 2021 05 07.
Article in English | MEDLINE | ID: covidwho-1219073

ABSTRACT

BACKGROUND: COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. METHODS: We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing. RESULTS: The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9-6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0 = 1.5), moderate-risk (R0 = 2.9), and high-risk (R0 = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. CONCLUSIONS: In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/prevention & control , Computer Simulation , Disease Outbreaks/prevention & control , Homeless Persons , Infection Control/methods , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing/statistics & numerical data , Cities/epidemiology , Cities/statistics & numerical data , Computer Simulation/statistics & numerical data , Cross-Sectional Studies , Disease Outbreaks/statistics & numerical data , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , Humans , Infection Control/statistics & numerical data , Mass Screening/methods , Mass Screening/statistics & numerical data , United States/epidemiology
8.
Am J Public Health ; 111(5): 907-916, 2021 05.
Article in English | MEDLINE | ID: covidwho-1177867

ABSTRACT

Objectives. To assess SARS-CoV-2 transmission within a correctional facility and recommend mitigation strategies.Methods. From April 29 to May 15, 2020, we established the point prevalence of COVID-19 among incarcerated persons and staff within a correctional facility in Arkansas. Participants provided respiratory specimens for SARS-CoV-2 testing and completed questionnaires on symptoms and factors associated with transmission.Results. Of 1647 incarcerated persons and 128 staff tested, 30.5% of incarcerated persons (range by housing unit = 0.0%-58.2%) and 2.3% of staff tested positive for SARS-CoV-2. Among those who tested positive and responded to symptom questions (431 incarcerated persons, 3 staff), 81.2% and 33.3% were asymptomatic, respectively. Most incarcerated persons (58.0%) reported wearing cloth face coverings 8 hours or less per day, and 63.3% reported close contact with someone other than their bunkmate.Conclusions. If testing remained limited to symptomatic individuals, fewer cases would have been detected or detection would have been delayed, allowing transmission to continue. Rapid implementation of mass testing and strict enforcement of infection prevention and control measures may be needed to mitigate spread of SARS-CoV-2 in this setting.


Subject(s)
COVID-19 Testing , COVID-19 , Correctional Facilities/statistics & numerical data , Adult , Aged , Aged, 80 and over , Arkansas/epidemiology , COVID-19/epidemiology , COVID-19/transmission , Housing/statistics & numerical data , Humans , Male , Middle Aged , Prevalence , Prisoners/statistics & numerical data , Surveys and Questionnaires
9.
J Public Health Manag Pract ; 27(3): 285-294, 2021.
Article in English | MEDLINE | ID: covidwho-1150043

ABSTRACT

CONTEXT: Local agencies across the United States have identified public health isolation sites for individuals with coronavirus disease 2019 (COVID-19) who are not able to isolate in residence. PROGRAM: We describe logistics of establishing and operating isolation and noncongregate hotels for COVID-19 mitigation and use the isolation hotel as an opportunity to understand COVID-19 symptom evolution among people experiencing homelessness (PEH). IMPLEMENTATION: Multiple agencies in Atlanta, Georgia, established an isolation hotel for PEH with COVID-19 and noncongregate hotel for PEH without COVID-19 but at risk of severe illness. PEH were referred to the isolation hotel through proactive, community-based testing and hospital-based testing. Daily symptoms were recorded prospectively. Disposition location was recorded for all clients. EVALUATION: During April 10 to September 1, 2020, 181 isolation hotel clients (77 community referrals; 104 hospital referrals) were admitted a median 3 days after testing. Overall, 32% of community referrals and 7% of hospital referrals became symptomatic after testing positive; 83% of isolation hotel clients reported symptoms at some point; 93% completed isolation. Among 302 noncongregate hotel clients, median stay was 18 weeks; 61% were discharged to permanent housing or had a permanent housing discharge plan. DISCUSSION: Overall, a high proportion of PEH completed isolation at the hotel, suggesting a high level of acceptability. Many PEH with COVID-19 diagnosed in the community developed symptoms after testing, indicating that proactive, community-based testing can facilitate early isolation. Noncongregate hotels can be a useful COVID-19 community mitigation strategy by bridging PEH at risk of severe illness to permanent housing.


Subject(s)
COVID-19/prevention & control , Guidelines as Topic , Homeless Persons/statistics & numerical data , Housing/standards , Public Health/standards , Quarantine/standards , Social Isolation , Adolescent , Adult , Aged , Aged, 80 and over , Disease Management , Female , Georgia/epidemiology , Housing/statistics & numerical data , Humans , Male , Middle Aged , Public Health/statistics & numerical data , Quarantine/statistics & numerical data , SARS-CoV-2 , Young Adult
10.
J R Soc Med ; 114(4): 182-211, 2021 04.
Article in English | MEDLINE | ID: covidwho-1148193

ABSTRACT

OBJECTIVE: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. DESIGN: Causal mediation analysis. SETTING: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). PARTICIPANTS: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). MAIN OUTCOME MEASURES: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. RESULTS: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. CONCLUSION: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.


Subject(s)
COVID-19 , Family Characteristics/ethnology , Housing , Mortality/ethnology , Residence Characteristics/statistics & numerical data , Age Factors , Aged , COVID-19/mortality , COVID-19/prevention & control , Child , England/epidemiology , Family , Female , Health Status Disparities , Housing/standards , Housing/statistics & numerical data , Humans , Male , Risk Assessment , SARS-CoV-2 , Sex Factors , Socioeconomic Factors
11.
Int J Health Serv ; 51(3): 311-324, 2021 07.
Article in English | MEDLINE | ID: covidwho-1112399

ABSTRACT

Social inequalities in health are known to be influenced by the socioeconomic status of the territory in which people live. In the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, this study is aimed at assessing the role of 5 area-level indicators in shaping the risk of contagion in the provinces of Milan and Lodi (Lombardy, Italy), namely: educational disadvantage, unemployment, housing crowding, mobility, and population density. The study area includes the municipalities at the origin of the first Italian epidemic outbreak. Data on COVID-19 patients from the Integrated Datawarehouse for COVID Analysis in Milan were used and matched with aggregate-level data from the National Institute of Statistics Italy (Istat). Multilevel logistic regression models were used to estimate the association between the census block-level predictors and COVID-19 infection, independently of age, sex, country of birth, and preexisting health conditions. All the variables were significantly associated with the outcome, with different effects before and after the lockdown and according to the province of residence. This suggests a pattern of socioeconomic inequalities in the outbreak, which should be taken into account in the eventuality of future epidemics to contain their spread and its related disparities.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Residence Characteristics/statistics & numerical data , Socioeconomic Factors , Adult , Age Distribution , Aged , Comorbidity , Female , Housing/statistics & numerical data , Humans , Italy/epidemiology , Logistic Models , Male , Middle Aged , Pandemics , Population Density , SARS-CoV-2 , Sex Distribution , Social Class
12.
JAMA Pediatr ; 175(5): 494-500, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1107463

ABSTRACT

Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined. Objective: To determine the association of eviction actions during pregnancy with birth outcomes. Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020. Exposures: Eviction actions occurring during gestation. Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death. Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively. Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.


Subject(s)
Infant Welfare/statistics & numerical data , Maternal Welfare/statistics & numerical data , Poverty/statistics & numerical data , Pregnancy Outcome/epidemiology , Public Housing/statistics & numerical data , Vulnerable Populations/statistics & numerical data , Adult , COVID-19/epidemiology , Case-Control Studies , Family Characteristics , Female , Georgia , Housing/statistics & numerical data , Humans , Infant , Infant, Newborn , Pregnancy , Public Health
13.
Indoor Air ; 31(5): 1484-1494, 2021 09.
Article in English | MEDLINE | ID: covidwho-1109549

ABSTRACT

Air quality in indoor environments can have significant impacts on people's health, comfort, and productivity. Particulate matter (PM; also referred to as aerosols) is an important type of air pollutant, and exposure to outdoor PM has been associated with a variety of diseases. In addition, there is increasing recognition and concern of airborne transmission of viruses, including severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2), especially in indoor environments. Despite its importance, indoor PM data during the COVID-19 pandemic are scarce. In this work, we measured and compared particle number and mass concentrations in aircraft cabins during commercial flights with various indoor environments in Atlanta, GA, during July 2020, including retail stores, grocery stores, restaurants, offices, transportation, and homes. Restaurants had the highest particle number and mass concentrations, dominated by cooking emissions, while in-flight aircraft cabins had the lowest observed concentrations out of all surveyed spaces.


Subject(s)
Air Pollution, Indoor/analysis , Air Pollution , Particulate Matter/analysis , Aircraft/statistics & numerical data , COVID-19/epidemiology , Cooking , Environmental Monitoring , Housing/statistics & numerical data , Humans , Particle Size , Restaurants/statistics & numerical data , SARS-CoV-2 , Supermarkets
14.
Int J Infect Dis ; 102: 509-516, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-926973

ABSTRACT

OBJECTIVE: With an eye toward possible public policy implications, our objective is to identify the socio-economic and demographic factors that drive the large variation in COVID-19 incidence rates observed within relatively compact geographic regions, and to quantify the relative impact of each of these factors. We use international comparisons as a starting point. METHODS: New York City, consisting of some 175 zip codes, is an ideal arena to pursue the above study given the large variation in case incidence rates across zip codes. We conducted systematic regression studies employing data with zip code granularity. Our model specifications are based on a well-established epidemiologic model that explains the effects of household sizes on R0. RESULTS: Average household size emerges as the single most important driver behind the large variation in COVID-19 incidence rates. It independently explains 62% of the variation. The percentage of the population above the age of 65 and the percentage below the poverty line are also strongly positively associated with zip code incidence rates. As to ethnic/racial characteristics, the percentages of African Americans, Hispanics and Asians within the population are significantly associated, but the magnitude of the impact is smaller. (The proportion of Asians within a zip code has a negative association.) Contrary to common belief, population density, by itself, does not have a significantly positive impact (other than when a high population is driven by large household sizes). CONCLUSION: Our findings support implemented and proposed policies to quarantine patients and separate infected individuals from families or dormitories; they also support newly revised nursing home admission policies.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Crowding , Adult , Aged , Aged, 80 and over , COVID-19/economics , COVID-19/psychology , Female , Housing/statistics & numerical data , Humans , Male , Middle Aged , New York City/epidemiology , Population Density , Poverty
15.
Health Educ Behav ; 48(1): 14-19, 2021 02.
Article in English | MEDLINE | ID: covidwho-901733

ABSTRACT

U.S. college students are a distinct population facing major challenges due to the COVID-19 pandemic. Before the pandemic, students were already experiencing substantial mental health concerns, putting both their health and academic success in jeopardy. College students now face increasing housing and food insecurity, financial hardships, a lack of social connectedness and sense of belonging, uncertainty about the future, and access issues that impede their academic performance and well-being. There is also reason to believe that COVID-19 is exacerbating inequalities for students of color and low-income students. We provide several recommendations for institutions of higher education to mitigate these obstacles, including engaging in data-driven decision making, delivering clear and informative messaging to students, prioritizing and expanding student support services, and using an equity framework to guide all processes.


Subject(s)
COVID-19/epidemiology , Mental Health , Students/psychology , Universities/organization & administration , Academic Performance , Adolescent , Adult , Communication , Health Status , Housing/statistics & numerical data , Humans , Minority Groups/psychology , Pandemics , Risk Factors , SARS-CoV-2 , Socioeconomic Factors , Student Health Services/organization & administration , Young Adult
16.
Health Educ Behav ; 47(6): 850-854, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-858383

ABSTRACT

We are the next generation of public health practitioners. As public health students, we acknowledge that the COVID-19 (coronavirus disease 2019) pandemic will continue to fundamentally alter the field that we are preparing to enter. We will be the first wave of public health professionals whose education is being shaped by this pandemic. For decades to come, we will be working to address the impacts of this pandemic. In this commentary, we are lending our voice to discuss and highlight the importance of considering the intersections of various determinants of health and COVID-19, including education, food insecurity, housing instability, and economic hardship. We provide a discussion on what is being done across the United States in attempts to reduce the growing health inequities. As the next generation of public health leaders, we believe that only by investing in these issues can we begin to address the social and economic impact of the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Health/education , Social Determinants of Health , Students/psychology , Betacoronavirus , COVID-19 , Educational Status , Food Supply/statistics & numerical data , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Housing/statistics & numerical data , Humans , Pandemics , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
17.
West J Emerg Med ; 21(5): 1048-1053, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-792475

ABSTRACT

INTRODUCTION: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19-April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. RESULTS: A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. CONCLUSION: SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Status Disparities , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cross-Sectional Studies , Female , Health Policy , Health Surveys , Humans , Infection Control/methods , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Prevalence , Rhode Island/epidemiology , SARS-CoV-2 , Young Adult
18.
Clin Microbiol Infect ; 26(12): 1658-1662, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-753742

ABSTRACT

OBJECTIVES: Environmental surfaces have been suggested as likely contributors in the transmission of COVID-19. This study assessed the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contaminating surfaces and objects in two hospital isolation units and a quarantine hotel. METHODS: SARS-CoV-2 virus stability and infectivity on non-porous surfaces was tested under controlled laboratory conditions. Surface and air sampling were conducted at two COVID-19 isolation units and in a quarantine hotel. Viral RNA was detected by RT-PCR and infectivity was assessed by VERO E6 CPE test. RESULTS: In laboratory-controlled conditions, SARS-CoV-2 gradually lost its infectivity completely by day 4 at ambient temperature, and the decay rate of viral viability on surfaces directly correlated with increase in temperature. Viral RNA was detected in 29/55 surface samples (52.7%) and 16/42 surface samples (38%) from the surroundings of symptomatic COVID-19 patients in isolation units of two hospitals and in a quarantine hotel for asymptomatic and very mild COVID-19 patients. None of the surface and air samples from the three sites (0/97) were found to contain infectious titres of SARS-Cov-2 on tissue culture assay. CONCLUSIONS: Despite prolonged viability of SARS-CoV-2 under laboratory-controlled conditions, uncultivable viral contamination of inanimate surfaces might suggest low feasibility for indirect fomite transmission.


Subject(s)
COVID-19/transmission , Fomites/virology , Hospitals, Isolation/statistics & numerical data , Housing/statistics & numerical data , Microbial Viability , SARS-CoV-2/isolation & purification , COVID-19/virology , Humans , RNA, Viral/isolation & purification , Surface Properties , Temperature
19.
Indoor Air ; 31(2): 335-347, 2021 03.
Article in English | MEDLINE | ID: covidwho-735923

ABSTRACT

One of the main modes of transmission and propagation of COVID-19 (SARS-CoV-2) is the direct contact with respiratory droplets transmitted among individuals at a certain distance. There are indoor spaces, such as dwellings, in which the transmission risk is high. This research aims to record and analyze risk close contacts in this scope, experimentally assessing the effectiveness of using electronic proximity warning sound devices or systems. For this purpose, the methodology is based on monitoring the location of the occupants of a dwelling. Then, the days in which a proximity warning sound system is installed and activated are compared to the days in which the system is not activated. The results stressed the significant reduction of time and number of close contacts among individuals when the warning was activated. Regarding the relation between the number and the duration of close contacts, together with the reductions mentioned, the possibility of making certain predictions based on the distributions obtained is proved. All this contributes to the progress in the prevention of COVID-19 transmission because of close contacts in dwellings.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Housing/statistics & numerical data , Adult , COVID-19/prevention & control , Child , Female , Humans , Male , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2
20.
MMWR Morb Mortal Wkly Rep ; 69(33): 1139-1143, 2020 Aug 21.
Article in English | MEDLINE | ID: covidwho-724591

ABSTRACT

Preventing coronavirus disease 2019 (COVID-19) in correctional and detention facilities* can be challenging because of population-dense housing, varied access to hygiene facilities and supplies, and limited space for isolation and quarantine (1). Incarcerated and detained populations have a high prevalence of chronic diseases, increasing their risk for severe COVID-19-associated illness and making early detection critical (2,3). Correctional and detention facilities are not closed systems; SARS-CoV-2, the virus that causes COVID-19, can be transmitted to and from the surrounding community through staff member and visitor movements as well as entry, transfer, and release of incarcerated and detained persons (1). To better understand SARS-CoV-2 prevalence in these settings, CDC requested data from 15 jurisdictions describing results of mass testing events among incarcerated and detained persons and cases identified through earlier symptom-based testing. Six jurisdictions reported SARS-CoV-2 prevalence of 0%-86.8% (median = 29.3%) from mass testing events in 16 adult facilities. Before mass testing, 15 of the 16 facilities had identified at least one COVID-19 case among incarcerated or detained persons using symptom-based testing, and mass testing increased the total number of known cases from 642 to 8,239. Case surveillance from symptom-based testing has likely underestimated SARS-CoV-2 prevalence in correctional and detention facilities. Broad-based testing can provide a more accurate assessment of prevalence and generate data to help control transmission (4).


Subject(s)
Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/epidemiology , Disease Outbreaks/prevention & control , Mass Screening , Pneumonia, Viral/epidemiology , Prisons , COVID-19 , COVID-19 Testing , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Housing/statistics & numerical data , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prevalence , United States/epidemiology
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