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1.
Med Care ; 60(7): 538-544, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1806714

ABSTRACT

IMPORTANCE: As states reopened their economies state and local officials made decisions on policies and restrictions that had an impact on the evolution of the pandemic and the health of the citizens. Some states made the decision to lift mask mandates starting spring 2021. Data-driven methods help evaluate the appropriateness and consequences of such decisions. OBJECTIVE: To investigate the association of lifting the mask mandate with changes in the cumulative coronavirus case rate. DESIGN: Synthetic control study design on lifting mask mandate in the state of Iowa implemented on February 7, 2021. SETTING: Daily state-level data from the COVID-19 Community Profile Report published by the US Department of Health & Human Services, COVIDcast dataset of the Delphi Research Group, and Google Community Mobility Reports. EXPOSURES AND OUTCOME: Mask mandate policy lift at the state level. State-day observations of the cumulative case rate measured as the cumulative number of new cases per 100,000 people in the previous 7 days. RESULTS: The cumulative case rate in Iowa increased by 20%-30% within 3 weeks of lifting the mask mandate as compared with a synthetic control unit. This association appeared to be related to people, in fact, reducing their mask-wearing habits. CONCLUSIONS: Lifting the mask mandate in Iowa was associated with an increase in new COVID-19 cases. Caution should be applied when making this type of policy decision before having achieved a more stable control of the pandemic.


Subject(s)
COVID-19 , COVID-19/prevention & control , Humans , Iowa/epidemiology , Pandemics , Policy , SARS-CoV-2
2.
Workplace Health Saf ; 70(1): 17-23, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1626724

ABSTRACT

Background: Migrant and seasonal farmworkers (MSFW) experience disproportionate infection, severe disease and death from COVID-19. This report describes an innovative process to address the safety of MSFW that utilized cohorting that eventually allowed for safe release to work in the fields on a large family farm in Iowa. Methods: Upon worker departure from Mexico, the employer arranged for bus seat assignments, mask use, and hand hygiene practice during the 3-day trip to Iowa. Upon arrival at the farm, surveillance testing and low-density housing cohorting based upon travel seat assignments allowed for early identification of infected workers and appropriate quarantine as per CDC guidelines. Upon completion of isolation or quarantine as appropriate, workers were released to congregate housing and work in the fields. Findings: Compared to a migrant farmworker COVID-19 outbreak without travel pre-planning, the cohorting process produced a 3.5% positivity rate compared to an earlier season July farmworker group on the same farm with a 12.7% positivity rate. Conclusions/Application to Practice: The success of this model points to the power of collaboration between farm employer, health care providers and workers to minimize worker infection and enable safe work in the fields. Increased state and federal support for MSFW protections could support infrastructure to proactively plan for prevention mechanisms to prevent the spread of known communicable disease. With support in place from the top down, employers, workers, and health care providers will be able to prioritize the management of infectious diseases and the needs of essential workers.


Subject(s)
COVID-19 , Transients and Migrants , Farmers , Humans , Iowa , SARS-CoV-2
3.
Viruses ; 14(2)2022 01 19.
Article in English | MEDLINE | ID: covidwho-1625724

ABSTRACT

Bats are a reservoir for coronaviruses (CoVs) that periodically spill over to humans, as evidenced by severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2. A collection of 174 bat samples originating from South Dakota, Minnesota, Iowa, and Nebraska submitted for rabies virus testing due to human exposure were analyzed using a pan-coronavirus PCR. A previously partially characterized CoV, Eptesicus bat CoV, was identified in 12 (6.9%) samples by nested RT-PCR. Six near-complete genomes were determined. Genetic analysis found a high similarity between all CoV-positive samples, Rocky Mountain bat CoV 65 and alphacoronavirus HCQD-2020 recently identified in South Korea. Phylogenetic analysis of genome sequences showed EbCoV is closely related to bat CoV HKU2 and swine acute diarrhea syndrome CoV; however, topological incongruences were noted for the spike gene that was more closely related to porcine epidemic diarrhea virus. Similar to some alphaCoVs, a novel gene, ORF7, was discovered downstream of the nucleocapsid, whose protein lacked similarity to known proteins. The widespread circulation of EbCoV with similarities to bat viruses that have spilled over to swine warrants further surveillance.


Subject(s)
Alphacoronavirus/classification , Alphacoronavirus/genetics , Chiroptera/virology , Disease Reservoirs/veterinary , Disease Reservoirs/virology , Phylogeny , Alphacoronavirus/isolation & purification , Animals , Genome, Viral , Iowa , Midwestern United States , Minnesota , Republic of Korea , Sequence Analysis, DNA , South Dakota , Viral Zoonoses/transmission
4.
Am J Infect Control ; 50(3): 277-282, 2022 03.
Article in English | MEDLINE | ID: covidwho-1611567

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. METHODS: We retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. RESULTS: A total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. CONCLUSIONS: Our IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.


Subject(s)
COVID-19 , COVID-19/prevention & control , Humans , Infection Control , Iowa/epidemiology , Pandemics/prevention & control , SARS-CoV-2
6.
Emerg Infect Dis ; 28(1): 69-75, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1463442

ABSTRACT

In September of 2020, the Iowa Department of Public Health released guidance stating that persons exposed to someone with coronavirus disease (COVID-19) need not quarantine if the case-patient and the contact wore face masks at the time of exposure. This guidance differed from that issued by the Centers for Disease Control and Prevention. To determine the best action, we matched exposure information from COVID-19 case investigations with reported test results and calculated the secondary attack rates (SARs) after masked and unmasked exposures. Mask use by both parties reduced the SAR by half, from 25.6% to 12.5%. Longer exposure duration significantly increased SARs. Masks significantly reduced virus transmission when worn by both the case-patient and the contact, but SARs for each group were higher than anticipated. This finding suggests that quarantine after COVID-19 exposure is beneficial even if parties wore masks.


Subject(s)
COVID-19 , Humans , Iowa , Masks , Quarantine , SARS-CoV-2
7.
Am J Prev Med ; 61(5 Suppl 1): S108-S117, 2021 11.
Article in English | MEDLINE | ID: covidwho-1453985

ABSTRACT

INTRODUCTION: Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas. However, little is known about the best practices for such partnerships. Iowa TelePrEP, a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa, expanded statewide between 2017 and 2019. This qualitative evaluation assessed the barriers and facilitators to statewide expansion and the lessons learned. METHODS: Key informants from public health partners across Iowa participated in a focus group and interviews between May 2019 and November 2020. Public health partners included local health departments and disease intervention specialist/partner services programs. Qualitative data were transcribed and thematically coded. Program documents and routinely collected reporting data were reviewed to provide the context for qualitative findings. Data were analyzed in 2020. RESULTS: TelePrEP expanded in 4 phases through partnerships with 12 public health partners. Public health partners referred 708 clients with pre-exposure prophylaxis indications to telenavigation; of these, 258 were navigated to TelePrEP, and 167 initiated pre-exposure prophylaxis. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings. The barriers included the need to adapt communication and processes to varying public health partners, difficulty in engaging underserved populations, the COVID-19 pandemic, and perceived gaps in understanding client outcomes. CONCLUSIONS: Partnerships between regional telehealth programs and local health departments can expand to the state level and increase the capacity to implement pre-exposure prophylaxis in rural and small urban settings. Partnerships should consider how to balance program adaptability to local public health partners with standardization and scalability.


Subject(s)
COVID-19 , Pre-Exposure Prophylaxis , Humans , Iowa , Pandemics , Qualitative Research , SARS-CoV-2
8.
Health Aff (Millwood) ; 40(8): 1270-1276, 2021 08.
Article in English | MEDLINE | ID: covidwho-1337569

ABSTRACT

During the COVID-19 pandemic, safely reopening schools has been one of the most pressing public health challenges in the United States. At the beginning of the 2020-21 school year, the Centers for Disease Control and Prevention strongly encouraged schools to require mask wearing. Although teachers unions frequently supported such policies, the adoption of mask mandates was uneven. We examined whether teachers unions were associated with mask mandates, using proprietary data on school district-level unionization and mask mandates from the Iowa State Education Association, the state's main teachers union. We found that a 1-standard-deviation increase in the teachers' unionization rate was associated with a 12.5 percent relative increase in the probability that a school district adopted a mask mandate. These findings, which are robust to multiple specification checks, help illuminate an important mechanism by which labor unions have informed safety policies in schools during the COVID-19 pandemic.


Subject(s)
COVID-19 , Humans , Iowa , Masks , Pandemics , SARS-CoV-2 , Schools , United States
9.
J Med Internet Res ; 23(7): e28812, 2021 07 26.
Article in English | MEDLINE | ID: covidwho-1334873

ABSTRACT

BACKGROUND: The COVID-19 pandemic has changed public health policies and human and community behaviors through lockdowns and mandates. Governments are rapidly evolving policies to increase hospital capacity and supply personal protective equipment and other equipment to mitigate disease spread in affected regions. Current models that predict COVID-19 case counts and spread are complex by nature and offer limited explainability and generalizability. This has highlighted the need for accurate and robust outbreak prediction models that balance model parsimony and performance. OBJECTIVE: We sought to leverage readily accessible data sets extracted from multiple states to train and evaluate a parsimonious predictive model capable of identifying county-level risk of COVID-19 outbreaks on a day-to-day basis. METHODS: Our modeling approach leveraged the following data inputs: COVID-19 case counts per county per day and county populations. We developed an outbreak gold standard across California, Indiana, and Iowa. The model utilized a per capita running 7-day sum of the case counts per county per day and the mean cumulative case count to develop baseline values. The model was trained with data recorded between March 1 and August 31, 2020, and tested on data recorded between September 1 and October 31, 2020. RESULTS: The model reported sensitivities of 81%, 92%, and 90% for California, Indiana, and Iowa, respectively. The precision in each state was above 85% while specificity and accuracy scores were generally >95%. CONCLUSIONS: Our parsimonious model provides a generalizable and simple alternative approach to outbreak prediction. This methodology can be applied to diverse regions to help state officials and hospitals with resource allocation and to guide risk management, community education, and mitigation strategies.


Subject(s)
COVID-19/epidemiology , Computer Simulation , Datasets as Topic , Disease Outbreaks/statistics & numerical data , Forecasting/methods , Heuristics , Public Sector , COVID-19/prevention & control , California/epidemiology , Humans , Indiana/epidemiology , Iowa/epidemiology , Models, Biological , SARS-CoV-2
10.
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
11.
J Vet Med Educ ; 49(2): 141-150, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1217034

ABSTRACT

Policy changes in response to the coronavirus disease 2019 (COVID-19) pandemic at Iowa State University College of Veterinary Medicine (ISU-CVM) included the administrative directive that fourth-year (VM4) clinical rotations immediately transition from in-person to virtual format. This article summarizes the efforts, successes, and challenges experienced by ISU-CVM clinical faculty during this transition. Numerous data sources were reviewed, including college records and announcements, faculty survey results, and student rotation evaluations. Data were explored using quantitative and qualitative methods. Between March and July 2020, 36 faculty from 15 different clinical services invested approximately 5,000 hours in delivering virtual content to 165 VM4 students from ISU-CVM and Caribbean veterinary schools. With departmental, college, and university assistance, faculty effectively used educational technologies (Zoom, Canvas, Echo360) and developed adaptive and innovative methods for virtual content delivery. Virtual VM4 rotations were collectively well received and appreciated by students, and student evaluation scores for virtual rotations were statistically equivalent to or higher than those for the corresponding in-person rotations in the preceding year. Although certain hands-on skills could not be adequately acquired in a virtual environment, students gained theoretical knowledge and case-based problem-solving skills in the online format. Faculty reported satisfaction with their adaptability and resilience in these challenging circumstances. These findings demonstrate that ISU-CVM clinical faculty invested substantial time and effort to transition in-person clinical rotations to virtual format during the early COVID-19 pandemic. This is particularly noteworthy given that many of these same faculty simultaneously served as essential personnel managing clinical cases in the university's teaching hospital.


Subject(s)
COVID-19 , Education, Veterinary , Animals , COVID-19/epidemiology , COVID-19/veterinary , Humans , Iowa/epidemiology , Pandemics , Universities
12.
Am J Public Health ; 111(6): 1035-1039, 2021 06.
Article in English | MEDLINE | ID: covidwho-1216999

ABSTRACT

We report on data we collected from a 2018 survey examining jails' human papillomavirus virus vaccine delivery capacity and on a secondary analysis we conducted to describe factors similarly associated with delivery planning for the COVID-19 vaccine. We provide recommendations for delivering the COVID-19 vaccine in jails, based on evidence from Kansas, Iowa, Nebraska, and Missouri. Our key finding is that jails have limited staff to implement vaccination and will require collaboration between jail administrators, jail medical staff, and local health departments.


Subject(s)
COVID-19 Vaccines/administration & dosage , Health Personnel , Immunization Programs , Jails , Public Health , COVID-19/prevention & control , Female , Humans , Iowa , Kansas , Male , Missouri , Papillomavirus Vaccines/administration & dosage
13.
J Agromedicine ; 26(3): 346-351, 2021 07.
Article in English | MEDLINE | ID: covidwho-1203487

ABSTRACT

Migrant and seasonal farmworkers are a vulnerable population with unique health and safety challenges related to the entire spectrum of the social determinants of health. These challenges place migrant and seasonal farmworkers at a disproportionate risk of infection and illness because of the COVID-19 pandemic. This report presents a case study of an early COVID-19 outbreak among migrant farmworkers in Iowa and describes the role that a nimble and responsive mobile federally qualified health center played in the successful mitigation and response to this outbreak. Early during the pandemic, the clinic adopted a new model of service delivery utilizing telemedicine primary care visits, followed by in-person visits when necessary. As the pandemic progressed, clinic staff strategized to provide increased pandemic-related support to agricultural employers and migrant farmworkers across the state. Emphasis was placed on on-site testing and education regarding social distancing, mask utilization, and hand washing. Eventually, as migrant workers were infected and became symptomatic, more complex mitigation strategies such as isolation, quarantine, and clinical follow-up were also implemented. This report describes how a mobile primary care clinic developed a pandemic responsive model to provide successful mitigation of an early COVID-19 outbreak among essential and highly vulnerable migrant farmworkers.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility , Mobile Health Units , Occupational Health Services , Primary Health Care , SARS-CoV-2 , Disease Outbreaks , Farmers , Humans , Iowa , Transients and Migrants
14.
Psychiatr Danub ; 33(1): 107-113, 2021.
Article in English | MEDLINE | ID: covidwho-1187233

ABSTRACT

BACKGROUND: The aim of this study is to investigate risk-taking behavior and decision-making processes in recovered COVID-19 patients. SUBJECTS AND METHODS: Twenty patients recovered from COVID-19 as confirmed by polymerase chain reaction (PCR) tests and twenty-one healthy individuals were recruited. A computerized version of the Iowa Gambling Test (IGT) for measuring risk-taking behavior tendencies as a decision-making process and State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and WMS-R Digit Span Forward Test (DSFT) for clinical assessments included. The assessments of the recovered patients were applied on the initial phase that the tests of the patients were negative and on the 4-week follow up phase. RESULTS: The results showed that the anxiety scores were significantly higher in the healthy control group than in the group of recovered patients. The IGT-Net 4 scores were significantly and IGT-Net total scores were marginally significantly lower in the group of recovered patients. In other words, recovered patients showed higher risk-taking behavior tendencies. This tendency difference is consistent with the anxiety levels of the groups. These IGT scores showed to be persistent in the 4-week follow up phase. CONCLUSIONS: Our findings indicate that recovered patients show higher risk-taking behavior tendencies than healthy controls and this may be the result of overcoming the COVID-19 threat.


Subject(s)
COVID-19 , Gambling , Decision Making , Humans , Iowa , Risk-Taking , SARS-CoV-2
15.
Vaccine ; 39(17): 2445-2451, 2021 04 22.
Article in English | MEDLINE | ID: covidwho-1127058

ABSTRACT

BACKGROUND: Vaccine hesitancy could undermine the effectiveness of COVID-19 vaccination programs. Knowledge about people's lived experiences regarding COVID-19 vaccination can enhance vaccine promotion and increase uptake. AIM: To use COVID-19 vaccine trial participants' experiences to identify key themes in the lived experience of vaccination early in the vaccine approval and distribution process. METHODS: We interviewed 31 participants in the Iowa City, Iowa US site of the Pfizer/BioNTech COVID-19 vaccine phase 3 clinical trial. While trial participation differs from clinical receipt of an approved vaccine in key ways, it offers the first view of people's lived experiences of potentially receiving a COVID-19 vaccine. The trial context is also useful since decision-making about vaccination and medical research participation often involve similar hopes and concerns, and because the public appears to view even approved COVID-19 vaccines as experimental given their novelty. Semi-structured interviews addressed subjects' experiences, including decision-making and telling others about their trial participation. We analyzed verbatim transcripts of these interviews thematically and identified common themes relevant for vaccination decision-making. RESULTS: Participants across demographic groups, including age, sex/gender, race/ethnicity, and political affiliation, described largely similar experiences. Key motivations for participation included ending the pandemic/restoring normalcy, protecting oneself and others, doing one's duty, promoting/modeling vaccination, and expressing aspects of identity like being a helper, career-related motivations, and support of science/vaccines. Participants often felt uniquely qualified to help via trial participation due to personal attributes like health, sex/gender or race/ethnicity. They reported hearing concerns about side effects and the speed and politicization of vaccine development. Participants responded by normalizing and contextualizing side effects, de-politicizing vaccine development, and explaining how the rapid development process was nevertheless safe. CONCLUSION: These findings regarding participants' reported motivations for trial participation and interactions with concerned others can be incorporated into COVID-19 vaccine promotion messaging aimed at similar populations.


Subject(s)
COVID-19 , Vaccines , COVID-19 Vaccines , Humans , Iowa , Motivation , SARS-CoV-2
16.
Am J Perinatol ; 38(6): 614-621, 2021 05.
Article in English | MEDLINE | ID: covidwho-1091441

ABSTRACT

OBJECTIVE: This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN: This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. RESULTS: In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26-33 years) and body mass index was 31.75 kg/m2 (IQR 27.7-37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. CONCLUSION: In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. KEY POINTS: · SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.. · Infections are higher among minorities, non-English speakers, and patients without private insurance.. · No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers..


Subject(s)
COVID-19 Testing , COVID-19 , Cesarean Section , Pregnancy Complications, Infectious , Pregnancy Outcome/ethnology , SARS-CoV-2/isolation & purification , Adult , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Electronic Health Records/statistics & numerical data , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Iowa/epidemiology , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Premature Birth/epidemiology , Seroepidemiologic Studies , Severity of Illness Index , Tertiary Healthcare/statistics & numerical data
17.
JAMA Netw Open ; 3(5): e2011102, 2020 05 01.
Article in English | MEDLINE | ID: covidwho-267438

ABSTRACT

Importance: Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state. Objective: To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order. Design, Setting, and Participants: This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10 000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates. Exposures: Issuing a stay-at-home order. Main Outcomes and Measures: Comparison of cumulative cases of COVID-19 per 10 000 residents in border counties in Iowa and Illinois. Results: The total populations were 462 445 in the Iowa border counties and 272 385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10 000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10 000 residents vs 0.026 per 10 000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10 000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10 000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10 000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings. Conclusions and Relevance: This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10 000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Humans , Illinois/epidemiology , Iowa/epidemiology , Population Density , SARS-CoV-2
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