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1.
Medicine (Baltimore) ; 100(41): e27399, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1501200

ABSTRACT

ABSTRACT: The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.


Subject(s)
Ambulatory Care/organization & administration , Office Visits/statistics & numerical data , Telemedicine/organization & administration , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , Delivery of Health Care, Integrated/organization & administration , Humans , Kentucky/epidemiology , Pandemics , Primary Health Care/organization & administration , Quality Improvement , SARS-CoV-2
2.
Public Health Rep ; 136(1_suppl): 72S-79S, 2021.
Article in English | MEDLINE | ID: covidwho-1495836

ABSTRACT

OBJECTIVE: Traditional public health surveillance of nonfatal opioid overdose relies on emergency department (ED) billing data, which can be delayed substantially. We compared the timeliness of 2 new data sources for rapid drug overdose surveillance-emergency medical services (EMS) and syndromic surveillance-with ED billing data. METHODS: We used data on nonfatal opioid overdoses in Kentucky captured in EMS, syndromic surveillance, and ED billing systems during 2018-2019. We evaluated the time-series relationships between EMS and ED billing data and syndromic surveillance and ED billing data by calculating cross-correlation functions, controlling for influences of autocorrelations. A case example demonstrates the usefulness of EMS and syndromic surveillance data to monitor rapid changes in opioid overdose encounters in Kentucky during the COVID-19 epidemic. RESULTS: EMS and syndromic surveillance data showed moderate-to-strong correlation with ED billing data on a lag of 0 (r = 0.694; 95% CI, 0.579-0.782; t = 9.73; df = 101; P < .001; and r = 0.656; 95% CI, 0.530-0.754; t = 8.73; df = 101; P < .001; respectively) at the week-aggregated level. After the COVID-19 emergency declaration, EMS and syndromic surveillance time series had steep increases in April and May 2020, followed by declines from June through September 2020. The ED billing data were available for analysis 3 months after the end of a calendar quarter but closely followed the trends identified by the EMS and syndromic surveillance data. CONCLUSION: Data from EMS and syndromic surveillance systems can be reliably used to monitor nonfatal opioid overdose trends in Kentucky in near-real time to inform timely public health response.


Subject(s)
Analgesics, Opioid/poisoning , Drug Overdose/epidemiology , Emergency Medical Services/statistics & numerical data , Opioid-Related Disorders/epidemiology , Population Surveillance/methods , Public Health Surveillance/methods , Sentinel Surveillance , Analgesics, Opioid/administration & dosage , COVID-19/epidemiology , Drug Overdose/prevention & control , Emergencies/epidemiology , Emergency Medical Services/trends , Humans , Kentucky/epidemiology , Pandemics , Public Health , SARS-CoV-2
3.
Am J Addict ; 30(4): 330-333, 2021 07.
Article in English | MEDLINE | ID: covidwho-1494383

ABSTRACT

BACKGROUND AND OBJECTIVES: We sought to understand the impact of COVID-19 on emergency department (ED) overdoses and county coroner verified overdose deaths. METHODS: Electronic medical health record and county coroner data were gathered and comparisons were made between three 16-week time periods. In the three time periods, 873 individuals had an overdose diagnosis in the ED and 440 individuals in the county died of drug overdose. RESULTS: While total ED patient volume decreased substantially, the number of ED overdose patients increased between March 6 and June 25, 2020. Furthermore, during this same period, coroner data revealed an increase in overdose deaths. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This preliminary evidence provides a key insight into the impact of COVID-19 on both overdose presentations to the ED and county overdose deaths. These results emphasize the critical need for increasing vigilance to prevent overdose by continuously developing and optimizing both accessible and quality treatment as we navigate through this pandemic and its ongoing effects on persons with substance use disorder. (Am J Addict 2021;00:00-00).


Subject(s)
COVID-19/psychology , Drug Overdose/diagnosis , Drug Overdose/mortality , Emergency Medical Services/statistics & numerical data , Substance-Related Disorders/mortality , Adult , COVID-19/epidemiology , Female , Humans , Kentucky/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Socioeconomic Factors
4.
Sci Rep ; 11(1): 18285, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1410888

ABSTRACT

Serological assays intended for diagnosis, sero-epidemiologic assessment, and measurement of protective antibody titers upon infection or vaccination are essential for managing the SARS-CoV-2 pandemic. Serological assays measuring the antibody responses against SARS-CoV-2 antigens are readily available. However, some lack appropriate characteristics to accurately measure SARS-CoV-2 antibodies titers and neutralization. We developed an Enzyme-linked Immunosorbent Assay (ELISA) methods for measuring IgG, IgA, and IgM responses to SARS-CoV-2, Spike (S), receptor binding domain (RBD), and nucleocapsid (N) proteins. Performance characteristics of sensitivity and specificity have been defined. ELISA results show positive correlation with microneutralization and Plaque Reduction Neutralization assays with infectious SARS-CoV-2. Our ELISA was used to screen healthcare workers in Louisville, KY during the first wave of the local pandemic in the months of May and July 2020. We found a seropositive rate of approximately 1.4% and 2.3%, respectively. Our analyses demonstrate a broad immune response among individuals and suggest some non-RBD specific S IgG and IgA antibodies neutralize SARS-CoV-2.


Subject(s)
Antibodies, Viral/blood , COVID-19/epidemiology , SARS-CoV-2/immunology , Area Under Curve , COVID-19/blood , COVID-19/virology , Coronavirus Nucleocapsid Proteins/immunology , Enzyme-Linked Immunosorbent Assay , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Kentucky/epidemiology , Pandemics , Phosphoproteins/immunology , ROC Curve , SARS-CoV-2/isolation & purification , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/chemistry , Spike Glycoprotein, Coronavirus/immunology
5.
MMWR Morb Mortal Wkly Rep ; 70(32): 1081-1083, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1355297

ABSTRACT

Although laboratory evidence suggests that antibody responses following COVID-19 vaccination provide better neutralization of some circulating variants than does natural infection (1,2), few real-world epidemiologic studies exist to support the benefit of vaccination for previously infected persons. This report details the findings of a case-control evaluation of the association between vaccination and SARS-CoV-2 reinfection in Kentucky during May-June 2021 among persons previously infected with SARS-CoV-2 in 2020. Kentucky residents who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.58-3.47). These findings suggest that among persons with previous SARS-CoV-2 infection, full vaccination provides additional protection against reinfection. To reduce their risk of infection, all eligible persons should be offered vaccination, even if they have been previously infected with SARS-CoV-2.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Reinfection/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Kentucky/epidemiology , Male , Middle Aged , Reinfection/epidemiology , Risk Assessment , Young Adult
6.
PLoS One ; 16(7): e0248324, 2021.
Article in English | MEDLINE | ID: covidwho-1329132

ABSTRACT

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14-20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.


Subject(s)
COVID-19/prevention & control , Masks/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Humans , Kentucky/epidemiology , Pandemics , Prevalence , Public Facilities , Public Health/methods , SARS-CoV-2/isolation & purification
7.
PLoS One ; 16(7): e0250152, 2021.
Article in English | MEDLINE | ID: covidwho-1290230

ABSTRACT

Early in the pandemic, slowing the spread of novel coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions. All U.S. states adopted social-distancing restrictions in March and April of 2020, though policies varied both in timing and scope. Compared to states with Democratic governors, those with Republican governors often adopted measures for shorter durations and with greater resistance from their residents. In Kentucky, an extremely close gubernatorial election immediately prior to the discovery of SARS-CoV-2 replaced a Republican incumbent with a Democrat, despite Republicans easily winning all other statewide races. This chance election result offers a unique opportunity to examine the impact of early social distancing policies in a relatively conservative, rural, white-working-class state. Our study begins by estimating an event-study model to link adoption of several common social distancing measures-public school closures, bans on large gatherings, closures of entertainment-related businesses such as restaurants, and shelter-in-place orders (SIPOs)-to the growth rate of cases across counties in the Midwest and South in the early stages of the pandemic. These policies combined to slow the daily growth rate of COVID-19 cases by 9 percentage points after 16 days, with SIPOs and entertainment establishment closures accounting for the entire effect. In order to obtain results with more direct applicability to Kentucky, we then estimate a model that interacts the policy variables with a "white working class" index characterized by political conservatism, rurality, and high percentages of white, evangelical Christian residents without college degrees. We find that the effectiveness of early social distancing measures decreased with higher values of this index. The results imply that the restrictions combined to slow the spread of COVID-19 by 12 percentage points per day in Kentucky's two largest urban counties but had no statistically detectable effect across the rest of the state.


Subject(s)
COVID-19/epidemiology , Physical Distancing , COVID-19/prevention & control , Health Policy , Humans , Kentucky/epidemiology , Models, Econometric , SARS-CoV-2/isolation & purification , United States
8.
MMWR Morb Mortal Wkly Rep ; 70(17): 639-643, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1207943

ABSTRACT

Although COVID-19 mRNA vaccines demonstrated high efficacy in clinical trials (1), they were not 100% efficacious. Thus, some infections postvaccination are expected. Limited data are available on effectiveness in skilled nursing facilities (SNFs) and against emerging variants. The Kentucky Department for Public Health (KDPH) and a local health department investigated a COVID-19 outbreak in a SNF that occurred after all residents and health care personnel (HCP) had been offered vaccination. Among 83 residents and 116 HCP, 75 (90.4%) and 61 (52.6%), respectively, received 2 vaccine doses. Twenty-six residents and 20 HCP received positive test results for SARS-CoV-2, the virus that causes COVID-19, including 18 residents and four HCP who had received their second vaccine dose >14 days before the outbreak began. An R.1 lineage variant was detected with whole genome sequencing (WGS). Although the R.1 variant has multiple spike protein mutations, vaccinated residents and HCP were 87% less likely to have symptomatic COVID-19 compared with those who were unvaccinated. Vaccination of SNF populations, including HCP, is critical to reduce the risk for SARS-CoV-2 introduction, transmission, and severe outcomes in SNFs. An ongoing focus on infection prevention and control practices is also essential.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , COVID-19/virology , Disease Outbreaks , SARS-CoV-2/genetics , Skilled Nursing Facilities , Aged , COVID-19/prevention & control , Humans , Immunization Programs , Kentucky/epidemiology , SARS-CoV-2/isolation & purification
9.
MMWR Morb Mortal Wkly Rep ; 70(8): 273-277, 2021 Feb 26.
Article in English | MEDLINE | ID: covidwho-1102699

ABSTRACT

Reinfection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is believed to be rare (1). Some level of immunity after SARS-CoV-2 infection is expected; however, the evidence regarding duration and level of protection is still emerging (2). The Kentucky Department for Public Health (KDPH) and a local health department conducted an investigation at a skilled nursing facility (SNF) that experienced a second COVID-19 outbreak in October 2020, 3 months after a first outbreak in July. Five residents received positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results during both outbreaks. During the first outbreak, three of the five patients were asymptomatic and two had mild symptoms that resolved before the second outbreak. Disease severity in the five residents during the second outbreak was worse than that during the first outbreak and included one death. Because test samples were not retained, phylogenetic strain comparison was not possible. However, interim period symptom resolution in the two symptomatic patients, at least four consecutive negative RT-PCR tests for all five patients before receiving a positive test result during the second outbreak, and the 3-month interval between the first and the second outbreaks, suggest the possibility that reinfection occurred. Maintaining physical distance, wearing face coverings or masks, and frequent hand hygiene are critical mitigation strategies necessary to prevent transmission of SARS-CoV-2 to SNF residents, a particularly vulnerable population at risk for poor COVID-19-associated outcomes.* Testing, containment strategies (isolation and quarantine), and vaccination of residents and health care personnel (HCP) are also essential components to protecting vulnerable residents. The findings of this study highlight the importance of maintaining public health mitigation and protection strategies that reduce transmission risk, even among persons with a history of COVID-19 infection.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Disease Outbreaks , Reinfection/diagnosis , Skilled Nursing Facilities , Aged , Aged, 80 and over , COVID-19 Nucleic Acid Testing , Female , Humans , Kentucky/epidemiology , Male , Middle Aged
10.
Am J Infect Control ; 49(3): 281-285, 2021 03.
Article in English | MEDLINE | ID: covidwho-1014299

ABSTRACT

BACKGROUND: The proportion of positive patients admitted to acute-care hospitals for reasons other than coronavirus disease-19 (COVID-19) is unknown. These patients potentially put other patients and healthcare workers at risk of infection. OBJECTIVE: The objective of this study was to define the proportion of asymptomatic patients admitted with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Secondary objectives were to define the positivity rate, reasons for admission, and the geographic distribution in the region. METHODS: Universal surveillance testing for SARS-CoV-2 was performed on patients admitted to this hospital over a 12-week period from April 9, 2020 to July 1, 2020. Positive patients were categorized as either symptomatic or asymptomatic as defined by the 11 criteria per the Centers for Disease Control and Prevention. The positivity rate, proportion with and without symptoms, reasons for admission, and geographic distribution in the region were recorded. RESULTS: The positivity rate ranged from 0.8% to 6.2%. The proportion of asymptomatic patients with SARS-CoV-2 was 37%. Asymptomatic patients primarily presented to the hospital because of either trauma or labor. Some clusters in the region were identified of both symptomatic and asymptomatic patients. CONCLUSIONS: The proportion of asymptomatic patients admitted with SARS-CoV-2 was significant. Identifying and isolating asymptomatic patients likely prevented exposure and development of hospital-acquired COVID-19 cases among healthcare workers and other patients, supporting the universal surveillance of all admitted patients.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/transmission , Patient Admission/statistics & numerical data , Population Surveillance/methods , SARS-CoV-2 , Adult , Cross Infection/prevention & control , Cross Infection/virology , Female , Humans , Infection Control/methods , Infection Control/statistics & numerical data , Kentucky/epidemiology , Male , Middle Aged
11.
Medicine (Baltimore) ; 99(38): e22254, 2020 Sep 18.
Article in English | MEDLINE | ID: covidwho-787427

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in December 2019 and has subsequently escalated exponentially worldwide. As this virus has never been experienced previously, it poses a significant challenge to healthcare systems who are poorly equipped to handle the large number of gravely ill patients who seek medical attention. Additionally, treating providers are placing their own lives at risk due to the lack of adequate personal protective equipment. We are reporting the proactive measures that were implemented at our healthcare system in a metropolitan community in Kentucky to address COVID-19. The primary goal was to maintain a safe environment for providers, staff, and patients. Three key strategies were incorporated at our healthcare system, including.


Subject(s)
Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Health Plan Implementation , Hospital Bed Capacity , Humans , Kentucky/epidemiology , Male , Occupational Health , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Process Assessment, Health Care , SARS-CoV-2
12.
MMWR Morb Mortal Wkly Rep ; 69(34): 1173-1176, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-732628

ABSTRACT

State and local health departments in the United States are using various indicators to identify differences in rates of reported coronavirus disease 2019 (COVID-19) and severe COVID-19 outcomes, including hospitalizations and deaths. To inform mitigation efforts, on May 19, 2020, the Kentucky Department for Public Health (KDPH) implemented a reporting system to monitor five indicators of state-level COVID-19 status to assess the ability to safely reopen: 1) composite syndromic surveillance data, 2) the number of new COVID-19 cases,* 3) the number of COVID-19-associated deaths,† 4) health care capacity data, and 5) public health capacity for contact tracing (contact tracing capacity). Using standardized methods, KDPH compiles an indicator monitoring report (IMR) to provide daily analysis of these five indicators, which are combined with publicly available data into a user-friendly composite status that KDPH and local policy makers use to assess state-level COVID-19 hazard status. During May 19-July 15, 2020, Kentucky reported 12,742 COVID-19 cases, and 299 COVID-19-related deaths (1). The mean composite state-level hazard status during May 19-July 15 was 2.5 (fair to moderate). IMR review led to county-level hotspot identification (identification of counties meeting criteria for temporal increases in number of cases and incidence) and facilitated collaboration among KDPH and local authorities on decisions regarding mitigation efforts. Kentucky's IMR might easily be adopted by state and local health departments in other jurisdictions to guide decision-making for COVID-19 mitigation, response, and reopening.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Epidemiological Monitoring , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Hospitalization/statistics & numerical data , Humans , Kentucky/epidemiology , Mortality/trends , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Public Health Practice
13.
Stroke ; 51(9): e2111-e2114, 2020 09.
Article in English | MEDLINE | ID: covidwho-636734

ABSTRACT

BACKGROUND AND PURPOSE: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. METHODS: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. RESULTS: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. CONCLUSIONS: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Stroke/complications , Stroke/therapy , COVID-19 , Coronavirus Infections/epidemiology , Humans , Indiana/epidemiology , Kentucky/epidemiology , Ohio/epidemiology , Pandemics , Patient Care Team , Pneumonia, Viral/epidemiology , Prospective Studies , Referral and Consultation/statistics & numerical data , Reperfusion , Stroke/epidemiology , Thrombectomy , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment , Treatment Outcome
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