Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 34
Filter
1.
Contraception ; 115: 17-21, 2022 11.
Article in English | MEDLINE | ID: covidwho-1966462

ABSTRACT

OBJECTIVES: Prior research identified a significant decline in the number of abortions in Louisiana at the onset of the COVID-19 pandemic, as well as increases in second-trimester abortions and decreases in medication abortions. This study examines how service disruptions in particular areas of the state disparately affected access to abortion care based on geography. STUDY DESIGN: We collected monthly service data from Louisiana's abortion clinics (January 2018-May 2020) and conducted mystery client calls to determine whether clinics were scheduling appointments at pandemic onset (April-May 2020). We used segmented regression to assess whether service disruptions modified the main pandemic effects on the number, timing, and type of abortions using stratified models and interaction terms. Additionally, we calculated the median distance that Louisiana residents traveled to the clinic where they obtained care. RESULTS: For residents whose closest clinic was consistently scheduling appointments at the onset of the pandemic, the number of monthly abortions did not change (IRR = 1.07, 95% CI: 0.84-1.36). For those whose closest clinic services were disrupted, the number of monthly abortions decreased by 46% (IRR = 0.54, 95% CI: 0.45-0.65). Similarly, increases in second-trimester abortions and decreases in medication abortions were concentrated in areas where residents experienced service disruptions (AOR = 2.25, 95% CI: 1.21-4.56 and AOR = 0.59, 95% CI: 0.29-0.87, respectively) and were not seen elsewhere in the state. CONCLUSION: Changes in the number, timing and type of abortions were concentrated among residents in particular areas of Louisiana. The early stages of the COVID-19 pandemic exacerbated geographic disparities in access to abortion care. IMPLICATIONS: Disruptions in services at the beginning of the COVID-19 pandemic in Louisiana meaningfully affected pregnant people's ability to obtain an abortion at their nearest clinic. These findings reinforce the importance of developing mechanisms to support pregnant people during emergency situations when traveling to a nearby clinic is no longer possible.


Subject(s)
Abortion, Induced , COVID-19 , Healthcare Disparities , Pandemics , Abortion, Induced/statistics & numerical data , COVID-19/epidemiology , Female , Geography , Healthcare Disparities/statistics & numerical data , Humans , Louisiana/epidemiology , Pregnancy
2.
Proc Natl Acad Sci U S A ; 119(27): e2123533119, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-1908381

ABSTRACT

High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.


Subject(s)
African Americans , COVID-19 , Health Equity , Healthcare Disparities , COVID-19/mortality , Healthcare Disparities/ethnology , Humans , Louisiana/epidemiology , Population Density , Race Factors
3.
Ann Epidemiol ; 71: 1-8, 2022 07.
Article in English | MEDLINE | ID: covidwho-1803518

ABSTRACT

PURPOSE: To quantify and compare SARS-CoV-2 transmission potential across Alabama, Louisiana, and Mississippi and selected counties. METHODS: To determine the time-varying reproduction number Rt of SARS-CoV-2, we applied the R package EpiEstim to the time series of daily incidence of confirmed cases (mid-March 2020 - May 17, 2021) shifted backward by 9 days. Median Rt percentage change when policies changed was determined. Linear regression was performed between log10-transformed cumulative incidence and log10-transformed population size at four time points. RESULTS: Stay-at-home orders, face mask mandates, and vaccinations were associated with the most significant reductions in SARS-CoV-2 transmission in the three southern states. Rt across the three states decreased significantly by ≥20% following stay-at-home orders. We observed varying degrees of reductions in Rt across states following other policies. Rural Alabama counties experienced higher per capita cumulative cases relative to urban ones as of June 17 and October 17, 2020. Meanwhile, Louisiana and Mississippi saw the disproportionate impact of SARS-CoV-2 in rural counties compared to urban ones throughout the study period. CONCLUSION: State and county policies had an impact on local pandemic trajectories. The rural-urban disparities in case burden call for evidence-based approaches in tailoring health promotion interventions and vaccination campaigns to rural residents.


Subject(s)
COVID-19 , SARS-CoV-2 , Alabama/epidemiology , COVID-19/epidemiology , Cost of Illness , Humans , Louisiana/epidemiology , Mississippi/epidemiology , United States
4.
PLoS One ; 17(2): e0264336, 2022.
Article in English | MEDLINE | ID: covidwho-1708908

ABSTRACT

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 µm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.


Subject(s)
Air Pollution/analysis , Asthma/epidemiology , COVID-19/epidemiology , 34658 , COVID-19/virology , Hospitalization/statistics & numerical data , Humans , Incidence , Louisiana/epidemiology , Ozone/analysis , Pandemics , Particulate Matter/analysis , Risk Factors , SARS-CoV-2/isolation & purification
5.
New Solut ; 32(1): 57-64, 2022 05.
Article in English | MEDLINE | ID: covidwho-1643066

ABSTRACT

Guestworkers are a critical labor component of many industries considered essential to U.S. infrastructure. Despite their essential role in the U.S. labor force, guestworkers are vulnerable to exploitative labor practices. The COVID-19 pandemic compounded guestworkers' vulnerability to include a lack of public health protective measures in addition to longstanding labor abuses. The pandemic has created greater public health awareness about structural determinants of health inequities, such as unsafe and exploitative working conditions. As public health increases its focus on social and structural determinants of health, it can contribute to improved labor conditions for guestworkers. This article highlights guestworkers' experiences in Louisiana's crawfish industry to demonstrate the marginalized role of guestworker labor in a major Louisiana industry. This article also examines local public health approaches that can bring attention and resources to labor issues.


Subject(s)
COVID-19 , Health Equity , Humans , Louisiana/epidemiology , Pandemics , Public Health
6.
MMWR Morb Mortal Wkly Rep ; 70(40): 1425-1426, 2021 Oct 08.
Article in English | MEDLINE | ID: covidwho-1456570

ABSTRACT

According to sequencing data reported by CDC, the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, has been the predominant lineage circulating in Louisiana since the week of June 20, 2021 (1). In Louisiana, the increased spread of the Delta variant corresponded with the start of the state's fourth and largest increase in average daily COVID-19 incidence to date (1,2). This report describes COVID-19 outbreaks in Louisiana youth summer camps as the Delta variant became the predominant lineage during June-July 2021. This activity was reviewed by the Louisiana Department of Health (LDH) and was conducted consistent with applicable state law and LDH policy.


Subject(s)
COVID-19/epidemiology , Camping , Disease Outbreaks , Adolescent , Adult , COVID-19/prevention & control , COVID-19/transmission , COVID-19/virology , Child , Child, Preschool , Contact Tracing , Humans , Louisiana/epidemiology , Middle Aged , SARS-CoV-2/isolation & purification , Seasons , Young Adult
7.
PLoS One ; 16(10): e0257437, 2021.
Article in English | MEDLINE | ID: covidwho-1456086

ABSTRACT

INTRODUCTION: This article presents the Louisiana Hepatitis C Elimination Program's evaluation protocol underway at the Louisiana State University Health Sciences Center-New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years. MATERIALS AND METHODS: A cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid. DISCUSSION: The evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/drug therapy , Cross-Sectional Studies , Health Services Accessibility , Hepacivirus/drug effects , Humans , Louisiana/epidemiology , Medicaid , New Orleans/epidemiology , United States/epidemiology
8.
PLoS One ; 16(10): e0257302, 2021.
Article in English | MEDLINE | ID: covidwho-1456082

ABSTRACT

BACKGROUND: In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was an overall shortage of diagnostic testing capability at that time, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses. METHODS: A multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources. FINDINGS: Our model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.


Subject(s)
COVID-19 , Delivery of Health Care , Disease Outbreaks , Health Personnel , Inpatients , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Female , Humans , Louisiana/epidemiology , Male , Patient Care , Personal Protective Equipment
10.
Mayo Clin Proc ; 96(12): 3030-3041, 2021 12.
Article in English | MEDLINE | ID: covidwho-1415644

ABSTRACT

OBJECTIVE: To evaluate clinical characteristics of patients admitted to the hospital with coronavirus disease 2019 (COVID-19) in Southern United States and development as well as validation of a mortality risk prediction model. PATIENTS AND METHODS: Southern Louisiana was an early hotspot during the pandemic, which provided a large collection of clinical data on inpatients with COVID-19. We designed a risk stratification model to assess the mortality risk for patients admitted to the hospital with COVID-19. Data from 1673 consecutive patients diagnosed with COVID-19 infection and hospitalized between March 1, 2020, and April 30, 2020, was used to create an 11-factor mortality risk model based on baseline comorbidity, organ injury, and laboratory results. The risk model was validated using a subsequent cohort of 2067 consecutive hospitalized patients admitted between June 1, 2020, and December 31, 2020. RESULTS: The resultant model has an area under the curve of 0.783 (95% CI, 0.76 to 0.81), with an optimal sensitivity of 0.74 and specificity of 0.69 for predicting mortality. Validation of this model in a subsequent cohort of 2067 consecutively hospitalized patients yielded comparable prognostic performance. CONCLUSION: We have developed an easy-to-use, robust model for systematically evaluating patients presenting to acute care settings with COVID-19 infection.


Subject(s)
COVID-19 , Hospitalization/statistics & numerical data , Proportional Hazards Models , Risk Assessment/methods , COVID-19/mortality , COVID-19/prevention & control , COVID-19/therapy , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Comorbidity , Female , Hospital Mortality , Humans , Louisiana/epidemiology , Male , Middle Aged , Organ Dysfunction Scores , Prognosis , Reproducibility of Results , Risk Factors , Severity of Illness Index
11.
J Mol Diagn ; 23(9): 1078-1084, 2021 09.
Article in English | MEDLINE | ID: covidwho-1386076

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious and has caused significant medical/socioeconomic impacts. Other than vaccination, effective public health measures, including contact tracing, isolation, and quarantine, is critical for deterring viral transmission, preventing infection progression and resuming normal activities. Viral transmission is affected by many factors, but the viral load and vitality could be among the most important ones. Although in vitro studies have indicated that the amount of virus isolated from infected individuals affects the successful rate of virus isolation, whether the viral load carried at the individual level would determine the transmissibility was unknown. We examined whether the cycle threshold (Ct) value, a measurement of viral load by RT-PCR assay, could differentiate the spreaders from the non-spreaders in a population of college students. Our results indicate that while at the population level the Ct value is lower, suggesting a higher viral load, in the symptomatic spreaders than that in the asymptomatic non-spreaders, there is a significant overlap in the Ct values between the two groups. Thus, Ct value, or the viral load, at the individual level could not predict the transmissibility. Instead, a sensitive method to detect the presence of virus is needed to identify asymptomatic individuals who may carry a low viral load but can still be infectious.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/transmission , COVID-19/virology , Multiplex Polymerase Chain Reaction/methods , Universities/statistics & numerical data , COVID-19/epidemiology , Carrier State/virology , Contact Tracing , Female , Humans , Louisiana/epidemiology , Male , Nasopharynx/virology , Public Health , Quarantine , Retrospective Studies , Students/statistics & numerical data , Viral Load , Young Adult
12.
Cell ; 184(19): 4939-4952.e15, 2021 09 16.
Article in English | MEDLINE | ID: covidwho-1330684

ABSTRACT

The emergence of the COVID-19 epidemic in the United States (U.S.) went largely undetected due to inadequate testing. New Orleans experienced one of the earliest and fastest accelerating outbreaks, coinciding with Mardi Gras. To gain insight into the emergence of SARS-CoV-2 in the U.S. and how large-scale events accelerate transmission, we sequenced SARS-CoV-2 genomes during the first wave of the COVID-19 epidemic in Louisiana. We show that SARS-CoV-2 in Louisiana had limited diversity compared to other U.S. states and that one introduction of SARS-CoV-2 led to almost all of the early transmission in Louisiana. By analyzing mobility and genomic data, we show that SARS-CoV-2 was already present in New Orleans before Mardi Gras, and the festival dramatically accelerated transmission. Our study provides an understanding of how superspreading during large-scale events played a key role during the early outbreak in the U.S. and can greatly accelerate epidemics.


Subject(s)
COVID-19/epidemiology , Epidemics , SARS-CoV-2/physiology , COVID-19/transmission , Databases as Topic , Disease Outbreaks , Humans , Louisiana/epidemiology , Phylogeny , Risk Factors , SARS-CoV-2/classification , Texas , Travel , United States/epidemiology
13.
J Am Heart Assoc ; 10(3): e018510, 2021 02 02.
Article in English | MEDLINE | ID: covidwho-1221677

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) pandemic disproportionately affects individuals with hypertension and health disparities. Methods and Results We assessed the experiences and beliefs of low-income and minority patients with hypertension during the COVID-19 pandemic. Participants (N=587) from the IMPACTS-BP (Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control) study completed a telephone survey in May and June of 2020. Participants were 65.1% Black and 59.7% female, and 57.7% reported an income below the federal poverty level. Overall, 2.7% tested positive and 15.3% had lost a family member or friend to COVID-19. These experiences were significantly more common in Black (3.9% and 19.4%, respectively) than in non-Black participants (0.5% and 7.8%, respectively). In addition, 14.5% lost a job and 15.9% reported food shortages during the pandemic. Most participants complied with stay-at-home orders (98.3%), social distancing (97.8%), and always wearing a mask outside their home (74.6%). Participants also reported high access to needed health care (94.7%) and prescription medications (97.6%). Furthermore, 95.7% of respondents reported that they continued to take their regular dosage of antihypertensive medications. Among the 44.5% of participants receiving a healthcare appointment by telehealth, 96.6% got the help they needed, and 80.8% reported that the appointment quality was as good as or better than in-person visits. Finally, 88.9% were willing to return to their primary care clinic. Conclusions These data suggest that low-income patients, especially Black patients, were negatively impacted by COVID-19. However, most patients were able to access needed healthcare services and were willing to return to their primary care clinic for hypertension management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03483662.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/methods , Hypertension/epidemiology , Income , Pandemics , Telemedicine/methods , Comorbidity , Culture , Female , Humans , Louisiana/epidemiology , Male , Middle Aged , Mississippi/epidemiology , Poverty , SARS-CoV-2
14.
Psychiatry Res ; 298: 113821, 2021 04.
Article in English | MEDLINE | ID: covidwho-1096208

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 500,000 deaths, and hospitalization of thousands of individuals worldwide. Cross-sectional data indicate that anxiety and depression levels are greater during the pandemic, yet no known prospective studies have tested this assertion. Further, individuals with elevated trait anxiety prior to a global pandemic may theoretically be more apt to experience greater pandemic-related anxiety and/or impairment. The current study tested whether anxiety and depression increased from the month before the state's Stay-At-Home order to the period of the Stay-At-Home order among 120 young adults in Louisiana, a state with especially high rates of COVID-19 related infections and deaths. We also tested whether pre-pandemic social anxiety was related to greater pandemic related anxiety, depression, and COVID-related worry and impairment. Depression but not anxiety increased during the Stay-At-Home order. Further, pre-pandemic trait anxiety, social anxiety, and depression were statistically significant predictors of anxiety and depression during the Stay-At-Home order, although only social anxiety was robustly related to COVID-related worry and impairment. Emotional distress increased during the COVID-19 pandemic Stay-At-Home order and this is especially the case among individuals with pre-pandemic elevations in trait anxiety (especially social anxiety) and depression.


Subject(s)
Anxiety , COVID-19 , Communicable Disease Control , Depression , Psychological Distress , Adult , Anxiety/epidemiology , Anxiety/etiology , Depression/epidemiology , Depression/etiology , Female , Humans , Longitudinal Studies , Louisiana/epidemiology , Male , Young Adult
15.
Front Public Health ; 8: 617976, 2020.
Article in English | MEDLINE | ID: covidwho-1069771

ABSTRACT

Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly associated with COVID-19 incidence. Census tracts with higher levels of social vulnerability were associated with higher COVID-19 incidence after adjusting for population density (adjusted RR: 1.52, 95% CI: 1.41-1.65). Conclusions: The results of this study indicate that increased social vulnerability is linked with COVID-19 incidence. Additional resources should be allocated to areas of increased social disadvantage to reduce the incidence of COVID-19 in vulnerable populations.


Subject(s)
COVID-19/epidemiology , Censuses , Vulnerable Populations/statistics & numerical data , Humans , Incidence , Louisiana/epidemiology , Population Surveillance , SARS-CoV-2 , Socioeconomic Factors
16.
Orthopedics ; 43(6): 351-355, 2020 Nov 01.
Article in English | MEDLINE | ID: covidwho-1067820

ABSTRACT

This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [Orthopedics. 2020;43(6):351-355.].


Subject(s)
Coronavirus Infections/epidemiology , Orthopedic Procedures/statistics & numerical data , Orthopedic Surgeons , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians' , Betacoronavirus , COVID-19 , Elective Surgical Procedures/statistics & numerical data , Facilities and Services Utilization , Female , Health Care Surveys , Hospital Administration , Humans , Income , Louisiana/epidemiology , Male , Orthopedic Surgeons/economics , Pandemics , Remote Consultation , SARS-CoV-2
17.
Med Sci Sports Exerc ; 53(7): 1391-1399, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1033274

ABSTRACT

PURPOSE: The spread of COVID-19 and the associated stay-at-home orders and shutdowns of gyms and fitness centers have drastically influenced health behaviors leading to widespread reductions in physical activity (PA). The recent Call to Action from the American College of Sports Medicine has promoted "innovative strategies to promote PA during the COVID-19 pandemic." We aimed to identify individual-level factors that protected against declines in PA levels amid the COVID-19 restrictions. METHODS: We used the Pennington Biomedical COVID-19 Health Behaviors Survey for our analyses and used mixed-effect linear and generalized linear models to estimate the effects of individual-level factors on changes in PA levels during the COVID-19 restrictions. RESULTS: Participants (n = 4376) provided information on PA behaviors before and during the COVID-19 shutdown. Overall, PA levels declined by a mean ± SD of 112 ± 1460 MET·min·wk-1 during the COVID-19 shutdown; however, changes in PA were heterogeneous, with 55% of the participants reporting increases in or maintenance of PA during that time. Several social and demographic factors were significantly related to declines in PA, including high prepandemic PA levels, living alone (difference = 118 MET·min·wk-1), low household income (difference between the highest and the lowest income group = 363 MET·min·wk-1), COVID-19-related changes in income (difference = 110 MET·min·wk-1), and loss of employment (difference = 168 MET·min·wk-1). The substitution of prepandemic gym attendance with the purchase and use of home exercise equipment or exercise through virtual fitness platforms promoted increases in PA during the COVID-19 shutdown. CONCLUSIONS: While promoting PA through the COVID-19 pandemic, it is important to consider demographic factors, which greatly influence health behaviors and implementation of, and access to, replacement behaviors. The promotion of such strategies could help maintain PA levels during potential future stay-at-home orders.


Subject(s)
COVID-19 , Exercise/psychology , Health Behavior , Actigraphy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Surveys , Humans , Linear Models , Louisiana/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Protective Factors , Self Report , Social Environment , Social Support , Socioeconomic Factors , Sports and Recreational Facilities , Young Adult
18.
Clin Microbiol Infect ; 27(4): 633.e9-633.e16, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1009402

ABSTRACT

OBJECTIVE: While many seroprevalence studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been performed, few are demographically representative. This investigation focused on defining the nature and frequency of symptomatic and asymptomatic SARS-CoV-2 infection in a representative, cross-sectional sample of communities in Louisiana, USA. METHODS: A sample of 4778 adults from New Orleans and Baton Rouge, Louisiana were given a survey of symptoms and co-morbidities, nasopharyngeal swab to test for active infection (PCR), and blood draw to test for past infection (IgG). Odds ratios, cluster analysis, quantification of virus and antibody, and linear modelling were used to understand whether certain symptoms were associated with a positive test, how symptoms grouped together, whether virus or antibody varied by symptom status, and whether being symptomatic was different across the age span. RESULTS: Reported anosmia/ageusia was strongly associated with a positive test; 40.6% (93/229) tested positive versus 4.8% (218/4549) positivity in those who did not report anosmia/ageusia (OR 13.6, 95% CI 10.1-18.3). Of the people who tested positive, 47.3% (147/311) were completely asymptomatic. Symptom presentation clustered into three groups; low/no symptoms (0.4 ± 0.9, mean ± SD), highly symptomatic (7.5 ± 1.9) or moderately symptomatic (4.0 ± 1.5). Quantity of virus was lower in the asymptomatic versus symptomatic group (cycle number 23.3 ± 8.3 versus 17.3 ± 9.0; p < 0.001). Modelling the probability of symptoms showed changes with age; the highest probability of reporting symptoms was 64.6% (95% CI 50.4-76.5) at age 29 years, which decreased to a probability of 49.3% (95% CI 36.6-62.0) at age 60 years and only 25.1% (95% CI 5.0-68.1) at age 80 years. CONCLUSION: Anosmia/ageusia can be used to differentiate SARS-CoV-2 infection from other illnesses, and, given the high ratio of asymptomatic individuals, contact tracing should include those without symptoms. Regular testing in congregant settings of those over age 60 years may help mitigate asymptomatic spread.


Subject(s)
Ageusia/diagnosis , Anosmia/diagnosis , Asymptomatic Infections/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Antibodies, Viral/blood , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Comorbidity , Cross-Sectional Studies , Female , Humans , Immunoglobulin G/blood , Louisiana/epidemiology , Male , Middle Aged , Prevalence , SARS-CoV-2/immunology
19.
Emerg Infect Dis ; 27(2): 421-429, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1006452

ABSTRACT

To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Disease Transmission, Infectious/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , COVID-19/diagnosis , COVID-19/transmission , Female , Humans , Incidence , Louisiana/epidemiology , Male , Prisons , Prospective Studies
20.
PLoS One ; 15(12): e0243028, 2020.
Article in English | MEDLINE | ID: covidwho-1004440

ABSTRACT

BACKGROUND: Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. METHODS: The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. RESULTS: Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. CONCLUSION: While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Poverty Areas , Residence Characteristics/statistics & numerical data , Employment/statistics & numerical data , Humans , Income/statistics & numerical data , Louisiana/epidemiology , Vulnerable Populations/statistics & numerical data
SELECTION OF CITATIONS
SEARCH DETAIL