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1.
Pediatr Rheumatol Online J ; 19(1): 172, 2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1577202

ABSTRACT

BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection. There is a paucity of research describing risk factors, optimal management, and outcomes of this life-threatening condition. METHODS: This is a case series of 26 patients diagnosed with MIS-C in a West Michigan pediatric tertiary care center from April 2020 to February 2021. We describe the clinical, imaging, and laboratory characteristics of these patients and detail their treatments and outcomes with comparisons between Pediatric Intensive Care Unit (PICU) and non-PICU patients. Categorical testing utilized Chi-square and Fisher's Exact tests. Comparison between groups used T-tests or Kruskal-Wallis. RESULTS: Fifteen patients (57%) required intensive care. There was no statistically significant difference in demographics between PICU and non-PICU patients, however all Black patients required intensive care. Gastrointestinal symptoms were present in 22 patients (84%). Seventeen patients (65%) had Kawasaki-like features and 12 (46%) developed coronary artery dilation. Patients requiring intensive care were less likely to have a reported history of COVID-19 disease or exposure (p = 0.0362). Statistically significant differences were also noted in peak ferritin (p = 0.0075), procalcitonin, and BNP in those who required intensive care. CONCLUSIONS: Although overlap exists with other hyperinflammatory conditions, our study provides further evidence that MIS-C is a distinct, albeit heterogenous, disorder with various degrees of cardiac involvement. Anakinra, in conjunction with steroid use, appears to be effective and safe in the treatment of MIS-C. This report identifies procalcitonin, peak ferritin, and BNP as potentially useful biomarkers for severity of disease.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , Adolescent , COVID-19/epidemiology , COVID-19/etiology , COVID-19/therapy , Child , Female , Humans , Intensive Care Units, Pediatric , Male , Michigan/epidemiology , Risk Factors , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
2.
JAMA Surg ; 156(7): 620-626, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1573991

ABSTRACT

Importance: While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic. Objective: To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic. Design, Setting, and Participants: Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020). Exposures: Telehealth implementation owing to the COVID-19 pandemic in March 2020. Main Outcomes and Measures: (1) Conversion rate defined as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019. This outcome adjusts for a substantial decrease in outpatient care during the pandemic. (2) Weekly number of new patient telehealth visits divided by weekly number of total new patient visits. Results: Among 4405 surgeons in the cohort, 2588 (58.8%) performed telehealth in any patient care context. Specifically for new patient visits, 1182 surgeons (26.8%) used telehealth. A total of 109 610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for patients who received care in-person. Prior to March 2020, less than 1% (8 of 173 939) of new patient visits were conducted through telehealth. Telehealth use peaked in April 2020 (week 14) and facilitated 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume. During period 2, a mean (SD) of 16.6% (12.0%) of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes). During period 3, 3.0% (2168 of 71 819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). Mean (SD) telehealth conversion rates varied by specialty with urology being the highest (14.3% [7.7%]). Conclusions and Relevance: Results from this study showed that telehealth use grew across all surgical specialties in Michigan in response to the COVID-19 pandemic. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic.


Subject(s)
COVID-19/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Specialties, Surgical , Telemedicine/statistics & numerical data , Cohort Studies , Humans , Michigan/epidemiology , Pandemics , SARS-CoV-2
3.
Medicine (Baltimore) ; 100(40): e27422, 2021 Oct 08.
Article in English | MEDLINE | ID: covidwho-1462561

ABSTRACT

ABSTRACT: As severe acute respiratory syndrome coronavirus 2 continues to spread, easy-to-use risk models that predict hospital mortality can assist in clinical decision making and triage. We aimed to develop a risk score model for in-hospital mortality in patients hospitalized with 2019 novel coronavirus (COVID-19) that was robust across hospitals and used clinical factors that are readily available and measured standardly across hospitals.In this retrospective observational study, we developed a risk score model using data collected by trained abstractors for patients in 20 diverse hospitals across the state of Michigan (Mi-COVID19) who were discharged between March 5, 2020 and August 14, 2020. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 during hospitalization or were discharged with an ICD-10 code for COVID-19 (U07.1) were included. We employed an iterative forward selection approach to consider the inclusion of 145 potential risk factors available at hospital presentation. Model performance was externally validated with patients from 19 hospitals in the Mi-COVID19 registry not used in model development. We shared the model in an easy-to-use online application that allows the user to predict in-hospital mortality risk for a patient if they have any subset of the variables in the final model.Two thousand one hundred and ninety-three patients in the Mi-COVID19 registry met our inclusion criteria. The derivation and validation sets ultimately included 1690 and 398 patients, respectively, with mortality rates of 19.6% and 18.6%, respectively. The average age of participants in the study after exclusions was 64 years old, and the participants were 48% female, 49% Black, and 87% non-Hispanic. Our final model includes the patient's age, first recorded respiratory rate, first recorded pulse oximetry, highest creatinine level on day of presentation, and hospital's COVID-19 mortality rate. No other factors showed sufficient incremental model improvement to warrant inclusion. The area under the receiver operating characteristics curve for the derivation and validation sets were .796 (95% confidence interval, .767-.826) and .829 (95% confidence interval, .782-.876) respectively.We conclude that the risk of in-hospital mortality in COVID-19 patients can be reliably estimated using a few factors, which are standardly measured and available to physicians very early in a hospital encounter.


Subject(s)
COVID-19/mortality , Hospital Mortality/trends , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Comorbidity , Creatinine/blood , Female , Health Behavior , Humans , Logistic Models , Male , Michigan/epidemiology , Middle Aged , Oximetry , Prognosis , ROC Curve , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Socioeconomic Factors
5.
Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Article in English | MEDLINE | ID: covidwho-1406167

ABSTRACT

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Economics, Hospital/organization & administration , Gastroenterology/education , Hospital Administration/methods , SARS-CoV-2 , Cities/economics , Cities/epidemiology , Education, Medical, Graduate/organization & administration , Gastroenterology/economics , Hospital Administration/economics , Humans , Internship and Residency , Michigan/epidemiology , Organizational Affiliation/economics , Organizational Affiliation/organization & administration , Prospective Studies , Schools, Medical/organization & administration
6.
J Forensic Nurs ; 17(2): 93-97, 2021.
Article in English | MEDLINE | ID: covidwho-1371766

ABSTRACT

INTRODUCTION: Despite a global focus on intimate partner violence during the COVID-19 pandemic, there has been little exploration into how the pandemic and its associated restrictions have impacted sexual assault survivors and their ability to access specialized care and resources. The purpose of this research brief is to use longitudinal data to compare the number of medical forensic examinations done seasonally prepandemic and during the COVID-19 pandemic shelter-in-place order. METHODS: This analysis uses retrospective data on medical forensic examinations from January 2010 through November 2020 from one large academic Midwestern hospital. RESULTS: Results show that monthly medical forensic examinations have increased over time, from a mean of 4.5 cases per month (range: 1-9) in 2010 to a mean of 9 cases per month (range: 7-11) in 2019. In April 2020, when COVID-19-related shutdowns were at their first peak, cases dropped to a historic low of 0 examinations (the lowest number of cases in the past 10 years). CONCLUSIONS: The data show an initial drop in the number of survivors seeking postassault care after the COVID shutdown; however, cases rebounded through the second full month of shutdown orders. Programs that provide medical forensic examinations need to be prepared for subsequent waves of survivors, who may be COVID-19 positive. We must be better prepared for many of the adverse consequences impacting individuals around the country related to COVID-19 responses.


Subject(s)
COVID-19/epidemiology , Crime Victims , Health Services Accessibility/trends , Physical Examination/trends , Sex Offenses , Survivors , Humans , Michigan/epidemiology , Retrospective Studies , SARS-CoV-2
7.
Hypertens Pregnancy ; 40(3): 226-235, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1371660

ABSTRACT

Objective: To evaluate of COVID-19 disease in pregnant women and its association with hypertensive disorders of pregnancy.Design: Retrospective Cohort StudySetting: Multicenter study from a large metropolitan hospital systemMethods: Patients who tested positive for COVID-19 during their pregnancy and delivered were compared to the three subsequent deliveries of patients who tested negative (controls). We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy.Results: Compared with pregnancies negative for SARs-CoV-2 infection, maternal SARs-CoV-2 infection was associated with an increased risk for hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 - 8.10).Tweetable AbstractPatients who test positive for COVID-19 during their pregnancy are at increased risk of developing a hypertensive disorder of pregnancy. Earlier SARs-CoV-2 infection results in an increased risk of developing a hypertensive disorder.


Subject(s)
COVID-19/complications , Hypertension, Pregnancy-Induced/etiology , Pregnancy Complications, Infectious , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Case-Control Studies , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Logistic Models , Michigan/epidemiology , Multivariate Analysis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Retrospective Studies , Risk Factors
8.
J Occup Environ Med ; 63(6): 476-481, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1367067

ABSTRACT

OBJECTIVE: Examine the effect of a universal facemask policy for healthcare workers (HCW) and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity. METHODS: Daily number of symptomatic HCW tested, SARS-CoV-2 positivity rates, and HCW job-descriptions were collected pre and post Universal HCW facemask policy (March 26, 2020). Multiple change point regression was used to model positive-test-rate data. SARS-CoV-2 testing and positivity rates were compared for pre-intervention, transition, post-intervention, and follow-up periods. RESULTS: Between March 12 and August 10, 2020, 19.2% of HCW were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. A single change point was identified ∼March 28-30 (95% probability). Before the change point, the odds of a tested HCW having a positive result doubled every 4.5 to 7.5 days. Post-change-point, the odds of a tested HCW having a positive result halved every 10.5 to 13.5 days. CONCLUSIONS: Universal facemasks were associated with reducing HCW's risk of acquiring COVID-19.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , Health Policy/legislation & jurisprudence , Masks , SARS-CoV-2/isolation & purification , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Testing , Delivery of Health Care , Health Personnel/classification , Humans , Michigan/epidemiology
9.
JAMA Netw Open ; 4(8): e2120728, 2021 08 02.
Article in English | MEDLINE | ID: covidwho-1366205

ABSTRACT

Importance: Emergency department (ED) and emergency medical services (EMS) volumes decreased during the COVID-19 pandemic, but the amount attributable to voluntary refusal vs effects of the pandemic and public health restrictions is unknown. Objective: To examine the factors associated with EMS refusal in relation to COVID-19 cases, public health interventions, EMS responses, and prehospital deaths. Design, Setting, and Participants: A retrospective cohort study was conducted in Detroit, Michigan, from March 1 to June 30, 2020. Emergency medical services responses geocoded to Census tracts were analyzed by individuals' age, sex, date, and community resilience using the Centers for Disease Control and Prevention Social Vulnerability Index. Response counts were adjusted with Poisson regression, and odds of refusals and deaths were adjusted by logistic regression. Exposures: A COVID-19 outbreak characterized by a peak in local COVID-19 incidence and the strictest stay-at-home orders to date, followed by a nadir in incidence and broadly lifted restrictions. Main Outcomes and Measures: Multivariable-adjusted difference in 2020 vs 2019 responses by incidence rate and refusals or deaths by odds. The Social Vulnerability Index was used to capture community social determinants of health as a risk factor for death or refusal. The index contains 4 domain subscores; possible overall score is 0 to 15, with higher scores indicating greater vulnerability. Results: A total of 80 487 EMS responses with intended ED transport, 2059 prehospital deaths, and 16 064 refusals (62 636 completed EMS to ED transports) from 334 Census tracts were noted during the study period. Of the cohort analyzed, 38 621 were women (48%); mean (SD) age was 49.0 (21.4) years, and mean (SD) Social Vulnerability Index score was 9.6 (1.6). Tracts with the highest per-population EMS transport refusal rates were characterized by higher unemployment, minority race/ethnicity, single-parent households, poverty, disability, lack of vehicle access, and overall Social Vulnerability Index score (9.6 vs 9.0, P = .002). At peak COVID-19 incidence and maximal stay-at-home orders, there were higher total responses (adjusted incident rate ratio [aIRR], 1.07; 1.03-1.12), odds of deaths (adjusted odds ratio [aOR], 1.60; 95% CI, 1.20-2.12), and refusals (aOR, 2.33; 95% CI, 2.09-2.60) but fewer completed ED transports (aIRR, 0.82; 95% CI, 0.78-0.86). With public health restrictions lifted and the nadir of COVID-19 cases, responses (aIRR, 1.01; 0.97-1.05) and deaths (aOR, 1.07; 95% CI, 0.81-1.41) returned to 2019 baselines, but differences in refusals (aOR, 1.27; 95% CI, 1.14-1.41) and completed transports (aIRR, 0.95; 95% CI, 0.90-0.99) remained. Multivariable-adjusted 2020 refusal was associated with female sex (aOR, 2.71; 95% CI, 2.43-3.03 in 2020 at the peak; aOR 1.47; 95% CI, 1.32-1.64 at the nadir). Conclusions and Relevance: In this cohort study, EMS transport refusals increased with the COVID-19 outbreak's peak and remained elevated despite receding public health restrictions, COVID-19 incidence, total EMS responses, and prehospital deaths. Voluntary refusal was associated with decreased EMS transports to EDs, disproportionately so among women and vulnerable communities.


Subject(s)
COVID-19/epidemiology , Emergency Medical Services/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Transportation of Patients/statistics & numerical data , Treatment Refusal/statistics & numerical data , Adult , Aged , COVID-19/prevention & control , Communicable Disease Control/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Logistic Models , Male , Michigan/epidemiology , Middle Aged , Odds Ratio , Retrospective Studies , SARS-CoV-2
11.
Glob Public Health ; 16(8-9): 1396-1410, 2021.
Article in English | MEDLINE | ID: covidwho-1364688

ABSTRACT

The COVID-19 pandemic has overwhelmed health systems around the globe, and intensified the lethality of social and political inequality. In the United States, where public health departments have been severely defunded, Black, Native, Latinx communities and those experiencing poverty in the country's largest cities are disproportionately infected and disproportionately dying. Based on our collective ethnographic work in three global cities in the U.S. (San Francisco, Los Angeles, and Detroit), we identify how the political geography of racialisation potentiated the COVID-19 crisis, exacerbating the social and economic toll of the pandemic for non-white communities, and undercut the public health response. Our analysis is specific to the current COVID19 crisis in the U.S, however the lessons from these cases are important for understanding and responding to the corrosive political processes that have entrenched inequality in pandemics around the world.


Subject(s)
COVID-19 , Pandemics , Politics , Anthropology, Cultural , COVID-19/epidemiology , Cities/epidemiology , Health Status Disparities , Humans , Los Angeles/epidemiology , Michigan/epidemiology , San Francisco/epidemiology
12.
BMJ Open ; 11(7): e044921, 2021 07 23.
Article in English | MEDLINE | ID: covidwho-1322819

ABSTRACT

OBJECTIVE: To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan. DESIGN: Multicentre retrospective cohort study. SETTING: 32 acute care hospitals in the state of Michigan. PARTICIPANTS: Patients discharged (16 March-11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected demographic information on all patients and detailed clinical data on a subset of COVID-19-positive patients. PRIMARY OUTCOME MEASUREMENTS: Patient characteristics, treatment and outcomes including cardiopulmonary resuscitation, mortality and venous thromboembolism within and across hospitals. RESULTS: Demographic-only data from 1593 COVID-19-positive and 1259 persons under investigation discharges were collected. Among 1024 cases with detailed data, the median age was 63 years; median body mass index was 30.6; and 51.4% were black. Cough, fever and shortness of breath were the top symptoms. 37.2% reported a known COVID-19 contact; 7.0% were healthcare workers; and 16.1% presented from congregated living facilities.During hospitalisation, 232 (22.7%) patients were treated in an intensive care unit (ICU); 558 (54.9%) in a 'cohorted' unit; 161 (15.7%) received mechanical ventilation; and 90 (8.8%) received high-flow nasal cannula. ICU patients more often received hydroxychloroquine (66% vs 46%), corticosteroids (34% vs 18%) and antibiotic therapy (92% vs 71%) than general ward patients (p<0.05 for all). Overall, 219 (21.4%) patients died, with in-hospital mortality ranging from 7.9% to 45.7% across hospitals. 73% received at least one COVID-19-specific treatment, ranging from 32% to 96% across sites.Across 14 hospitals, the proportion of patients admitted directly to an ICU ranged from 0% to 43.8%; mechanical ventilation on admission from 0% to 12.8%; mortality from 7.9% to 45.7%. Use of at least one COVID-19-specific therapy varied from 32% to 96.3% across sites. CONCLUSIONS: During the early days of the Michigan outbreak of COVID-19, patient characteristics, treatment and outcomes varied widely within and across hospitals.


Subject(s)
COVID-19 , Hospitals , Humans , Intensive Care Units , Michigan/epidemiology , Middle Aged , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
13.
Pediatrics ; 148(4)2021 10.
Article in English | MEDLINE | ID: covidwho-1304498

ABSTRACT

BACKGROUND AND OBJECTIVES: Emerging data suggest the coronavirus disease 2019 (COVID-19) pandemic has been associated with worsening symptoms of eating disorders (EDs) among both adults and adolescents. With this study, we sought to determine if medical admission patterns among adolescents admitted to our institution for restrictive EDs changed during the pandemic, relative to prepandemic counts of admissions per month. METHODS: We performed a chart review of patients aged 10 to 23 years admitted to our children's hospital for restrictive EDs from March 2017 through March 2021 and completed an interrupted time series analysis of admission counts per month. Demographic variables for admitted patients were compared by using χ2, Fisher's exact, and 2-sample t tests. RESULTS: ED-related medical admissions at our institution increased significantly during the COVID-19 pandemic. The total number of admissions during the first 12 months of the COVID-19 pandemic (April 1, 2020, through March 31, 2021, n = 125) was more than double the mean number of admissions per year for the same time frame (April 1 through March 31) for the previous 3 years (mean = 56). Patient demographics were similar before and during the pandemic, with the exception that patients admitted during the COVID-19 pandemic were less likely than those admitted before the pandemic to have public insurance. CONCLUSIONS: Medical admissions related to restrictive EDs among adolescents increased significantly during the COVID-19 pandemic. Pediatric providers in a variety of settings should be prepared to care for adolescents with restrictive EDs during the pandemic.


Subject(s)
Avoidant Restrictive Food Intake Disorder , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Pandemics , Adolescent , Child , Female , Humans , Interrupted Time Series Analysis , Male , Michigan/epidemiology , SARS-CoV-2 , Young Adult
14.
J Infect Dis ; 224(1): 49-59, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1294731

ABSTRACT

BACKGROUND: We investigated frequency of reinfection with seasonal human coronaviruses (HCoVs) and serum antibody response following infection over 8 years in the Household Influenza Vaccine Evaluation (HIVE) cohort. METHODS: Households were followed annually for identification of acute respiratory illness with reverse-transcription polymerase chain reaction-confirmed HCoV infection. Serum collected before and at 2 time points postinfection were tested using a multiplex binding assay to quantify antibody to seasonal, severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins and SARS-CoV-2 spike subdomains and N protein. RESULTS: Of 3418 participants, 40% were followed for ≥3 years. A total of 1004 HCoV infections were documented; 303 (30%) were reinfections of any HCoV type. The number of HCoV infections ranged from 1 to 13 per individual. The mean time to reinfection with the same type was estimated at 983 days for 229E, 578 days for HKU1, 615 days for OC43, and 711 days for NL63. Binding antibody levels to seasonal HCoVs were high, with little increase postinfection, and were maintained over time. Homologous, preinfection antibody levels did not significantly correlate with odds of infection, and there was little cross-response to SARS-CoV-2 proteins. CONCLUSIONS: Reinfection with seasonal HCoVs is frequent. Binding anti-spike protein antibodies do not correlate with protection from seasonal HCoV infection.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus , Family Characteristics , Influenza Vaccines/immunology , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Severe Acute Respiratory Syndrome/epidemiology , Antibodies, Viral/blood , Antibodies, Viral/immunology , COVID-19/epidemiology , COVID-19/virology , Coinfection/epidemiology , Coronavirus/classification , Coronavirus/genetics , Coronavirus/immunology , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/virology , Cross Reactions/immunology , Humans , Influenza Vaccines/administration & dosage , Influenza, Human/virology , Kaplan-Meier Estimate , Michigan/epidemiology , Proportional Hazards Models , Public Health Surveillance , Reinfection/epidemiology , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Seasons , Seroepidemiologic Studies , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/immunology , Severe Acute Respiratory Syndrome/virology , Viral Load
18.
Am J Public Health ; 111(3): 430-437, 2021 03.
Article in English | MEDLINE | ID: covidwho-1200009

ABSTRACT

The global influenza pandemic that emerged in 1918 has become the event of reference for a broad spectrum of policymakers seeking to learn from the past. This article sheds light on multiple waves of excess mortality that occurred in the US state of Michigan at the time with insights into how epidemics might evolve and propagate across space and time. We analyzed original monthly data on all-cause deaths by county for the 83 counties of Michigan and interpreted the results in the context of what is known about the pandemic. Counties in Michigan experienced up to four waves of excess mortality over a span of two years, including a severe one in early 1920. Some counties experienced two waves in late 1918 while others had only one. The 1920 wave propagated across the state in a different manner than the fall and winter 1918 waves. The twin waves in late 1918 were likely related to the timing of the statewide imposition of a three-week social distancing order. Michigan's experience holds sobering lessons for those who wish to understand how immunologically naïve populations encounter novel viral pathogens.


Subject(s)
COVID-19/epidemiology , COVID-19/history , Influenza Pandemic, 1918-1919/history , Influenza Pandemic, 1918-1919/mortality , Cause of Death , History, 20th Century , History, 21st Century , Humans , Michigan/epidemiology , Pandemics , SARS-CoV-2
19.
Ann Clin Psychiatry ; 33(2): 101-107, 2021 05.
Article in English | MEDLINE | ID: covidwho-1194814

ABSTRACT

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.


Subject(s)
COVID-19 , Health Personnel , Occupational Stress , Stress, Psychological , Adult , Anxiety/diagnosis , Anxiety/etiology , COVID-19/epidemiology , COVID-19/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/etiology , Female , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Male , Mental Health/statistics & numerical data , Michigan/epidemiology , Needs Assessment , Occupational Health/statistics & numerical data , Occupational Stress/diagnosis , Occupational Stress/epidemiology , Occupational Stress/etiology , Occupational Stress/psychology , Psychiatric Status Rating Scales , SARS-CoV-2 , Stress Disorders, Traumatic/etiology , Stress Disorders, Traumatic/prevention & control , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology
20.
BMJ Open ; 11(4): e042042, 2021 04 07.
Article in English | MEDLINE | ID: covidwho-1172757

ABSTRACT

OBJECTIVE: To report the clinical characteristics of patients hospitalised with COVID-19 in Southeast Michigan. DESIGN: Retrospective cohort study. SETTING: Eight hospitals in Southeast Michigan. PARTICIPANTS: 3219 hospitalised patients with a positive SARS-CoV-2 infection by nasopharyngeal PCR test from 13 March 2020 until 29 April 2020. MAIN OUTCOMES MEASURES: Outcomes were discharge from the hospital or in-hospital death. Examined predictors included patient demographics, chronic diseases, home medications, mechanical ventilation, in-hospital medications and timeframe of hospital admission. Multivariable logistic regression was conducted to identify risk factors for in-hospital mortality. RESULTS: During the study period, 3219 (90.4%) patients were discharged or died in the hospital. The median age was 65.2 (IQR 52.6-77.2) years, the median length of stay in the hospital was 6.0 (IQR 3.2-10.1) days, and 51% were female. Hypertension was the most common chronic disease, occurring in 2386 (74.1%) patients. Overall mortality rate was 16.0%. Blacks represented 52.3% of patients and had a mortality rate of 13.5%. Mortality was highest at 18.5% in the prepeak hospital COVID-19 volume, decreasing to 15.3% during the peak period and to 10.8% in the postpeak period. Multivariable regression showed increasing odds of in-hospital death associated with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for every increase in 1 year of age and being male (OR 1.47, 95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases increased the odds of in-hospital mortality, especially chronic kidney disease. Administration of vitamin C, corticosteroids and therapeutic heparin in the hospital was associated with higher odds of death. CONCLUSION: In-hospital mortality was highest in early admissions and improved as our experience in treating patients with COVID-19 increased. Blacks were more likely to get admitted to the hospital and to receive mechanical ventilation, but less likely to die in the hospital than whites.


Subject(s)
COVID-19/epidemiology , Hospital Mortality , Hospitalization/statistics & numerical data , Aged , COVID-19 Testing , Comorbidity , Female , Humans , Male , Michigan/epidemiology , Middle Aged , Respiration, Artificial , Retrospective Studies
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