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1.
Am J Phys Med Rehabil ; 100(11): 1031-1032, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1537604

ABSTRACT

ABSTRACT: This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Personnel , Infection Control/standards , Pneumonia, Viral/prevention & control , Rehabilitation Centers , Adult , COVID-19/epidemiology , Disease Outbreaks/prevention & control , Female , Guideline Adherence , Humans , Inpatients , Male , Mass Screening , Pennsylvania/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
2.
J Med Microbiol ; 70(9)2021 Sep.
Article in English | MEDLINE | ID: covidwho-1429385

ABSTRACT

To the best of our knowledge to date there are no scientific studies specifically investigating whether the SARS-CoV-2 virus is present in the air or on the various surfaces in the school environment. The aim of this study was to determine if SARS-CoV-2 is present on various high touch surfaces and in the air across the elementary, middle and high schools in the Chester County of Pennsylvania, USA. One hundred and fifty surface swab samples and 45 air samples were analysed for the presence of the virus. All the samples tested were negative for the presence of SARS-CoV-2. The results indicate that the spread of the virus through contact and through air in the school buildings across the USA is highly unlikely.


Subject(s)
Air Microbiology , COVID-19 , Pandemics/prevention & control , SARS-CoV-2/isolation & purification , Schools , COVID-19/transmission , COVID-19/virology , Humans , Pennsylvania/epidemiology
4.
J Health Commun ; 26(6): 402-412, 2021 06 03.
Article in English | MEDLINE | ID: covidwho-1320274

ABSTRACT

As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.


Subject(s)
COVID-19/prevention & control , Health Behavior , Health Promotion/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pennsylvania/epidemiology , Surveys and Questionnaires , Young Adult
5.
World Neurosurg ; 151: e178-e184, 2021 07.
Article in English | MEDLINE | ID: covidwho-1297236

ABSTRACT

OBJECTIVE: The 2020 coronavirus disease 2019 (COVID-19) pandemic resulted in state-specific quarantine protocols and introduced the concept of social distancing into modern parlance. We assess the impact of the COVID-19 pandemic on neurotrauma presentations in the first 3 months after shutdown throughout Pennsylvania. METHODS: The Pennsylvania Trauma Systems Foundation was queried for registry data from the Pennsylvania Trauma Outcomes Study between March 12 and June 5 in each year from 2017 to 2020. RESULTS: After the COVID-19 shutdown, there was a 27% reduction in neurotrauma volume, from 2680 cases in 2017 to 2018 cases in 2020, and a 28.8% reduction in traumatic brain injury volume. There was no significant difference in neurotrauma phenotype incurred relative to total cases. Injury mechanism was less likely to be motor vehicle collision and more likely caused by falls, gunshot wound, and recreational vehicle accidents (P < 0.05). Location of injury was less likely on roads and public locations and more likely at indoor private locations (P < 0.05). The proportion of patients with neurotrauma with blood alcohol concentration >0.08 g/dL was reduced in 2020 (11.4% vs. 9.0%; P < 0.05). Mortality was higher during 2020 compared with pre-COVID years (7.7% vs. 6.4%; P < 0.05). CONCLUSIONS: During statewide shutdown, neurotrauma volume and alcohol-related trauma decreased and low-impact traumas and gunshot wounds increased, with a shift toward injuries occurring in private, indoor locations. These changes increased mortality. However, there was not a change in the types of injuries sustained.


Subject(s)
COVID-19/epidemiology , Nervous System Diseases/epidemiology , Quarantine/trends , Trauma Centers/trends , Wounds and Injuries/epidemiology , Accidental Falls , Accidents, Traffic/trends , Adolescent , Adult , Aged , Brain Injuries, Traumatic/epidemiology , Brain Injuries, Traumatic/therapy , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Nervous System Diseases/therapy , Pennsylvania/epidemiology , Registries , Wounds and Injuries/therapy , Wounds, Gunshot/epidemiology , Wounds, Gunshot/therapy , Young Adult
6.
Vaccine ; 39(31): 4291-4295, 2021 07 13.
Article in English | MEDLINE | ID: covidwho-1272767

ABSTRACT

BACKGROUND: This investigation sought to determine whether early season rates of pediatric influenza vaccination changed in a season when there was a concurrent COVID-19 pandemic. METHODS: This study used cohort and cross sectional data from an academic primary care division in Southcentral Pennsylvania that serves approximately 17,500 patients across 4 practice sites. Early season (prior to November 1) vaccination rates in 2018, 2019 and 2020 were recorded for children, age 6 months to 17 years. To explore the impact of COVID-19 on vaccination, we fit a model with a logit link (estimated via generalized estimating equations to account for clustering by patient over time) on calendar year, adjusted for race, ethnicity, age, and insurance type. We examined interaction effects of demographic covariates with calendar year. RESULTS: Early vaccination rates were lower in 2020 (29.7%) compared with 2018 and 2019 (34.2% and 33.3%). After adjusting for covariates and accounting for clustering over time, the odds of early vaccination in 2020 were 19% lower compared to 2018 (OR 0.81, 95% CI: 0.78-0.85). In 2020, children with private insurance were more likely to receive early vaccination than in 2018 (OR 1.51, 95% CI: 1.04-1.15), whereas children with public insurance were less likely to receive early vaccination in 2020 than in 2018 (OR 0.62, 95% CI: 1.38-1.65). CONCLUSIONS: Early influenza vaccination rates declined in a year with a concurrent COVID-19 pandemic. Modeling that accounts for individual trends and demographic variables identified specific populations with lower odds of early vaccination in 2020. Additional research is needed to investigate whether the COVID-19 pandemic impacted parental intent to obtain the influenza vaccine, or introduced barriers to healthcare access.


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Child , Cross-Sectional Studies , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics , Pennsylvania/epidemiology , SARS-CoV-2 , Vaccination
7.
J Trauma Acute Care Surg ; 91(3): 559-565, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1254951

ABSTRACT

BACKGROUND: The COVID-19 pandemic reshaped the health care system in 2020. COVID-19 infection has been associated with poor outcomes after orthopedic surgery and elective, general surgery, but the impact of COVID-19 on outcomes after trauma is unknown. METHODS: We conducted a retrospective cohort study of patients admitted to Pennsylvania trauma centers from March 21 to July 31, 2020. The exposure of interest was COVID-19 (COV+) and the primary outcome was inpatient mortality. Secondary outcomes were length of stay and complications. We compared demographic and injury characteristics between positive, negative, and not-tested patients. We used multivariable regression with coarsened exact matching to estimate the impact of COV+ on outcomes. RESULTS: Of 15,550 included patients, 8,170 (52.5%) were tested for COVID-19 and 219 (2.7%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in terms of age and sex, but were less often white (53.5% vs. 74.7%, p < 0.0001), and more often uninsured (10.1 vs. 5.6%, p = 0.002). Injury severity was similar, but firearm injuries accounted for 11.9% of COV+ patients versus 5.1% of COV- patients (p < 0.001). Unadjusted mortality for COV+ was double that of COV- patients (9.1% vs. 4.7%, p < 0.0001) and length of stay was longer (median, 5 vs. 4 days; p < 0.001). Using coarsened exact matching, COV+ patients had an increased risk of death (odds ratio [OR], 6.05; 95% confidence interval [CI], 2.29-15.99), any complication (OR, 1.85; 95% CI, 1.08-3.16), and pulmonary complications (OR, 5.79; 95% CI, 2.02-16.54) compared with COV- patients. CONCLUSION: Patients with concomitant traumatic injury and COVID-19 infection have elevated risks of morbidity and mortality. Trauma centers must incorporate an understanding of these risks into patient and family counseling and resource allocation during this pandemic. LEVEL OF EVIDENCE: Level II, Prognostic Study.


Subject(s)
COVID-19/epidemiology , Length of Stay/statistics & numerical data , Trauma Centers/statistics & numerical data , Wounds and Injuries/mortality , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/ethnology , COVID-19 Testing/statistics & numerical data , Comorbidity , Female , Humans , Male , Medically Uninsured/statistics & numerical data , Middle Aged , Pennsylvania/epidemiology , Retrospective Studies , SARS-CoV-2 , Wounds and Injuries/complications , Wounds, Gunshot/epidemiology
8.
J Med Virol ; 93(9): 5582-5587, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1245503

ABSTRACT

Identify factors associated with readmission after an index hospital admission for coronavirus disease 2019 (COVID-19) infection in a single center serving an underserved and predominantly minority population. This retrospective descriptive study included 275 patients who tested COVID-19 positive via reverse transcriptase-polymerase chain reaction assay at our institution and who survived the index hospitalization. The main outcomes were 1- and 6-month readmission rates after an index hospitalization for COVID-19. The mortality rate among the readmitted patients was also determined. Factors independently associated with readmission were investigated using multivariable logistic regression. A final sample of 275 patients was included. The mean age was 64.69 ± 14.64 (SD), 133 (48%) were female and 194 (70%) were African American. Their chronic medical conditions included hypertension 203 (74%) and diabetes mellitus 121 (44%). After the hospitalization, 1-month readmission rate was 7.6%, while 6-month readmission rate was 24%. Nine percent of patients who were readmitted subsequently died. Coronary artery disease (CAD) was significantly associated with 6-month readmission odds ratio (OR), 2.15 (95% confidence interval [CI]: 1.04-4.44; p = 0.039) after adjustment for age, gender, ethnicity, and comorbidities. Readmissions were due to cardiac, respiratory, and musculoskeletal symptoms. Hispanic ethnicity was associated with increased readmission OR, 3.16 (95% CI: 1.01-9.88; p = 0.048). No significant difference was found between inflammatory markers or clinical outcomes during the index hospitalization among patients who were readmitted compared to those who were not. A significant number of patients hospitalized for COVID-19 may be readmitted. The presence of CAD is independently associated with high rates of 6-month readmission.


Subject(s)
COVID-19/therapy , Patient Readmission/statistics & numerical data , SARS-CoV-2 , Aged , COVID-19/mortality , Comorbidity , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Pennsylvania/epidemiology , Retrospective Studies , Risk Factors , Time Factors
9.
Ann Intern Med ; 174(5): 613-621, 2021 05.
Article in English | MEDLINE | ID: covidwho-1239133

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN: Single-health system, multihospital retrospective cohort study. SETTING: 5 hospitals within the University of Pennsylvania Health System. PATIENTS: Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic. MEASUREMENTS: The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions. RESULTS: Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. LIMITATIONS: Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications. CONCLUSION: Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Critical Illness/mortality , Critical Illness/therapy , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Shock/mortality , Shock/therapy , APACHE , Academic Medical Centers , Aged , Female , Hospital Mortality , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Patient Readmission/statistics & numerical data , Pennsylvania/epidemiology , Pneumonia, Viral/virology , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Shock/virology , Survival Rate
10.
Curr Med Res Opin ; 37(6): 911-915, 2021 06.
Article in English | MEDLINE | ID: covidwho-1177179

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, Americans have increasingly relied on internet versus television news. The extent to which this change in health news consumption practice impacts health knowledge is not known. This study investigates the relationship between most trusted information source and COVID-19 knowledge. METHODS: A cross-sectional online survey was sent to a convenience sample from a list of adults on a central Pennsylvania health system's marketing database 25-31 March 2020. Respondents were grouped by their trusted news sources and comparison of respondent COVID-19 knowledge was made between these groups for 5948 respondents. RESULTS: Those who selected government health websites as their most trusted source were more likely to answer COVID-19 questions correctly than those who selected other internet news sources or television news (OR 1.21, p < .05; 1.08, p > .05; and 0.87, p < .05, respectively). Those who used Facebook as an additional source of news in any way were less likely to answer COVID-19 questions correctly than those who did not (OR 0.93, p < .05). CONCLUSIONS: COVID-19 knowledge correlates with trusted news source. To increase public knowledge of COVID-19 in order to maximize information dissemination and compliance with COVID-19-related public health recommendations, those who provide health information should consider use of the public's most trusted sources of information, as well as monitoring and correcting misinformation presented by other sources. Independent content review for accuracy in media may be warranted in public health emergencies to improve knowledge.


Subject(s)
COVID-19 , Health Communication , Health Knowledge, Attitudes, Practice , Adult , Cross-Sectional Studies , Humans , Internet , Pennsylvania/epidemiology , SARS-CoV-2 , Social Media , Television
12.
Cancer Prev Res (Phila) ; 14(5): 521-526, 2021 05.
Article in English | MEDLINE | ID: covidwho-1102214

ABSTRACT

Disruptions in cancer screening due to the COVID-19 pandemic may disproportionally affect patients with inherited cancer predisposition syndromes, including Lynch syndrome. Herein, we study the effect of the COVID-19 pandemic on endoscopic surveillance in Lynch syndrome through a prospective study of patients with Lynch syndrome at a tertiary referral center who were scheduled for endoscopic surveillance during the COVID-19 pandemic shutdown between March 16, 2020 and June 4, 2020. Of our cohort of 302 individuals with Lynch syndrome, 34 (11%) had endoscopic procedures scheduled during the COVID-19 pandemic shutdown. Of the 27 patients whose endoscopic surveillance was canceled during this period, 85% rescheduled procedures within 6 months with a median delay of 72 days [interquartile range (IQR), 55-84 days], with identification of an advanced adenoma or gastrointestinal cancer in 13%. Individuals who did not have a rescheduled endoscopic procedure were significantly younger than those with a rescheduled procedure [age 35 (IQR, 26-43) vs. age 55 (IQR, 43-63), P = 0.018]. Male sex was also suggestive of increasing likelihood of not having a rescheduled procedure. Taken together, our study demonstrates that the COVID-19 pandemic shutdown led to delayed endoscopic surveillance in Lynch syndrome, with potentially impactful delays among young patients. These data also emphasize the importance of timely surveillance in Lynch syndrome during this current, as well as potential future, global pandemics. PREVENTION RELEVANCE: The COVID-19 pandemic has led to unprecedented disruptions in cancer screening, which may have disproportionate effects on individuals at increased cancer risk, including those with Lynch syndrome. Herein, we show that the COVID-19 pandemic led to significant disruptions in Lynch syndrome surveillance with potentially impactful delays, thus highlighting the importance of ensuring timely surveillance among this high-risk cohort.


Subject(s)
COVID-19/epidemiology , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Early Detection of Cancer/statistics & numerical data , Endoscopy, Gastrointestinal/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , SARS-CoV-2/physiology , Adult , COVID-19/virology , Female , Humans , Male , Middle Aged , Pennsylvania/epidemiology , Prospective Studies
13.
Int J Environ Res Public Health ; 18(4)2021 02 12.
Article in English | MEDLINE | ID: covidwho-1085095

ABSTRACT

COVID-19 has become a global pandemic, with over 81 million cases worldwide. To assess changes in tobacco use as a result of the pandemic, we surveyed a convenience sample of current tobacco users between April and June 2020. The sample was taken from a tobacco user research registry (n = 3396) from the Penn State College of Medicine in Hershey, Pennsylvania, USA. Participants who responded to the survey and were eligible for this study (n = 291) were 25.6% male, 93% white, and had a mean age of 47.3 (SD = 11.6) years. There were no reports of participants testing positive for COVID-19, but 21.7% reported experiencing symptoms associated with the virus. Most participants (67%) believed that their risk of contracting COVID-19 was the same as non-tobacco users, but 57.7% believed that their risk of serious complications, if infected, was greater compared to non-tobacco users. A total of 28% reported increasing their cigarette use during the pandemic. The most common reasons for increased use were increased stress, more time at home, and boredom while quarantined. Nearly 15% reported decreasing their tobacco use. The most common reasons for reduced use were health concerns and more time around non-smokers (including children). A total of 71 (24.5%) users reported making a quit attempt. Characterizing these pandemic-related changes in tobacco use may be important to understanding the full scope of subsequent health outcomes resulting from the pandemic. Tobacco cessation resources should be tailored to allow for safe, appropriate access for those interested in quitting.


Subject(s)
COVID-19 , Health Knowledge, Attitudes, Practice , Tobacco Use/trends , Adult , Female , Health Status , Humans , Male , Middle Aged , Pandemics , Pennsylvania/epidemiology , Risk Assessment , Smoking Cessation/statistics & numerical data
14.
J Sch Nurs ; 37(4): 292-297, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1069511

ABSTRACT

Pennsylvania responded to the COVID-19 pandemic by closing schools and moving to online instruction in March 2020. We surveyed Pennsylvania school nurses (N = 350) in May 2020 to assess the impact of COVID-19 on nurses' concerns about returning to school and impact on practice. Data were analyzed using χ2 tests and regression analyses. Urban school nurses were more concerned about returning to the school building without a COVID-19 vaccine than rural nurses (OR = 1.58, 95% CI [1.05, 2.38]). Nurses in urban locales were more likely to report being asked for guidance on COVID-19 (OR = 1.69, 95% CI [1.06, 2.68]), modify communication practices (OR = 2.33, 95% CI [1.42, 3.82]), and be "very/extremely concerned" about their safety (OR = 2.16, 95% CI [1.35, 3.44]). Locale and student density are important factors to consider when resuming in-person instruction; however, schools should recognize school nurses for their vital role in health communication to assist in pandemic preparedness and response.


Subject(s)
Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/psychology , Nurses/psychology , Nurses/statistics & numerical data , School Health Services/standards , School Nursing/standards , Adult , Female , Guidelines as Topic , Humans , Male , Middle Aged , Pandemics , Pennsylvania/epidemiology , Rural Population/statistics & numerical data , SARS-CoV-2 , School Nursing/statistics & numerical data , Surveys and Questionnaires , Urban Population/statistics & numerical data
15.
JAMA Intern Med ; 181(2): 195-202, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1064281

ABSTRACT

Importance: Health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) are at risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, to our knowledge, there is no effective pharmacologic prophylaxis for individuals at risk. Objective: To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy. Design, Setting, and Participants: This randomized, double-blind, placebo-controlled clinical trial (the Prevention and Treatment of COVID-19 With Hydroxychloroquine Study) was conducted at 2 tertiary urban hospitals, with enrollment from April 9, 2020, to July 14, 2020; follow-up ended August 4, 2020. The trial randomized 132 full-time, hospital-based HCWs (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists), of whom 125 were initially asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab. The trial was terminated early for futility before reaching a planned enrollment of 200 participants. Interventions: Hydroxychloroquine, 600 mg, daily, or size-matched placebo taken orally for 8 weeks. Main Outcomes and Measures: The primary outcome was the incidence of SARS-CoV-2 infection as determined by a nasopharyngeal swab during the 8 weeks of treatment. Secondary outcomes included adverse effects, treatment discontinuation, presence of SARS-CoV-2 antibodies, frequency of QTc prolongation, and clinical outcomes for SARS-CoV-2-positive participants. Results: Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, -9 to 17; vs placebo: 3 milliseconds; 95% CI, -5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered. Conclusions and Relevance: In this randomized clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04329923.


Subject(s)
COVID-19/drug therapy , COVID-19/prevention & control , Cross Infection/prevention & control , Cross Infection/virology , Hydroxychloroquine/administration & dosage , Personnel, Hospital , Pre-Exposure Prophylaxis , Adult , COVID-19/epidemiology , Double-Blind Method , Female , Hospitals, Urban , Humans , Incidence , Male , Pennsylvania/epidemiology , SARS-CoV-2
16.
Perspect Psychol Sci ; 16(1): 161-174, 2021 01.
Article in English | MEDLINE | ID: covidwho-1067154

ABSTRACT

For 35 years, our laboratory has been involved in identifying psychosocial factors that predict who becomes ill when they are exposed to a virus affecting the upper respiratory tract. To pursue this question, we used a unique viral-challenge design in which we assessed behavioral, social, and psychological factors in healthy adults. We subsequently exposed these adults to a cold or influenza virus and then monitored them in quarantine for 5 to 6 days for onset of respiratory illness. Factors we found to be associated with greater risk of respiratory illnesses after virus exposure included smoking, ingesting an inadequate level of vitamin C, and chronic psychological stress. Those associated with decreased risk included social integration, social support, physical activity, adequate and efficient sleep, and moderate alcohol intake. We cautiously suggest that our findings could have implications for identifying who becomes ill when exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19). This argument is based on evidence that the associations we report are replicable across multiple respiratory viruses and that the pathways found to link psychosocial factors to colds and influenza may play similar roles in COVID-19.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/psychology , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Adolescent , Adult , Alcohol Drinking/epidemiology , Ascorbic Acid Deficiency/epidemiology , Comorbidity , Exercise , Female , Humans , Life Style , Male , Middle Aged , Pennsylvania/epidemiology , Risk Factors , SARS-CoV-2 , Sleep , Smoking/epidemiology , Social Support , United Kingdom/epidemiology , Young Adult
18.
Am J Public Health ; 111(3): 494-497, 2021 03.
Article in English | MEDLINE | ID: covidwho-1040090

ABSTRACT

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods.Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020.Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic.Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.


Subject(s)
African Americans/statistics & numerical data , COVID-19/epidemiology , Food Insecurity , Poverty/statistics & numerical data , Humans , Longitudinal Studies , Pandemics , Pennsylvania/epidemiology , Residence Characteristics/statistics & numerical data , Risk Factors , SARS-CoV-2 , United States/epidemiology
19.
Proc Natl Acad Sci U S A ; 118(4)2021 01 26.
Article in English | MEDLINE | ID: covidwho-1038242

ABSTRACT

The ability to cast a mail ballot can safeguard the franchise. However, because there are often additional procedural protections to ensure that a ballot cast in person counts, voting by mail can also jeopardize people's ability to cast a recorded vote. An experiment carried out during the COVID-19 pandemic illustrates both forces. Philadelphia officials randomly sent 46,960 Philadelphia registrants postcards encouraging them to apply to vote by mail in the lead-up to the June 2020 primary election. While the intervention increased the likelihood a registrant cast a mail ballot by 0.4 percentage points (P = 0.017)-or 3%-many of these additional mail ballots counted only because a last-minute policy intervention allowed most mail ballots postmarked by Election Day to count.


Subject(s)
COVID-19/epidemiology , Politics , Reminder Systems , COVID-19/psychology , Humans , Pandemics , Pennsylvania/epidemiology , Postal Service , SARS-CoV-2/isolation & purification
20.
BMC Womens Health ; 21(1): 20, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-1035134

ABSTRACT

BACKGROUND: Almost one-half of U.S. women will experience intimate partner violence (IPV), defined as physical, sexual, or psychological harm by a current or former partner. IPV is associated with an increased risk of homicide, with firearms as the most commonly used weapon. We designed this study to better understand the correlation of interpersonal trauma exposures and demographic factors on firearm perceptions among a cohort of IPV-exposed women. METHODS: Two hundred sixty-seven women in central Pennsylvania with exposure to IPV were surveyed about perceptions of gun access, safety, and gun presence in the home. Trauma variables included IPV type, IPV recency, unwanted sexual exposure, and adverse childhood experiences (ACEs). Multivariable analyses examined three questions examining firearm perceptions controlling for trauma exposures and demographics. RESULTS: Ease of firearm acquisition: Women who were older (mean 44.92 years +/- SD 12.05), compared to women who were younger (40.91 +/- SD 11.81 years) were more likely to describe it as easy or very easy to acquire a gun (aOR 1.05, 95%CI 1.004, 1.10). Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gun nearby (aOR 0.31, 95%CI 0.14, 0.67). Odds of guns in the home: Women who were divorced or separated (aOR 0.22, 95%CI 0.09, 0.54), women were widowed or single (aOR0.23, 95%CI 0.08, 0.67), and women who were partnered (aOR 0.45 95%CI 0.20, 0.97) had lower odds of having a gun in the home, compared to married women. There was no significant effect of the trauma variables on the odds of having a gun at home. CONCLUSIONS: Women with more severe childhood trauma felt less safe around firearms, but trauma exposures did not predict the perception of gun prevalence in the local community or gun ownership. Instead, demographic factors of marriage predicted presence of a gun in the home.


Subject(s)
Firearms , Intimate Partner Violence , Cross-Sectional Studies , Female , Humans , Pennsylvania/epidemiology , Perception , Prevalence , Risk Factors
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