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1.
BMC Infect Dis ; 21(1): 871, 2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-1477269

ABSTRACT

BACKGROUND: Epidemic projections and public health policies addressing Coronavirus disease (COVID)-19 have been implemented without data reporting on the seroconversion of the population since scalable antibody testing has only recently become available. METHODS: We measured the percentage of severe acute respiratory syndrome- Coronavirus-2 (SARS-CoV-2) seropositive individuals from 2008 blood donors drawn in the state of Rhode Island (RI). We utilized multiple antibody testing platforms, including lateral flow immunoassays (LFAs), enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). To estimate seroprevalence, we utilized the Bayesian statistical method to adjust for sensitivity and specificity of the commercial tests used. RESULTS: We report than an estimated seropositive rate of RI blood donors of approximately 0.6% existed in April-May of 2020. Daily new case rates peaked in RI in late April 2020. We found HTSAs and LFAs were positively correlated with ELISA assays to detect antibodies specific to SARS-CoV-2 in blood donors. CONCLUSIONS: These data imply that seroconversion, and thus infection, is likely not widespread within this population. We conclude that IgG LFAs and HTSAs are suitable to conduct seroprevalence assays in random populations. More studies will be needed using validated serological tests to improve the precision and report the kinetic progression of seroprevalence estimates.


Subject(s)
Antibodies, Viral/blood , Blood Donors , COVID-19/epidemiology , SARS-CoV-2 , Bayes Theorem , Humans , Rhode Island/epidemiology , Seroepidemiologic Studies
2.
Child Obes ; 17(S1): S11-S21, 2021 09.
Article in English | MEDLINE | ID: covidwho-1442994

ABSTRACT

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.


Subject(s)
Pediatric Obesity , Centers for Disease Control and Prevention, U.S. , Child , Health Promotion , Humans , Pediatric Obesity/epidemiology , Pediatric Obesity/prevention & control , Quality of Life , Rhode Island/epidemiology , United States
3.
JAMA Netw Open ; 4(9): e2125538, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1414845

ABSTRACT

Importance: The rate of deaths from overdose has increased during the COVID-19 pandemic, and recent US overdose mortality rates have been markedly high. However, scant data are available on the causes of this increase or subpopulations at elevated risk. Objective: To evaluate the rates and characteristics of deaths from drug overdose before vs during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective, population-based cohort study used data from 4 statewide databases linked at the person level via the Rhode Island Data Ecosystem on adults with deaths due to overdose in Rhode Island from January 1 to August 31, 2019, and January 1 to August 31, 2020. Main Outcomes and Measures: The rates of unintentional deaths from drug-related overdose during the 2019 and 2020 observation periods overall and by sociodemographic characteristics, drugs contributing to the cause of death, location of death, and socioeconomic factors were evaluated. In subgroup analyses restricted to Medicaid beneficiaries (n = 271), the proportions of deaths from overdose by behavioral health treatment and diagnosis claims in the year before death were also examined. Results: A total of 470 adults who died of drug overdose were included in the analysis (353 men [75%]; mean [SD] age, 43.5 [12.1] years). The rate of deaths from overdose in Rhode Island increased 28.1%, from 29.2 per 100 000 person-years in 2019 to 37.4 per 100 000 person-years in 2020 (P = .009). Compared with 2019, rates of deaths due to overdose during 2020 were higher among men (43.2 vs 59.2 per 100 000 person-years; P = .003), non-Hispanic White individuals (31.0 vs 42.0 per 100 000 person-years; P = .005), single individuals (54.8 vs 70.4 per 100 000 person-years; P = .04), deaths involving synthetic opioids (20.8 vs 28.3 per 100 000 person-years; P = .005), and deaths occurring in a personal residence (13.2 vs 19.7 per 100 000 person-years; P = .003). A decrease in the proportion of deaths from overdose involving heroin (11 of 206 [5%] vs <2% [exact value suppressed]; P = .02) and an increase among persons experiencing job loss (16 of 206 [8%] vs 41 of 264 [16%]; P = .01) from 2019 to 2020 were observed. Among individuals who died of overdose and were Medicaid beneficiaries, the proportions of those aged 50 to 59 years with anxiety (11 of 121 [9%] vs 29 of 150 [19%]; P = .03), men with depression (27 of 121 [22%] vs 57 of 150 [38%]; P = .008), and men with anxiety (28 of 121 [23%] vs 55 of 150 [37%]; P = .02) increased during 2020 compared with 2019. Conclusions and Relevance: In this cohort study, during the first 8 months of 2020, the rate of deaths from overdose increased in Rhode Island compared with the same period in 2019, and several emerging characteristics of deaths from drug overdose during the first year of the COVID-19 pandemic were identified. These findings may inform interventions that address macroenvironmental changes associated with the pandemic.


Subject(s)
COVID-19 , Drug Overdose/mortality , Adult , Cohort Studies , Drug Overdose/epidemiology , Female , Humans , Male , Middle Aged , Quarantine/psychology , Quarantine/statistics & numerical data , Retrospective Studies , Rhode Island/epidemiology
6.
Emerg Infect Dis ; 27(9): 2445-2449, 2021 09.
Article in English | MEDLINE | ID: covidwho-1369630

ABSTRACT

We developed a testing program for severe acute respiratory syndrome coronavirus 2 in an urban Latinx neighborhood in Providence, Rhode Island, USA. Approximately 11% of Latinx participants (n = 180) tested positive. Culturally tailored, community-based programs that reduce barriers to testing help identify persons at highest risk for coronavirus disease.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Testing , Humans , Medically Underserved Area , Rhode Island/epidemiology
8.
BMC Med ; 19(1): 162, 2021 07 13.
Article in English | MEDLINE | ID: covidwho-1308097

ABSTRACT

BACKGROUND: When three SARS-CoV-2 vaccines came to market in Europe and North America in the winter of 2020-2021, distribution networks were in a race against a major epidemiological wave of SARS-CoV-2 that began in autumn 2020. Rapid and optimized vaccine allocation was critical during this time. With 95% efficacy reported for two of the vaccines, near-term public health needs likely require that distribution is prioritized to the elderly, health care workers, teachers, essential workers, and individuals with comorbidities putting them at risk of severe clinical progression. METHODS: We evaluate various age-based vaccine distributions using a validated mathematical model based on current epidemic trends in Rhode Island and Massachusetts. We allow for varying waning efficacy of vaccine-induced immunity, as this has not yet been measured. We account for the fact that known COVID-positive cases may not have been included in the first round of vaccination. And, we account for age-specific immune patterns in both states at the time of the start of the vaccination program. Our analysis assumes that health systems during winter 2020-2021 had equal staffing and capacity to previous phases of the SARS-CoV-2 epidemic; we do not consider the effects of understaffed hospitals or unvaccinated medical staff. RESULTS: We find that allocating a substantial proportion (>75%) of vaccine supply to individuals over the age of 70 is optimal in terms of reducing total cumulative deaths through mid-2021. This result is robust to different profiles of waning vaccine efficacy and several different assumptions on age mixing during and after lockdown periods. As we do not explicitly model other high-mortality groups, our results on vaccine allocation apply to all groups at high risk of mortality if infected. A median of 327 to 340 deaths can be avoided in Rhode Island (3444 to 3647 in Massachusetts) by optimizing vaccine allocation and vaccinating the elderly first. The vaccination campaigns are expected to save a median of 639 to 664 lives in Rhode Island and 6278 to 6618 lives in Massachusetts in the first half of 2021 when compared to a scenario with no vaccine. A policy of vaccinating only seronegative individuals avoids redundancy in vaccine use on individuals that may already be immune, and would result in 0.5% to 1% reductions in cumulative hospitalizations and deaths by mid-2021. CONCLUSIONS: Assuming high vaccination coverage (>28%) and no major changes in distancing, masking, gathering size, hygiene guidelines, and virus transmissibility between 1 January 2021 and 1 July 2021 a combination of vaccination and population immunity may lead to low or near-zero transmission levels by the second quarter of 2021.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19 , Communicable Disease Control/organization & administration , Health Care Rationing/organization & administration , Resource Allocation/organization & administration , Vaccination Coverage , Vaccination , Age Factors , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Incidence , Massachusetts/epidemiology , Models, Theoretical , Public Health/methods , Public Health/standards , Rhode Island/epidemiology , SARS-CoV-2 , Vaccination/methods , Vaccination/statistics & numerical data , Vaccination Coverage/statistics & numerical data , Vaccination Coverage/supply & distribution
9.
PLoS One ; 16(6): e0252411, 2021.
Article in English | MEDLINE | ID: covidwho-1278175

ABSTRACT

BACKGROUND: In order for healthcare systems to prepare for future waves of COVID-19, an in-depth understanding of clinical predictors is essential for efficient triage of hospitalized patients. METHODS: We performed a retrospective cohort study of 259 patients admitted to our hospitals in Rhode Island to examine differences in baseline characteristics (demographics and comorbidities) as well as presenting symptoms, signs, labs, and imaging findings that predicted disease progression and in-hospital mortality. RESULTS: Patients with severe COVID-19 were more likely to be older (p = 0.02), Black (47.2% vs. 32.0%, p = 0.04), admitted from a nursing facility (33.0% vs. 17.9%, p = 0.006), have diabetes (53.9% vs. 30.4%, p<0.001), or have COPD (15.4% vs. 6.6%, p = 0.02). In multivariate regression, Black race (adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI]: 1.1-3.9) and diabetes (aOR 2.2, 95%CI: 1.3-3.9) were independent predictors of severe disease, while older age (aOR 1.04, 95% CI: 1.01-1.07), admission from a nursing facility (aOR 2.7, 95% CI 1.1-6.7), and hematological co-morbidities predicted mortality (aOR 3.4, 95% CI 1.1-10.0). In the first 24 hours, respiratory symptoms (aOR 7.0, 95% CI: 1.4-34.1), hypoxia (aOR 19.9, 95% CI: 2.6-152.5), and hypotension (aOR 2.7, 95% CI) predicted progression to severe disease, while tachypnea (aOR 8.7, 95% CI: 1.1-71.7) and hypotension (aOR 9.0, 95% CI: 3.1-26.1) were associated with increased in-hospital mortality. CONCLUSIONS: Certain patient characteristics and clinical features can help clinicians with early identification and triage of high-risk patients during subsequent waves of COVID-19.


Subject(s)
COVID-19/epidemiology , Hospital Mortality , Hospitalization/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Aged , COVID-19/mortality , COVID-19/virology , Comorbidity , Diabetes Mellitus/epidemiology , Epidemics , Female , Humans , Hypotension/epidemiology , Male , Middle Aged , Retrospective Studies , Rhode Island/epidemiology , Risk Factors , SARS-CoV-2/physiology , Tachypnea/epidemiology , Triage/methods
10.
Pediatr Infect Dis J ; 40(3): 175-181, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1197051

ABSTRACT

BACKGROUND: The objective was to evaluate patterns of pediatric coronavirus disease 2019 testing in a large health system throughout the pandemic, before and after school reopening. METHODS: This was a cross-sectional time-series study of clinical virology results from children tested for severe acute respiratory syndrome coronavirus 2 in Southern Connecticut and areas of New York and Rhode Island. Data collected include demographics, hospital admission, changes in percent positive tests over time, detection intervals in persistently positive children and cycle threshold values. The setting was the Yale New Haven Health System has 6 hospitals at 4 Connecticut locations, 1 hospital in Rhode Island and ambulatory locations in Connecticut, Rhode Island and New York. Participants included twenty-three-thousand one-hundred thirty-seven children ≤ 18 years of age, tested for coronavirus disease 2019 at an ambulatory testing site, the emergency department or on an inpatient unit within the Yale New Haven Health System. RESULTS: Among all tests, 3.2% were positive. Older children consistently made up the larger portion of positive pediatric cases, regardless of community prevalence. Increased pediatric cases later in the pandemic when prevalence in adults was relatively low correlates with a higher number of tests performed in children and not with an increased positivity rate. No significant changes in trends of positivity were detected after the reopening of schools. Symptomatic and asymptomatic children had similar cycle threshold values regardless of age, and a subset of children demonstrated persistent viral detection, some for as long as 6 weeks. CONCLUSION: An increase in pediatric cases documented in the late summer was predominately due to increased access to testing for children. The percent positivity in children did not change in the first 3 weeks after school opened. A subset of children has detectable severe acute respiratory syndrome coronavirus 2 RNA in the upper respiratory tract for weeks after the initial infection.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2/isolation & purification , Adolescent , COVID-19/virology , COVID-19 Testing , Child , Child, Preschool , Connecticut/epidemiology , Cross-Sectional Studies , Demography , Female , Hospitalization , Humans , Inpatients , Male , New York/epidemiology , Prevalence , Rhode Island/epidemiology , SARS-CoV-2/genetics
11.
Emerg Infect Dis ; 27(3): 823-834, 2021 03.
Article in English | MEDLINE | ID: covidwho-1100027

ABSTRACT

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , Hospitals/statistics & numerical data , Nursing Homes/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/transmission , Female , Humans , Male , Middle Aged , Occupational Exposure/statistics & numerical data , Odds Ratio , Personal Protective Equipment/statistics & numerical data , Rhode Island/epidemiology , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Seroepidemiologic Studies , Young Adult
12.
Am J Public Health ; 111(4): 700-703, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1088805

ABSTRACT

Objectives. To characterize statewide seroprevalence and point prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Rhode Island.Methods. We conducted a cross-sectional survey of randomly selected households across Rhode Island in May 2020. Antibody-based and polymerase chain reaction (PCR)-based tests for SARS-CoV-2 were offered. Hispanics/Latinos and African Americans/Blacks were oversampled to ensure adequate representation. Seroprevalence estimations accounted for test sensitivity and specificity and were compared according to age, race/ethnicity, gender, housing environment, and transportation mode.Results. Overall, 1043 individuals from 554 households were tested (1032 antibody tests, 988 PCR tests). The estimated seroprevalence of SARS-CoV-2 antibodies was 2.1% (95% credible interval [CI] = 0.6, 4.1). Seroprevalence was 7.5% (95% CI = 1.3, 17.5) among Hispanics/Latinos, 3.8% (95% CI = 0.0, 15.0) among African Americans/Blacks, and 0.8% (95% CI = 0.0, 2.4) among non-Hispanic Whites. Overall PCR-based prevalence was 1.5% (95% CI = 0.5, 3.1).Conclusions. Rhode Island had low seroprevalence relative to other settings, but seroprevalence was substantially higher among African Americans/Blacks and Hispanics/Latinos. Rhode Island sits along the highly populated northeast corridor, making our findings broadly relevant to this region of the country. Continued monitoring via population-based sampling is needed to quantify these impacts going forward.


Subject(s)
COVID-19 Serological Testing , COVID-19 , Seroepidemiologic Studies , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/ethnology , Child , Child, Preschool , Cross-Sectional Studies , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Rhode Island/epidemiology , Young Adult
13.
Am J Public Health ; 110(12): 1817-1824, 2020 12.
Article in English | MEDLINE | ID: covidwho-1067486

ABSTRACT

Objectives. To identify spatiotemporal patterns of epidemic spread at the community level.Methods. We extracted influenza cases reported between 2016 and 2019 and COVID-19 cases reported in March and April 2020 from a hospital network in Rhode Island. We performed a spatiotemporal hotspot analysis to simulate a real-time surveillance scenario.Results. We analyzed 6527 laboratory-confirmed influenza cases and identified microepidemics in more than 1100 neighborhoods, and more than half of the neighborhoods that had hotspots in a season became hotspots in the next season. We used data from 731 COVID-19 cases, and we found that a neighborhood was 1.90 times more likely to become a COVID-19 hotspot if it had been an influenza hotspot in 2018 to 2019.Conclusions. The use of readily available hospital data allows the real-time identification of spatiotemporal trends and hotspots of microepidemics.Public Health Implications. As local governments move to reopen the economy and ease physical distancing, the use of historic influenza hotspots could guide early prevention interventions, while the real-time identification of hotspots would enable the implementation of interventions that focus on small-area containment and mitigation.


Subject(s)
COVID-19/epidemiology , Influenza, Human/epidemiology , Humans , Influenza A virus , Pandemics , Public Health Surveillance , Rhode Island/epidemiology , SARS-CoV-2 , Spatio-Temporal Analysis
14.
R I Med J (2013) ; 104(1): 55-60, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1055475

ABSTRACT

OBJECTIVE: To describe characteristics of children undergoing SARS-CoV-2 testing during the initial wave of infections in Rhode Island. METHODS: This is a descriptive study of 729 children tested for SARS-CoV-2 at four emergency departments April 9 to May 7, 2020 in Rhode Island. Demographic information and symptoms were cataloged for those tested. RESULTS: 81 (11%) children tested positive for SARS-CoV-2. 94% of positive children were symptomatic. 74% of positive cases had constitutional symptoms and 72% had upper respiratory symptoms. While only 34% of those tested were Hispanic, 68% of the SARS-CoV-2- positive cases occurred in Hispanic children. CONCLUSION: This study details the pediatric population's experience during the first wave of the pandemic in Rhode Island. It could inform testing allocation strategies in healthcare settings. It also highlights vulnerable populations in need of further public health support in our state.


Subject(s)
COVID-19/diagnosis , Adolescent , Asymptomatic Diseases , COVID-19/epidemiology , COVID-19/pathology , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Infant , Male , Retrospective Studies , Rhode Island/epidemiology , SARS-CoV-2 , Young Adult
16.
Curr Probl Diagn Radiol ; 50(5): 665-668, 2021.
Article in English | MEDLINE | ID: covidwho-797123

ABSTRACT

INTRODUCTION: Amidst COVID-19 crisis, confusion exists over current radiology operations due to influx of new data and new protocols. In order to decrease confusion and reduce imaging facility related COVID-19 transmissions, we created a dedicated radiology COVID-19 call center and dedicated out-patient COVID-19 imaging sites (referred to "HOT" sites). MATERIALS AND METHODS: We created a central radiology call center hotline, staffed by our radiology technologists, to answer all radiology questions related to COVID-19 and help with scheduling exams. All out-patient x-ray exams became mandatory to schedule through the call center so proper COVID-19 screening could occur. If positive for COVID-19 symptoms, they are sent to "HOT" sites. Various statistical analyses were performed. RESULTS: A total of 2548 calls were received over 7 weeks with linear increase in calls during this period (R 2 = 0.17, P = 0.003). Most common reasons for calling were related to scheduling (n = 2336, 92%) and radiology operations (n = 145, 6%). At our main "HOT" site, from a total of 371 separate patient encounters by date of study, 72 patient encounters (19%) were COVID-19 positive at time of exam. DISCUSSION: This project provides efficient and reassuring radiology operations during an emergency situation by providing a single reliable point of contact and a source of truth for all facets of radiology. In doing so, we facilitate high quality patient centered care while protecting the health of our patients and staff.


Subject(s)
Ambulatory Care/organization & administration , COVID-19/epidemiology , Diagnostic Imaging , Hotlines , Appointments and Schedules , Connecticut/epidemiology , Efficiency, Organizational , Humans , Mass Screening , Pandemics , Quality Assurance, Health Care , Retrospective Studies , Rhode Island/epidemiology , SARS-CoV-2 , Technology, Radiologic
17.
West J Emerg Med ; 21(5): 1048-1053, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-792475

ABSTRACT

INTRODUCTION: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19-April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. RESULTS: A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. CONCLUSION: SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Status Disparities , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cross-Sectional Studies , Female , Health Policy , Health Surveys , Humans , Infection Control/methods , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Prevalence , Rhode Island/epidemiology , SARS-CoV-2 , Young Adult
18.
MMWR Morb Mortal Wkly Rep ; 69(34): 1170-1172, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-732629

ABSTRACT

On June 1, 2020, with declines in coronavirus disease 2019 (COVID-19) cases and hospitalizations in Rhode Island,* child care programs in the state reopened after a nearly 3-month closure implemented as part of mitigation efforts. To reopen safely, the Rhode Island Department of Human Services (RIDHS) required licensed center- and home-based child care programs to reduce enrollment, initially to a maximum of 12 persons, including staff members, in stable groups (i.e., staff members and students not switching between groups) in physically separated spaces, increasing to a maximum of 20 persons on June 29. Additional requirements included universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.† As of July 31, 666 of 891 (75%) programs were approved to reopen, with capacity for 18,945 children, representing 74% of the state's January 2020 child care program population (25,749 children).


Subject(s)
Child Care , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Adult , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Child , Child Care/organization & administration , Child, Preschool , Clinical Laboratory Techniques , Contact Tracing , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Guideline Adherence/statistics & numerical data , Humans , Infant , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Rhode Island/epidemiology , SARS-CoV-2 , Young Adult
19.
Epidemiol Infect ; 148: e140, 2020 07 09.
Article in English | MEDLINE | ID: covidwho-650589

ABSTRACT

Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic, and there is limited data on effective therapies. Bacillus Calmette-Guérin (BCG) vaccine, a live-attenuated strain derived from an isolate of Mycobacterium bovis and originally designed to prevent tuberculosis, has shown some efficacy against infection with unrelated pathogens. In this study, we reviewed 120 consecutive adult patients (≥18 years old) with COVID-19 at a major federally qualified health centre in Rhode Island, United States from 19 March to 29 April 2020. Median age was 39.5 years (interquartile range, 27.0-50.0), 30% were male and 87.5% were Latino/Hispanics. Eighty-two (68.3%) patients had BCG vaccination. Individuals with BCG vaccination were less likely to require hospital admission during the disease course (3.7% vs. 15.8%, P = 0.019). This association remained unchanged after adjusting for demographics and comorbidities (P = 0.017) using multivariate regression analysis. The finding from our study suggests the potential of BCG in preventing more severe COVID-19.


Subject(s)
BCG Vaccine/immunology , Coronavirus Infections/immunology , Pneumonia, Viral/immunology , Adult , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Pandemics , Pneumonia, Viral/epidemiology , Rhode Island/epidemiology , Severity of Illness Index
20.
J Int AIDS Soc ; 23(7): e25573, 2020 07.
Article in English | MEDLINE | ID: covidwho-609401

ABSTRACT

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US. METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US. RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%. CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.


Subject(s)
Coronavirus Infections/complications , HIV Infections/complications , Inpatients , Outpatients , Pneumonia, Viral/complications , Telemedicine , Adult , Aged , Ambulatory Care/standards , Betacoronavirus , COVID-19 , Coinfection/epidemiology , Coronavirus Infections/epidemiology , Female , HIV Infections/epidemiology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Rhode Island/epidemiology , Risk Factors , SARS-CoV-2 , United States
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