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1.
Proc Natl Acad Sci U S A ; 119(12): e2121675119, 2022 03 22.
Article in English | MEDLINE | ID: covidwho-1740534

ABSTRACT

The uneven spread of COVID-19 has resulted in disparate experiences for marginalized populations in urban centers. Using computational models, we examine the effects of local cohesion on COVID-19 spread in social contact networks for the city of San Francisco, finding that more early COVID-19 infections occur in areas with strong local cohesion. This spatially correlated process tends to affect Black and Hispanic communities more than their non-Hispanic White counterparts. Local social cohesion thus acts as a potential source of hidden risk for COVID-19 infection.


Subject(s)
COVID-19/epidemiology , Healthcare Disparities , SARS-CoV-2 , COVID-19/transmission , COVID-19/virology , Geography, Medical , Humans , Public Health Surveillance , San Francisco/epidemiology
3.
Clin Infect Dis ; 74(1): 32-39, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1636422

ABSTRACT

BACKGROUND: Sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genome from patient samples is an important epidemiological tool for monitoring and responding to the pandemic, including the emergence of new mutations in specific communities. METHODS: SARS-CoV-2 genomic sequences were generated from positive samples collected, along with epidemiological metadata, at a walk-up, rapid testing site in the Mission District of San Francisco, California during 22 November to 1 December, 2020, and 10-29 January 2021. Secondary household attack rates and mean sample viral load were estimated and compared across observed variants. RESULTS: A total of 12 124 tests were performed yielding 1099 positives. From these, 928 high-quality genomes were generated. Certain viral lineages bearing spike mutations, defined in part by L452R, S13I, and W152C, comprised 54.4% of the total sequences from January, compared to 15.7% in November. Household contacts exposed to the "California" or "West Coast" variants (B.1.427 and B.1.429) were at higher risk of infection compared to household contacts exposed to lineages lacking these variants (0.36 vs 0.29, risk ratio [RR] = 1.28; 95% confidence interval [CI]: 1.00-1.64). The reproductive number was estimated to be modestly higher than other lineages spreading in California during the second half of 2020. Viral loads were similar among persons infected with West Coast versus non-West Coast strains, as was the proportion of individuals with symptoms (60.9% vs 64.3%). CONCLUSIONS: The increase in prevalence, relative household attack rates, and reproductive number are consistent with a modest transmissibility increase of the West Coast variants. Summary: We observed a growing prevalence and modestly elevated attack rate for "West Coast" severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in a community testing setting in San Francisco during January 2021, suggesting its modestly higher transmissibility.


Subject(s)
COVID-19 , SARS-CoV-2 , Genomics , Humans , Incidence , San Francisco/epidemiology
4.
Nat Microbiol ; 7(2): 277-288, 2022 02.
Article in English | MEDLINE | ID: covidwho-1616987

ABSTRACT

Associations between vaccine breakthrough cases and infection by different SARS coronavirus 2 (SARS-CoV-2) variants have remained largely unexplored. Here we analysed SARS-CoV-2 whole-genome sequences and viral loads from 1,373 persons with COVID-19 from the San Francisco Bay Area from 1 February to 30 June 2021, of which 125 (9.1%) were vaccine breakthrough infections. Vaccine breakthrough infections were more commonly associated with circulating antibody-resistant variants carrying ≥1 mutation associated with decreased antibody neutralization (L452R/Q, E484K/Q and/or F490S) than infections in unvaccinated individuals (78% versus 48%, P = 1.96 × 10-8). Differences in viral loads were non-significant between unvaccinated and fully vaccinated cases overall (P = 0.99) and according to lineage (P = 0.09-0.78). Symptomatic vaccine breakthrough infections had comparable viral loads (P = 0.64), whereas asymptomatic breakthrough infections had decreased viral loads (P = 0.023) compared with infections in unvaccinated individuals. In 5 cases with serial samples available for serologic analyses, vaccine breakthrough infections were found to be associated with low or undetectable neutralizing antibody levels attributable to an immunocompromised state or infection by an antibody-resistant lineage. Taken together, our results show that vaccine breakthrough infections are overrepresented by antibody-resistant SARS-CoV-2 variants, and that symptomatic breakthrough infections may be as efficient in spreading COVID-19 as unvaccinated infections, regardless of the infecting lineage.


Subject(s)
Antibodies, Viral/blood , COVID-19/epidemiology , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Adolescent , Adult , Aged , Antibodies, Neutralizing/blood , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/immunology , COVID-19 Vaccines/immunology , Cohort Studies , Female , Genome, Viral , Humans , Male , Middle Aged , Mutation , Phylogeny , San Francisco/epidemiology , Vaccination , Viral Load/statistics & numerical data , Whole Genome Sequencing , Young Adult
5.
J Occup Environ Med ; 63(11): e807-e812, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1605104

ABSTRACT

OBJECTIVES: Despite having close contact with the general public, members of the San Francisco Fire Department (SFFD) reported relatively few cases of COVID-19 during the first half of 2020. Our objective was to explore evidence for prior undetected infections by conducting a seroprevalence survey, and to document both risk and protective factors for prior COVID-19 infection. METHODS: This cross-sectional study assessed workplace practices and exposures of SFFD personnel during the first 6 months of 2020 via questionnaire and documented prior COVID-19 infections by serologic antibody testing using an orthogonal testing protocol. RESULTS: Of 1231 participating emergency responders, three (0.25%) had confirmed positive COVID-19 antibody results. CONCLUSIONS: Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.


Subject(s)
COVID-19 , Firefighters , Allied Health Personnel , Cross-Sectional Studies , Humans , SARS-CoV-2 , San Francisco/epidemiology , Seroepidemiologic Studies
6.
Am J Public Health ; 112(1): 43-47, 2022 01.
Article in English | MEDLINE | ID: covidwho-1594512

ABSTRACT

When COVID-19 cases surge, identifying ways to improve the efficiency of contact tracing and prioritize vulnerable communities for isolation and quarantine support services is critical. During a fall 2020 COVID-19 resurgence in San Francisco, California, prioritization of telephone-based case investigation by zip code and using a chatbot to screen for case participants who needed isolation support reduced the number of case participants who would have been assigned for a telephone interview by 31.5% and likely contributed to 87.5% of Latinx case participants being successfully interviewed. (Am J Public Health. 2022;112(1):43-47. https://doi.org/10.2105/AJPH.2021.306563).


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Contact Tracing/methods , Humans , SARS-CoV-2 , San Francisco/epidemiology , Technology , Telephone
7.
Ann Epidemiol ; 67: 81-100, 2022 03.
Article in English | MEDLINE | ID: covidwho-1517026

ABSTRACT

PURPOSE: We describe the design of a longitudinal cohort study to determine SARS-CoV-2 incidence and prevalence among a population-based sample of adults living in six San Francisco Bay Area counties. METHODS: Using an address-based sample, we stratified households by county and by census-tract risk. Risk strata were determined by using regression models to predict infections by geographic area using census-level sociodemographic and health characteristics. We disproportionately sampled high and medium risk strata, which had smaller population sizes, to improve precision of estimates, and calculated a desired sample size of 3400. Participants were primarily recruited by mail and were followed monthly with PCR testing of nasopharyngeal swabs, testing of venous blood samples for antibodies to SARS-CoV-2 spike and nucleocapsid antigens, and testing of the presence of neutralizing antibodies, with completion of questionnaires about socio-demographics and behavior. Estimates of incidence and prevalence will be weighted by county, risk strata and sociodemographic characteristics of non-responders, and will take into account laboratory test performance. RESULTS: We enrolled 3842 adults from August to December 2020, and completed follow-up March 31, 2021. We reached target sample sizes within most strata. CONCLUSIONS: Our stratified random sampling design will allow us to recruit a robust general population cohort of adults to determine the incidence of SARS-CoV-2 infection. Identifying risk strata was unique to the design and will help ensure precise estimates, and high-performance testing for presence of virus and antibodies will enable accurate ascertainment of infections.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Antibodies, Viral , COVID-19/epidemiology , Cohort Studies , Humans , Incidence , Longitudinal Studies , Prevalence , San Francisco/epidemiology
8.
Child Obes ; 18(2): 143-146, 2022 03.
Article in English | MEDLINE | ID: covidwho-1455214

ABSTRACT

Pandemic mitigation measures may lead to excess weight gain in children. Our objective was to assess weight gain during the COVID-19 pandemic in children of ages 4-12 years with overweight and obesity in San Francisco, CA. Children with BMI ≥85th percentile measured at a clinic visit from January to March 2020 were recruited. Follow-up BMI measurements were obtained between October 2020 and March 2021 from the electronic medical record or through a video study visit. Pre- and post-BMI measurements were obtained on n = 91 participants. The majority were Latino (85%) and publicly insured (91%). Mean monthly weight gain was 0.73 kg [standard deviation (SD) 0.47], equivalent to yearly weight gain of 8.8 kg. Mean monthly change in BMI z-score was 0.02 (SD 0.04) equivalent to yearly increase in BMI-z of 0.24. Weight gain among children in San Francisco with overweight and obesity during the COVID-19 pandemic far exceeded healthy weight gain for this age group.


Subject(s)
COVID-19 , Pediatric Obesity , Body Mass Index , COVID-19/epidemiology , Child , Child, Preschool , Humans , Overweight/epidemiology , Pandemics , Pediatric Obesity/epidemiology , SARS-CoV-2 , San Francisco/epidemiology , Weight Gain
10.
MMWR Morb Mortal Wkly Rep ; 69(17): 521-522, 2020 May 01.
Article in English | MEDLINE | ID: covidwho-1389843

ABSTRACT

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Homeless Persons/statistics & numerical data , Housing/statistics & numerical data , Pneumonia, Viral/epidemiology , Boston/epidemiology , COVID-19 , Cities , Georgia/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2 , San Francisco/epidemiology , Washington/epidemiology
11.
Clin Infect Dis ; 73(Suppl 2): S127-S135, 2021 07 30.
Article in English | MEDLINE | ID: covidwho-1387758

ABSTRACT

BACKGROUND: There is an urgent need to understand the dynamics and risk factors driving ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during shelter-in-place mandates. METHODS: We offered SARS-CoV-2 reverse-transcription polymerase chain reaction (PCR) and antibody (Abbott ARCHITECT IgG) testing, regardless of symptoms, to all residents (aged ≥4 years) and workers in a San Francisco census tract (population: 5174) at outdoor, community-mobilized events over 4 days. We estimated SARS-CoV-2 point prevalence (PCR positive) and cumulative incidence (antibody or PCR positive) in the census tract and evaluated risk factors for recent (PCR positive/antibody negative) vs prior infection (antibody positive/PCR negative). SARS-CoV-2 genome recovery and phylogenetics were used to measure viral strain diversity, establish viral lineages present, and estimate number of introductions. RESULTS: We tested 3953 persons (40% Latinx; 41% White; 9% Asian/Pacific Islander; and 2% Black). Overall, 2.1% (83/3871) tested PCR positive: 95% were Latinx and 52% were asymptomatic when tested; 1.7% of census tract residents and 6.0% of workers (non-census tract residents) were PCR positive. Among 2598 tract residents, estimated point prevalence of PCR positives was 2.3% (95% confidence interval [CI], 1.2%-3.8%): 3.9% (95% CI, 2.0%-6.4%) among Latinx persons vs 0.2% (95% CI, .0-.4%) among non-Latinx persons. Estimated cumulative incidence among residents was 6.1% (95% CI, 4.0%-8.6%). Prior infections were 67% Latinx, 16% White, and 17% other ethnicities. Among recent infections, 96% were Latinx. Risk factors for recent infection were Latinx ethnicity, inability to shelter in place and maintain income, frontline service work, unemployment, and household income <$50 000/year. Five SARS-CoV-2 phylogenetic lineages were detected. CONCLUSIONS: SARS-CoV-2 infections from diverse lineages continued circulating among low-income, Latinx persons unable to work from home and maintain income during San Francisco's shelter-in-place ordinance.


Subject(s)
COVID-19 , SARS-CoV-2 , Emergency Shelter , Humans , Phylogeny , San Francisco/epidemiology
12.
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
13.
Int J Drug Policy ; 97: 103405, 2021 11.
Article in English | MEDLINE | ID: covidwho-1336373

ABSTRACT

BACKGROUND: The COVID-19 pandemic created a major public health crisis that disrupted economic systems, social networks and individual behaviors, which led to changes in patterns of health care use. Factors associated with emergency department (ED) visits during the pandemic among especially high-risk individuals are unknown. We used a "Big Events" approach, which considers major disruptions that create social instability, to investigate ED use in people experiencing homelessness or housing instability, many of whom use drugs. METHODS: Between July and December 2020, we conducted a community-based San Francisco study to compare homeless and unstably housed (HUH) women who did and did not use an ED during the first 10 months of the pandemic. RESULTS: Among 128 study participants, 34% had ≥1 ED visit during the pandemic. In adjusted analysis, factors significantly associated with ED use included experiencing homelessness, cocaine use and increased difficulties receiving drug use treatment during the pandemic. CONCLUSION: These findings build on the "Big Events" approach to considering risk pathways among people who use drugs. They suggest the importance of ensuring access to housing and low-barrier non-COVID health services, including drug treatment, alongside crisis management activities, to reduce the health impacts of public health crises.


Subject(s)
COVID-19 , Homeless Persons , Emergency Service, Hospital , Female , Housing , Humans , Pandemics , SARS-CoV-2 , San Francisco/epidemiology
14.
Emerg Infect Dis ; 27(8): 2227-2229, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1319586

ABSTRACT

A mandated shelter-in-place and other restrictions associated with the coronavirus disease pandemic precipitated a decline in tuberculosis diagnoses in San Francisco, California, USA. Several months into the pandemic, severe illness resulting in hospitalization or death increased compared with prepandemic levels, warranting heightened vigilance for tuberculosis in at-risk populations.


Subject(s)
COVID-19 , Tuberculosis , Emergency Shelter , Hospitalization , Humans , SARS-CoV-2 , San Francisco/epidemiology , Tuberculosis/epidemiology
15.
Clin Infect Dis ; 73(2): 324-327, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1315663

ABSTRACT

We report the public health response to a coronavirus disease 2019 (COVID-19) outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.


Subject(s)
COVID-19 , Homeless Persons , Disease Outbreaks , Humans , SARS-CoV-2 , San Francisco/epidemiology
16.
AIDS Patient Care STDS ; 35(7): 249-254, 2021 07.
Article in English | MEDLINE | ID: covidwho-1303887

ABSTRACT

Approximately 1.2 million people are living with HIV in the United States, with 16,000 in San Francisco. Many HIV-positive individuals have difficulty maintaining follow-up clinic visits under normal circumstances, and this is complicated by the coronavirus disease 2019 (COVID-19) pandemic as many institutions transition to a telehealth-focused model of care to maintain patient and provider safety. However, it was unknown how telehealth would impact patient attendance and perceptions about their care, particularly in populations at high risk of appointment nonattendance. To quantify the impact of telehealth on retention in care for a vulnerable HIV-infected population and to identify patient perspectives of telehealth and its effect on appointment attendance, we studied patients at the University of California, San Francisco (UCSF) 360 Wellness Center, an HIV primary care clinic in urban San Francisco, California. Anonymous surveys were conducted to assess patient perceptions of telehealth, and 21% of patients sent surveys responded. Appointment attendance rates for all visits were analyzed before and after the shelter-in-place order in San Francisco on March 16, 2020. With the transition to telehealth, the overall nonattendance rate decreased by ∼3%. Most common perceived strengths of telehealth included convenience and safety, whereas disadvantages included technical barriers and unfamiliarity. Despite barriers and disadvantages listed by patients, a majority are willing to attend telehealth visits, as 80.5% of respondents reported being equally or more likely to attend telehealth visits. This is a critical finding during the COVID-19 pandemic and beyond; we believe that telehealth can improve appointment attendance for vulnerable populations who often face barriers to receiving health care.


Subject(s)
COVID-19 , HIV Infections , Telemedicine , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Pandemics , SARS-CoV-2 , San Francisco/epidemiology , United States/epidemiology
17.
J Occup Environ Med ; 63(6): 528-531, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1288155

ABSTRACT

BACKGROUND: Health care workers (HCWs) experience increased occupational risk of contracting COVID-19, with temporal trends that might inform surveillance. METHODS: We analyzed data from a Veterans Affairs hospital-based COVID-19 worker telephone hotline collected over 40 weeks (2020). We calculated the proportion of COVID-19+ cases among persons-under-investigation (PUIs) for illness compared to rates from a nearby large university-based health care institution. RESULTS: We observed 740 PUIs, 65 (8.8%) COVID-19+. Time trends were similar at the study and comparison hospitals; only for the first of 10 four-week observation periods was the ratio for observed to expected COVID-19+ significant (P < 0.001). DISCUSSION: These data suggest that employee health COVID-19+ to PUI ratios could be utilized as a barometer of community trends. Pooling experience among heath care facilities may yield insights into occupational infectious disease outbreaks.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , Occupational Exposure/statistics & numerical data , COVID-19/diagnosis , Cohort Studies , Hospitals, University , Hospitals, Veterans , Humans , Incidence , Occupational Health/statistics & numerical data , SARS-CoV-2/isolation & purification , San Francisco/epidemiology , Sentinel Surveillance
18.
JMIR Public Health Surveill ; 7(6): e23976, 2021 06 11.
Article in English | MEDLINE | ID: covidwho-1266619

ABSTRACT

BACKGROUND: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. OBJECTIVE: This study aims to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community. METHODS: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. RESULTS: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). CONCLUSIONS: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs.


Subject(s)
Asian Americans/psychology , COVID-19 Testing/statistics & numerical data , COVID-19/ethnology , Healthcare Disparities/ethnology , Mental Disorders/ethnology , Pandemics , Risk Reduction Behavior , Adolescent , Adult , Aged , Asian Americans/statistics & numerical data , COVID-19/prevention & control , Child , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , San Francisco/epidemiology , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
19.
Pediatrics ; 148(3)2021 09.
Article in English | MEDLINE | ID: covidwho-1266575

ABSTRACT

OBJECTIVES: In fall 2020, community hubs opened in San Francisco, California, to support vulnerable groups of students in remote learning. Our objectives were to (1) describe adherence to coronavirus disease 2019 (COVID-19) mitigation policies in these urban, low-income educational settings; (2) assess associations between policy adherence and in-hub COVID-19 transmission; and (3) identify barriers to and facilitators of adherence. METHODS: We conducted a mixed-methods study from November 2020 to February 2021. We obtained COVID-19 case data from the San Francisco Department of Public Health, conducted field observations to observe adherence to COVID-19 mitigation policies, and surveyed hub leaders about barriers to and facilitators of adherence. We summarized quantitative data using descriptive statistics and qualitative data using thematic content analysis. RESULTS: A total of 1738 children were enrolled in 85 hubs (39% Hispanic, 29% Black). We observed 54 hubs (n = 1175 observations of children and 295 observations of adults). There was high community-based COVID-19 incidence (2.9-41.2 cases per 100 000 residents per day), with 36 cases in hubs and only 1 case of hub-based transmission (adult to adult). Sixty-seven percent of children and 99% of adults were masked. Fifty-five percent of children and 48% of adults were distanced ≥6 ft. Facilitators of mitigation policies included the following: for masking, reminders, adequate supplies, and "unmasking zones"; for distancing, reminders and distanced seating. CONCLUSIONS: We directly observed COVID-19 mitigation in educational settings, and we found variable adherence. However, with promotion of multiple policies, there was minimal COVID-19 transmission (despite high community incidence). We detail potential strategies for increasing adherence to COVID-19 mitigation.


Subject(s)
COVID-19/prevention & control , Education, Distance , Guideline Adherence , Students , Vulnerable Populations , Adolescent , Adult , African Americans/education , African Americans/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Cohort Studies , Data Analysis , Data Collection , Education, Distance/organization & administration , Education, Distance/statistics & numerical data , Hand Disinfection , /statistics & numerical data , Humans , Incidence , Masks/statistics & numerical data , Physical Distancing , Poverty Areas , San Francisco/epidemiology , Students/statistics & numerical data , Symptom Assessment , Urban Population
20.
J Public Health Policy ; 42(2): 211-221, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1258617

ABSTRACT

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City's Department of Health expanded contact tracing capability in anticipation of changes in San Francisco's 'shelter in place' order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco's scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Contact Tracing/methods , Public Health Administration/methods , COVID-19/diagnosis , COVID-19 Testing/statistics & numerical data , Data Management/organization & administration , Efficiency, Organizational , Humans , Pandemics , Quarantine/psychology , SARS-CoV-2 , San Francisco/epidemiology , Social Work/organization & administration
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