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1.
Ann Intern Med ; 174(2): JC14, 2021 02.
Article in English | MEDLINE | ID: covidwho-1110692

ABSTRACT

SOURCE CITATION: Lynch JB, Davitkov P, Anderson DJ, et al. Infectious Diseases Society of America guidelines on infection prevention for health care personnel caring for patients with suspected or known COVID-19. Clin Infect Dis. 2020. [Epub ahead of print.] 32716496.


Subject(s)
/prevention & control , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Personal Protective Equipment , Practice Guidelines as Topic , Humans , Societies, Medical , United States
3.
4.
Lancet ; 397(10270): 182, 2021 01 16.
Article in English | MEDLINE | ID: covidwho-1093257
10.
MMWR Morb Mortal Wkly Rep ; 70(7): 254-257, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1089245

ABSTRACT

Universal masking is one of the prevention strategies recommended by CDC to slow the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). As of February 1, 2021, 38 states and the District of Columbia had universal masking mandates. Mask wearing has also been mandated by executive order for federal property* as well as on domestic and international transportation conveyances.† Masks substantially reduce exhaled respiratory droplets and aerosols from infected wearers and reduce exposure of uninfected wearers to these particles. Cloth masks§ and medical procedure masks¶ fit more loosely than do respirators (e.g., N95 facepieces). The effectiveness of cloth and medical procedure masks can be improved by ensuring that they are well fitted to the contours of the face to prevent leakage of air around the masks' edges. During January 2021, CDC conducted experimental simulations using pliable elastomeric source and receiver headforms to assess the extent to which two modifications to medical procedure masks, 1) wearing a cloth mask over a medical procedure mask (double masking) and 2) knotting the ear loops of a medical procedure mask where they attach to the mask's edges and then tucking in and flattening the extra material close to the face (knotted and tucked masks), could improve the fit of these masks and reduce the receiver's exposure to an aerosol of simulated respiratory droplet particles of the size considered most important for transmitting SARS-CoV-2. The receiver's exposure was maximally reduced (>95%) when the source and receiver were fitted with modified medical procedure masks. These laboratory-based experiments highlight the importance of good fit to optimize mask performance. Until vaccine-induced population immunity is achieved, universal masking is a highly effective means to slow the spread of SARS-CoV-2** when combined with other protective measures, such as physical distancing, avoiding crowds and poorly ventilated indoor spaces, and good hand hygiene. Innovative efforts to improve the fit of cloth and medical procedure masks to enhance their performance merit attention.


Subject(s)
/prevention & control , Masks/standards , /epidemiology , Centers for Disease Control and Prevention, U.S. , Humans , Masks/statistics & numerical data , United States/epidemiology
11.
MMWR Morb Mortal Wkly Rep ; 70(7): 250-253, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1089244

ABSTRACT

Certain hazard controls, including physical barriers, cloth face masks, and other personal protective equipment (PPE), are recommended to reduce coronavirus 2019 (COVID-19) transmission in the workplace (1). Evaluation of occupational hazard control use for COVID-19 prevention can identify inadequately protected workers and opportunities to improve use. CDC's National Institute for Occupational Safety and Health used data from the June 2020 SummerStyles survey to characterize required and voluntary use of COVID-19-related occupational hazard controls among U.S. non-health care workers. A survey-weighted regression model was used to estimate the association between employer provision of hazard controls and voluntary use, and stratum-specific adjusted risk differences (aRDs) among workers reporting household incomes <250% and ≥250% of national poverty thresholds were estimated to assess effect modification by income. Approximately one half (45.6%; 95% confidence interval [CI] = 41.0%-50.3%) of non-health care workers reported use of hazard controls in the workplace, 55.5% (95% CI = 48.8%-62.2%) of whom reported employer requirements to use them. After adjustment for occupational group and proximity to others at work, voluntary use was approximately double, or 22.3 absolute percentage points higher, among workers who were provided hazard controls than among those who were not. This effect was more apparent among lower-income (aRD = 31.0%) than among higher-income workers (aRD = 16.3%). Employers can help protect workers from COVID-19 by requiring and encouraging use of occupational hazard controls and providing hazard controls to employees (1).


Subject(s)
/prevention & control , Mandatory Programs/statistics & numerical data , Occupational Diseases/prevention & control , Occupational Health/statistics & numerical data , Voluntary Programs/statistics & numerical data , Adolescent , Adult , Architectural Accessibility/statistics & numerical data , Female , Humans , Male , Masks/statistics & numerical data , Middle Aged , Personal Protective Equipment/statistics & numerical data , Surveys and Questionnaires , United States/epidemiology , Workplace/statistics & numerical data , Young Adult
12.
MMWR Morb Mortal Wkly Rep ; 70(7): 245-249, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1089243

ABSTRACT

On March 13, 2020, the United States declared a national emergency concerning the novel coronavirus disease 2019 (COVID-19) outbreak (1). In response, many state and local governments issued shelter-in-place or stay-at-home orders, restricting nonessential activities outside residents' homes (2). CDC initially issued guidance recommending postponing routine adult vaccinations, which was later revised to recommend continuing to administer routine adult vaccines (3). In addition, factors such as disrupted operations of health care facilities and safety concerns regarding exposure to SARS-CoV-2, the virus that causes COVID-19, resulted in delay or avoidance of routine medical care (4), likely further affecting delivery of routine adult vaccinations. Medicare enrollment and claims data of Parts A (hospital insurance), B (medical insurance), and D (prescription drug insurance) were examined to assess the change in receipt of routine adult vaccines during the pandemic. Weekly receipt of four vaccines (13-valent pneumococcal conjugate vaccine [PCV13], 23-valent pneumococcal polysaccharide vaccine [PPSV23], tetanus-diphtheria or tetanus-diphtheria-acellular pertussis vaccine [Td/Tdap], and recombinant zoster vaccine [RZV]) by Medicare beneficiaries aged ≥65 years during January 5-July 18, 2020, was compared with that during January 6-July 20, 2019, for the total study sample and by race and ethnicity. Overall, weekly administration rates of the four examined vaccines declined by up to 89% after the national emergency declaration in mid-March (1) compared with those during the corresponding period in 2019. During the first week following the national emergency declaration, the weekly vaccination rates were 25%-62% lower than those during the corresponding week in 2019. After reaching their nadirs of 70%-89% below 2019 rates in the second to third week of April 2020, weekly vaccination rates gradually began to recover through mid-July, but by the last study week were still lower than were those during the corresponding period in 2019, with the exception of PPSV23. Vaccination declined sharply for all vaccines studied, overall and across all racial and ethnic groups. While the pandemic continues, vaccination providers should emphasize to patients the importance of continuing to receive routine vaccinations and provide reassurance by explaining the procedures in place to ensure patient safety (3).


Subject(s)
/epidemiology , Medicare/statistics & numerical data , Pandemics , Vaccination/statistics & numerical data , Vaccines/administration & dosage , Aged , Humans , United States/epidemiology
13.
MMWR Morb Mortal Wkly Rep ; 70(7): 240-244, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1089242

ABSTRACT

Telehealth can facilitate access to care, reduce risk for transmission of SARS-CoV-2 (the virus that causes coronavirus disease 2019 [COVID-19]), conserve scarce medical supplies, and reduce strain on health care capacity and facilities while supporting continuity of care. Health Resources and Services Administration (HRSA)-funded health centers* expanded telehealth† services during the COVID-19 pandemic (1). The Centers for Medicare & Medicaid Services eliminated geographic restrictions and enhanced reimbursement so that telehealth services-enabled health centers could expand telehealth services and continue providing care during the pandemic (2,3). CDC and HRSA analyzed data from 245 health centers that completed a voluntary weekly HRSA Health Center COVID-19 Survey§ for 20 consecutive weeks to describe trends in telehealth use. During the weeks ending June 26-November 6, 2020, the overall percentage of weekly health care visits conducted via telehealth (telehealth visits) decreased by 25%, from 35.8% during the week ending June 26 to 26.9% for the week ending November 6, averaging 30.2% over the study period. Weekly telehealth visits declined when COVID-19 cases were decreasing and plateaued as cases were increasing. Health centers in the South and in rural areas consistently reported the lowest average percentage of weekly telehealth visits over the 20 weeks, compared with health centers in other regions and urban areas. As the COVID-19 pandemic continues, maintaining and expanding telehealth services will be critical to ensuring access to care while limiting exposure to SARS-CoV-2.


Subject(s)
/epidemiology , Health Facilities/statistics & numerical data , Pandemics , Telemedicine/statistics & numerical data , Telemedicine/trends , Health Care Surveys , Humans , United States/epidemiology
14.
MMWR Morb Mortal Wkly Rep ; 70(7): 229-235, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1089241

ABSTRACT

During 2018, Black or African American (Black) persons accounted for 43% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Among Black persons with diagnosed HIV infection in 41 states and the District of Columbia for whom complete laboratory reporting* was available, the percentages of Black persons linked to care within 1 month of diagnosis (77.1%) and with viral suppression within 6 months of diagnosis (62.9%) during 2018 were lower than the Ending the HIV Epidemic initiative objectives of 95% for linkage to care and viral suppression goals (2). Access to HIV-related care and treatment services varies by residence area (3-5). Identifying urban-rural differences in HIV care outcomes is crucial for addressing HIV-related disparities among Black persons with HIV infection. CDC used National HIV Surveillance System† (NHSS) data to describe HIV care outcomes among Black persons with diagnosed HIV infection during 2018 by population area of residence§ (area). During 2018, Black persons in rural areas received a higher percentage of late-stage diagnoses (25.2%) than did those in urban (21.9%) and metropolitan (19.0%) areas. Linkage to care within 1 month of diagnosis was similar across all areas, whereas viral suppression within 6 months of diagnosis was highest in metropolitan areas (63.8%). The Ending the HIV Epidemic initiative supports scalable, coordinated, and innovative efforts to increase HIV diagnosis, treatment, and prevention among populations disproportionately affected by or who are at higher risk for HIV infection (6), especially during syndemics (e.g. with coronavirus disease 2019).


Subject(s)
African Americans/statistics & numerical data , HIV Infections/ethnology , HIV Infections/therapy , Healthcare Disparities/ethnology , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Adolescent , Adult , Cities , Female , Humans , Male , Middle Aged , Treatment Outcome , United States , Young Adult
16.
Drugs Today (Barc) ; 57(1): 61-67, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1088647

ABSTRACT

Participants from industry and academia attended the American Heart Association Scientific Sessions 2020 (AHA 2020) Annual Meeting held over November 13-17, 2020. AHA 2020 was originally scheduled to be held in Dallas, Texas, but due to public health concerns surrounding the SARS-CoV-2 (COVID-19) crisis, it was instead presented as a virtual summit. The virtual online program included oral, poster and poster discussion presentations, as well as track-based clinical science symposia throughout the conference.


Subject(s)
American Heart Association , Humans , United States
17.
Crit Care ; 25(1): 70, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088611

ABSTRACT

BACKGROUND: The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes. METHODS: Retrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020, to May 15, 2020, at one of 26 hospitals within an integrated delivery system in the Western USA. Patient demographics, comorbidities, and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period. RESULTS: Of 620 patients with COVID-19 admitted to the ICU [mean age 63.5 years (SD 15.7) and 69% male], 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first 2 weeks of the study period to 67.6% in the last 2 weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (biweekly change, adjusted odds ratio [aOR] 1.22, 95% CI 1.04-1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19-positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (biweekly change, aOR 1.18, 95% CI 1.00-1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92-0.98, P < 0.01). CONCLUSIONS: During the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19-positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.


Subject(s)
/epidemiology , Pandemics , Patient Discharge/statistics & numerical data , Aged , Critical Care , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Retrospective Studies , Survival Analysis , United States/epidemiology
18.
Public Health Rep ; 136(2): 148-153, 2021.
Article in English | MEDLINE | ID: covidwho-1088393

ABSTRACT

Force health protection (FHP) is defined as "the prevention of disease and injury in order to protect the strength and capabilities" of any service population. FHP was the foundational principal of the US Public Health Service (USPHS). President John Adams' signing of An Act for Sick and Disabled Seamen on July 16, 1798, marked the first dedication of US federal resources to ensuring the well-being of US civilian sailors and Naval service members. On January 4, 1889, President Cleveland enacted the USPHS Commissioned Corps, creating the world's first (and still only) uniformed service dedicated to promoting, protecting, and advancing the health and safety of the United States and the world. Building on the lessons of the 2014-2015 response to the Ebola virus pandemic, the Corps Care program was formalized in 2017 to establish and implement a uniform and comprehensive strategy to meet the behavioral health, medical, and spiritual needs of all Commissioned Corps officers. Its role was expanded in response to the coronavirus disease 2019 (COVID-19) pandemic, which has placed unprecedented demands on health care workers and spotlighted the need for FHP strategies. We describe the FHP roles of the Corps Care program for the resiliency of Commission Corps officers in general and the Corps' impact during the response to the COVID-19 pandemic. Qualitative analysis of FHP discussions with deployed officers highlights the unique challenges to FHP presented by the pandemic response.


Subject(s)
/epidemiology , Health Personnel/psychology , Hemorrhagic Fever, Ebola/epidemiology , Resilience, Psychological , United States Public Health Service , /therapy , Hemorrhagic Fever, Ebola/therapy , United States
19.
BMJ Open ; 11(2): e043863, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088259

ABSTRACT

OBJECTIVES: We aim to assess the impact of temperature and relative humidity on the transmission of COVID-19 across communities after accounting for community-level factors such as demographics, socioeconomic status and human mobility status. DESIGN: A retrospective cross-sectional regression analysis via the Fama-MacBeth procedure is adopted. SETTING: We use the data for COVID-19 daily symptom-onset cases for 100 Chinese cities and COVID-19 daily confirmed cases for 1005 US counties. PARTICIPANTS: A total of 69 498 cases in China and 740 843 cases in the USA are used for calculating the effective reproductive numbers. PRIMARY OUTCOME MEASURES: Regression analysis of the impact of temperature and relative humidity on the effective reproductive number (R value). RESULTS: Statistically significant negative correlations are found between temperature/relative humidity and the effective reproductive number (R value) in both China and the USA. CONCLUSIONS: Higher temperature and higher relative humidity potentially suppress the transmission of COVID-19. Specifically, an increase in temperature by 1°C is associated with a reduction in the R value of COVID-19 by 0.026 (95% CI (-0.0395 to -0.0125)) in China and by 0.020 (95% CI (-0.0311 to -0.0096)) in the USA; an increase in relative humidity by 1% is associated with a reduction in the R value by 0.0076 (95% CI (-0.0108 to -0.0045)) in China and by 0.0080 (95% CI (-0.0150 to -0.0010)) in the USA. Therefore, the potential impact of temperature/relative humidity on the effective reproductive number alone is not strong enough to stop the pandemic.


Subject(s)
/transmission , Humidity , Models, Theoretical , Temperature , China/epidemiology , Cities , Cross-Sectional Studies , Humans , Retrospective Studies , United States/epidemiology
20.
BMJ Open ; 11(2): e042898, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088253

ABSTRACT

OBJECTIVES: We aim to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines. DESIGN: We developed a stochastic dynamic transmission model of COVID-19. SETTING: One anonymous large urban US jail. PARTICIPANTS: Several thousand staff and incarcerated individuals. INTERVENTIONS: There were four intervention phases during the outbreak: the start of the outbreak, depopulation of the jail, increased proportion of people in single cells and asymptomatic testing. These interventions were implemented incrementally and in concert with one another. PRIMARY AND SECONDARY OUTCOME MEASURES: The basic reproduction ratio, R 0 , in each phase, as estimated using the next generation method. The fraction of new cases, hospitalisations and deaths averted by these interventions (along with the standard measures of sanitisation, masking and social distancing interventions). RESULTS: For the first outbreak phase, the estimated R 0 was 8.44 (95% credible interval (CrI): 5.00 to 13.10), and for the subsequent phases, R 0,phase 2 =3.64 (95% CrI: 2.43 to 5.11), R 0,phase 3 =1.72 (95% CrI: 1.40 to 2.12) and R 0,phase 4 =0.58 (95% CrI: 0.43 to 0.75). In total, the jail's interventions prevented approximately 83% of projected cases, hospitalisations and deaths over 83 days. CONCLUSIONS: Depopulation, single celling and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. Decision makers should prioritise reductions in the jail population, single celling and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.


Subject(s)
/prevention & control , Disease Outbreaks/prevention & control , Humans , Public Health , United States
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