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1.
Ethn Health ; 26(1): 36-48, 2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1060123

RESUMEN

OBJECTIVES: Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization. DESIGN: An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020). RESULTS: A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45-0.74), Blacks (r = 0.51, 95% CI 0.32-0.66), or Asians (r = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites (r = -0.63, 95% CI -0.75, -0.45). CONCLUSIONS: We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.


Asunto(s)
/estadística & datos numéricos , Disparidades en Atención de Salud , Hospitalización/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Adulto , /epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud , Femenino , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Washingtón/epidemiología
3.
Int J Environ Res Public Health ; 17(24)2020 12 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1006978

RESUMEN

Individual-level Coronavirus Disease 2019 (COVID-19) case data suggest that certain populations may be more impacted by the pandemic. However, few studies have considered the communities from which positive cases are prevalent, and the variations in testing rates between communities. In this study, we assessed community factors that were associated with COVID-19 testing and test positivity at the census tract level for the Seattle, King County, Washington region at the summer peak of infection in July 2020. Multivariate Poisson regression was used to estimate confirmed case counts, adjusted for testing numbers, which were associated with socioeconomic status (SES) indicators such as poverty, educational attainment, transportation cost, as well as with communities with high proportions of people of color. Multivariate models were also used to examine factors associated with testing rates, and found disparities in testing for communities of color and communities with transportation cost barriers. These results demonstrate the ability to identify tract-level indicators of COVID-19 risk and specific communities that are most vulnerable to COVID-19 infection, as well as highlight the ongoing need to ensure access to disease control resources, including information and education, testing, and future vaccination programs in low-SES and highly diverse communities.


Asunto(s)
/diagnóstico , Factores Socioeconómicos , Grupos Étnicos , Disparidades en Atención de Salud , Humanos , Pandemias , Pobreza , Transportes , Washingtón/epidemiología
5.
Lancet ; 396(10247): 320-332, 2020 08 01.
Artículo en Inglés | MEDLINE | ID: covidwho-981695

RESUMEN

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS: In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS: The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION: The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING: None.


Asunto(s)
Infecciones por Coronavirus/patología , Neumonía Viral/patología , Adulto , Anciano , Anciano de 80 o más Años , Células Epiteliales Alveolares/patología , Células Epiteliales Alveolares/ultraestructura , Células Epiteliales Alveolares/virología , Autopsia , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Femenino , Tracto Gastrointestinal/patología , Tracto Gastrointestinal/ultraestructura , Tracto Gastrointestinal/virología , Corazón/virología , Humanos , Riñón/patología , Riñón/ultraestructura , Riñón/virología , Hígado/patología , Hígado/ultraestructura , Hígado/virología , Masculino , Persona de Mediana Edad , Miocardio/patología , Miocardio/ultraestructura , Pandemias , Neumonía Viral/epidemiología , Alveolos Pulmonares/patología , Alveolos Pulmonares/ultraestructura , Mucosa Respiratoria/patología , Mucosa Respiratoria/ultraestructura , Mucosa Respiratoria/virología , Bazo/patología , Bazo/ultraestructura , Bazo/virología , Trombosis/patología , Tráquea/patología , Tráquea/ultraestructura , Tráquea/virología , Washingtón/epidemiología
6.
Am J Clin Pathol ; 154(5): 585-591, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: covidwho-968615

RESUMEN

OBJECTIVES: The coronavirus disease 2019 pandemic has halted in-person medical student education in many large academic centers, including the University of Washington. We identified a unique opportunity to bring comprehensive and targeted anatomic pathology training to large numbers of medical students who would not receive it otherwise but also need credited coursework. METHODS: We developed a comprehensive 2-week remote-learning course encompassing lectures, virtual slides, discussion groups, and unique case-based activities. Activities are tailored to the nonpathologist future clinician, emphasizing basic microscopy and pathology terminology. We employ multiple strategies and technologies to increase engagement while distance learning, including screen annotation, "flipped classroom" slide presentations, and repetition of common themes. RESULTS: Given 13 virtual courses to choose between 13% of students enrolled in our course (70 of our 540 rising third- and fourth-year students), a nearly 10-fold increase in average pathology rotators. CONCLUSIONS: This is an unprecedented opportunity to provide tailored anatomic pathology instruction, both helping our medical students continue training during crisis and illuminating the field of pathology for our future colleagues. Preliminary results have been overwhelmingly positive regarding understanding of pathology concepts as well as attitudes toward pathology.


Asunto(s)
Educación Médica , Patólogos/educación , Patología/educación , Estudiantes de Medicina , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/diagnóstico , Curriculum , Educación Médica/métodos , Evaluación Educacional , Humanos , Pandemias , Neumonía Viral/diagnóstico , Washingtón
8.
BMJ Open ; 10(10): e041772, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: covidwho-883375

RESUMEN

OBJECTIVES: Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands. DESIGN: Rapid clinical ethnography of patient-provider encounters during an initial pandemic 'surge' conducted by a team of clinician-researchers using a structured protocol for qualitative data collection and analysis. SETTING: Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020. PARTICIPANTS: Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients. RESULTS: We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale. CONCLUSIONS: Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.


Asunto(s)
Actitud del Personal de Salud , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Investigación Cualitativa , Centros Traumatológicos/estadística & datos numéricos , Humanos , Washingtón/epidemiología
9.
Health Educ Behav ; 47(6): 845-849, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-858382

RESUMEN

The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19-related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.


Asunto(s)
Infecciones por Coronavirus/etnología , Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Neumonía Viral/etnología , Betacoronavirus , Barreras de Comunicación , Política de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Vivienda/normas , Humanos , Pandemias , Traducción , Estados Unidos/epidemiología , Washingtón/epidemiología , Trabajo/estadística & datos numéricos
10.
J Adolesc Health ; 67(5): 714-717, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-849769

RESUMEN

PURPOSE: Young adults are at high risk for increases in loneliness and mental health problems during the COVID-19 pandemic. The present study examined increases in loneliness in a young adult sample, for whom increases were greater, and association with increases in depression and anxiety. METHOD: Data from 564 young adults (ages 22-29, 60.7% women) were collected in January 2020 (pre-pandemic) and April/May 2020 (during pandemic). RESULTS: Loneliness increased from January to April/May and changes in loneliness were greater for females, those with higher perceived social support in January, and those with greater concerns about the pandemic's social impacts. Depression (but not anxiety) increased during this time with changes in loneliness accounting for much of the increase in depression. CONCLUSIONS: Intervention strategies with young adults need to address loneliness and feelings of reduced social support during this time, especially for those who may have had greater disruption in their social lives.


Asunto(s)
Infecciones por Coronavirus/psicología , Depresión/etiología , Soledad/psicología , Neumonía Viral/psicología , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Trastornos Mentales/etiología , Salud Mental , Pandemias , Aislamiento Social/psicología , Washingtón , Adulto Joven
11.
J Equine Vet Sci ; 87: 102906, 2020 04.
Artículo en Inglés | MEDLINE | ID: covidwho-828485

RESUMEN

Equine coronavirus (ECoV) is a known cause of fever, anorexia, and lethargy in adult horses. Although there are multiple reports of ECoV outbreaks, less is known about the clinical presentation of individual horses during a nonoutbreak situation. The purpose of this study was to describe the clinical presentation of horses diagnosed with ECoV infection that were not associated with an outbreak. Medical records of all horses admitted to Washington State University, Veterinary Teaching Hospital, during an 8-year period were reviewed (2010-2018). The five horses included in this study were older than 1 year of age, were diagnosed with colitis, tested positive for ECoV using real-time polymerase chain reaction, and were negative to other enteric pathogens. Interestingly, 4 of 5 horses had moderate to severe diarrhea, 3 had abnormal large colon ultrasonography, 2 had transient ventricular tachycardia and 2 had clinicopathologic evidence of liver dysfunction. ECoV should be included as a differential diagnosis for individual horses presenting with anorexia, fever, lethargy, and colitis. Early identification of ECoV cases is key to implement appropriate biosecurity measures to prevent the potential spread of this disease.


Asunto(s)
Betacoronavirus 1 , Colitis/veterinaria , Enfermedades de los Caballos , Animales , Caballos , Estudios Retrospectivos , Washingtón
15.
Emerg Med J ; 37(11): 707-713, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: covidwho-788175

RESUMEN

Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use is not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure and PPE use. We conducted a retrospective cohort investigation of laboratory-confirmed patients with COVID-19 in King County, Washington, USA, who received 9-1-1 EMS responses from 14 February 2020 to 26 March 2020. We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE. There were 274 EMS encounters for 220 unique COVID-19 patients involving 700 unique EMS providers with 988 EMS person-encounters. Use of 'full' PPE including mask (surgical or N95), eye protection, gown and gloves (MEGG) was 67%. There were 151 person-exposures among 129 individuals, who required 981 quarantine days. Of the 700 EMS providers, 3 (0.4%) tested positive within 14 days of encounter, though these positive tests were not attributed to occupational exposure from inadequate PPE. Programmatic changes were associated with a temporal reduction in exposures. When stratified at the study encounters midpoint, 94% (142/151) of exposures occurred during the first 137 EMS encounters compared with 6% (9/151) during the second 137 EMS encounters (p<0.01). By the investigation's final week, EMS deployed MEGG PPE in 34% (3579/10 468) of all EMS person-encounters. Less than 0.5% of EMS providers experienced COVID-19 illness within 14 days of occupational encounter. Programmatic strategies were associated with a reduction in exposures, while achieving a measured use of PPE.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Servicios Médicos de Urgencia/organización & administración , Exposición Profesional/prevención & control , Exposición Profesional/estadística & datos numéricos , Equipo de Protección Personal , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Tamizaje Masivo , Pandemias , Cuarentena , Estudios Retrospectivos , Medición de Riesgo , Washingtón/epidemiología
16.
J Pain Symptom Manage ; 60(1): e21-e26, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-773478

RESUMEN

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. METHODS: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership. RESULTS: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members. CONCLUSION: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.


Asunto(s)
Infecciones por Coronavirus/terapia , Planificación en Salud/métodos , Hospitalización , Cuidados Paliativos/métodos , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Centros Médicos Académicos , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Planificación de Atención al Paciente , Neumonía Viral/epidemiología , Universidades , Washingtón
17.
Science ; 370(6516): 564-570, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: covidwho-760215

RESUMEN

Accurate understanding of the global spread of emerging viruses is critical for public health responses and for anticipating and preventing future outbreaks. Here we elucidate when, where, and how the earliest sustained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission networks became established in Europe and North America. Our results suggest that rapid early interventions successfully prevented early introductions of the virus from taking hold in Germany and the United States. Other, later introductions of the virus from China to both Italy and Washington state, United States, founded the earliest sustained European and North America transmission networks. Our analyses demonstrate the effectiveness of public health measures in preventing onward transmission and show that intensive testing and contact tracing could have prevented SARS-CoV-2 outbreaks from becoming established in these regions.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Filogenia , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Viaje en Avión , China/epidemiología , Simulación por Computador , Trazado de Contacto , Infecciones por Coronavirus/prevención & control , Evolución Molecular , Genoma Viral , Alemania/epidemiología , Humanos , Italia/epidemiología , Tamizaje Masivo , Mutación , Pandemias/prevención & control , Neumonía Viral/prevención & control , Washingtón/epidemiología
18.
Science ; 370(6516): 571-575, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: covidwho-760213

RESUMEN

After its emergence in Wuhan, China, in late November or early December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus rapidly spread globally. Genome sequencing of SARS-CoV-2 allows the reconstruction of its transmission history, although this is contingent on sampling. We analyzed 453 SARS-CoV-2 genomes collected between 20 February and 15 March 2020 from infected patients in Washington state in the United States. We find that most SARS-CoV-2 infections sampled during this time derive from a single introduction in late January or early February 2020, which subsequently spread locally before active community surveillance was implemented.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Genoma Viral , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Teorema de Bayes , Humanos , Funciones de Verosimilitud , Pandemias , Filogenia , Washingtón/epidemiología
19.
Emerg Infect Dis ; 26(8): 1671-1678, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-737802

RESUMEN

We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected ≈6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.


Asunto(s)
Betacoronavirus/patogenicidad , Trazado de Contacto/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Betacoronavirus/genética , Niño , Preescolar , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Salud Pública/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Viaje , Washingtón/epidemiología
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