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1.
Open Forum Infect Dis ; 8(9): ofab415, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34514021

ABSTRACT

Vaccination and nonpharmaceutical interventions (NPIs) reduce transmission of severe acute respiratory syndrome coronavirus 2 infection, but their effectiveness depends on coverage and adherence levels. We used scenario modeling to evaluate their effects on cases and deaths averted and herd immunity. NPIs and vaccines worked synergistically in different parts of the pandemic to reduce disease burden.

2.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S19-S28, 2021.
Article in English | MEDLINE | ID: mdl-33239560

ABSTRACT

CONTEXT: In March, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causal agent of coronavirus disease 2019 (COVID-19), was spreading in the Bay Area, especially in Santa Clara County, causing increases in cases, hospitalizations, and deaths. PROGRAM: The Association of Bay Area Health Officials (ABAHO) represents 13 Bay Area health jurisdictions. IMPLEMENTATION: On March 15, 2020, the local health officers of 7 ABAHO members (counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara and the city of Berkeley) decided to issue legal orders on March 16 for 6.7 million residents to shelter in place to prevent the spread of SARS-CoV-2, the causal agent of COVID-19. The Bay Area was the first region in the United States to shelter in place, and within days, other regions in the United States followed. EVALUATION: Subsequent comparative analyses have confirmed that acting early in issuing shelter-in-place orders prevented a large number of cases, hospitalizations, and deaths in the Bay Area throughout the United States. The quality of a decision-in this case, for crisis decision making-cannot be judged by the outcome. A good decision can have a bad outcome, and a bad decision can have a good outcome. The quality of a decision depends only on the quality of the decision-making process at the time the decision was made. DISCUSSION: In this Field Report, we review how we made this collective decision. With the benefit of hindsight and reflection, we recount our story through the lens of public health legal authority, meta-leadership, and decision intelligence. Our purpose is to improve the crisis decision-making skills of public health officials by improving how we make high-stakes decisions each day in our continuing fight to contain the SARS-CoV-2 pandemic, to save lives, and to eliminate COVID-19 racial/ethnic inequities.


Subject(s)
COVID-19/prevention & control , Guidelines as Topic , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , Politics , Public Health/legislation & jurisprudence , Public Health/standards , Adult , Aged , Aged, 80 and over , California/epidemiology , Decision Making , Female , Humans , Leadership , Male , Middle Aged , New York/epidemiology , Pandemics/statistics & numerical data , SARS-CoV-2 , United States/epidemiology
3.
J Infect Dis ; 192(5): 811-8, 2005 Sep 01.
Article in English | MEDLINE | ID: mdl-16088830

ABSTRACT

BACKGROUND: Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of disease. The purpose of this study was to determine the characteristics and dynamics of nasal strains of MRSA, as well as their relation to community-associated disease activity. METHODS: This study is a cross-sectional survey and molecular epidemiologic analysis of nasal colonization by S. aureus in homeless and runaway youths, an underserved population at high risk for staphylococcal disease. RESULTS: Of the 308 study participants, 27.6% carried S. aureus, and 6.2% carried MRSA. Subgroups of individuals with increased MRSA carriage rates were also at highest risk for community-associated MRSA infection; these subgroups included individuals with either HIV infection or AIDS, injection drug users, patients with abscesses, and those recently hospitalized. Multilocus sequence typing and pulsed-field gel electrophoresis identified 2 genotypes--ST59:P (USA1000) and ST8:S (USA300)--that accounted for 84.2% (16/19) of the MRSA isolates carried. The genotypes were distinct from nosocomial genotypes endemic in the hospital, although they originated from individuals with prior exposure to health care. CONCLUSIONS: Comparison of MRSA strains from asymptomatic carriers versus concurrently collected community-associated clinical strains from patients treated at local health-care facilities allowed for the identification of 3 population dynamics of nasal strains of MRSA: (1) endemic clones--for example, ST8:C and ST59:P--sustained asymptomatic carriage and infection over prolonged periods; (2) an epidemic clone, ST8:S, demonstrated enhanced capacity for rapid transmission and widespread infections; and (3) an outbreak clone, ST30:Z (USA1100), was highly infectious but exhibited poor asymptomatic transmission.


Subject(s)
Community-Acquired Infections/microbiology , Methicillin Resistance , Nasal Mucosa/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/physiology , Adolescent , Adult , Community-Acquired Infections/epidemiology , Cross-Sectional Studies , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Female , Genotype , Ill-Housed Persons , Humans , Male , Microbial Sensitivity Tests , San Francisco/epidemiology , Sequence Analysis, DNA , Staphylococcal Infections/epidemiology , Staphylococcus aureus/genetics , Staphylococcus aureus/growth & development , Staphylococcus aureus/pathogenicity
4.
Clin Infect Dis ; 37(10): 1384-8, 2003 Nov 15.
Article in English | MEDLINE | ID: mdl-14583874

ABSTRACT

Staphylococcus aureus clinical isolates obtained from patients who were inmates of the San Francisco County jail system showed an increase in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) from 29%, in 1997, to 74%, in 2002; 91% of the MRSA isolates carried staphylococcal chromosomal cassette mec (SCCmec) type IV. Pulsed field gel electrophoresis and multilocus sequence typing demonstrated 2 major clonal groups. One of these clonal groups is genetically indistinguishable from the strain responsible for an outbreak of MRSA in the Los Angeles County jail system in 2002.


Subject(s)
Anti-Bacterial Agents/pharmacology , Methicillin Resistance/genetics , Methicillin/pharmacology , Prisons , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , California/epidemiology , Female , Genotype , Humans , Male , Microbial Sensitivity Tests , Prevalence , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification
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