Association of COVID-19 mortality with politics and on-demand testing in 217 U.S. counties.

BACKGROUND: Previous research found increased COVID-19 spread associated with politics and on-demand testing but not in the same study. The objective of this study is to estimate the contribution of each corrected for the other and a variety of known risk factors. METHODS: Using data from 217 U.S. counties of more than 50,000 population where testing data were available in April, 2021, the associations of COVID-19 deaths with politics, testing and other risk factors were examined by Poisson and least squares regression. RESULTS: Statistical controls for 15 risk factors failed to eliminate the association of COVID mortality risk with percent of vote for Donald Trump in 2016 or negative tests per population. Each is independently predictive of increased mortality. CONCLUSION: Apparently, many people who test negative for the SARS-CoV-2 virus engage in activities that increase their risk, a problem likely to increase with the availability of home tests. There is no association of negative tests with the Trump vote but, according to polling data, Trump voters' past resistance to public health recommendations has been extended to resistance to being vaccinated, threatening the goal of herd immunity.

Did people's behavior after receiving negative COVID-19 tests contribute to the spread?

BACKGROUND: Testing on demand for coronavirus disease (COVID-19) is hypothesized to increase spread of the virus as some persons who test negative falsely assume that they can engage in activities that increase spread. METHODS: Daily new COVID-19 hospitalization counts through 2020 from 25 countries that reported testing and hospitalizations were studied by regression of logarithms of new hospitalizations 14 days out against log(new hospitalizations on a given day), log(negative tests), log(positivity rate) and days since the first hospitalizations were reported. The regression coefficients were examined separately for periods in countries that were following three different testing policies. RESULTS: Corrected for the other factors, negative test numbers when tested on demand and tested if symptomatic only are associated with an increase in hospitalizations 14 days after the tests. When only the symptomatic and more vulnerable are tested, negative tests are associated with fewer hospitalizations 2 weeks out. CONCLUSIONS: A policy of testing only vulnerable populations, whether symptomatic or not, appears to avoid spreading the virus as a result of testing policy. False confidence of reduced risk among those who test negative may have contributed to the spread in countries that allowed testing on demand or testing only those who claimed to have symptoms.

Predictors of COVID-19-Confirmed Cases and Fatalities in 883 US Counties with a Population of 50,000 or More: Estimated Effect of Initial Prevention Policies.

Control of diseases transmitted from person to person may be more effectively and less economically damaging if preventive and ameliorative efforts are focused on the more vulnerable local areas rather than entire countries, provinces, or states. The spread of the COVID-19 virus is highly concentrated in urban US counties. Sixteen factors known or thought to be related to spread of the COVID-19 virus were studied by Poisson regression analysis of confirmed cases and deaths in 883 US counties with a population of 50,000 or more as of May 31, 2020. Evidence of crowding in homes, workplaces, religious gatherings, preexisting health conditions in the population, and local economic and demographic conditions, with one exception, was predictive of incidence and mortality. Based on the correlation of cases and deaths to length of stay-at-home orders, the orders were associated with about 52% reduced cases and about 55% reduced deaths from those expected without the orders.

Temperature, precipitation, ozone pollution, and daily fatal unintentional injuries in Jiangsu Province, China during 2015-2017.

BACKGROUND: The correlation of unintentional injury mortality to rising temperatures found in several studies could result from changes in behavior that increases exposure to hazards or risk when exposed. Temperature, precipitation and air pollutants may contribute to symptoms and distractions that increase risk or avoidance behavior that reduces risk. This study examines data that allows estimates of the relation of daily maximum temperature, precipitation and ozone pollution to injury mortality risk, each corrected statistically for the correlation with the others. METHODS: Daily data on unintentional injury deaths and exposures to temperature, precipitation and ozone in 9 cities in Jiangsu Province, China during 2015-2017 were analyzed using Poisson regression. The regression estimates were adjusted for weekends, holidays, an anomalous difference in death rates in Nanjing, and population size. RESULTS: Non transport injury death risk increased substantially in relation to higher temperatures when temperatures were in the moderate range and even more so at temperatures 35 degrees (C) and higher. Transport deaths were related to increasing deaths when temperatures were low but the correlation reversed at higher temperatures. Deaths were lower on rainy days when temperatures were cool and moderate with the exception of non-transport injuries when temperatures were moderate. Higher ozone concentrations were associated with more deaths except when temperatures were low. CONCLUSIONS: The variations in deaths in relation to temperature, precipitation and ozone suggest that people are behaving differently or are in different environments when specific combinations of the predictor variables are prevalent, putting them at greater or less risk. More study of the behaviors and circumstances that result in injury under those conditions is needed.

Science and public health principles used to reduce road deaths.

An editorial in a previous issue of this journal falsely claims that the US government's efforts to reduce road fatalities are not based on science. It says that, as a result, the United States has fallen behind other countries in road death prevention. A large body of research and evaluation informed federal and state safety programs from the outset. Evans's comparisons of death trends among countries without adjustment for changes in relevant risk factors or specification of the injury reduction policies among the countries tell us nothing about the causes of the declines or the effects of specific ameliorative efforts.

Prevention of motor-vehicle deaths by changing vehicle factors.

OBJECTIVE: To estimate the effect of changing vehicle factors to reduce mortality in a comprehensive study. Design/ METHODS: Odds of death in the United States during 2000-2005 were analyzed, involving specific makes and models of 1999-2005 model year cars, minivans, and sport utility vehicles using logistic regression after selection of factors to be included by examination of least-squares correlations of vehicle factors to maximize independence of predictors. Based on the regression coefficients, percentages of deaths preventable by changes in selected factors were calculated. Correlations of vehicle characteristics to environmental and behavioral risk factors were also examined to assess any potential confounding. RESULTS: Deaths in the studied vehicles would have been 42% lower had all had electronic stability control (ESC) systems. Improved crashworthiness as measured by offset frontal and side crash tests would have produced an additional 28% reduction, and static stability improvement would have reduced the deaths 11%. Although weight-power that reduces fuel economy is associated with lower risk to drivers, it increases risk of deaths to pedestrians and bicyclists but has an overall minor effect compared to the other factors. CONCLUSION: A large majority of motor-vehicle-related fatalities could be avoided by universal adoption of the most effective technologies.

Blood and oil: vehicle characteristics in relation to fatality risk and fuel economy.

I examined the potential for a lower risk of death compatible with increased fuel economy among 67 models of 1999-2002 model year cars, vans, and sport-utility vehicles (SUVs) during the calendar years 2000 to 2004. The odds of death for drivers and all persons killed in vehicle collisions were related to vehicle weight, size, stability, and crashworthiness. I calculated that fatality rates would have been 28% lower and fuel use would have been reduced by 16% if vehicle weights had been reduced to the weight of vehicles with the lowest weight per size, where size is measured by the lateral distance needed to perform a 180-degree turn. If, in addition, all vehicles had crashworthiness and stability equal to those of the top-rated vehicles, more than half the deaths involving passenger cars, vans, and SUVs could have been prevented by vehicle modifications.

Motor vehicle deaths: failed policy analysis and neglected policy.

The author of a recent book inferred that the slowed decline in U.S. vehicle fatality rates in the 1990 s relative to other industrialized countries resulted from too much emphasis on vehicle factors. He claimed that Canada had the same vehicle mix but a lower fatality rate. Actually, U.S. death rates by make and model applied to Canadian vehicle sales indicates that Canada's death rate would be the same as the U.S. if Canada had the same vehicle mix and annual miles driven. The U.S. had much greater growth in sales of large SUVs and pickup trucks that are heavier and stiffer than passenger cars, contributing to excess deaths of other road users in collisions. They are also more unstable, contributing to excess deaths of their occupants in rollovers. Lack of policy regarding these vehicle characteristics is the primary reason for the attenuated decline in vehicular fatality rates.