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Mercer MP, Day L, Ansari M, Kwan E, Kotis D, Caplan V, Nguyen TQ, Lee C, Smith M, Tenner AG, Sangha B, Rivera T, Saelee K, Horton C, Green A, Giang V, Ovbiagele B, Quock J, LeVine T, Sears J, Chow A, Schafer E, Morse E, Brown J, Connelly E, Marks J, Enanoria W, Ehrlich S, Philip S, Bobba N, Colfax G. The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems' Response to the Covid-19 Pandemic. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2024; 5:10.1056/CAT.23.0330. [PMID: 39350897 PMCID: PMC11441330 DOI: 10.1056/cat.23.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, in response to the emerging coronavirus epidemic, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers: local hospital and health systems' CEOs coordinating with SFDPH executives; hospital chief medical and nursing officers coordinating high-level surge capacity assessments and mitigation plans; and local clinical operational managers working with public health response operational leaders to coordinate scarce resource utilization. Fluctuating with the tempo of the disease indicators and medical surge, governance and coordination were maintained through a tiered meeting and reporting system. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources, including identifying additional surge bed capacity for use systemwide, as well as ensuring efficient and equitable vaccine distribution through implementation of five mass-vaccination sites with prioritized access for vulnerable communities. Applying these four principles of shared priorities, accountability, transparency, and operational coordination and pragmatism helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative (which had served as the term used internally to refer to the group) and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States. Similar principles and implementation methods can be adopted by other health jurisdictions for future emergency outbreak response.
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Affiliation(s)
- Mary P Mercer
- Chief of Medical Staff, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Former Covid-19 Vaccine Section Chief and Covid-19 Health Systems Deputy Director, San Francisco Department of Public Health, San Francisco, California, USA
- Director, Emergency Medical Services and Disaster Medicine Section, University of California San Francisco Department of Emergency Medicine, San Francisco, California, USA
- Professor of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Lukejohn Day
- Chief Medical Officer, University of California San Francisco Health System, San Francisco, California, USA
- Former Chief Medical Officer, Zuckerberg San Francisco General Hospital, San Francisco Department of Public Health, San Francisco, California, USA
- Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Maria Ansari
- Chief Executive Officer and Executive Director, The Permanente Medical Group Inc., Oakland, California, USA
- President and Chief Executive Officer, Mid-Atlantic Permanente Medical Group, Rockland, Maryland, USA
- Co-Chief Executive Officer, The Permanente Federation, Oakland, California, USA
- Former Physician in Chief, Kaiser Permanente Medical Group, San Francisco, California, USA
| | - Elizabeth Kwan
- Former Covid-19 Vaccine Logistics Branch Director, San Francisco Department of Public Health, San Francisco, California, USA
- Associate Professor of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Desi Kotis
- Chief Pharmacy Executive, UCSF Health, San Francisco, California, USA
- Associate Dean and Faculty Member, UCSF School of Pharmacy, San Francisco, California, USA
| | - Valerie Caplan
- Data Visualization & Reporting Team Manager, Center for Data Science, San Francisco Department of Public Health, San Francisco, California, USA
| | - Trang Quyen Nguyen
- Epidemiologist, Applied Research, Community Health Epidemiology, and Surveillance Branch Population, Health Division, San Francisco Department of Public Health, San Francisco, California, USA
| | - Christopher Lee
- Epidemiologist, San Francisco Department of Public Health, San Francisco, California, USA
| | - Matthew Smith
- Analytics Engineer, DataSF, Office of the City Administrator, San Francisco, California, USA
- Former Principal Analyst, San Francisco Department of Public Health, San Francisco, California, USA
| | - Andrea G Tenner
- Director of Public Health Emergency Preparedness and Response, San Francisco Department of Public Health, San Francisco, California, USA
- Associate Clinical Professor, Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Baljeet Sangha
- System Chief Operating Officer and Deputy Director, San Francisco Department of Public Health, San Francisco, California, USA
| | - Tiffany Rivera
- Deputy Director, Public Health Emergency Preparedness and Response, San Francisco Department of Public Health, San Francisco, California, USA
| | - Kenpou Saelee
- Program Coordinator, Emergency Preparedness, San Francisco Department of Public Health, San Francisco, California, USA
| | - Claire Horton
- Vice President and Associate Chief Medical Officer, National Medicaid Program, Kaiser Permanente National Health Plan and Hospitals, Oakland, California, USA
- Former Chief Medical Officer, San Francisco Health Network, San Francisco Department of Public Health, San Francisco, California, USA
| | - Adrienne Green
- Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- CEO, San Francisco Campus for Jewish Living, San Francisco, California, USA
| | - Vernon Giang
- Chief Medical Executive, California Pacific Medical Center, Sutter Health, San Francisco, California, USA
| | - Bruce Ovbiagele
- Chief of Staff, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Justin Quock
- Chief, Department of Internal Medicine, Chinese Hospital, San Francisco, California, USA
| | - Todd LeVine
- Chief Medical Officer, Dignity Health/CommonSpirit, San Francisco, California, USA
| | - Jonathan Sears
- Senior Lean Specialist, California Department of Health, Sacramento, California, USA
- Former Covid-19 Vaccine Branch Director, San Francisco Department of Public Health, San Francisco, California, USA
| | - Amabel Chow
- Special Projects Manager, San Francisco Department of Emergency Management, San Francisco, California, USA
- Former Covid-19 Vaccine Branch Operations Lead, San Francisco Department of Public Health, San Francisco, California, USA
| | - Ellie Schafer
- Former Program Coordinator, Covid-19 Vaccine Branch Operations, San Francisco Department of Emergency Management, San Francisco, California, USA
| | - Eleanor Morse
- Program Coordinator, San Francisco Department of Public Health, San Francisco, California, USA
- Former Covid-19 Vaccine Branch Logistics Unit Deputy, San Francisco Department of Public Health, San Francisco, California, USA
| | - John Brown
- Medical Director, San Francisco Emergency Medical Services Agency, San Francisco Department of Public Health, San Francisco, California, USA
- Clinical Professor of Emergency Medicine, University of California San Francisco Medical School, San Francisco, California, USA
| | - Elizabeth Connelly
- Kaizen Promotion Office, Predictive Analytics Fellow, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Former Covid-19 Advanced Planning Branch Director, San Francisco Department of Public Health, San Francisco, California, USA
| | - Jim Marks
- Professor of Anesthesiology, University of California San Francisco School of Medicine, San Francisco, California, USA
- Former Chief of Performance Excellence, Zuckerberg San Francisco General Hospital, San Francisco Department of Public Health, San Francisco, California, USA
| | - Wayne Enanoria
- Chief Science Officer, Santa Clara County Department of Public Health, San Jose, California, USA
- Assistant Professor, Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- Former Director of Applied Research Community Health Epidemiology and Surveillance (ARCHES), San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Ehrlich
- CEO, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Susan Philip
- Health Officer, City and County of San Francisco, San Francisco, California, USA
- Director, Population Health Division, San Francisco Department of Public Health, San Francisco, California, USA
| | - Naveena Bobba
- Deputy Director of Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - Grant Colfax
- Director of Health, City and County of San Francisco, San Francisco, California, USA
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Lei J, MacNab Y. Bayesian hierarchical spatiotemporal models for prediction of (under)reporting rates and cases: COVID-19 infection among the older people in the United States during the 2020-2022 pandemic. Spat Spatiotemporal Epidemiol 2024; 49:100658. [PMID: 38876569 DOI: 10.1016/j.sste.2024.100658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
The gap between the reported and actual COVID-19 infection cases has been an issue of concern. Here, we present Bayesian hierarchical spatiotemporal disease mapping models for state-level predictions of COVID-19 infection risks and (under)reporting rates among people aged 65 and above during the first two years of the pandemic in the United States. With prior elicitation based on recent prevalence studies, the study suggests that the median state-level reporting rate of COVID-19 infection was 90% (interquartile range: [78%, 96%]). Our study uncovers spatiotemporal variations and dynamics in state-level infection risks and (under)reporting rates, suggesting time-varying associations between higher population density, higher percentage of minorities, and higher percentage of vaccination and increased risks of COVID-19 infection, as well as an association between more easily accessible tests and higher reporting rates. With sensitivity analyses, we highlight the impact and importance of incorporating covariates information and objective prior references for evaluating the issue of underreporting.
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Affiliation(s)
- Jingxin Lei
- School of Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
| | - Ying MacNab
- School of Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada
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Kobzeva-Herzog A, O'Shea T, Young S, Kenzik K, Zhao X, Slanetz P, Phillips J, Merrill A, Cassidy MR. Breast Cancer Screening and BI-RADS Scoring Trends Before and During the COVID-19 Pandemic in an Academic Safety-Net Hospital. Ann Surg Oncol 2024; 31:2253-2260. [PMID: 38177460 DOI: 10.1245/s10434-023-14787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic affected screening mammography rates and Breast Imaging Reporting and Data Systems (BI-RADS) categorizations within populations facing social and economic inequities. Our study seeks to compare trends in breast cancer screening and BI-RADS assessments in an academic safety-net patient population before and during the COVID-19 pandemic. PATIENTS AND METHODS Our single-center retrospective study evaluated women ≥ 18 years old with no known breast cancer diagnosis who received breast cancer screening from March 2019-September 2020. The screening BI-RADS score, completion of recommended diagnostic imaging, and diagnostic BI-RADS scores were compared between the pre-COVID-19 era (from 1 March 2019 to 19 March 2020) and COVID-19 era (from 20 March 2020 to 30 September 2020). RESULTS Among the 11,798 patients identified, screened patients were younger (median age 57 versus 59 years, p < 0.001) and more likely covered by private insurance (35.9% versus 32.3%, p < 0.001) during the COVID-19 era compared with the pre-COVID-19 era. During the pandemic, there was an increase in screening mammograms categorized as BI-RADS 0 compared with the pre-COVID-19 era (20% versus 14.5%, p < 0.0001). There was no statistically significant difference in rates of completion of diagnostic imaging (81.6% versus 85.4%, p = 0.764) or assignment of suspicious BI-RADS scores (BI-RADS 4-5; 79.9% versus 80.8%, p = 0.762) between the two eras. CONCLUSIONS Although more patients were recommended to undergo diagnostic imaging during the pandemic, there were no significant differences in race, completion of diagnostic imaging, or proportions of mammograms categorized as suspicious between the two time periods. These findings likely reflect efforts to maintain equitable care among diverse racial groups served by our safety-net hospital.
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Affiliation(s)
- Anna Kobzeva-Herzog
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Thomas O'Shea
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sara Young
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Xuewei Zhao
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Priscilla Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jordana Phillips
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Merrill
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michael R Cassidy
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
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Sachdev DD, Petersen M, Havlir DV, Schwab J, Enanoria WT, Nguyen TQ, Mercer MP, Scheer S, Bennett A, Tenner AG, Marks JD, Bobba N, Philip S, Colfax G. San Francisco's Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022. Public Health Rep 2023; 138:747-755. [PMID: 37408322 PMCID: PMC10323495 DOI: 10.1177/00333549231181353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity.
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Affiliation(s)
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Diane V. Havlir
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua Schwab
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Trang Q. Nguyen
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Mary P. Mercer
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ayanna Bennett
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Andrea G. Tenner
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - James D. Marks
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - Naveena Bobba
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Grant Colfax
- San Francisco Department of Public Health, San Francisco, CA, USA
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Bristow J, Hamilton J, Weinshel J, Rovig R, Wallace R, Olney C, Lindquist KJ. Interplay of demographics, geography and COVID-19 pandemic responses in the Puget Sound region: The Vashon, Washington Medical Reserve Corps experience. PLoS One 2023; 18:e0274345. [PMID: 37585489 PMCID: PMC10431654 DOI: 10.1371/journal.pone.0274345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/11/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Rural U.S. communities are at risk from COVID-19 due to advanced age and limited access to acute care. Recognizing this, the Vashon Medical Reserve Corps (VMRC) in King County, Washington, implemented an all-volunteer, community-based COVID-19 response program. This program integrated public engagement, SARS-CoV-2 testing, contact tracing, vaccination, and material community support, and was associated with the lowest cumulative COVID-19 case rate in King County. This study aimed to investigate the contributions of demographics, geography and public health interventions to Vashon's low COVID-19 rates. METHODS This observational cross-sectional study compares cumulative COVID-19 rates and success of public health interventions from February 2020 through November 2021 for Vashon Island with King County (including metropolitan Seattle) and Whidbey Island, located ~50 km north of Vashon. To evaluate the role of demography, we developed multiple linear regression models of COVID-19 rates using metrics of age, race/ethnicity, wealth and educational attainment across 77 King County zip codes. To investigate the role of remote geography we expanded the regression models to include North, Central and South Whidbey, similarly remote island communities with varying demographic features. To evaluate the effectiveness of VMRC's community-based public health measures, we directly compared Vashon's success of vaccination and contact tracing with that of King County and South Whidbey, the Whidbey community most similar to Vashon. RESULTS Vashon's cumulative COVID-19 case rate was 29% that of King County overall (22.2 vs 76.8 cases/K). A multiple linear regression model based on King County demographics found educational attainment to be a major correlate of COVID-19 rates, and Vashon's cumulative case rate was just 38% of predicted (p < .05), so demographics alone do not explain Vashon's low COVID-19 case rate. Inclusion of Whidbey communities in the model identified a major effect of remote geography (-49 cases/K, p < .001), such that observed COVID-19 rates for all remote communities fell within the model's 95% prediction interval. VMRC's vaccination effort was highly effective, reaching a vaccination rate of 1500 doses/K four months before South Whidbey and King County and maintaining a cumulative vaccination rate 200 doses/K higher throughout the latter half of 2021 (p < .001). Including vaccination rates in the model reduced the effect of remote geography to -41 cases/K (p < .001). VMRC case investigation was also highly effective, interviewing 96% of referred cases in an average of 1.7 days compared with 69% in 3.7 days for Washington Department of Health investigating South Whidbey cases and 80% in 3.4 days for Public Health-Seattle & King County (both p<0.001). VMRC's public health interventions were associated with a 30% lower case rate (p<0.001) and 55% lower hospitalization rate (p = 0.056) than South Whidbey. CONCLUSIONS While the overall magnitude of the pre-Omicron COVID-19 pandemic in rural and urban U.S. communities was similar, we show that island communities in the Puget Sound region were substantially protected from COVID-19 by their geography. We further show that a volunteer community-based COVID-19 response program was highly effective in the Vashon community, augmenting the protective effect of geography. We suggest that Medical Reserve Corps should be an important element of future pandemic planning.
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Affiliation(s)
- James Bristow
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
| | - Jamie Hamilton
- Island County Public Health Department, Coupeville, Washington, United States of America
| | - John Weinshel
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
- VashonBePrepared, Vashon, Washington, United States of America
| | - Robert Rovig
- Atlas Genomics, Seattle, Washington, United States of America
| | - Rick Wallace
- VashonBePrepared, Vashon, Washington, United States of America
| | - Clayton Olney
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, United States of America
| | | | - Karla J. Lindquist
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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Doctor JN, Berg AH, Knight TK, Kadono M, Stewart E, Sonik R, Hochman M, Sood N. Cross-sectional study examining household factors associated with SARS-CoV-2 seropositivity in low-income children in Los Angeles. BMJ Open 2023; 13:e070291. [PMID: 37258079 PMCID: PMC10254815 DOI: 10.1136/bmjopen-2022-070291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES This study aims to quantify the degree to which an underserved, Hispanic population in Los Angeles is impacted by SARS-CoV-2, and determine factors associated with paediatric seropositivity. DESIGN Cross-sectional. SETTING AltaMed, a Federally Qualified Health Center in Los Angeles. PARTICIPANTS A random sample of households who had received healthcare at AltaMed Medical Group was invited to participate. Households with at least one adult and one paediatric participant between 5 and 17 years of age were eligible to participate. Consented participants completed a survey on social determinants of health and were tested for antibodies using Abbott Architect SARS-CoV-2-IgG and SARS-CoV-2-IgM tests. PRIMARY OUTCOME MEASURE Seropositive status. RESULTS We analysed 390 adults (mean age in years, 38.98 (SD 12.11)) and 332 paediatric participants (11.26 (SD 3.51)) from 196 households. Estimated seropositivity was 52.11% (95% CI 49.61% to 55.19%) in paediatric participants and 63.58% (95% CI 60.39% to 65.24%) in adults. Seropositivity was 11.47% (95% CI 6.82% to 14.09%) lower in paediatric participants, but high relative to other populations. A household member with type 2 diabetes (OR 2.94 (95% CI 1.68 to 5.14)), receipt of food stamps (OR 1.66 (95% CI 1.08 to 2.56)) and lower head-of-household education (OR 1.73 (95% CI 1.06 to 2.84)) were associated with paediatric seropositivity. CONCLUSIONS SARS-CoV-2 seropositivity is high in Hispanic children and adolescents in Los Angeles. Food insecure households with low head-of-household education, and at least one household member with type 2 diabetes, had the highest risk. These factors may inform paediatrician COVID-19 mitigation recommendations. TRIAL REGISTRATION NUMBER NCT04901624.
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Affiliation(s)
- Jason N Doctor
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Anders H Berg
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tara K Knight
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Mika Kadono
- Institute of Health Equity, AltaMed Health Services Corporation, Los Angeles, California, USA
| | - Emily Stewart
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Rajan Sonik
- Institute of Health Equity, AltaMed Health Services Corporation, Los Angeles, California, USA
| | - Michael Hochman
- Institute of Health Equity, USC Keck School of Medicine, Los Angeles, California, USA
| | - Neeraj Sood
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
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Gong AJ, Lee EE, Visvanathan K, Oluyemi ET. Impact of Patient Navigation on Reducing Breast Imaging Disparities and Applications in the COVID-19 Era. JOURNAL OF BREAST IMAGING 2023; 5:346-350. [PMID: 38416882 DOI: 10.1093/jbi/wbac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 03/01/2024]
Abstract
The coronavirus (COVID-19) pandemic has impacted breast cancer screening with concerns that this may lead to increased overall breast cancer mortality and worsened racial and ethnic disparities in breast cancer survival. As pandemic recovery efforts are underway, we must be prepared to address barriers to timely access of breast imaging services, including those that existed prior to the pandemic, as well as any new barriers that may arise as a result of the pandemic. Patient navigation is an important tool that has been shown to address barriers to timely breast imaging access and help reduce disparities. Patient navigation programs can serve as a key part of the strategy to mitigate the impact of the COVID-19 pandemic on timely breast cancer diagnosis. These programs have been shown to be successful in promoting adherence to breast cancer screening guidelines as well as encouraging timely diagnostic follow-up, particularly in underserved communities. Further research is needed to explore the role of using a telehealth platform for patient navigation and evaluate the cost-effectiveness of patient navigator programs as well as more randomized controlled trials to further explore the impact of patient navigation programs.
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Affiliation(s)
- Anna J Gong
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
| | - Emerson E Lee
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Eniola T Oluyemi
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
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Cheng Y, Ji C, Zhou HY, Zheng H, Wu A. Web Resources for SARS-CoV-2 Genomic Database, Annotation, Analysis and Variant Tracking. Viruses 2023; 15:1158. [PMID: 37243244 PMCID: PMC10222785 DOI: 10.3390/v15051158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The SARS-CoV-2 genomic data continue to grow, providing valuable information for researchers and public health officials. Genomic analysis of these data sheds light on the transmission and evolution of the virus. To aid in SARS-CoV-2 genomic analysis, many web resources have been developed to store, collate, analyze, and visualize the genomic data. This review summarizes web resources used for the SARS-CoV-2 genomic epidemiology, covering data management and sharing, genomic annotation, analysis, and variant tracking. The challenges and further expectations for these web resources are also discussed. Finally, we highlight the importance and need for continued development and improvement of related web resources to effectively track the spread and understand the evolution of the virus.
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Affiliation(s)
- Yexiao Cheng
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 211100, China
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
- Suzhou Institute of Systems Medicine, Suzhou 215123, China
| | - Chengyang Ji
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
- Suzhou Institute of Systems Medicine, Suzhou 215123, China
| | - Hang-Yu Zhou
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
- Suzhou Institute of Systems Medicine, Suzhou 215123, China
| | - Heng Zheng
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 211100, China
| | - Aiping Wu
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
- Suzhou Institute of Systems Medicine, Suzhou 215123, China
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Mavragani A, Leon-Thomas M, Smith SL, Silverman L, Perez-Torres C, Hall WC, Iadarola S. COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots. JMIR Form Res 2023; 7:e39045. [PMID: 36630649 PMCID: PMC9879317 DOI: 10.2196/39045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. OBJECTIVE This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named "Ana" and (2) characterize and evaluate user experiences of these innovative technologies. METHODS Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. RESULTS A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the "smiley" and "loved" emojis, and negative ranking comprised the "neutral," "sad," and "mad" emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). CONCLUSIONS This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19-related information.
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Affiliation(s)
| | - Mariela Leon-Thomas
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Sabrina L Smith
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Laura Silverman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Claudia Perez-Torres
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Wyatte C Hall
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Suzannah Iadarola
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
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10
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Robertson MM, Shamsunder MG, Brazier E, Mantravadi M, Zimba R, Rane MS, Westmoreland DA, Parcesepe AM, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/Ethnic Disparities in Exposure, Disease Susceptibility, and Clinical Outcomes during COVID-19 Pandemic in National Cohort of Adults, United States. Emerg Infect Dis 2022; 28:2171-2180. [PMID: 36191624 PMCID: PMC9622253 DOI: 10.3201/eid2811.220072] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined racial/ethnic disparities for COVID-19 seroconversion and hospitalization within a prospective cohort (n = 6,740) in the United States enrolled in March 2020 and followed-up through October 2021. Potential SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity. Hispanic and Black non-Hispanic participants had more exposure risk and difficulty with healthcare access than white participants. Participants with more exposure had greater odds of seroconversion. Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization. Race/ethnicity positively modified the association between susceptibility and hospitalization. Findings might help to explain the disproportionate burden of SARS-CoV-2 infections and complications among Hispanic/Latino/a and Black non-Hispanic persons. Primary and secondary prevention efforts should address disparities in exposure, vaccination, and treatment for COVID-19.
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11
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Reproducibility and implementation of a rapid, community-based COVID-19 "test and respond" model in low-income, majority-Latino communities in Northern California. PLoS One 2022; 17:e0276257. [PMID: 36301834 PMCID: PMC9612491 DOI: 10.1371/journal.pone.0276257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities. METHODS In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events. RESULTS Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%). CONCLUSION Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities.
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12
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Wang Y, Reyes L, Greenfield EA, Allred SR. Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder-Oaxaca Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13963. [PMID: 36360847 PMCID: PMC9656431 DOI: 10.3390/ijerph192113963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.
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Affiliation(s)
- Yuqi Wang
- Department of Social Work, China Youth University of Political Studies, Beijing 100089, China
| | - Laurent Reyes
- School of Social Welfare, University of California, Berkeley, CA 94720, USA
| | | | - Sarah R. Allred
- Department of Psychology, Rutgers University, Camden, NJ 08102, USA
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13
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Cohen SE, Stookey J, Anderson N, Morris D, Singzon T, Dann M, Burk K, Chen CC. Using Geocoding to Identify COVID-19 Outbreaks in Congregate Residential Settings: San Francisco's Outbreak Response in Single-Room Occupancy Hotels. Public Health Rep 2022; 138:7-13. [PMID: 36239486 PMCID: PMC9574538 DOI: 10.1177/00333549221128301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
More than 500 single-room occupancy hotels (SROs), a type of low-cost congregate housing with shared bathrooms and kitchens, are available in San Francisco. SRO residents include essential workers, people with disabilities, and multigenerational immigrant families. In March 2020, with increasing concerns about the potential for rapid transmission of COVID-19 among a population with disproportionate rates of comorbidity, poor access to care, and inability to self-isolate, the San Francisco Department of Public Health formed an SRO outbreak response team to identify and contain COVID-19 clusters in this congregate residential setting. Using address-matching geocoding, the team conducted active surveillance to identify new cases and outbreaks of COVID-19 at SROs. An outbreak was defined as 3 separate households in the SRO with a positive test result for COVID-19. From March 2020 through February 2021, the SRO outbreak response team conducted on-site mass testing of all residents at 52 SROs with outbreaks identified through geocoding. The rate of positive COVID-19 tests was significantly higher at SROs with outbreaks than at SROs without outbreaks (12.7% vs 6.4%; P < .001). From March through May 2020, the rate of COVID-19 cases among SRO residents was higher than among residents of other settings (ie, non-SRO residents), before decreasing and remaining at an equal level to non-SRO residents during later periods of 2020. The annual case fatality rate for SRO residents and non-SRO residents was similar (1.8% vs 1.5%). This approach identified outbreaks in a setting at high risk of COVID-19 and facilitated rapid deployment of resources. The geocoding surveillance approach could be used for other diseases and in any setting for which a list of addresses is available.
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Affiliation(s)
- Stephanie E. Cohen
- Disease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA,COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Stephanie E. Cohen, MD, MPH, San Francisco Department of Public Health, Disease Prevention and Control Branch, Population Health Division, 356 7th St, San Francisco, CA 94103, USA.
| | - Jodi Stookey
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Maternal, Child & Adolescent Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nora Anderson
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Community Health Equity and Promotion Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Devan Morris
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Trudy Singzon
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Maggie Dann
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Katie Burk
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Community Health Equity and Promotion Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Carol C. Chen
- COVID Command Center, San Francisco Department of Public Health, San Francisco, CA, USA,Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
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14
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Lu Z, Brunton AE, Mohebnasab M, Deloney A, Williamson KJ, Layton BA, Mansell S, Brawley-Chesworth A, Abrams P, Wilcox KA, Franklin FA, McWeeney SK, Streblow DN, Fan G, Hansel DE. Community-Based SARS-CoV-2 Testing Using Saliva or Nasopharyngeal Swabs to Compare the Performance of Weekly COVID-19 Screening to Wastewater SARS-CoV-2 Signals. ACS ES&T WATER 2022; 2:1667-1677. [PMID: 37552730 PMCID: PMC9528017 DOI: 10.1021/acsestwater.2c00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 08/10/2023]
Abstract
Multiple studies worldwide have confirmed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be detected in wastewater. However, there is a lack of data directly comparing the wastewater SARS-CoV-2 RNA concentration with the prevalence of coronavirus disease 2019 (COVID-19) in individuals living in sewershed areas. Here, we correlate wastewater SARS-CoV-2 signals with SARS-CoV-2 positivity rates in symptomatic and asymptomatic individuals and compare positivity rates in two underserved communities in Portland, Oregon to those reported in greater Multnomah County. 403 individuals were recruited via two COVID-19 testing sites over a period of 16 weeks. The weekly SARS-CoV-2 positivity rate in our cohort ranged from 0 to 21.7% and trended higher than symptomatic positivity rates reported by Multnomah County (1.9-8.7%). Among the 362 individuals who reported symptom status, 76 were symptomatic and 286 were asymptomatic. COVID-19 was detected in 35 participants: 24 symptomatic, 9 asymptomatic, and 2 of unknown symptomatology. Wastewater testing yielded 0.33-149.9 viral RNA genomic copies/L/person and paralleled community COVID-19 positive test rates. In conclusion, wastewater sampling accurately identified increased SARS-CoV-2 within a community. Importantly, the rate of SARS-CoV-2 positivity in underserved areas is higher than positivity rates within the County as a whole, suggesting a disproportionate burden of SARS-CoV-2 in these communities.
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Affiliation(s)
- Zhengchun Lu
- Department of Pathology & Laboratory Medicine,
Oregon Health & Science University, Portland,
Oregon97239, United States
| | - Amanda E. Brunton
- School of Public Health, Oregon Health
& Science University—Portland State University, Portland,
Oregon97239, United States
| | - Maedeh Mohebnasab
- Department of Pathology & Laboratory Medicine,
Oregon Health & Science University, Portland,
Oregon97239, United States
| | - Anthony Deloney
- Self Enhancement, Inc.,
Portland, Oregon97227, United States
| | - Kenneth J. Williamson
- Department of Research and Innovation,
Clean Water Services, Hillsboro, Oregon97123, United
States
| | - Blythe A. Layton
- Department of Research and Innovation,
Clean Water Services, Hillsboro, Oregon97123, United
States
| | - Scott Mansell
- Department of Research and Innovation,
Clean Water Services, Hillsboro, Oregon97123, United
States
| | | | - Peter Abrams
- City of Portland Bureau of Environmental
Services, Portland, Oregon97204, United States
| | - Kimberly A. Wilcox
- Department of Pathology & Laboratory Medicine,
Oregon Health & Science University, Portland,
Oregon97239, United States
| | - F. Abron Franklin
- School of Public Health, Epidemiology Division,
Oregon Health & Science University—Portland State
University, Portland, Oregon97239, United States
- Departments of Community Health and Preventive Medicine
and Graduate Education in Public Health, Morehouse School of
Medicine, Atlanta, Georgia30310, United States
| | - Shannon K. McWeeney
- Knight Cancer Institute, Oregon Health
and Science University, Portland, Oregon97239, United
States
- Division of Bioinformatics and Computational Biology,
Department of Medical Informatics and Clinical Epidemiology, Oregon Health
and Science University, Portland, Oregon97239, United
States
| | - Daniel N. Streblow
- Vaccine & Gene Therapy Institute,
Oregon Health & Science University, Beaverton,
Oregon97006United States
- Division of Pathobiology and Immunology,
Oregon National Primate Research Center, Beaverton,
Oregon97006, United States
| | - Guang Fan
- Department of Pathology & Laboratory Medicine,
Oregon Health & Science University, Portland,
Oregon97239, United States
| | - Donna E. Hansel
- Department of Pathology & Laboratory Medicine,
Oregon Health & Science University, Portland,
Oregon97239, United States
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15
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Marquez C, Kerkhoff AD, Schrom J, Rojas S, Black D, Mitchell A, Wang CY, Pilarowski G, Ribeiro S, Jones D, Payan J, Manganelli S, Rojas S, Lemus J, Jain V, Chamie G, Tulier-Laiwa V, Petersen M, DeRisi J, Havlir DV. COVID-19 Symptoms and Duration of Rapid Antigen Test Positivity at a Community Testing and Surveillance Site During Pre-Delta, Delta, and Omicron BA.1 Periods. JAMA Netw Open 2022; 5:e2235844. [PMID: 36215069 PMCID: PMC9552893 DOI: 10.1001/jamanetworkopen.2022.35844] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
Importance Characterizing the clinical symptoms and evolution of community-based SARS-CoV-2 infections may inform health practitioners and public health officials in a rapidly changing landscape of population immunity and viral variants. Objectives To compare COVID-19 symptoms among people testing positive with a rapid antigen test (RAT) during the Omicron BA.1 variant period (December 1, 2021, to January 30, 2022) with the pre-Delta (January 10 to May 31, 2021) and Delta (June 1 to November 30, 2021) variant periods and to assess the duration of RAT positivity during the Omicron BA.1 surge. Design, Setting, and Participants This cross-sectional study was conducted from January 10, 2021, to January 31, 2022, at a walk-up community COVID-19 testing site in San Francisco, California. Participants included children and adults seeking COVID-19 testing with an RAT, regardless of age, vaccine status, or symptoms. Main Outcomes and Measures Fisher exact tests or χ2 tests were used to compare COVID-19 symptoms during the Omicron BA.1 period with the pre-Delta and Delta periods for vaccination status and age group. Among people returning for repeated testing during the Omicron period, the proportion with a positive RAT between 4 and 14 days from symptom onset or since first positive test if asymptomatic was estimated. Results Among 63 277 persons tested (median [IQR] age, 32 [21-44] years, with 12.0% younger than 12 years; 52.0% women; and 68.5% Latinx), a total of 18 301 people (28.9%) reported symptoms, of whom 4565 (24.9%) tested positive for COVID-19. During the Omicron BA.1 period, 3032 of 7283 symptomatic participants (41.6%) tested positive, and the numbers of these reporting cough and sore throat were higher than during pre-Delta and Delta periods (cough: 2044 [67.4%] vs 546 [51.3%] of 1065 participants, P < .001 for pre-Delta, and 281 [60.0%] of 468 participants, P = .002, for Delta; sore throat: 1316 [43.4%] vs 315 [29.6%] of 1065 participants, P < .001 for pre-Delta, and 136 [29.1%] of 468 participants, P < .001, for Delta). Compared with the 1065 patients with positive test results in the pre-Delta period, congestion among the 3032 with positive results during the Omicron BA.1 period was more common (1177 [38.8%] vs 294 [27.6%] participants, P < .001), and loss of taste or smell (160 [5.3%] vs 183 [17.2%] participants, P < .001) and fever (921 [30.4%] vs 369 [34.7%] participants, P = .01) were less common. In addition, during the Omicron BA.1 period, fever was less common among the people with positive test results who had received a vaccine booster compared with those with positive test results who were unvaccinated (97 [22.5%] of 432 vs 42 [36.2%] of 116 participants, P = .003), and fever and myalgia were less common among participants who had received a booster compared with those with positive results who had received only a primary series (fever: 97 [22.5%] of 432 vs 559 [32.8%] of 1705 participants, P < .001; myalgia: 115 [26.6%] of 432 vs 580 [34.0%] of 1705 participants, P = .003). During the Omicron BA.1 period, 5 days after symptom onset, 507 of 1613 people (31.1%) with COVID-19 stated that their symptoms were similar, and 95 people (5.9%) reported worsening symptoms. Among people testing positive, 80.2% of participants who were symptomatic and retested remained positive 5 days after symptom onset. Conclusions and Relevance In this cross-sectional study, COVID-19 upper respiratory tract symptoms were more commonly reported during the Omicron BA.1 period than during the pre-Delta and Delta periods, with differences by vaccination status. Rapid antigen test positivity remained high 5 days after symptom onset, supporting guidelines requiring a negative test to inform the length of the isolation period.
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Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - John Schrom
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Susana Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | - Susy Rojas
- Unidos en Salud, San Francisco, California
| | | | - Vivek Jain
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Valerie Tulier-Laiwa
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley
| | | | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
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16
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Irish A, Whitman JD, Clark EH, Marcus R, Bern C. Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States. Emerg Infect Dis 2022; 28:1313-1320. [PMID: 35731040 PMCID: PMC9239882 DOI: 10.3201/eid2807.212221] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Geographic scale estimates of disease in older Latin America–born US residents may be useful for prevention and early recognition of chronic sequelae. We combined American Community Survey data with age-specific Trypanosoma cruzi prevalence derived from US surveys and World Health Organization reports to yield estimates of Chagas disease in the United States, which we mapped at the local level. In addition, we used blood donor data to estimate the relative prevalence of autochthonous T. cruzi infection. Our estimates indicate that 288,000 infected persons, including 57,000 Chagas cardiomyopathy patients and 43,000 infected reproductive-age women, currently live in the United States; 22–108 congenital infections occur annually. We estimated ≈10,000 prevalent cases of locally acquired T. cruzi infection. Mapping shows marked geographic heterogeneity of T. cruzi prevalence and illness. Reliable demographic and geographic data are key to guiding prevention and management of Chagas disease. Population-based surveys in high prevalence areas could improve the evidence base for future estimates. Knowledge of the demographics and geographic distribution of affected persons may aid practitioners in recognizing Chagas disease.
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children generally have milder presentations, but severe disease can occur in all ages. MIS-C and persistent post-acute COVID-19 symptoms can be experienced by children with previous infection and emphasize the need for infection prevention. Optimal treatment for COVID-19 is not known, and clinical trials should include children to guide therapy. Vaccines are the best tool at preventing infection and severe outcomes of COVID-19. Children suffered disproportionately during the pandemic not only from SARS-CoV-2 infection but because of disruptions to daily life, access to primary care, and worsening income inequalities.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356423, Seattle, WA 98195, USA.
| | - Janet A Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, 4800 Sand Point Way NE - MA7.234, Seattle, WA 98105, USA
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18
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Nöstlinger C, Van Landeghem E, Vanhamel J, Rotsaert A, Manirankunda L, Ddungu C, Reyniers T, Katsuva D, Vercruyssen J, Dielen S, Meudec M. COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium. Int J Equity Health 2022; 21:67. [PMID: 35578292 PMCID: PMC9108705 DOI: 10.1186/s12939-022-01672-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/27/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. Despite the established importance of community involvement in epidemic preparedness, we lack in-depth understanding of these communities' experiences with and responses to COVID-19. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities. METHODS This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and professional community workers. Data were collected between May 2020-May 2021 through key informant-, in-depth interviews and group discussions (N = 71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process. RESULTS Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures' most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status). CONCLUSION Study participants' narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics. This justifies conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities' structural vulnerabilities and resilience.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stef Dielen
- Department of Public Health, Antwerp, Belgium
| | - Marie Meudec
- Department of Public Health, Antwerp, Belgium
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium
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19
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Castellon-Lopez YM, Carson SL, Mansfield L, Garrison NA, Barron J, Morris D, Ntekume E, Vassar SD, Norris KC, Brown AF, Casillas A. "The System Doesn't Let Us in"-A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos' Experience of Pandemic Hardships and Inequities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5785. [PMID: 35627322 PMCID: PMC9141159 DOI: 10.3390/ijerph19105785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies. METHODS We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis. RESULTS Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access. CONCLUSIONS Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Lisa Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
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20
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Routledge I, Takahashi S, Epstein A, Hakim J, Janson O, Turcios K, Vinden J, Risos JT, Baniqued MR, Pham L, Di Germanio C, Busch M, Kushel M, Greenhouse B, Rodríguez-Barraquer I. Using sero-epidemiology to monitor disparities in vaccination and infection with SARS-CoV-2. Nat Commun 2022; 13:2451. [PMID: 35508478 PMCID: PMC9068757 DOI: 10.1038/s41467-022-30051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/07/2022] [Indexed: 01/02/2023] Open
Abstract
As SARS-CoV-2 continues to spread and vaccines are rolled-out, the "double burden" of disparities in exposure and vaccination intersect to determine patterns of infection, immunity, and mortality. Serology provides a unique opportunity to measure prior infection and vaccination simultaneously. Leveraging algorithmically-selected residual sera from two hospital networks in the city of San Francisco, cross-sectional samples from 1,014 individuals from February 4-17, 2021 were each tested on two assays (Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 and Roche Elecsys Anti-SARS-CoV-2), capturing the first year of the epidemic and early roll-out of vaccination. We estimated, using Bayesian estimation of infection and vaccination, that infection risk of Hispanic/Latinx residents was five times greater than of White residents aged 18-64 (95% Credible Interval (CrI): 3.2-10.3), and that White residents over 65 were twice as likely to be vaccinated as Black/African American residents (95% CrI: 1.1-4.6). We found that socioeconomically-deprived zipcodes had higher infection probabilities and lower vaccination coverage than wealthier zipcodes. While vaccination has created a 'light at the end of the tunnel' for this pandemic, ongoing challenges in achieving and maintaining equity must also be considered.
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Affiliation(s)
- Isobel Routledge
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Saki Takahashi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Adrienne Epstein
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jill Hakim
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Owen Janson
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Keirstinne Turcios
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jo Vinden
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Infectious Disease and Immunity Graduate Group, University of California Berkeley, Berkeley, CA, USA
| | - John Tomas Risos
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Rose Baniqued
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lori Pham
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Michael Busch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
- Vitalant Research Institute, San Francisco, CA, USA
| | - Margot Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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21
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Schrom J, Marquez C, Pilarowski G, Wang CY, Mitchell A, Puccinelli R, Black D, Rojas S, Ribeiro S, Tulier-Laiwa V, Martinez J, Payan J, Rojas S, Jones D, Martinez D, Nakamura R, Chamie G, Jain V, Petersen M, DeRisi J, Havlir D. Comparison of SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge : A Cross-Sectional Study. Ann Intern Med 2022; 175:682-690. [PMID: 35286144 PMCID: PMC8943844 DOI: 10.7326/m22-0202] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND SARS-CoV-2 rapid antigen tests are an important public health tool. OBJECTIVE To evaluate field performance of the BinaxNOW rapid antigen test (Abbott) compared with reverse transcriptase polymerase chain reaction (RT-PCR) for detecting infection with the Omicron variant of SARS-CoV-2. DESIGN Cross-sectional surveillance study. SETTING Free, walk-up, outdoor, urban community testing and vaccine site led by Unidos en Salud, serving a predominantly Latinx community highly impacted by COVID-19. PARTICIPANTS Persons seeking COVID-19 testing in January 2022. MEASUREMENTS Simultaneous BinaxNOW and RT-PCR from nasal, cheek, and throat swabs, including cycle threshold (Ct) measures; a lower Ct value is a surrogate for higher amounts of virus. RESULTS Among 731 persons tested with nasal swabs, there were 296 (40.5%) positive results on RT-PCR; 98.9% were the Omicron variant. BinaxNOW detected 95.2% (95% CI, 91% to 98%) of persons who tested positive on RT-PCR with a Ct value below 30, 82.1% (CI, 77% to 87%) of those who tested positive on RT-PCR with a Ct value below 35, and 65.2% (CI, 60% to 71%) of all who were positive on RT-PCR. Among 75 persons with simultaneous nasal and cheek swabs, BinaxNOW using a cheek swab failed to detect 91% (20 of 22) of specimens that were positive on BinaxNOW with a nasal swab. Among persons with simultaneous nasal and throat swabs who were positive on RT-PCR with a Ct value below 30, 42 of 49 (85.7%) were detected by nasal BinaxNOW, 23 of 49 (46.9%) by throat BinaxNOW, and 44 of 49 (89.8%) by either. LIMITATION Participants were a cross-sectional sample from a community-based sentinel surveillance site, precluding study of viral or symptom dynamics. CONCLUSION BinaxNOW detected persons with high SARS-CoV-2 levels during the Omicron surge, enabling rapid responses to positive test results. Cheek or throat swabs should not replace nasal swabs. As currently recommended, high-risk persons with an initial negative BinaxNOW result should have repeated testing. PRIMARY FUNDING SOURCE University of California, San Francisco.
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Affiliation(s)
- John Schrom
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Carina Marquez
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Genay Pilarowski
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Chung-Yu Wang
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Anthea Mitchell
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Robert Puccinelli
- University of California, Berkeley, Berkeley, California (R.P., M.P.)
| | - Doug Black
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Susana Rojas
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Salustiano Ribeiro
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Valerie Tulier-Laiwa
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Jacqueline Martinez
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Joselin Payan
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Susy Rojas
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Diane Jones
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Daniel Martinez
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Robert Nakamura
- California Department of Public Health, Richmond, California (R.N.)
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Vivek Jain
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Maya Petersen
- University of California, Berkeley, Berkeley, California (R.P., M.P.)
| | - Joe DeRisi
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
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22
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Buitrago-Garcia D, Ipekci AM, Heron L, Imeri H, Araujo-Chaveron L, Arevalo-Rodriguez I, Ciapponi A, Cevik M, Hauser A, Alam MI, Meili K, Meyerowitz EA, Prajapati N, Qiu X, Richterman A, Robles-Rodriguez WG, Thapa S, Zhelyazkov I, Salanti G, Low N. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: Update of a living systematic review and meta-analysis. PLoS Med 2022; 19:e1003987. [PMID: 35617363 PMCID: PMC9135333 DOI: 10.1371/journal.pmed.1003987] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Debate about the level of asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address 3 questions: (1) Among people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv, and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range (IQR) 14% to 50%, prediction interval 2% to 90%), or in 84 studies based on screening of defined populations (IQR 20% to 65%, prediction interval 4% to 94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% confidence interval (CI) 15% to 25%, prediction interval 2% to 70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16 to 0.64, prediction interval 0.11 to 0.95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic, and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2. REVIEW PROTOCOL Open Science Framework (https://osf.io/9ewys/).
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Affiliation(s)
- Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lucia Araujo-Chaveron
- EHESP French School of Public Health, Paris and Rennes, France
- Institut Pasteur, Paris, France
| | - Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Fife, Scotland, United Kingdom
| | - Anthony Hauser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Kaspar Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eric A. Meyerowitz
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, New York, United States of America
| | | | - Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aaron Richterman
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Shabnam Thapa
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | | | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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23
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Smith-Jeffcoat SE, Sleweon S, Koh M, Khalil GM, Schechter MC, Rebolledo PA, Kasinathan V, Hoffman A, Rossetti R, Shragai T, O'Laughlin K, Espinosa CC, Bankamp B, Bowen MD, Paulick A, Gargis AS, Folster JM, da Silva J, Biedron C, Stewart RJ, Wang YF, Kirking HL, Tate JE. Risk-Factors for Exposure Associated With SARS-CoV-2 Detection After Recent Known or Potential COVID-19 Exposures Among Patients Seeking Medical Care at a Large Urban, Public Hospital in Fulton County, Georgia - A Cross-Sectional Investigation. Front Public Health 2022; 10:809356. [PMID: 35425748 PMCID: PMC9004481 DOI: 10.3389/fpubh.2022.809356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
We aimed to describe frequency of COVID-19 exposure risk factors among patients presenting for medical care at an urban, public hospital serving mostly uninsured/Medicare/Medicaid clients and risk factors associated with SARS-CoV-2 infection. Consenting, adult patients seeking care at a public hospital from August to November 2020 were enrolled in this cross-sectional investigation. Saliva, anterior nasal and nasopharyngeal swabs were collected and tested for SARS-CoV-2 using RT-PCR. Participant demographics, close contact, and activities ≤14 days prior to enrollment were collected through interview. Logistic regression was used to identify risk factors associated with testing positive for SARS-CoV-2. Among 1,078 participants, 51.8% were male, 57.0% were aged ≥50 years, 81.3% were non-Hispanic Black, and 7.6% had positive SARS-CoV-2 tests. Only 2.7% reported COVID-19 close contact ≤14 days before enrollment; this group had 6.79 adjusted odds of testing positive (95%CI = 2.78-16.62) than those without a reported exposure. Among participants who did not report COVID-19 close contact, working in proximity to ≥10 people (adjusted OR = 2.17; 95%CI = 1.03-4.55), choir practice (adjusted OR = 11.85; 95%CI = 1.44-97.91), traveling on a plane (adjusted OR = 5.78; 95%CI = 1.70-19.68), and not participating in an essential indoor activity (i.e., grocery shopping, public transit use, or visiting a healthcare facility; adjusted OR = 2.15; 95%CI = 1.07-4.30) were associated with increased odds of testing positive. Among this population of mostly Black, non-Hispanic participants seeking care at a public hospital, we found several activities associated with testing positive for SARS-CoV-2 infection in addition to close contact with a case. Understanding high-risk activities for SARS-CoV-2 infection among different communities is important for issuing awareness and prevention strategies.
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Affiliation(s)
| | - Sadia Sleweon
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mitsuki Koh
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - George M. Khalil
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marcos C. Schechter
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Paulina A. Rebolledo
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Emory University School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States
| | - Vyjayanti Kasinathan
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Adam Hoffman
- Grady Memorial Hospital, Atlanta, GA, United States
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
| | - Rebecca Rossetti
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Talya Shragai
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kevin O'Laughlin
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Bettina Bankamp
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael D. Bowen
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ashley Paulick
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amy S. Gargis
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Juliana da Silva
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Caitlin Biedron
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Yun F. Wang
- Grady Memorial Hospital, Atlanta, GA, United States
- Emory University School of Medicine, Pathology & Laboratory Medicine, Atlanta, GA, United States
| | - Hannah L. Kirking
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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24
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Reid MJA, Bulfone TC, Blat C, Chen YH, Rutherford GW, Philip S, Gutierrez-Mock L, Nickerson A, Buback L, Welty S, Reingold A, Enanoria WTA. Factors Associated With SARS-CoV-2 Transmission in Settings of High COVID-19 Vaccination Coverage: A Case-Control Study. Am J Epidemiol 2022; 191:1336-1339. [PMID: 35247046 PMCID: PMC8903439 DOI: 10.1093/aje/kwac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Michael J A Reid
- Correspondence Address: Michael Reid; Institute for Global Health Sciences, University of California, San Francisco, 550 16 Street, San Francisco, CA, USA 94158; (e-mail: )
| | - Tommaso C Bulfone
- School of Medicine, University of California, San Francisco, CA, USA UC,Berkeley, School of Public Health
| | - Cinthia Blat
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Yea-Hung Chen
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA,School of Medicine, University of California, San Francisco, CA, USA UC,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Susan Philip
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA,San Francisco Department of Public Health, San Francisco, CA, USA
| | - Luis Gutierrez-Mock
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Andrea Nickerson
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Laura Buback
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Susie Welty
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | | | - Wayne T A Enanoria
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA,San Francisco Department of Public Health, San Francisco, CA, USA
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25
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Lusk JB, Xu H, Thomas LE, Cohen LW, Hernandez AF, Forrest CB, Michtalik HJ, Turner KB, O'Brien EC, Barrett NJ. Racial/Ethnic Disparities in Healthcare Worker Experiences During the COVID-19 Pandemic: An Analysis of the HERO Registry. EClinicalMedicine 2022; 45:101314. [PMID: 35265822 PMCID: PMC8898082 DOI: 10.1016/j.eclinm.2022.101314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
Background The extent to which healthcare worker (HCWs) experiences during the COVID-19 pandemic vary by race or ethnicity after adjustment for confounding factors is not currently known. Methods We performed an observational prospective cohort study of 24,769 healthcare workers from 50 U.S. states and the District of Columbia, enrolled between April 10, 2020 and June 30, 2021, and evaluated participant experiences during the COVID-19 pandemic, including testing, diagnosis with COVID-19, emotional experiences, burnout, and interest in vaccines and vaccine clinical trials. Findings After adjustment for professional role, medical history, and community characteristics, Black and Asian participants were less likely to receive SARS-CoV-2 viral testing (adjusted odds ratio (aOR) 0·82 [0·70, 0·96], p=0·012 and aOR 0·77 [0·67, 0·89], p<0·001 respectively) than White participants. Hispanic participants were more likely to have evidence of COVID-19 infection (aOR 1·23 (1·00, 1·50, p=0·048). Black and Asian participants were less likely to report interest in a COVID-19 vaccine (aOR 0·11 [0·05, 0·25], p<0·001 and aOR 0·48 [0·27, 0·85] p=0·012). Black participants were less likely to report interest in participating in a COVID-19 vaccine trial (aOR = 0·39 [0·28, 0·54], p<0·001). Black participants were also less likely to report 3 or more daily emotional impacts of COVID-19 (aOR = 0·66 [0·53, 0·82], p=<0·001). Black participants were additionally less likely to report burnout (aOR = 0·66 ([0·49, 0·95], p=0·025). Interpretation In a large, national study of healthcare workers, after adjustment for individual and community characteristics, race/ethnicity disparities in COVID-19 outcomes persist. Future work is urgently needed to understand precise mechanisms behind these disparities and to develop and implement targeted interventions to improve health equity for healthcare workers. Funding This work was funded by the Patient-Centered Outcomes Research Institute (PCORI), Contract # COVID-19-2020-001.
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Affiliation(s)
- Jay B. Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Laine E. Thomas
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lauren W. Cohen
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | | | | | | | - Emily C. O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Nadine J. Barrett
- Department of Family Medicine and Community Health, Duke University, Durham, UA
| | - on behalf of the HERO Research Program
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Family Medicine and Community Health, Duke University, Durham, UA
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26
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Cheng Q, Spear RC. Exploring the Local Determinants of SARS-CoV-2 Transmission and Control via an Exposure-Based Model. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:1801-1810. [PMID: 35015513 DOI: 10.1021/acs.est.1c05633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A simulation model was developed aimed at assisting local public health authorities in exploring strategies for the suppression of SARS-CoV-2 transmission. A mechanistic modeling framework is utilized based on the daily airborne exposure of individuals defined in terms of inhaled viruses. Comparison of model outputs and observed data confirms that the model can generate realistic patterns of secondary cases. In the example investigated, the highest risk of being newly infected was among young adults, males, and people living in large households. Among risky occupations are food preparation and serving, personal care and service, sales, and production-related occupations. Results also show a pattern consistent with superspreading with 70% of initial cases who do not transmit at all while 13.4% of primary cases contribute 80% of secondary cases. The impacts of school closure and masking on the synthetic population are very small, but for students, school closure resulted in more time at home and increased secondary cases among them by over 25%. Requiring masks at schools decreased the case count by 80%. We conclude that the simulator can be useful in exploring local intervention scenarios and provides output useful in assessing the confidence that might be placed on its predictions.
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Affiliation(s)
- Qu Cheng
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California 94720, United States
| | - Robert C Spear
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California 94720, United States
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27
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Naso J, Rojas S, Peng J, Marquez C, Contreras M, Castellanos E, Rojas S, Rubio L, Jones D, Jacobo J, Black D, Tulier-Laiwa V, Martinez J, Chamie G, Pilarowski G, DeRisi J, Havlir D, Petersen M. High Parental Vaccine Motivation at a Neighborhood-Based Vaccine and Testing Site Serving a Predominantly Latinx Community. Health Equity 2022; 5:840-846. [PMID: 35018317 PMCID: PMC8742294 DOI: 10.1089/heq.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To understand vaccine attitudes of Latinx parents highly impacted by COVID-19. Methods: In April 2021, we surveyed parents about their attitudes for COVID-19 vaccination of their children at a community-based outdoor testing/vaccination site serving predominantly low-income Latinx persons in San Francisco. Results: Among 1033 parents (75% Latinx), 92% would "definitely" or "probably" vaccinate their children. Vaccine concerns were higher for younger children and included side effects and impacts on fertility. Doctors and community organizations were noted as trusted sources of information, including among vaccine-concerned parents. Conclusion: Latinx parents accessing neighborhood-based COVID-19 testing/vaccination services are highly motivated to vaccinate their children for COVID-19.
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Affiliation(s)
- Jamie Naso
- Unidos en Salud, San Francisco, California, USA
| | - Susy Rojas
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - James Peng
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | | | - Susana Rojas
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - Luis Rubio
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, California, USA
| | - Jon Jacobo
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Joseph DeRisi
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Maya Petersen
- Division of Biostatistics, The School of Public Health, University of California, Berkeley, Berkeley, California, USA
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28
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Robertson MM, Shamsunder M, Brazier E, Mantravadi M, Rane MS, Westmoreland DA, Parcesepe AM, Zimba R, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.01.11.22269101. [PMID: 35043126 PMCID: PMC8764735 DOI: 10.1101/2022.01.11.22269101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Meghana Shamsunder
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Mekhala Mantravadi
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Madhura S Rane
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Gillings School of Public Health, University of North Carolina, 427 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
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29
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Peng J, Liu J, Mann SA, Mitchell AM, Laurie MT, Sunshine S, Pilarowski G, Ayscue P, Kistler A, Vanaerschot M, Li LM, McGeever A, Chow ED, Marquez C, Nakamura R, Rubio L, Chamie G, Jones D, Jacobo J, Rojas S, Rojas S, Tulier-Laiwa V, Black D, Martinez J, Naso J, Schwab J, Petersen M, Havlir D, DeRisi J. Estimation of Secondary Household Attack Rates for Emergent Spike L452R Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants Detected by Genomic Surveillance at a Community-Based Testing Site in San Francisco. Clin Infect Dis 2022; 74:32-39. [PMID: 33788923 PMCID: PMC8083548 DOI: 10.1093/cid/ciab283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- James Peng
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jamin Liu
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- University of California, Berkeley—University of California, San Francisco Graduate Program in Bioengineering, Berkeley, California, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Anthea M Mitchell
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Matthew T Laurie
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sara Sunshine
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Genay Pilarowski
- Department of Pathology, Stanford University, Stanford, California, USA
| | | | - Amy Kistler
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Lucy M Li
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Eric D Chow
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Robert Nakamura
- California Department of Public Health, Richmond, California, USA
| | - Luis Rubio
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, California, USA
| | - Jon Jacobo
- Unidos en Salud, San Francisco, California, USA
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, California, USA
| | | | - Douglas Black
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Jamie Naso
- Unidos en Salud, San Francisco, California, USA
| | - Joshua Schwab
- Division of Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Maya Petersen
- Division of Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joseph DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - IDseq Team
- Chan Zuckerberg Initiative, Redwood City, CaliforniaUSA
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30
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Adams C, Horton M, Solomon O, Wong M, Wu SL, Fuller S, Shao X, Fedrigo I, Quach HL, Quach DL, Meas M, Lopez L, Broughton A, Barcellos AL, Shim J, Seymens Y, Hernandez S, Montoya M, Johnson DM, Beckman KB, Busch MP, Coloma J, Lewnard JA, Harris E, Barcellos LF. Health inequities in SARS-CoV-2 infection, seroprevalence, and COVID-19 vaccination: Results from the East Bay COVID-19 study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000647. [PMID: 36962725 PMCID: PMC10022102 DOI: 10.1371/journal.pgph.0000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
Comprehensive data on transmission mitigation behaviors and both SARS-CoV-2 infection and serostatus are needed from large, community-based cohorts to identify COVID-19 risk factors and the impact of public health measures. We conducted a longitudinal, population-based study in the East Bay Area of Northern California. From July 2020-March 2021, approximately 5,500 adults were recruited and followed over three data collection rounds to investigate the association between geographic and demographic characteristics and transmission mitigation behavior with SARS-CoV-2 prevalence. We estimated the populated-adjusted prevalence of antibodies from SARS-CoV-2 infection and COVID-19 vaccination, and self-reported COVID-19 test positivity. Population-adjusted SARS-CoV-2 seroprevalence was low, increasing from 1.03% (95% CI: 0.50-1.96) in Round 1 (July-September 2020), to 1.37% (95% CI: 0.75-2.39) in Round 2 (October-December 2020), to 2.18% (95% CI: 1.48-3.17) in Round 3 (February-March 2021). Population-adjusted seroprevalence of COVID-19 vaccination was 21.64% (95% CI: 19.20-24.34) in Round 3, with White individuals having 4.35% (95% CI: 0.35-8.32) higher COVID-19 vaccine seroprevalence than individuals identifying as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, two or more races, or other. No evidence for an association between transmission mitigation behavior and seroprevalence was observed. Despite >99% of participants reporting wearing masks individuals identifying as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, two or more races, or other, as well as those in lower-income households, and lower-educated individuals had the highest SARS-CoV-2 seroprevalence and lowest vaccination seroprevalence. Results demonstrate that more effective policies are needed to address these disparities and inequities.
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Affiliation(s)
- Cameron Adams
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Mary Horton
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Olivia Solomon
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Marcus Wong
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Sean L Wu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Sophia Fuller
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Xiaorong Shao
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Indro Fedrigo
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Hong L Quach
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Diana L Quach
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Michelle Meas
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Luis Lopez
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Abigail Broughton
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Anna L Barcellos
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Joan Shim
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Yusef Seymens
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Samantha Hernandez
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Magelda Montoya
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Darrell M Johnson
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kenneth B Beckman
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Josefina Coloma
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Joseph A Lewnard
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Eva Harris
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Lisa F Barcellos
- School of Public Health, University of California, Berkeley, California, United States of America
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31
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Spinelli MA, Brown LB, Glidden DV, Hunter K, Martin-Tuite P, Zheng J, Sera C, Havlir D, Buchbinder SP, Gandhi M. SARS-CoV-2 incidence, testing rates, and severe COVID-19 outcomes among people with and without HIV. AIDS 2021; 35:2545-2547. [PMID: 34870933 PMCID: PMC8673488 DOI: 10.1097/qad.0000000000003075] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To assess SARS-CoV-2 outcomes, we matched a municipal COVID-19 registry and clinic rosters from a municipal primary care network containing a large HIV clinic and assessed clinical outcomes by HIV status. The risk of severe COVID-19 was higher among people with HIV (PWH, adjusted relative risk = 1.84, 95% confidence interval = 1.05-3.25), while SARS-CoV-2 incidence was lower despite higher testing rates. SARS-CoV-2 vaccination campaigns should prioritize PWH to prevent severe COVID-19 disease given potentially higher risk.
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Affiliation(s)
- Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kyle Hunter
- Department of Medicine, University of California, San Francisco
| | | | - James Zheng
- Department of Medicine, University of California, San Francisco
| | - Curtis Sera
- Department of Medicine, University of California, San Francisco
| | - Diane Havlir
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Susan P. Buchbinder
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
- San Francisco Department of Public Health
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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32
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Munch PK, Espenhain L, Hansen CH, Müller L, Krause TG, Ethelberg S. Societal activities associated with SARS-CoV-2 infection: a case-control study in Denmark, November 2020. Epidemiol Infect 2021; 150:e9. [PMID: 34784997 PMCID: PMC8755547 DOI: 10.1017/s0950268821002478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Identification of societal activities associated with SARS-CoV-2 infection may provide an evidence base for implementing preventive measures. Here, we investigated potential determinants for infection in Denmark in a situation where society was only partially open. We conducted a national matched case-control study. Cases were recent RT-PCR test-positives, while controls, individually matched on age, sex and residence, had not previously tested positive for SARS-CoV-2. Questions concerned person contact and community exposures. Telephone interviews were performed over a 7-day period in December 2020. We included 300 cases and 317 controls and determined odds ratios (ORs) and 95% confidence intervals (95% CI) by conditional logistical regression with adjustment for household size and country of origin. Contact (OR 4.9, 95% CI 2.4-10) and close contact (OR 13, 95% CI 6.7-25) with a person with a known SARS-CoV-2 infection were main determinants. Contact most often took place in the household or work place. Community determinants included events with singing (OR 2.1, 95% CI 1.1-4.1), attending fitness centres (OR 1.8, 95% CI 1.1-2.8) and consumption of alcohol in a bar (OR 10, 95% CI 1.5-65). Other community exposures appeared not to be associated with infection, these included shopping at supermarkets, travel by public transport, dining at restaurants and private social events with few participants. Overall, the restrictions in place at the time of the study appeared to be sufficient to reduce transmission of disease in the public space, which instead largely took place following direct exposures to people with known SARS-CoV-2 infections.
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Affiliation(s)
- Pernille Kold Munch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
| | - Laura Espenhain
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
| | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
| | - Luise Müller
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
| | - Tyra Grove Krause
- Division of Infectious Disease Preparedness, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen S, Denmark
- Department of Public Health, Global Health Section, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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33
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Design of a population-based longitudinal cohort study of SARS-CoV-2 incidence and prevalence among adults in the San Francisco Bay Area. Ann Epidemiol 2021; 67:81-100. [PMID: 34800659 PMCID: PMC8596645 DOI: 10.1016/j.annepidem.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
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.
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Mendez AD, Escobar M, Romero M, Wojcicki JM. Overcrowding and exposure to secondhand smoke increase risk for COVID-19 infection among Latinx families in the greater San Francisco Bay Area. Tob Induc Dis 2021; 19:79. [PMID: 34712109 PMCID: PMC8507798 DOI: 10.18332/tid/140827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Environmental risk factors, including community level pollution burden and exposure to smoking and secondhand smoke, have not been evaluated in relation to risk for infection with COVID-19 in high risk, urban Latinx families. METHODS We evaluated risk factors for COVID-19 infection in three, preexisting, longitudinal, Latinx family cohorts in the San Francisco Bay Area from May through September 2020 (N=383 households, 1875 people). All households were previously recruited before the pandemic. For the COVID-19 sub-study, participants responded to a telephone interview where we assessed food consumption patterns, housing and employment status, and history of COVID-19 infection. Secondhand smoke exposure was based on previously collected selfreported data, and environmental pollution exposure was determined from census tract residence. Non-parametric tests and multiple logistic regression were used to assess independent predictors of COVID-19 infection. RESULTS Larger household size increased risk for infection (OR=1.58; 95% CI: 1.12–2.23, p<0.01) as did increasing number of children in household (OR=3.79; 95% CI: 1.51–9.56). Any exposure to secondhand smoke was also associated with increased risk for COVID infection (OR 4.69; 95% CI: 1.01–21.85) and having a greater number of family members eating at home was protective against infection (OR=0.10; 95% CI: 0.02–0.52, p<0.01). CONCLUSIONS Crowding, as indicated by larger household size, increases risk for COVID-19 infection in Latinx families, as does exposure to secondhand smoke. Public policy and health interventions need to ensure that multiunit residential complexes do not allow exposure to secondhand smoke between units, that individuals eat in the home environment, and that large households can safely separate individuals exposed to COVID-19.
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Affiliation(s)
- Andrea DeCastro Mendez
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
| | - Milagro Escobar
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
| | - Maria Romero
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
| | - Janet M Wojcicki
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
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Performance characteristics of the Abbott BinaxNOW SARS-CoV-2 antigen test in comparison to real-time RT-PCR and viral culture in community testing sites during November 2020. J Clin Microbiol 2021; 60:e0174221. [PMID: 34705535 PMCID: PMC8769733 DOI: 10.1128/jcm.01742-21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Point-of-care antigen tests are an important tool for SARS-CoV-2 detection. Antigen tests are less sensitive than real-time reverse-transcriptase PCR (rRT-PCR). Data on the performance of the BinaxNOW antigen test compared to rRT-PCR and viral culture by symptom and known exposure status, timing during disease or exposure period and demographic variables are limited. During November 3rd-17th, 2020, we collected paired upper respiratory swab specimens to test for SARS-CoV-2 by rRT-PCR and Abbott BinaxNOW (BinaxNOW) antigen test at two community testing sites in Pima County, Arizona. We administered a questionnaire to capture symptoms, known exposure status and previous SARS-CoV-2 test results. Specimens positive by either test were analyzed by viral culture. Previously we showed overall BinaxNOW sensitivity was 52.5%. Here we showed BinaxNOW sensitivity increased to 65.7% among currently symptomatic individuals reporting a known exposure. BinaxNOW sensitivity was lower among participants with a known exposure and previously symptomatic (32.4%) or never symptomatic (47.1%) within 14 days of testing. Sensitivity was 71.1% in participants within a week of symptom onset. In participants with a known exposure, sensitivity was highest 8-10 days post-exposure (75%). The positive predictive value for recovery of virus in cell culture was 56.7% for BinaxNOW-positive and 35.4% for rRT-PCR-positive specimens. Result reporting time was 2.5 hours for BinaxNOW and 26 hours for rRT-PCR. Point-of-care antigen tests have a shorter turn-around time compared to laboratory-based nucleic acid amplification tests, which allows for more rapid identification of infected individuals. Antigen test sensitivity limitations are important to consider when developing a testing program.
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Routledge I, Takahashi S, Epstein A, Hakim J, Janson O, Turcios K, Vinden J, Risos JT, Baniqued MR, Pham L, Di Germanio C, Busch M, Kushel M, Greenhouse B, Rodríguez-Barraquer I. Using sero-epidemiology to monitor disparities in vaccination and infection with SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.06.21264573. [PMID: 34642695 PMCID: PMC8509086 DOI: 10.1101/2021.10.06.21264573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As COVID-19 vaccines continue to be rolled-out, the "double burden" of health disparities in both exposure to infection and vaccination coverage intersect to determine the current and future patterns of infection, immunity, and mortality. Serology provides a unique opportunity to measure biomarkers of infection and vaccination simultaneously, and to relate these metrics to demographic and geographic factors. METHODS Leveraging algorithmically selected residual serum samples from two hospital networks in San Francisco, we sampled 1014 individuals during February 2021, capturing transmission during the first 11 months of the epidemic and the early roll out of vaccination. These samples were tested using two serologic assays: one detecting antibodies elicited by infection, and not by vaccines, and one detecting antibodies elicited by both infection and vaccination. We used Bayesian statistical models to estimate the proportion of the population that was naturally infected and the proportion protected due to vaccination. FINDINGS We estimated that the risk of prior infection of Latinx residents was 5.3 (95% CI: 3.2 - 10.3) times greater than the risk of white residents aged 18-64 and that white San Francisco residents over the age of 65 were twice as likely (2.0, 95% CI: 1.1 - 4.6) to be vaccinated as Black residents. We also found socioeconomically deprived zipcodes in the city had high probabilities of natural infections and lower vaccination coverage than wealthier zipcodes. INTERPRETATION Using a platform we created for SARS-CoV-2 serologic data collection in San Francisco, we characterized and quantified the stark disparities in infection rates and vaccine coverage by demographic groups over the first year of the pandemic. While the arrival of the SARS-CoV-2 vaccine has created a 'light at the end of the tunnel' for this pandemic, ongoing challenges in achieving and maintaining equity must also be considered. FUNDING NIH, NIGMS, Schmidt Science Fellows in partnership with the Rhodes Trust and the Chan Zuckerberg Biohub.
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Affiliation(s)
- Isobel Routledge
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Saki Takahashi
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Adrienne Epstein
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jill Hakim
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Owen Janson
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Keirstinne Turcios
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jo Vinden
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Infectious Disease and Immunity Graduate Group, University of California Berkeley, Berkeley, California, USA
| | - John Tomas Risos
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Margaret Rose Baniqued
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lori Pham
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Michael Busch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
- Vitalant Research Institute, San Francisco, California, USA
| | - Margot Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Peng J, Marquez C, Rubio L, Chamie G, Jones D, Jacobo J, Rojas S, Rojas S, Tulier-Laiwa V, Black D, Martinez J, Pilarowski G, Cox C, Derisi J, Havlir D, Petersen M. High Likelihood of Accepting COVID-19 Vaccine in a Latinx Community at High SARS-CoV-2 Risk in San Francisco. Open Forum Infect Dis 2021; 8:ofab202. [PMID: 34642635 PMCID: PMC8083232 DOI: 10.1093/ofid/ofab202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Of 4133 persons surveyed at a low-barrier coronavirus disease 2019 (COVID-19) test site with high positivity in an urban Latinx community in January 2021, 86% indicated that they would accept a COVID-19 vaccination. The top reasons for vaccine hesitancy included concerns around side effects and safety and distrust of health care systems.
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Affiliation(s)
- James Peng
- University of California, San Francisco, San Francisco, California, USA
| | - Carina Marquez
- University of California, San Francisco, San Francisco, California, USA
| | - Luis Rubio
- University of California, San Francisco, San Francisco, California, USA
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, California, USA
| | - Jon Jacobo
- Unidos en Salud, San Francisco, California, USA
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, California, USA
| | | | - Douglas Black
- University of California, San Francisco, San Francisco, California, USA
| | | | | | - Chesa Cox
- University of California, San Francisco, San Francisco, California, USA
| | - Joe Derisi
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California, USA
| | - Maya Petersen
- University of California, Berkeley, Berkeley, California, USA
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Lindsay L, Secrest MH, Rizzo S, Keebler DS, Yang F, Tsai L. Factors associated with COVID-19 viral and antibody test positivity and assessment of test concordance: a retrospective cohort study using electronic health records from the USA. BMJ Open 2021; 11:e051707. [PMID: 34598988 PMCID: PMC8488284 DOI: 10.1136/bmjopen-2021-051707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To identify factors associated with COVID-19 test positivity and assess viral and antibody test concordance. DESIGN Observational retrospective cohort study. SETTING Optum de-identified electronic health records including over 700 hospitals and 7000 clinics in the USA. PARTICIPANTS There were 891 754 patients who had a COVID-19 test identified in their electronic health record between 20 February 2020 and 10 July 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Per cent of viral and antibody tests positive for COVID-19 ('positivity rate'); adjusted ORs for factors associated with COVID-19 viral and antibody test positivity; and per cent concordance between positive viral and subsequent antibody test results. RESULTS Overall positivity rate was 9% (70 472 of 771 278) and 12% (11 094 of 91 741) for viral and antibody tests, respectively. Positivity rate was inversely associated with the number of individuals tested and decreased over time across regions and race/ethnicities. Antibody test concordance among patients with an initial positive viral test was 91% (71%-95% depending on time between tests). Among tests separated by at least 2 weeks, discordant results occurred in 7% of patients and 9% of immunocompromised patients. Factors associated with increased odds of viral and antibody positivity in multivariable models included: male sex, Hispanic or non-Hispanic black or Asian race/ethnicity, uninsured or Medicaid insurance and Northeast residence. We identified a negative dose effect between the number of comorbidities and viral and antibody test positivity. Paediatric patients had reduced odds (OR=0.60, 95% CI 0.57 to 0.64) of a positive viral test but increased odds (OR=1.90, 95% CI 1.62 to 2.23) of a positive antibody test compared with those aged 18-34 years old. CONCLUSIONS This study identified sociodemographic and clinical factors associated with COVID-19 test positivity and provided real-world evidence demonstrating high antibody test concordance among viral-positive patients.
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Affiliation(s)
- Lisa Lindsay
- Personalized Healthcare, Data Science, Genentech, South San Francisco, California, USA
| | - Matthew H Secrest
- Personalized Healthcare, Data Science, Genentech, South San Francisco, California, USA
| | - Shemra Rizzo
- Personalized Healthcare, Data Science, Genentech, South San Francisco, California, USA
| | - Daniel S Keebler
- Personalized Healthcare, Data Science, Genentech, South San Francisco, California, USA
| | - Fei Yang
- Roche Information Solutions, Roche Diagnostics International, Rotkreuz, Switzerland
| | - Larry Tsai
- Product Development, Genentech, South San Francisco, California, USA
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Marquez C, Kerkhoff AD, Naso J, Contreras MG, Castellanos Diaz E, Rojas S, Peng J, Rubio L, Jones D, Jacobo J, Rojas S, Gonzalez R, Fuchs JD, Black D, Ribeiro S, Nossokoff J, Tulier-Laiwa V, Martinez J, Chamie G, Pilarowski G, DeRisi J, Petersen M, Havlir DV. A multi-component, community-based strategy to facilitate COVID-19 vaccine uptake among Latinx populations: From theory to practice. PLoS One 2021; 16:e0257111. [PMID: 34543291 PMCID: PMC8452046 DOI: 10.1371/journal.pone.0257111] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 vaccine coverage in the Latinx community depends on delivery systems that overcome barriers such as institutional distrust, misinformation, and access to care. We hypothesized that a community-centered vaccination strategy that included mobilization, vaccination, and "activation" components could successfully reach an underserved Latinx population, utilizing its social networks to boost vaccination coverage. METHODS Our community-academic-public health partnership, "Unidos en Salud," utilized a theory-informed approach to design our "Motivate, Vaccinate, and Activate" COVID-19 vaccination strategy. Our strategy's design was guided by the PRECEDE Model and sought to address and overcome predisposing, enabling, and reinforcing barriers to COVID-19 vaccination faced by Latinx individuals in San Francisco. We evaluated our prototype outdoor, "neighborhood" vaccination program located in a central commercial and transport hub in the Mission District in San Francisco, using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework during a 16-week period from February 1, 2021 to May 19, 2021. Programmatic data, city-wide COVID-19 surveillance data, and a survey conducted between May 2, 2021 and May 19, 2021 among 997 vaccinated clients ≥16 years old were used in the evaluation. RESULTS There were 20,792 COVID-19 vaccinations administered at the neighborhood site during the 16-week evaluation period. Vaccine recipients had a median age of 43 (IQR 32-56) years, 53.9% were male and 70.5% were Latinx, 14.1% white, 7.7% Asian, 2.4% Black, and 5.3% other. Latinx vaccinated clients were substantially more likely than non-Latinx clients to have an annual household income of less than $50,000 a year (76.1% vs. 33.5%), be a first-generation immigrant (60.2% vs. 30.1%), not have health insurance (47.3% vs. 16.0%), and not have access to primary care provider (62.4% vs. 36.2%). The most frequently reported reasons for choosing vaccination at the site were its neighborhood location (28.6%), easy and convenient scheduling (26.9%) and recommendation by someone they trusted (18.1%); approximately 99% reported having an overall positive experience, regardless of ethnicity. Notably, 58.3% of clients reported that they were able to get vaccinated earlier because of the neighborhood vaccination site, 98.4% of clients completed both vaccine doses, and 90.7% said that they were more likely to recommend COVID-19 vaccination to family and friends after their experience; these findings did not substantially differ according to ethnicity. There were 40.3% of vaccinated clients who said they still knew at least one unvaccinated person (64.6% knew ≥3). Among clients who received both vaccine doses (n = 729), 91.0% said that after their vaccination experience, they had personally reached out to at least one unvaccinated person they knew (61.6% reached out to ≥3) to recommend getting vaccinated; 83.0% of clients reported that one or more friends, and/or family members got vaccinated as a result of their outreach, including 18.9% who reported 6 or more persons got vaccinated as a result of their influence. CONCLUSIONS A multi-component, "Motivate, Vaccinate, and Activate" community-based strategy addressing barriers to COVID-19 vaccination for the Latinx population reached the intended population, and vaccinated individuals served as ambassadors to recruit other friends and family members to get vaccinated.
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Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Jamie Naso
- Unidos en Salud, San Francisco, California, United States of America
| | - Maria G. Contreras
- Unidos en Salud, San Francisco, California, United States of America
- Department of Medicine, University of California, San Francisco, California, United States of America
- Clínica Martín Baró, San Francisco, California, United States of America
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Edgar Castellanos Diaz
- Unidos en Salud, San Francisco, California, United States of America
- Clínica Martín Baró, San Francisco, California, United States of America
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Susana Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - James Peng
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Luis Rubio
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Diane Jones
- Unidos en Salud, San Francisco, California, United States of America
| | - Jon Jacobo
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Susy Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Rafael Gonzalez
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Jonathan D. Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Salustiano Ribeiro
- Bay Area Phlebotomy and Laboratory Services (BayPLS), San Francisco, California, United States of America
| | - Jen Nossokoff
- Bay Area Phlebotomy and Laboratory Services (BayPLS), San Francisco, California, United States of America
| | - Valerie Tulier-Laiwa
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Genay Pilarowski
- Department of Pathology, Stanford University, Stanford, California, United States of America
| | - Joseph DeRisi
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, United States of America
| | - Maya Petersen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
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Galanis P, Kaitelidou D, Prezerakos P, Kotsiopoulos I, Siskou O, Konstantakopoulou O, Hadjichristodoulou C, Tsiodras S. Low seropositivity for SARS-CoV-2 antibodies among healthcare workers after the first COVID-19 pandemic wave in Greece. Public Health 2021; 198:223-229. [PMID: 34482100 PMCID: PMC8324404 DOI: 10.1016/j.puhe.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/19/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among healthcare workers (HCWs) in Greece and to identify high-risk groups in healthcare facilities. Study design The study design used in this study is a nationwide cross-sectional study. Methods Data were collected from 1 June to 9 July 2020. HCWs in the Greek National Health System were offered a free SARS-CoV-2 IgG antibody test, regardless of symptoms. Results Overall, 379 of 57,418 HCWs (0.66%, 95% confidence interval [CI]: 0.59–0.73) were positive for SARS-CoV-2 antibodies. The adjusted overall seroprevalence was 0.43% (95% CI: 0.35–0.51). We found that HCWs in non-reference hospitals for COVID-19 (odds ratio [OR]: 1.81, 95% CI: 1.23–2.64; P = 0.002) and reference hospitals for COVID-19 (OR: 1.66, 95% CI: 1.06–2.58; P = 0.03) were more likely to be seropositive than HCWs in primary care centres. Regarding professions, nurses (OR: 1.45, 95% CI: 1.07–1.98; P = 0.02), physicians (OR: 1.43, 95% CI: 1.06–1.93; P = 0.02), and administrative, cleaning and security staff (OR: 1.50, 95% CI: 1.09–2.06; P = 0.01) had a statistically higher chance of having a positive serology than laboratory employees. Conclusions The adjusted overall seroprevalence found in this study indicates a very low prevalence of SARS-CoV-2 among HCWs in Greece. This result is in line with the low incidence of COVID-19 during the first wave of the pandemic and is a direct benefit from the early implementation of lockdown.
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Affiliation(s)
- P Galanis
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - D Kaitelidou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - P Prezerakos
- Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece.
| | - I Kotsiopoulos
- General for Health Services, Ministry of Health, Athens, Greece.
| | - O Siskou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - O Konstantakopoulou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - C Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - S Tsiodras
- Faculty of Medicine, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Moore KS. The Impact of COVID-19 on the Latinx Population: A Scoping Literature Review. Public Health Nurs 2021; 38:789-800. [PMID: 33876506 PMCID: PMC8251024 DOI: 10.1111/phn.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore factors associated with the impact of COVID-19 on the Latinx population, a Scoping Review of literature was undertaken. DESIGN A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Scoping Review (PRISMA ScR) guidelines. A search of databases PubMed, CINAHL, and APA PsycINFO was conducted and included studies through November 23, 2020. SAMPLE Selected articles were limited to English language, included population data from the US, were specific to the topic of COVID-19, Latinx community findings significantly addressed, and added significant information to the developing narrative not covered elsewhere. RESULTS Sixteen studies in the final selection included meta-analyses, community-based assessments, and electronic health records reviews of hospital systems and local/state/national public databases. This review describes the prevalence of COVID-19 in the Latinx population, social factors related to disease burden, and the economic implications and disproportionality of COVID-19. CONCLUSIONS The impact of COVID-19 on the Latinx population is multi-factorial. More research is needed to examine each of these factors in greater detail.
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Milligan WR, Fuller ZL, Agarwal I, Eisen MB, Przeworski M, Sella G. Impact of essential workers in the context of social distancing for epidemic control. PLoS One 2021; 16:e0255680. [PMID: 34347855 PMCID: PMC8336873 DOI: 10.1371/journal.pone.0255680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
New emerging infectious diseases are identified every year, a subset of which become global pandemics like COVID-19. In the case of COVID-19, many governments have responded to the ongoing pandemic by imposing social policies that restrict contacts outside of the home, resulting in a large fraction of the workforce either working from home or not working. To ensure essential services, however, a substantial number of workers are not subject to these limitations, and maintain many of their pre-intervention contacts. To explore how contacts among such "essential" workers, and between essential workers and the rest of the population, impact disease risk and the effectiveness of pandemic control, we evaluated several mathematical models of essential worker contacts within a standard epidemiology framework. The models were designed to correspond to key characteristics of cashiers, factory employees, and healthcare workers. We find in all three models that essential workers are at substantially elevated risk of infection compared to the rest of the population, as has been documented, and that increasing the numbers of essential workers necessitates the imposition of more stringent controls on contacts among the rest of the population to manage the pandemic. Importantly, however, different archetypes of essential workers differ in both their individual probability of infection and impact on the broader pandemic dynamics, highlighting the need to understand and target intervention for the specific risks faced by different groups of essential workers. These findings, especially in light of the massive human costs of the current COVID-19 pandemic, indicate that contingency plans for future epidemics should account for the impacts of essential workers on disease spread.
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Affiliation(s)
- William R. Milligan
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Zachary L. Fuller
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Ipsita Agarwal
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Michael B. Eisen
- Howard Hughes Medical Institute, University of California, Berkeley, California, United States of America
- Department of Molecular and Cell Biology, University of California, Berkeley, California, United States of America
| | - Molly Przeworski
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
- Department of Systems Biology, Columbia University, New York City, New York, United States of America
- Program for Mathematical Genomics, Columbia University, New York City, New York, United States of America
| | - Guy Sella
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
- Program for Mathematical Genomics, Columbia University, New York City, New York, United States of America
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Velazquez AI, Hayward JH, Gregory B, Dixit N. Trends in Breast Cancer Screening in a Safety-Net Hospital During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2119929. [PMID: 34357398 PMCID: PMC8346942 DOI: 10.1001/jamanetworkopen.2021.19929] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ana I. Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jessica H. Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Blake Gregory
- San Francisco Health Network, San Francisco, California
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
- Division of Hematology/Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
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44
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Greenwald HD, Kennedy LC, Hinkle A, Whitney ON, Fan VB, Crits-Christoph A, Harris-Lovett S, Flamholz AI, Al-Shayeb B, Liao LD, Beyers M, Brown D, Chakrabarti AR, Dow J, Frost D, Koekemoer M, Lynch C, Sarkar P, White E, Kantor R, Nelson KL. Tools for interpretation of wastewater SARS-CoV-2 temporal and spatial trends demonstrated with data collected in the San Francisco Bay Area. WATER RESEARCH X 2021; 12:100111. [PMID: 34373850 DOI: 10.1101/2021.05.04.21256418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 05/26/2023]
Abstract
Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be integrated with COVID-19 case data to inform timely pandemic response. However, more research is needed to apply and develop systematic methods to interpret the true SARS-CoV-2 signal from noise introduced in wastewater samples (e.g., from sewer conditions, sampling and extraction methods, etc.). In this study, raw wastewater was collected weekly from five sewersheds and one residential facility. The concentrations of SARS-CoV-2 in wastewater samples were compared to geocoded COVID-19 clinical testing data. SARS-CoV-2 was reliably detected (95% positivity) in frozen wastewater samples when reported daily new COVID-19 cases were 2.4 or more per 100,000 people. To adjust for variation in sample fecal content, four normalization biomarkers were evaluated: crAssphage, pepper mild mottle virus, Bacteroides ribosomal RNA (rRNA), and human 18S rRNA. Of these, crAssphage displayed the least spatial and temporal variability. Both unnormalized SARS-CoV-2 RNA signal and signal normalized to crAssphage had positive and significant correlation with clinical testing data (Kendall's Tau-b (τ)=0.43 and 0.38, respectively), but no normalization biomarker strengthened the correlation with clinical testing data. Locational dependencies and the date associated with testing data impacted the lead time of wastewater for clinical trends, and no lead time was observed when the sample collection date (versus the result date) was used for both wastewater and clinical testing data. This study supports that trends in wastewater surveillance data reflect trends in COVID-19 disease occurrence and presents tools that could be applied to make wastewater signal more interpretable and comparable across studies.
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Affiliation(s)
- Hannah D Greenwald
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Lauren C Kennedy
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Adrian Hinkle
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Oscar N Whitney
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
| | - Vinson B Fan
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
| | - Alexander Crits-Christoph
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
| | | | - Avi I Flamholz
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Basem Al-Shayeb
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
| | - Lauren D Liao
- School of Public Health, University of California, Berkeley, CA, USA
| | - Matt Beyers
- Alameda County Public Health Department, San Leandro, CA, USA
| | | | | | - Jason Dow
- Central Marin Sanitation Agency, San Rafael, CA, USA
| | - Dan Frost
- Central Contra Costa Sanitary District, Martinez, CA, USA
| | | | - Chris Lynch
- Contra Costa Health Services, Martinez, CA, USA
| | - Payal Sarkar
- San José-Santa Clara Regional Wastewater Facility, San José, CA, USA
| | - Eileen White
- East Bay Municipal Utility District, Oakland, CA, USA
| | - Rose Kantor
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Kara L Nelson
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
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45
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Greenwald HD, Kennedy LC, Hinkle A, Whitney ON, Fan VB, Crits-Christoph A, Harris-Lovett S, Flamholz AI, Al-Shayeb B, Liao LD, Beyers M, Brown D, Chakrabarti AR, Dow J, Frost D, Koekemoer M, Lynch C, Sarkar P, White E, Kantor R, Nelson KL. Tools for interpretation of wastewater SARS-CoV-2 temporal and spatial trends demonstrated with data collected in the San Francisco Bay Area. WATER RESEARCH X 2021; 12:100111. [PMID: 34373850 PMCID: PMC8325558 DOI: 10.1016/j.wroa.2021.100111] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 05/18/2023]
Abstract
Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be integrated with COVID-19 case data to inform timely pandemic response. However, more research is needed to apply and develop systematic methods to interpret the true SARS-CoV-2 signal from noise introduced in wastewater samples (e.g., from sewer conditions, sampling and extraction methods, etc.). In this study, raw wastewater was collected weekly from five sewersheds and one residential facility. The concentrations of SARS-CoV-2 in wastewater samples were compared to geocoded COVID-19 clinical testing data. SARS-CoV-2 was reliably detected (95% positivity) in frozen wastewater samples when reported daily new COVID-19 cases were 2.4 or more per 100,000 people. To adjust for variation in sample fecal content, four normalization biomarkers were evaluated: crAssphage, pepper mild mottle virus, Bacteroides ribosomal RNA (rRNA), and human 18S rRNA. Of these, crAssphage displayed the least spatial and temporal variability. Both unnormalized SARS-CoV-2 RNA signal and signal normalized to crAssphage had positive and significant correlation with clinical testing data (Kendall's Tau-b (τ)=0.43 and 0.38, respectively), but no normalization biomarker strengthened the correlation with clinical testing data. Locational dependencies and the date associated with testing data impacted the lead time of wastewater for clinical trends, and no lead time was observed when the sample collection date (versus the result date) was used for both wastewater and clinical testing data. This study supports that trends in wastewater surveillance data reflect trends in COVID-19 disease occurrence and presents tools that could be applied to make wastewater signal more interpretable and comparable across studies.
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Affiliation(s)
- Hannah D. Greenwald
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Lauren C. Kennedy
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Adrian Hinkle
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Oscar N. Whitney
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
| | - Vinson B. Fan
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
| | - Alexander Crits-Christoph
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
| | | | - Avi I. Flamholz
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Basem Al-Shayeb
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
| | - Lauren D. Liao
- School of Public Health, University of California, Berkeley, CA, USA
| | - Matt Beyers
- Alameda County Public Health Department, San Leandro, CA, USA
| | | | | | - Jason Dow
- Central Marin Sanitation Agency, San Rafael, CA, USA
| | - Dan Frost
- Central Contra Costa Sanitary District, Martinez, CA, USA
| | | | - Chris Lynch
- Contra Costa Health Services, Martinez, CA, USA
| | - Payal Sarkar
- San José-Santa Clara Regional Wastewater Facility, San José, CA, USA
| | - Eileen White
- East Bay Municipal Utility District, Oakland, CA, USA
| | - Rose Kantor
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
| | - Kara L. Nelson
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Berkeley Water Center, University of California, Berkeley, CA, USA
- Innovative Genomics Institute, Berkeley, CA, USA
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46
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Lamba K, Bradley H, Shioda K, Sullivan PS, Luisi N, Hall EW, Mehrotra ML, Lim E, Jain S, Kamali A, Sanchez T, Lopman BA, Fahimi M, Siegler AJ. SARS-CoV-2 Cumulative Incidence and Period Seroprevalence: Results From a Statewide Population-Based Serosurvey in California. Open Forum Infect Dis 2021; 8:ofab379. [PMID: 34377733 PMCID: PMC8339610 DOI: 10.1093/ofid/ofab379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background California has reported the largest number of coronavirus disease 2019 (COVID-19) cases of any US state, with more than 3.5 million confirmed as of March 2021. However, the full breadth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in California is unknown as reported cases only represent a fraction of all infections. Methods We conducted a population-based serosurvey, utilizing mailed, home-based SARS-CoV-2 antibody testing along with a demographic and behavioral survey. We weighted data from a random sample to represent the adult California population and estimated period seroprevalence overall and by participant characteristics. Seroprevalence estimates were adjusted for waning antibodies to produce statewide estimates of cumulative incidence, the infection fatality ratio (IFR), and the reported fraction. Results California's SARS-CoV-2 weighted seroprevalence during August-December 2020 was 4.6% (95% CI, 2.8%-7.4%). Estimated cumulative incidence as of November 2, 2020, was 8.7% (95% CrI, 6.4%-11.5%), indicating that 2 660 441 adults (95% CrI, 1 959 218-3 532 380) had been infected. The estimated IFR was 0.8% (95% CrI, 0.6%-1.0%), and the estimated percentage of infections reported to the California Department of Public Health was 31%. Disparately high risk for infection was observed among persons of Hispanic/Latinx ethnicity and people with no health insurance and who reported working outside the home. Conclusions We present the first statewide SARS-CoV-2 cumulative incidence estimate among adults in California. As of November 2020, ~1 in 3 SARS-CoV-2 infections in California adults had been identified by public health surveillance. When accounting for unreported SARS-CoV-2 infections, disparities by race/ethnicity seen in case-based surveillance persist.
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Affiliation(s)
- Katherine Lamba
- California Department of Public Health, Richmond, California, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Megha L Mehrotra
- California Department of Public Health, Richmond, California, USA
| | - Esther Lim
- California Department of Public Health, Richmond, California, USA
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA
| | - Amanda Kamali
- California Department of Public Health, Richmond, California, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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47
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Citywide serosurveillance of the initial SARS-CoV-2 outbreak in San Francisco using electronic health records. Nat Commun 2021; 12:3566. [PMID: 34117227 PMCID: PMC8195995 DOI: 10.1038/s41467-021-23651-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/29/2021] [Indexed: 01/30/2023] Open
Abstract
Serosurveillance provides a unique opportunity to quantify the proportion of the population that has been exposed to pathogens. Here, we developed and piloted Serosurveillance for Continuous, ActionabLe Epidemiologic Intelligence of Transmission (SCALE-IT), a platform through which we systematically tested remnant samples from routine blood draws in two major hospital networks in San Francisco for SARS-CoV-2 antibodies during the early months of the pandemic. Importantly, SCALE-IT allows for algorithmic sample selection and rich data on covariates by leveraging electronic health record data. We estimated overall seroprevalence at 4.2%, corresponding to a case ascertainment rate of only 4.9%, and identified important heterogeneities by neighborhood, homelessness status, and race/ethnicity. Neighborhood seroprevalence estimates from SCALE-IT were comparable to local community-based surveys, while providing results encompassing the entire city that have been previously unavailable. Leveraging this hybrid serosurveillance approach has strong potential for application beyond this local context and for diseases other than SARS-CoV-2.
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48
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Reitsma MB, Claypool AL, Vargo J, Shete PB, McCorvie R, Wheeler WH, Rocha DA, Myers JF, Murray EL, Bregman B, Dominguez DM, Nguyen AD, Porse C, Fritz CL, Jain S, Watt JP, Salomon JA, Goldhaber-Fiebert JD. Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California. Health Aff (Millwood) 2021; 40:870-878. [PMID: 33979192 PMCID: PMC8458028 DOI: 10.1377/hlthaff.2021.00098] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined "high-exposure-risk" households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.
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Affiliation(s)
- Marissa B Reitsma
- Marissa B. Reitsma is a PhD student in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University, in Stanford, California. She and Anneke Claypool contributed equally to this article
| | - Anneke L Claypool
- Anneke L. Claypool is a PhD candidate in the Department of Management Science and Engineering, Stanford University. She and Marissa Reitsma contributed equally to this article
| | - Jason Vargo
- Jason Vargo is a lead research scientist in the Climate Change and Health Equity Program, Coronavirus Sciences Branch, and the Office of Health Equity, California Department of Public Health (CDPH), in Richmond, California
| | - Priya B Shete
- Priya B. Shete is an assistant professor in the Division of Pulmonary and Critical Care Medicine and UCSF Center for Tuberculosis, University of California San Francisco, and the COVID-19 modeling and analytics lead in the Coronavirus Sciences Branch, CDPH
| | - Ryan McCorvie
- Ryan McCorvie is a statistician in the Coronavirus Sciences Branch, CDPH
| | - William H Wheeler
- William H. Wheeler is a clinical informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - David A Rocha
- David A. Rocha is a clinical informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Jennifer F Myers
- Jennifer F. Myers is a senior informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Erin L Murray
- Erin L. Murray is an epidemiologist supervisor in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Brooke Bregman
- Brooke Bregman is a senior epidemiologist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Deniz M Dominguez
- Deniz M. Dominguez is a surveillance program manager in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Alyssa D Nguyen
- Alyssa D. Nguyen is a research scientist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Charsey Porse
- Charsey Porse is an epidemiologist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Curtis L Fritz
- Curtis L. Fritz is the State Public Health Veterinarian in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Seema Jain
- Seema Jain is the chief of the Disease Investigations Section, Infectious Diseases Branch, the Coronavirus Sciences Branch, and the Division of Communicable Disease Control, CDPH
| | - James P Watt
- James P. Watt is the chief of the Division of Communicable Disease Control, Coronavirus Sciences Branch, and the Division of Communicable Disease Control, CDPH
| | - Joshua A Salomon
- Joshua A. Salomon is a professor in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University
| | - Jeremy D Goldhaber-Fiebert
- Jeremy D. Goldhaber-Fiebert is an associate professor in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University
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Ma KC, Menkir TF, Kissler S, Grad YH, Lipsitch M. Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics. eLife 2021; 10:e66601. [PMID: 34003112 PMCID: PMC8221808 DOI: 10.7554/elife.66601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background The impact of variable infection risk by race and ethnicity on the dynamics of SARS-CoV-2 spread is largely unknown. Methods Here, we fit structured compartmental models to seroprevalence data from New York State and analyze how herd immunity thresholds (HITs), final sizes, and epidemic risk change across groups. Results A simple model where interactions occur proportionally to contact rates reduced the HIT, but more realistic models of preferential mixing within groups increased the threshold toward the value observed in homogeneous populations. Across all models, the burden of infection fell disproportionately on minority populations: in a model fit to Long Island serosurvey and census data, 81% of Hispanics or Latinos were infected when the HIT was reached compared to 34% of non-Hispanic whites. Conclusions Our findings, which are meant to be illustrative and not best estimates, demonstrate how racial and ethnic disparities can impact epidemic trajectories and result in unequal distributions of SARS-CoV-2 infection. Funding K.C.M. was supported by National Science Foundation GRFP grant DGE1745303. Y.H.G. and M.L. were funded by the Morris-Singer Foundation. M.L. was supported by SeroNet cooperative agreement U01 CA261277.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Tigist F Menkir
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
| | - Stephen Kissler
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical SchoolBostonUnited States
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
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50
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Lewnard JA, Mora AM, Nkwocha O, Kogut K, Rauch SA, Morga N, Hernandez S, Wong MP, Huen K, Andrejko K, Jewell NP, Parra KL, Holland N, Harris E, Cuevas M, Eskenazi B. Prevalence and Clinical Profile of Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Farmworkers, California, USA, June-November 2020. Emerg Infect Dis 2021; 27:1330-1342. [PMID: 33657340 DOI: 10.1101/2020.12.27.20248894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
During the ongoing coronavirus disease (COVID-19) pandemic, farmworkers in the United States are considered essential personnel and continue in-person work. We conducted prospective surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and antibody prevalence among farmworkers in Salinas Valley, California, during June 15-November 30, 2020. We observed 22.1% (1,514/6,864) positivity for SARS-CoV-2 infection among farmworkers compared with 17.2% (1,255/7,305) among other adults from the same communities (risk ratio 1.29, 95% CI 1.20-1.37). In a nested study enrolling 1,115 farmworkers, prevalence of current infection was 27.7% among farmworkers reporting >1 COVID-19 symptom and 7.2% among farmworkers without symptoms (adjusted odds ratio 4.16, 95% CI 2.85-6.06). Prevalence of SARS-CoV-2 antibodies increased from 10.5% (95% CI 6.0%-18.4%) during July 16-August 31 to 21.2% (95% CI 16.6%-27.4%) during November 1-30. High SARS-CoV-2 infection prevalence among farmworkers underscores the need for vaccination and other preventive interventions.
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