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Nilles EJ, Roberts K, de St Aubin M, Mayfield H, Restrepo AC, Garnier S, Abdalla G, Etienne MC, Duke W, Dumas D, Jarolim P, Oasan T, Peña F, Lopez B, Cruz LDL, Sanchez IM, Murray K, Baldwin M, Skewes-Ramm R, Paulino CT, Lau CL, Kucharski A. Convergence of SARS-CoV-2 spike antibody levels to a population immune setpoint. EBioMedicine 2024; 108:105319. [PMID: 39232463 PMCID: PMC11404201 DOI: 10.1016/j.ebiom.2024.105319] [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: 03/28/2024] [Revised: 08/06/2024] [Accepted: 08/17/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Individual immune responses to SARS-CoV-2 are well-studied, while the combined effect of these responses on population-level immune dynamics remains poorly understood. Given the key role of population immunity on pathogen transmission, delineation of the factors that drive population immune evolution has critical public health implications. METHODS We enrolled individuals 5 years and older selected using a multistage cluster survey approach in the Northwest and Southeast of the Dominican Republic. Paired blood samples were collected mid-pandemic (Aug 2021) and late pandemic (Nov 2022). We measured serum pan-immunoglobulin antibodies against the SARS-CoV-2 spike protein. Generalized Additive Models (GAMs) and random forest models were used to analyze the relationship between changes in antibody levels and various predictor variables. Principal component analysis and partial dependence plots further explored the relationships between predictors and antibody changes. FINDINGS We found a transformation in the distribution of antibody levels from an irregular to a normalized single peak Gaussian distribution that was driven by titre-dependent boosting. This led to the convergence of antibody levels around a common immune setpoint, irrespective of baseline titres and vaccination profile. INTERPRETATION Our results suggest that titre-dependent kinetics driven by widespread transmission direct the evolution of population immunity in a consistent manner. These findings have implications for targeted vaccination strategies and improved modeling of future transmission, providing a preliminary blueprint for understanding population immune dynamics that could guide public health and vaccine policy for SARS-CoV-2 and potentially other pathogens. FUNDING The study was primarily funded by the Centers for Disease Control and Prevention grant U01GH002238 (EN). Salary support was provided by Wellcome Trust grant 206250/Z/17/Z (AK) and the Australian National Health and Medical Research Council Investigator grant APP1158469 (CLL).
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Affiliation(s)
- Eric J Nilles
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA.
| | - Kathryn Roberts
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Michael de St Aubin
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | | | - Salome Garnier
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | | | - William Duke
- Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Devan Dumas
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Petr Jarolim
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Farah Peña
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Beatriz Lopez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Lucia de la Cruz
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | | | - Kristy Murray
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Margaret Baldwin
- Brigham and Womens Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Ronald Skewes-Ramm
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | | | | | - Adam Kucharski
- London School of Hygiene & Tropical Medicine, London, UK
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Siedner MJ, Sax PE. Repurposing Revisited: Exploring the Role of Metformin for Treatment of COVID-19. Clin Infect Dis 2024; 79:292-294. [PMID: 38690870 DOI: 10.1093/cid/ciae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Mark J Siedner
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Paul E Sax
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lopes R, Pham K, Klaassen F, Chitwood MH, Hahn AM, Redmond S, Swartwood NA, Salomon JA, Menzies NA, Cohen T, Grubaugh ND. Combining genomic data and infection estimates to characterize the complex dynamics of SARS-CoV-2 Omicron variants in the US. Cell Rep 2024; 43:114451. [PMID: 38970788 DOI: 10.1016/j.celrep.2024.114451] [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: 01/18/2024] [Revised: 05/03/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024] Open
Abstract
Omicron surged as a variant of concern in late 2021. Several distinct Omicron variants appeared and overtook each other. We combined variant frequencies and infection estimates from a nowcasting model for each US state to estimate variant-specific infections, attack rates, and effective reproduction numbers (Rt). BA.1 rapidly emerged, and we estimate that it infected 47.7% of the US population before it was replaced by BA.2. We estimate that BA.5 infected 35.7% of the US population, persisting in circulation for nearly 6 months. Other variants-BA.2, BA.4, and XBB-together infected 30.7% of the US population. We found a positive correlation between the state-level BA.1 attack rate and social vulnerability and a negative correlation between the BA.1 and BA.2 attack rates. Our findings illustrate the complex interplay between viral evolution, population susceptibility, and social factors during the Omicron emergence in the US.
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Affiliation(s)
- Rafael Lopes
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA.
| | - Kien Pham
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Fayette Klaassen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Melanie H Chitwood
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Anne M Hahn
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Seth Redmond
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Nicole A Swartwood
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA.
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
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Binswanger IA, Palmer-Toy DE, Barrow JC, Narwaney KJ, Bruxvoort KJ, Kraus CR, Lyons JA, Lam JA, Glanz JM. Assessing the association between antibody status and symptoms of long COVID: A multisite study. PLoS One 2024; 19:e0304262. [PMID: 38843198 PMCID: PMC11156415 DOI: 10.1371/journal.pone.0304262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
The association between SARS-CoV-2 humoral immunity and post-acute sequelae of COVID-19 (long COVID) remains uncertain. The objective of this population-based cohort study was to assess the association between SARS-CoV-2 seropositivity and symptoms consistent with long COVID. English and Spanish-speaking members ≥ 18 years old with SARS-CoV-2 serologic testing conducted prior to August 2021 were recruited from Kaiser Permanente Southern California and Kaiser Permanente Colorado. Between November 2021 and April 2022, participants completed a survey assessing symptoms, physical health, mental health, and cognitive function consistent with long COVID. Survey results were linked to SARS-CoV-2 antibody (Ab) and viral (RNA) lab results in electronic health records. Weighted descriptive analyses were generated for five mutually exclusive patient groups: (1) +Ab/+RNA; (2) +Ab/- or missing RNA; (3) -Ab/+RNA; (4a) -Ab/-RNA reporting no prior infection; and (4b) -Ab/-RNA reporting prior infection. The proportions reporting symptoms between the +Ab/+RNA and -Ab/+RNA groups were compared, adjusted for covariates. Among 3,946 participants, the mean age was 52.1 years old (SD 15.6), 68.3% were female, 28.4% were Hispanic, and the serologic testing occurred a median of 15 months prior (IQR = 12-18). Three quarters (74.5%) reported having had COVID-19. Among people with laboratory-confirmed COVID-19, there was no association between antibody positivity (+Ab/+RNA vs. -Ab/+RNA) and any symptoms, physical health, mental health, or cognitive function. As expected, physical health, cognitive function, and fatigue were worse, and palpitations and headaches limiting the ability to work were more prevalent among people with laboratory-confirmed prior infection and positive serology (+Ab/+RNA) compared to those without reported or confirmed prior infection and negative serology (-Ab/-RNA/no reported COVID-19). Among people with laboratory-confirmed COVID-19, SARS-CoV-2 serology from practice settings were not associated with long COVID symptoms and health status suggesting limited utility of serology testing for long COVID.
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Affiliation(s)
- Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
- Colorado Permanente Medical Group, Aurora, Colorado, United States of America
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
| | - Darryl E. Palmer-Toy
- Southern California Permanente Medical Group Regional Reference Laboratories, North Hollywood & Chino Hills, California, United States of America
| | - Jennifer C. Barrow
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
| | - Komal J. Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
| | - Katia J. Bruxvoort
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Courtney R. Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
| | - Jason A. Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
| | - Jessica A. Lam
- Department of Clinical Analysis at Southern California Permanente Medical Group, California, CA, United States of America
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, United States of America
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States of America
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Park J, Joo H, Kim D, Mase S, Christensen D, Maskery BA. Cost-effectiveness of mask mandates on subways to prevent SARS-CoV-2 transmission in the United States. PLoS One 2024; 19:e0302199. [PMID: 38748706 PMCID: PMC11095714 DOI: 10.1371/journal.pone.0302199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/30/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Community-based mask wearing has been shown to reduce the transmission of SARS-CoV-2. However, few studies have conducted an economic evaluation of mask mandates, specifically in public transportation settings. This study evaluated the cost-effectiveness of implementing mask mandates for subway passengers in the United States by evaluating its potential to reduce COVID-19 transmission during subway travel. MATERIALS AND METHODS We assessed the health impacts and costs of subway mask mandates compared to mask recommendations based on the number of infections that would occur during subway travel in the U.S. Using a combined box and Wells-Riley infection model, we estimated monthly infections, hospitalizations, and deaths averted under a mask mandate scenario as compared to a mask recommendation scenario. The analysis included costs of implementing mask mandates and COVID-19 treatment from a limited societal perspective. The cost-effectiveness (net cost per averted death) of mandates was estimated for three different periods based on dominant SARS-CoV-2 variants: Alpha, Beta, and Gamma (November 2020 to February 2021); Delta (July to October 2021); and early Omicron (January to March 2022). RESULTS Compared with mask recommendations only, mask mandates were cost-effective across all periods, with costs per averted death less than a threshold of $11.4 million (ranging from cost-saving to $3 million per averted death). Additionally, mask mandates were more cost-effective during the early Omicron period than the other two periods and were cost saving in January 2022. Our findings showed that mandates remained cost-effective when accounting for uncertainties in input parameters (e.g., even if mandates only resulted in small increases in mask usage by subway ridership). CONCLUSIONS The findings highlight the economic value of mask mandates on subways, particularly during high virus transmissibility periods, during the COVID-19 pandemic. This study may inform stakeholders on mask mandate decisions during future outbreaks of novel viral respiratory diseases.
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Affiliation(s)
- Joohyun Park
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heesoo Joo
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel Kim
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Georgia, United States of America
| | - Sundari Mase
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Deborah Christensen
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brian A. Maskery
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Klaassen F, Chitwood MH, Cohen T, Pitzer VE, Russi M, Swartwood NA, Salomon JA, Menzies NA. Changes in Population Immunity Against Infection and Severe Disease From Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variants in the United States Between December 2021 and November 2022. Clin Infect Dis 2023; 77:355-361. [PMID: 37074868 PMCID: PMC10425195 DOI: 10.1093/cid/ciad210] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Although a substantial fraction of the US population was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during December 2021-February 2022, the subsequent evolution of population immunity reflects the competing influences of waning protection over time and acquisition or restoration of immunity through additional infections and vaccinations. METHODS Using a Bayesian evidence synthesis model of reported coronavirus disease 2019 (COVID-19) data (diagnoses, hospitalizations), vaccinations, and waning patterns for vaccine- and infection-acquired immunity, we estimate population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States, by location (national, state, county) and week. RESULTS By 9 November 2022, 97% (95%-99%) of the US population were estimated to have prior immunological exposure to SARS-CoV-2. Between 1 December 2021 and 9 November 2022, protection against a new Omicron infection rose from 22% (21%-23%) to 63% (51%-75%) nationally, and protection against an Omicron infection leading to severe disease increased from 61% (59%-64%) to 89% (83%-92%). Increasing first booster uptake to 55% in all states (current US coverage: 34%) and second booster uptake to 22% (current US coverage: 11%) would increase protection against infection by 4.5 percentage points (2.4-7.2) and protection against severe disease by 1.1 percentage points (1.0-1.5). CONCLUSIONS Effective protection against SARS-CoV-2 infection and severe disease in November 2022 was substantially higher than in December 2021. Despite this high level of protection, a more transmissible or immune evading (sub)variant, changes in behavior, or ongoing waning of immunity could lead to a new SARS-CoV-2 wave.
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Affiliation(s)
- Fayette Klaassen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Melanie H Chitwood
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, USA
| | - Marcus Russi
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nicole A Swartwood
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Klaassen F, Chitwood MH, Cohen T, Pitzer VE, Russi M, Swartwood NA, Salomon JA, Menzies NA. Changes in population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States between December 2021 and November 2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.11.19.22282525. [PMID: 36451882 PMCID: PMC9709792 DOI: 10.1101/2022.11.19.22282525] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Importance While a substantial fraction of the US population was infected with SARS-CoV-2 during December 2021 - February 2022, the subsequent evolution of population immunity against SARS-CoV-2 Omicron variants reflects the competing influences of waning protection over time and acquisition or restoration of immunity through additional infections and vaccinations. Objective To estimate changes in population immunity against infection and severe disease due to circulating SARS-CoV-2 Omicron variants in the United States from December 2021 to November 2022, and to quantify the protection against a potential 2022-2023 winter SARS-CoV-2 wave. Design setting participants Bayesian evidence synthesis of reported COVID-19 data (diagnoses, hospitalizations), vaccinations, and waning patterns for vaccine- and infection-acquired immunity, using a mathematical model of COVID-19 natural history. Main Outcomes and Measures Population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States, by location (national, state, county) and week. Results By November 9, 2022, 94% (95% CrI, 79%-99%) of the US population were estimated to have been infected by SARS-CoV-2 at least once. Combined with vaccination, 97% (95%-99%) were estimated to have some prior immunological exposure to SARS-CoV-2. Between December 1, 2021 and November 9, 2022, protection against a new Omicron infection rose from 22% (21%-23%) to 63% (51%-75%) nationally, and protection against an Omicron infection leading to severe disease increased from 61% (59%-64%) to 89% (83%-92%). Increasing first booster uptake to 55% in all states (current US coverage: 34%) and second booster uptake to 22% (current US coverage: 11%) would increase protection against infection by 4.5 percentage points (2.4-7.2) and protection against severe disease by 1.1 percentage points (1.0-1.5). Conclusions and Relevance Effective protection against SARS-CoV-2 infection and severe disease in November 2022 was substantially higher than in December 2021. Despite this high level of protection, a more transmissible or immune evading (sub)variant, changes in behavior, or ongoing waning of immunity could lead to a new SARS-CoV-2 wave. Key points Question: How did population immunity against SARS-CoV-2 infection and subsequent severe disease change between December 2021, and November 2022?Findings: On November 9, 2022, the protection against a SARS-CoV-2 infection with the Omicron variant was estimated to be 63% (51%-75%) in the US, and the protection against severe disease was 89% (83%-92%).Meaning: As most of the newly acquired immunity has been accumulated in the December 2021-February 2022 Omicron wave, risk of reinfection and subsequent severe disease remains present at the beginning of the 2022-2023 winter, despite high levels of protection.
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Affiliation(s)
- Fayette Klaassen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA
| | - Melanie H Chitwood
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven CT
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven CT
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven CT
| | - Marcus Russi
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven CT
| | - Nicole A Swartwood
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University School of Medicine, Stanford CA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA
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Nwadiuko J, Bustamante AV. Little To No Correlation Found Between Immigrant Entry And COVID-19 Infection Rates In The United States. Health Aff (Millwood) 2022; 41:1635-1644. [DOI: 10.1377/hlthaff.2021.01955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joseph Nwadiuko
- Joseph Nwadiuko , University of California Los Angeles, Los Angeles, California
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Taylor K, Rivere E, Jagneaux T, LeBoeuf G, Estela K, Pierce C, O’Neal C. Clinical characteristics and outcomes of SARS-Cov-2 B.1.1.529 infections in hospitalized patients and multi-surge comparison in Louisiana. PLoS One 2022; 17:e0268853. [PMID: 36269696 PMCID: PMC9586372 DOI: 10.1371/journal.pone.0268853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background Peer reviewed data describing SARS-CoV-2 Omicron variant symptoms and clinical outcomes as compared to prior surges in the United States is thus far limited. We sought to determine disease severity, presenting features, and epidemiologic factors of the SARS-CoV-2 Omicron variant compared to prior surges. Methods Retrospective cohort analysis was performed on patients admitted during five surges in Louisiana between March 2020 and January 2022. Patient data was pulled from the medical record and a subset of patients during Surge 5 were manually abstracted. Patients who were admitted to one of six Louisiana hospitals with a positive SARS-CoV-2 test during the 5 defined surge periods were included. Surges were compared using chi-squared tests and one way ANOVA for age, sex, vaccination status, length of stay, ICU status, ventilation requirement, and disposition at discharge. The records of patients admitted during the omicron surge were analyzed for presenting symptoms and incidental SARS-CoV-2 diagnosis. Results With each subsequent surge, a smaller proportion of patients presenting to the emergency department were admitted. Patients admitted during surge 5 had shorter lengths of stay and fewer comorbidities than prior surges. Fewer patients in surge 5 presented with a respiratory condition and fewer required ICU admission. In surges 4 and 5, fewer vaccinated patients were admitted compared to their unvaccinated counterparts. Overall mortality was lower in surge 5 (9%) than in surge 4 (15%) p < .0005. Of the SARS-Cov-2 admissions in surge 5, 22.3% were felt to be incidental diagnoses. Conclusions As the COVID-19 pandemic progressed, a younger and less vaccinated population was associated with higher risk for severe disease, fewer patients required ICU admission and overall mortality decreased. Vaccinations seemed to be protective for overall risk of hospitalization but once admitted did not seem to confer additional protection against severe illness during the omicron surge. Age also contributed to patient outcomes.
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Affiliation(s)
- Katie Taylor
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Evan Rivere
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
- * E-mail:
| | - Tonya Jagneaux
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Gabrielle LeBoeuf
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
| | - Karen Estela
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
| | - Christi Pierce
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
| | - Catherine O’Neal
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA, United States of America
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
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Salomon JA, Bilinski A. Evaluating the Performance of Centers for Disease Control and Prevention COVID-19 Community Levels as Leading Indicators of COVID-19 Mortality. Ann Intern Med 2022; 175:1240-1249. [PMID: 35914253 PMCID: PMC9364882 DOI: 10.7326/m22-0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Centers for Disease Control and Prevention (CDC) defines low, medium, and high "COVID-19 community levels" to guide interventions, but associated mortality rates have not been reported. OBJECTIVE To evaluate the diagnostic performance of CDC COVID-19 community level metrics as predictors of elevated community mortality risk. DESIGN Time series analysis over the period of 30 May 2021 through 4 June 2022. SETTING U.S. states and counties. PARTICIPANTS U.S. population. MEASUREMENTS CDC "COVID-19 community level" metrics based on hospital admissions, bed occupancy, and reported cases; reported COVID-19 deaths; and sensitivity, specificity, and predictive values for CDC and alternative metrics. RESULTS Mean and median weekly mortality rates per 100 000 population after onset of high COVID-19 community level 3 weeks prior were, respectively, 2.6 and 2.4 (interquartile range [IQR], 1.7 to 3.1) across 90 high episodes in states and 4.3 and 2.1 (IQR, 0 to 5.4) across 7987 high episodes in counties. In 85 of 90 (94%) episodes in states and 4801 of 7987 (60%) episodes in counties, lagged weekly mortality after onset exceeded 0.9 per 100 000 population, and in 57 of 90 (63%) episodes in states and 4018 of 7987 (50%) episodes in counties, lagged weekly mortality after onset exceeded 2.1 per 100 000, which is equivalent to approximately 1000 daily deaths in the national population. Alternative metrics based on lower hospital admissions or case thresholds were associated with lower mortality and had higher sensitivity and negative predictive value for elevated mortality, but the CDC metrics had higher specificity and positive predictive value. Ratios between cases, hospitalizations, and deaths have varied substantially over time. LIMITATIONS Aggregate mortality does not account for nonfatal outcomes or disparities. Continuing evolution of viral variants, immunity, clinical interventions, and public health mitigation strategies complicate prediction for future waves. CONCLUSION Designing metrics for public health decision making involves tradeoffs between identifying early signals for action and avoiding undue restrictions when risks are modest. Explicit frameworks for evaluating surveillance metrics can improve transparency and decision support. PRIMARY FUNDING SOURCE Council of State and Territorial Epidemiologists.
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Affiliation(s)
- Joshua A Salomon
- Department of Health Policy, Stanford University School of Medicine, Stanford, California (J.A.S.)
| | - Alyssa Bilinski
- Departments of Health Services, Policy & Practice & Biostatistics, Brown University School of Public Health, Providence, Rhode Island (A.B.)
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