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1.
PLoS One ; 17(11): e0277748, 2022.
Article in English | MEDLINE | ID: covidwho-2140660

ABSTRACT

INTRODUCTION: Despite its benefits, HPV vaccine uptake has been historically lower than other recommended adolescent vaccines in the United States (US). While hesitancy and misinformation have threatened vaccinations for many years, the adverse impacts from COVID-19 pandemic on preventive services have been far-reaching. OBJECTIVES: To explore the perceptions and experiences of adolescent healthcare providers regarding routine vaccination services during the COVID-19 pandemic. METHODOLOGY: Between December 2020 and May 2021, in-depth qualitative interviews were conducted via Zoom video conferencing among a purposively selected, diverse group of adolescent healthcare providers (n = 16) within 5 healthcare practices in the US southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework. Our analysis was guided by the grounded theory and inductive approach. RESULTS: Participants reported that patient-provider communications; effective use of presumptive languaging; provider's continuing education/training; periodic reminders/recall messages; provider's personal conviction on vaccine safety/efficacy; early initiation of HPV vaccination series at 9 years; community partnerships with community health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets as well as outreaches to schools and churches served as facilitators to adolescent HPV vaccine uptake. Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all practices. Participants highlighted an initial decrease in patients due to the pandemic, while some practices avoided the distribution of vaccine informational materials due to sanitary concerns. CONCLUSION: As part of a larger study, we provided contextual information to refine an intervention package currently being developed to improve adolescent preventive care provision in healthcare practices. Our results could inform the implementation of comprehensive intervention strategies that improve HPV vaccination rates. Additionally, lessons learned (e.g. optimizing patient- provider interactions) could be adopted to expand COVID-19 vaccine acceptance on a sizable scale.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Humans , Adolescent , United States , Papillomavirus Infections/prevention & control , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Georgia/epidemiology , Tennessee/epidemiology , Health Knowledge, Attitudes, Practice , Papillomavirus Vaccines/therapeutic use , Vaccination , Health Personnel , Qualitative Research
2.
BMC Public Health ; 22(1): 1988, 2022 10 31.
Article in English | MEDLINE | ID: covidwho-2098327

ABSTRACT

BACKGROUND: Women have been especially impacted by the COVID-19 pandemic. This exploratory study aimed to characterize women's adverse experiences related to their work, home lives, and wellbeing during the height of the COVID-19 pandemic and to describe demographic differences of those lived experiences. METHODS: Using the validated Epidemic-Pandemic Impacts Inventory, we collected data from reproductive-aged women in the state of Georgia about their exposure to adverse events during the pandemic. A latent class analysis (LCA) was performed to identify subgroups of women reporting similar adverse experiences and describe their sociodemographic characteristics. An optional open-ended question yielded qualitative data that were analyzed thematically and merged with subgroup findings. Data were collected from September 2020 to January 2021. RESULTS: 423 individuals aged 18-49 completed the survey with 314 (74.2%) providing qualitative responses. The LCA yielded 4 subgroups: (1) a "low exposure" subgroup (n = 123, 29.1%) with relatively low probability of adverse experiences across domains (e.g. financial insecurity, health challenges, barriers to access to healthcare, intimate partner violence (IPV)); (2) a "high exposure" subgroup (n = 46, 10.9%) with high probability of experiencing multiple adversities across domains including the loss of loved ones to COVID-19; (3) a "caregiving stress" subgroup (n = 104, 24.6%) with high probability of experiencing challenges with home and work life including increased partner conflict; and (4) a "mental health changes" subgroup (n = 150, 35.5%) characterized by relatively low probability of adverse experiences but high probability of negative changes in mental health and lifestyle. Individuals in subgroups 1 and 4, which had low probabilities of adverse experiences, were significantly more likely to be non-Hispanic white. Individuals in subgroup 2 were more likely to identify with a sexual or racial/ethnic minority population. Inductive coding of qualitative data yielded themes such as stress, mental health, financial impact, and adaptation/resilience, providing context for pandemic-related adversity. CONCLUSION: Though many individuals in our sample experienced hardship, minority populations were unequally impacted by pandemic-related adversity in work life, home life, and wellbeing. Recovery and future emergency preparedness efforts in Georgia must incorporate support mechanisms for mental health and IPV, focusing especially on the intersectional needs of racial, ethnic, and sexual minorities.


Subject(s)
COVID-19 , Intimate Partner Violence , Female , Humans , Adult , Pandemics , COVID-19/epidemiology , Ethnicity , Georgia/epidemiology , Minority Groups
3.
Ann Epidemiol ; 76: 121-127, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2060388

ABSTRACT

BACKGROUND: Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia. METHODS: We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases. RESULTS: Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods. DISCUSSION: One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household.


Subject(s)
COVID-19 , SARS-CoV-2 , Child , Humans , Aged , COVID-19/epidemiology , Georgia/epidemiology , Family Characteristics , Cluster Analysis
4.
Public Health Rep ; 137(2_suppl): 61S-66S, 2022.
Article in English | MEDLINE | ID: covidwho-2002024

ABSTRACT

Few reports have described how university programs have controlled COVID-19 outbreaks. Emory University established a case investigation and contact tracing program in June 2020 to identify and mitigate transmission of SARS-CoV-2 in the Emory community. In February 2021, this program identified a surge in COVID-19 cases. In this case study, we present details of outbreak investigation, construction of transmission networks to assess clustering and identify groups for targeted testing, and program quality metrics demonstrating the efficiency of case investigation and contact tracing, which helped bring the surge under control. During February 10-March 5, 2021, Emory University identified 265 COVID-19 cases confirmed by nucleic acid testing in saliva or nasopharyngeal samples. Most students with COVID-19 were undergraduates (95%) and were affiliated with Greek life organizations (70%); 41% lived on campus. Network analysis identified 1 epidemiologically linked cluster of 198 people. Nearly all students diagnosed with COVID-19 (96%) were interviewed the same day as their positive test result. Of 340 close contacts, 90% were traced and 89% were tested. The median time from contact interview to first test was 2 days (interquartile range, 0-6 days); 43% received a positive test result during their quarantine. The surge was considered under control within 17 days, after which new cases were no longer epidemiologically linked. Early detection through systematic testing protocols and rapid and near-complete contact tracing, paired with isolation and quarantine measures, helped to contain the surge. Our approach emphasizes the importance of early preparation of adequate outbreak response infrastructure and staff to implement interventions appropriately and consistently during a pandemic.


Subject(s)
COVID-19 , Contact Tracing , Humans , Universities , COVID-19/epidemiology , COVID-19/prevention & control , Georgia/epidemiology , SARS-CoV-2 , Students , Disease Outbreaks/prevention & control
5.
West J Emerg Med ; 23(4): 532-535, 2022 Jun 29.
Article in English | MEDLINE | ID: covidwho-1975261

ABSTRACT

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has created significant burden on healthcare systems throughout the world. Syndromic surveillance, which collects real-time data based on a range of symptoms rather than laboratory diagnoses, can help provide timely information in emergency response. We examined the effectiveness of a web-based COVID-19 symptom checking tool (C19Check) in the state of Georgia (GA) in predicting COVID-19 cases and hospitalizations. METHODS: We analyzed C19Check use data, COVID-19 cases, and hospitalizations from April 22-November 28, 2020. Cases and hospitalizations in GA were extracted from the Georgia Department of Public Health data repository. We used the Granger causality test to assess whether including C19Check data can improve predictions compared to using previous COVID-19 cases and hospitalizations data alone. Vector autoregression (VAR) models were fitted to forecast cases and hospitalizations from November 29 - December 12, 2020. We calculated mean absolute percentage error to estimate the errors in forecast of cases and hospitalizations. RESULTS: There were 25,861 C19Check uses in GA from April 22-November 28, 2020. Time-lags tested in Granger causality test for cases (6-8 days) and hospitalizations (10-12 days) were significant (P= <0.05); the mean absolute percentage error of fitted VAR models were 39.63% and 15.86%, respectively. CONCLUSION: The C19Check tool was able to help predict COVID-19 cases and related hospitalizations in GA. In settings where laboratory tests are limited, a real-time, symptom-based assessment tool can provide timely and inexpensive data for syndromic surveillance to guide pandemic response. Findings from this study demonstrate that online symptom-checking tools can be a source of data for syndromic surveillance, and the data may help improve predictions of cases and hospitalizations.


Subject(s)
COVID-19 , Triage , COVID-19/diagnosis , COVID-19/epidemiology , Georgia/epidemiology , Hospitalization , Humans , Pandemics
6.
Gene ; 841: 146774, 2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-1956150

ABSTRACT

BACKGROUND: The COVID-19 is caused by a novel coronavirus SARS-CoV-2, which started from China. It spread rapidly throughout the world and was later declared a pandemic by the WHO. Over the course of time, SARS-CoV-2 has mutated for survival advantages, and this led to multiple variants. Multiple studies on mutations identification in SARS-CoV2 have been published covering extensive sample areas. The purpose of this study was to limit the sample area to the Georgia state in the U.S. and to analyze the genome sequences for mutation profiling across the genome and origin of variants. METHODS: The genome sequences (n = 3,970) were obtained from the NCBI database as of June 12, 2021, with the filter of being complete sequenced genomes, homo-sapiens host, and only from Georgia State of the U.S. NextClade, an online tool was used for the analysis of the sequences using Wuhan-Hu-1/2019 as a reference genome. The algorithm was sequence alignment, translation, mutation calling, phylogenetic placement, clade assignment, and quality control (QC). Thirty-six samples with bad QC were removed from the mutational analysis. RESULTS: A total 117,743 mutations in the nucleotides were identified (averaging 31.5 mutations per sample). The mutations A23403G, C3037T, C241T, and C14408T were detected in 98% of the samples. Also, a total of 75,517 mutations in the amino acid were identified (averaging 20.2 mutations per sample). The mutations D614G and P314L were identified in >97% samples whereas R203K, G204R, P681H, and N501Y were detected in >50% samples. Analysis also revealed 16 different clades with 20I (49.6%). Clades 20G (24.2%) and 20A (5.5%) being the most abundant, showed that SARS-CoV-2 in the Georgia State originated mainly from Southeast England, other parts of the U.S., and several countries in Western Europe. CONCLUSION: Looking at the three most common variants in Georgia State of the U.S., we could determine the primary locations of transmission or origin for the virus, and our analyses indicates that majority of the cases originated from Southeast England (Clade 20I), the U.S. itself (Clade 20G), and from Western Europe (Clade 20C).


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/genetics , Genome, Viral , Georgia/epidemiology , Humans , Mutation , Phylogeny , RNA, Viral/genetics , SARS-CoV-2/genetics , United States/epidemiology
7.
Public Health Rep ; 137(5): 832-840, 2022.
Article in English | MEDLINE | ID: covidwho-1938155

ABSTRACT

Engaging communities is a key strategy to increase COVID-19 vaccination. The Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Confidence Rapid Community Assessment Guide was developed for community partners to obtain insights about barriers to COVID-19 vaccine uptake and to engage community partners in designing interventions to build vaccine confidence. In spring 2021, 3 CDC teams were deployed to Alabama and Georgia to conduct a rapid community assessment in selected jurisdictions. Data collection included interviews, listening sessions, observations, and street intercept surveys. We identified 3 facilitators and barriers to vaccine uptake: (1) planning and coordination, (2) capacity and implementation, and (3) attitudes and beliefs. We found that the use of the rapid community assessment in Alabama and Georgia was feasible to implement, useful in eliciting unique community concerns and dispelling assumptions, and useful in informing intervention strategies. Our results underscore the importance of community engagement in COVID-19 mitigation strategies.


Subject(s)
COVID-19 Vaccines , COVID-19 , Alabama/epidemiology , Attitude to Health , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Community Participation , Georgia/epidemiology , Humans
8.
Int J Soc Psychiatry ; 68(5): 1036-1046, 2022 08.
Article in English | MEDLINE | ID: covidwho-1879175

ABSTRACT

AIMS: We aimed to identify the prevalence of anxiety, depression, and suicidality and identify relevant risk and protecting factors among university students during the COVID-19 pandemic in Georgia. MATERIALS AND METHODS: We conducted an anonymous online survey (n = 984, convenience sample by approaching all universities in Georgia and some student organizations) using valid instruments (e.g., STAI to assess anxiety, CES-D for depression, and RASS to assess suicidality). We calculated frequencies and prevalence and applied regression analysis and Chi-square tests to identify risk and protecting factors. FINDINGS: Respondents' mental health had been significantly affected (with a high prevalence of depression (46.7%) and anxiety (79%)) during the pandemic (which coincided with political turmoil and caused an economic crisis) in Georgia. Some of the critical factors affecting mental health were: female sex (p = .000), bad general health condition (anxiety p = .001, depression p = .004), finances (anxiety and depression p < .001), reduced physical activity (anxiety p < .001, depression p = .014), and a history of self-harming (suicidality p < .001). Less family conflicts (anxiety and depression p < .05), absence of nightmares (anxiety and depression p < .001), moderate or low fears of COVID-19 (anxiety p < .001), and lower substance use (anxiety p = .023) were among the potentially protective factors. International students coped better, despite vulnerability. Medical students had a lower risk of depression. CONCLUSIONS: In the complex socioeconomic context, mental health of students in Georgia suffered a lot during the COVID-19 pandemic, requiring thorough planning and delivery of student support services in higher educational institutions during and after the pandemic.


Subject(s)
COVID-19 , Anxiety/epidemiology , Anxiety/etiology , COVID-19/epidemiology , Depression/epidemiology , Depression/etiology , Female , Georgia/epidemiology , Humans , Mental Health , Pandemics , SARS-CoV-2 , Students/psychology , Universities
9.
Ann Epidemiol ; 72: 57-64, 2022 08.
Article in English | MEDLINE | ID: covidwho-1866848

ABSTRACT

PURPOSE: To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. METHODS: We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. RESULTS: Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04). CONCLUSIONS: After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.


Subject(s)
COVID-19 , Epidemics , Age Distribution , Georgia/epidemiology , Hospitalization , Humans
10.
J Acquir Immune Defic Syndr ; 85(1): 66-72, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1860998

ABSTRACT

BACKGROUND: COVID-19 and its social responses threaten the health of people living with HIV. We conducted a rapid-response interview to assess COVID-19 protective behaviors of people living with HIV and the impact of their responses on HIV-related health care. METHOD: Men and women living with HIV (N = 162) aged 20-37 years participating in a longitudinal study of HIV treatment and care completed routine study measures and an assessment of COVID-19-related experiences. RESULTS: At baseline, most participants demonstrated HIV viremia, markers indicative of renal disorders, and biologically confirmed substance use. At follow-up, in the first month of responding to COVID-19, engaging in more social distancing behaviors was related to difficulty accessing food and medications and increased cancelation of health care appointments, both by self and providers. We observed antiretroviral therapy adherence had improved during the initial month of COVID-19 response. CONCLUSIONS: Factors that may pose added risk for COVID-19 severity were prevalent among people living with HIV, and those with greater risk factors did not practice more COVID-19 protective behaviors. Social distancing and other practices intended to mitigate the spread of COVID-19 interfered with HIV care, and impeded access to food and medications, although an immediate adverse impact on medication adherence was not evident. These results suggest social responses to COVID-19 adversely impacted the health care of people living with HIV, supporting continued monitoring to determine the long-term effects of co-occurring HIV and COVID-19 pandemics.


Subject(s)
Betacoronavirus , Coinfection/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , HIV Infections/complications , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Adult , COVID-19 , Coinfection/virology , Coronavirus Infections/epidemiology , Female , Food Supply , Georgia/epidemiology , HIV Infections/epidemiology , HIV Infections/virology , HIV-1 , Humans , Male , Pneumonia, Viral/epidemiology , Risk Factors , SARS-CoV-2 , Viremia , Young Adult
11.
Contraception ; 113: 30-36, 2022 09.
Article in English | MEDLINE | ID: covidwho-1803825

ABSTRACT

OBJECTIVE: Assessing access to sexual and reproductive health care during the COVID-19 pandemic, experiences with intimate partner violence (IPV), and exploring sociodemographic disparities STUDY DESIGN: From September 2020 to January 2021, we recruited 436 individuals assigned female at birth (18-49 years.) in Georgia, USA for an online survey. The final convenience sample was n = 423; a response rate could not be calculated. Survey themes included: sociodemographic and financial information, access to contraceptive services/care, IPV, and pregnancy. Respondents who reported a loss of health insurance, difficulty accessing contraception, barriers to medical care, or IPV were characterized as having a negative sexual and reproductive health experience during the pandemic. We explored associations between sociodemographic variables and negative sexual and reproductive health experiences. RESULTS: Since March 2020, 66/436 (16%) of respondents lost their health insurance, and 45% (89/436) reported income loss. Of our sample, 144/436 people (33%) attempted to access contraception. The pandemic made contraceptive access more difficult for 38/144 (26%) of respondents; however, 106/144 (74%) said it had no effect or positive effect on access. Twenty-one respondents reported IPV (5%). COVID-19 amplified negative views of unplanned pregnancy. Seventy-six people (18%) reported at least 1 negative sexual and reproductive health experience during the pandemic; people in an urban setting and those identifying as homo/bisexual were more likely to report negative experiences (24%, 28% respectively). CONCLUSION: Urban and sexual minority populations had negative sexual and reproductive health experiences during COVID-19 more than their counterparts. The pandemic has shifted perspectives on family planning, likely due to the diverse impacts of COVID-19, including loss of health insurance and income. IMPLICATION: Females across Georgia reported varying impacts of the COVID-19's pandemic on their sexual and reproductive health care. These findings could be utilized to propose recommendations for care and intimate partner violence support mechanisms, tailored to urban and sexual minority populations.


Subject(s)
COVID-19 , Intimate Partner Violence , Spouse Abuse , Contraceptive Agents , Female , Georgia/epidemiology , Humans , Infant, Newborn , Pandemics , Pregnancy , Reproductive Health
12.
Front Public Health ; 10: 809356, 2022.
Article in English | MEDLINE | ID: covidwho-1792881

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.


Subject(s)
COVID-19 , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , Cross-Sectional Studies , Female , Georgia/epidemiology , Hospitals, Public , Humans , Male , Medicare , Risk Factors , SARS-CoV-2 , United States
13.
J Sch Health ; 92(7): 656-664, 2022 07.
Article in English | MEDLINE | ID: covidwho-1784705

ABSTRACT

BACKGROUND: In Spring 2020, Georgia public schools implemented remote learning to manage the spread of COVID-19. This study explores the effects of remote schooling on the learning of young children in Georgia during the early COVID-19 pandemic from the perspectives of school administrators and essential working parents. METHODS: A qualitative exploratory study was conducted with eight school administrators and 26 essential working parents of children in kindergarten through third grades of two rural and two urban schools in Georgia. Data collection included online surveys, virtual interviews and focus groups. Descriptive analyses of the demographics provided context to emerging themes from qualitative data. RESULTS: Most school administrators and parents reported declines in student learning and academic behavior related to remote learning. Lack of Wi-Fi, technology, and digital literacy were often cited as barriers to learning. Challenges with remote learning were amplified for students and parents of vulnerable groups. CONCLUSIONS: The findings of this study illustrate the need to institute policies, procedures, and supports to maximize schools' ability to safely offer in-person learning during the COVID-19 pandemic. Considerations should be made of the needs of essential working parents, vulnerable populations, and the digital divide.


Subject(s)
COVID-19 , COVID-19/epidemiology , Child , Child, Preschool , Georgia/epidemiology , Humans , Pandemics , Parents , Schools
14.
Public Health ; 205: 182-186, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1751168

ABSTRACT

OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.


Subject(s)
COVID-19 , Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/therapeutic use , COVID-19/epidemiology , Female , Georgia/epidemiology , Georgia (Republic)/epidemiology , Hepacivirus , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Humans , Pandemics , Pregnancy , Retrospective Studies
15.
Ann Intern Med ; 174(5): 649-654, 2021 05.
Article in English | MEDLINE | ID: covidwho-1726736

ABSTRACT

BACKGROUND: Identifying occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) can improve HCW and patient safety. OBJECTIVE: To quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among HCWs in a large health care system. DESIGN: A logistic regression model was fitted to data from a cross-sectional survey conducted in April to June 2020, linking risk factors for occupational and community exposure to coronavirus disease 2019 (COVID-19) with SARS-CoV-2 seropositivity. SETTING: A large academic health care system in the Atlanta, Georgia, metropolitan area. PARTICIPANTS: Employees and medical staff members elected to participate in SARS-CoV-2 serology testing offered to all HCWs as part of a quality initiative and completed a survey on exposure to COVID-19 and use of personal protective equipment. MEASUREMENTS: Demographic risk factors for COVID-19, residential ZIP code incidence of COVID-19, occupational exposure to HCWs or patients who tested positive on polymerase chain reaction test, and use of personal protective equipment as potential risk factors for infection. The outcome was SARS-CoV-2 seropositivity. RESULTS: Adjusted SARS-CoV-2 seropositivity was estimated to be 3.8% (95% CI, 3.4% to 4.3%) (positive, n = 582) among the 10 275 HCWs (35% of the Emory Healthcare workforce) who participated in the survey. Community contact with a person known or suspected to have COVID-19 (adjusted odds ratio [aOR], 1.9 [CI, 1.4 to 2.6]; 77 positive persons [10.3%]) and community COVID-19 incidence (aOR, 1.5 [CI, 1.0 to 2.2]) increased the odds of infection. Black individuals were at high risk (aOR, 2.1 [CI, 1.7 to 2.6]; 238 positive persons [8.3%]). LIMITATIONS: Participation rates were modest and key workplace exposures, including job and infection prevention practices, changed rapidly in the early phases of the pandemic. CONCLUSION: Demographic and community risk factors, including contact with a COVID-19-positive person and Black race, are more strongly associated with SARS-CoV-2 seropositivity among HCWs than is exposure in the workplace. PRIMARY FUNDING SOURCE: Emory COVID-19 Response Collaborative.


Subject(s)
COVID-19/epidemiology , Health Personnel , Infectious Disease Transmission, Patient-to-Professional , Occupational Diseases/epidemiology , Occupational Exposure/adverse effects , Pneumonia, Viral/epidemiology , Adult , COVID-19/ethnology , Cross-Sectional Studies , Female , Georgia/epidemiology , Humans , Male , Middle Aged , Occupational Diseases/ethnology , Pandemics , Personal Protective Equipment , Pneumonia, Viral/ethnology , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology
16.
J Am Med Dir Assoc ; 23(6): 942-946.e1, 2022 06.
Article in English | MEDLINE | ID: covidwho-1712740

ABSTRACT

OBJECTIVES: Estimate incidence of and risks for SARS-CoV-2 infection among nursing home staff in the state of Georgia during the 2020-2021 Winter COVID-19 Surge in the United States. DESIGN: Serial survey and serologic testing at 2 time points with 3-month interval exposure assessment. SETTING AND PARTICIPANTS: Fourteen nursing homes in the state of Georgia; 203 contracted or employed staff members from those 14 participating nursing homes who were seronegative at the first time point and provided a serology specimen at second time point, at which time they reported no COVID-19 vaccination or only very recent vaccination (≤4 weeks). METHODS: Interval infection was defined as seroconversion to antibody presence for both nucleocapsid protein and spike protein. We estimated adjusted odds ratios (aORs) and 95% CIs by job type, using multivariable logistic regression, accounting for community-based risks including interval community incidence and interval change in resident infections per bed. RESULTS: Among 203 eligible staff, 72 (35.5%) had evidence of interval infection. In multivariable analysis among unvaccinated staff, staff SARS-CoV-2 infection-induced seroconversion was significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility (aOR 5.3, 95% CI 1.0-28.4). This risk persisted but was attenuated when using the full study cohort including those with very recent vaccination. CONCLUSIONS AND IMPLICATIONS: Midway through the first year of the pandemic, job type continues to be associated with increased risk for infection despite enhanced infection prevention efforts including routine screening of staff. These results suggest that mitigation strategies prior to vaccination did not eliminate occupational risk for infection and emphasize critical need to maximize vaccine utilization to eliminate excess risk among front-line providers.


Subject(s)
COVID-19 , COVID-19/epidemiology , Georgia/epidemiology , Humans , Nursing Homes , Pandemics , SARS-CoV-2 , United States
17.
Am J Public Health ; 112(3): 393-396, 2022 03.
Article in English | MEDLINE | ID: covidwho-1703908

ABSTRACT

Refugee and immigrant populations are extremely vulnerable to the consequences of the COVID-19 pandemic. COVID-19 vaccination is a critical tool in mitigating these consequences, but these same communities often lack access to COVID-19 vaccines. We describe the efforts of a community-based primary care clinic in Clarkston, Georgia to provide access to COVID-19 vaccines in a culturally sensitive manner to address this health disparity and vaccine hesitancy.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/prevention & control , Emigrants and Immigrants , Immunization Programs/organization & administration , Refugees , COVID-19/ethnology , Cultural Competency , Georgia/epidemiology , Humans , Pandemics , SARS-CoV-2 , Trust
18.
J Infect Dis ; 225(3): 396-403, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1672203

ABSTRACT

BACKGROUND: Reported coronavirus disease 2019 (COVID-19) cases underestimate true severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Data on all infections, including asymptomatic infections, are needed. To minimize biases in estimates from reported cases and seroprevalence surveys, we conducted a household-based probability survey and estimated cumulative incidence of SARS-CoV-2 infections adjusted for antibody waning. METHODS: From August to December 2020, we mailed specimen collection kits (nasal swabs and blood spots) to a random sample of Georgia addresses. One household adult completed a survey and returned specimens for virus and antibody testing. We estimated cumulative incidence of SARS-CoV-2 infections adjusted for waning antibodies, reported fraction, and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored with weighted prevalence ratios (PR). RESULTS: Among 1370 participants, adjusted cumulative incidence of SARS-CoV-2 was 16.1% (95% credible interval [CrI], 13.5%-19.2%) as of 16 November 2020. The reported fraction was 26.6% and IFR was 0.78%. Non-Hispanic black (PR, 2.03; 95% confidence interval [CI], 1.0-4.1) and Hispanic adults (PR, 1.98; 95% CI, .74-5.31) were more likely than non-Hispanic white adults to be seropositive. CONCLUSIONS: As of mid-November 2020, 1 in 6 adults in Georgia had been infected with SARS-CoV-2. The COVID-19 epidemic in Georgia is likely substantially underestimated by reported cases.


Subject(s)
COVID-19 , Adult , Antibodies, Viral/blood , COVID-19/epidemiology , Georgia/epidemiology , Humans , Incidence , Seroepidemiologic Studies
19.
Clin Infect Dis ; 74(2): 319-326, 2022 01 29.
Article in English | MEDLINE | ID: covidwho-1662107

ABSTRACT

BACKGROUND: To inform prevention strategies, we assessed the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and settings in which transmission occurred in a Georgia public school district. METHODS: During 1 December 2020-22 January 2021, SARS-CoV-2-infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (eg, sports, elementary school classroom), index case role (ie, staff, student), and index case symptomatic status. RESULTS: We identified 86 index cases and 1119 contacts, 688 (61.5%) of whom received testing. Fifty-nine of 679 (8.7%) contacts tested positive; 15 of 86 (17.4%) index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SARs were in indoor, high-contact sports settings (23.8% [95% confidence interval {CI}, 12.7%-33.3%]), staff meetings/lunches (18.2% [95% CI, 4.5%-31.8%]), and elementary school classrooms (9.5% [95% CI, 6.5%-12.5%]). The SAR was higher for staff (13.1% [95% CI, 9.0%-17.2%]) vs student index cases (5.8% [95% CI, 3.6%-8.0%]) and for symptomatic (10.9% [95% CI, 8.1%-13.9%]) vs asymptomatic index cases (3.0% [95% CI, 1.0%-5.5%]). CONCLUSIONS: Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include coronavirus disease 2019 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.


Subject(s)
COVID-19 , SARS-CoV-2 , Contact Tracing , Georgia/epidemiology , Humans , Schools , Students
20.
J Natl Med Assoc ; 114(2): 218-226, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1635310

ABSTRACT

IMPORTANCE: The increased COVID-19 mortality for Black individuals over White individuals may be explained by the known racial disparities in access to insurance. OBJECTIVE: To determine whether racial disparities in COVID-19 mortality still exist when Blacks and Whites are equally insured. DESIGN: Routinely collected data on race, mortality, type of insurance, known risk factors, and lab results from the EPIC Patient Management System were analyzed using a multivariable logistic regression model. SETTING: Piedmont Healthcare is the largest hospital system in Georgia. Due to its multiple locations across the state of Georgia, it receives a relatively equitably insured population. PARTICIPANTS: All patients hospitalized with a positive COVID-19 status between March 1 and November 30, 2020. MAIN OUTCOMES: We hypothesized that Black patients would not have higher odds of mortality than White patients, and that type of insurance would predict COVID-19 mortality. RESULTS: 6,881 (3,674 Black, 3,207 White; 48% male, mean age = 60) patients were included. Race was not a significant predictor of COVID-19 mortality (p>0.05). When controlling for age and insurance, the mortality rate for Black patients was not statistically significant from that for White patients (p>0.05). Compared to those relying on Medicare, patients with commercial (OR=0.68, 95% CI: 0.48-0.96) or out-of-pocket (self-pay) insurance (OR=0.22, 95% CI: 0.03-0.88) had lower odds of mortality. CONCLUSIONS: National trends of racial disparities in COVID-19 mortality may be partially explained by disparities in insurance.


Subject(s)
COVID-19 , Aged , Blacks , Female , Georgia/epidemiology , Healthcare Disparities , Humans , Male , Medicare , Middle Aged , United States
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