Maintaining Adherence to COVID-19 Preventive Practices and Policies Pertaining to Masking and Distancing in the District of Columbia and Other US States: Systematic Observational Study.

BACKGROUND: Prior to the development of effective vaccines against SARS-CoV-2, masking and social distancing emerged as important strategies for infection control. Locations across the United States required or recommended face coverings where distancing was not possible, but it is unclear to what extent people complied with these policies. OBJECTIVE: This study provides descriptive information about adherence to public health policies pertaining to mask wearing and social distancing and examines differences in adherence to these policies among different population groups in the District of Columbia and 8 US states. METHODS: This study was part of a national systematic observational study using a validated research protocol for recording adherence to correct mask wearing and maintaining social distance (6 feet/1.83 meters) from other individuals. Data were collected from December 2020 to August 2021 by research team members who stationed themselves in outdoor areas with high pedestrian traffic, observed individuals crossing their paths, and collected data on whether individuals' masks were present (visible or not visible) or worn (correctly, incorrectly, not at all) and whether social distance was maintained if other individuals were present. Observational data were entered electronically into Google Forms and were exported in Excel format for analysis. All data analyses were conducted using SPSS. Information on local COVID-19 protection policies (eg, mask wearing requirements) was obtained by examining city and state health department websites for the locations where data were being collected. RESULTS: At the time these data were collected, most locations in our study required (5937/10,308, 57.6%) or recommended (4207/10,308, 40.8%) masking. Despite this, more than 30% of our sample were unmasked (2889/10136, 28.5%) or masked incorrectly (636/10136, 6.3%). Masking policy was significantly related to correct masking with locations that required or recommended masking (66% correct masking vs 28/164, 17.1% in locations that did not require masking, P<.001). Participants who maintained social distance from others were more likely to be correctly masked than those who were not (P<.001). Adherence to masking policy by location was significant (P<.001); however, this was driven by 100% compliance in Georgia, which did not require masks at any point during the data collection period. When the same analysis was conducted for compliance with mask requirements and recommendations, there was no significant difference by location. Overall adherence to masking policies was 66.9. CONCLUSIONS: Despite a clear relationship between mask policies and masking behavior, one-third of our sample was nonadherent to those policies, and approximately 23% of our sample did not have any mask, either on or visible. This may speak to the confusion surrounding "risk" and protective behaviors, as well as pandemic fatigue. These results underscore the importance of clear public health communication, particularly given variations in public health policies across states and localities.

Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study.

BACKGROUND: COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the US Centers for Disease Control and Prevention required 10 days of isolation after a positive test result. In December 2021, this was reduced to a minimum of 5 days with symptom improvement, followed by 5 days of mask wearing. As a result, several institutions of higher education, including the George Washington University, required persons testing positive for COVID-19 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after 5 days or to maintain a 10-day isolation period in the absence of a negative RAT and the presence of continued symptoms. RATs are tools that can be used both to shorten isolation periods and to ensure that persons testing positive for COVID-19 remain in isolation if infectious. OBJECTIVE: The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation. METHODS: In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC, uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analyses examined the odds of uploading a RAT by campus residential living status (ie, on or off campus), student or employee designation, age, and days in isolation. RESULTS: A total of 76% (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5; 45.4% (55/121) on day 6; 47.1% (99/210) on day 7; and 11.1% (7/63) on day 10 or beyond. Adjusted logistic regression modeling indicated cases living on campus had increased odds of uploading a RAT (odds ratio [OR] 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69) and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to lack of symptoms and timely submission, resulting in a total of 1547 days of lost productivity saved compared to all being in isolation for 10 days. CONCLUSIONS: RATs are beneficial, as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals' lives.

Postacute Sequelae of SARS-CoV-2 in University Setting.

Postacute sequelae of SARS-CoV-2 infection, commonly known as long COVID, is estimated to affect 10% to 80% of COVID-19 survivors. We examined the prevalence and predictors of long COVID from a sample of 1,338 COVID-19 cases among university members in Washington, DC, USA, during July 2021‒March 2022. Cases were followed up after 30 days of the initial positive result with confidential electronic surveys including questions about long COVID. The prevalence of long COVID was 36%. Long COVID was more prevalent among those who had underlying conditions, who were not fully vaccinated, who were female, who were former/current smokers, who experienced acute COVID-19 symptoms, who reported higher symptom counts, who sought medical care, or who received antibody treatment. Understanding long COVID among university members is imperative to support persons who have ongoing symptoms and to strengthen existing services or make referrals to other services, such as mental health, exercise programs, or long-term health studies.

Women's Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Since March 2020, the need to reduce patients' exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. OBJECTIVE: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. METHODS: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. RESULTS: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). CONCLUSIONS: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic.

The Characteristics of Student SARS-CoV-2 Cases on an Urban University Campus: Observational Study.

BACKGROUND: Academic institutions are central hubs for young adults, laden with academic and social interactions and communal living arrangements, heightening the risk of transmission of many communicable diseases, including COVID-19. Shortly after the start of the fall 2020 academic year, institutions of higher learning were identified as hot spots for rises in COVID-19 incidence among young adults. OBJECTIVE: This study aims to identify the characteristics of student SARS-CoV-2 cases, identify the extent to which the student population adhered to preventative strategies, and examine behaviors that would put them at higher risk of contracting or spreading COVID-19. METHODS: This observational study comprises 1175 university students at The George Washington University in Washington, DC, with a confirmed COVID-19 diagnosis between August 3, 2020, and November 30, 2021. Case investigation and contact tracing tools were developed by the Campus COVID-19 Support Team and captured in REDCap (Research Electronic Data Capture). Trained case investigators were notified of a case and attempted to contact all cases within 24 hours of the case receiving their lab result. Associations between case characteristics and number of contacts were examined using Wilcoxon rank sum tests. Knowledge of exposure, behaviors since exposure, student residence status, and fraternity and sorority life affiliation were examined using chi-square tests. RESULTS: Positive student cases reported a median of 3 close contacts, and 84.6% (993/1175) reported at least one symptom with a median of 4 COVID-19 symptoms. Congestion (628/1175, 53.4%), cough (530/1175, 45.1%), and headache (484/1175, 41.2%) were the most frequently reported symptoms. Moreover, 36% (415/1160) reported that they did not know how they were exposed to the virus. Among those aware of contact with a COVID-19 confirmed case, 55.1% (109/198) reported the contact was a close friend or family member, and 25.3% (50/198) reported that it was someone with whom they lived. Athlete (vs nonathlete; P<.001), on-campus (vs off-campus; P<.001), and undergraduate (vs graduate; P=.01) students all reported a significantly higher number of contacts. Students living on campus were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P=.004). Students with fraternity or sorority affiliation were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P<.001). CONCLUSIONS: COVID-19 cases have not yet stabilized to a predictable state, but this study provides case characteristics and insights for how academic institutions might prepare to mitigate outbreaks on their campuses as the world plans for the transition from pandemic to endemic COVID-19.

Social distancing and related factors during the COVID-19 pandemic in relation to COVID-19 symptoms and diagnosis and mental health.

Background: Many states, local authorities, organizations, and individuals have taken action to reduce the spread of COVID-19, particularly focused on restricting social interactions. Such actions have raised controversy regarding their implications for the spread of COVID-19 versus mental health. Methods: We examined correlates of: (1) COVID symptoms and test results (i.e., no symptoms/tested negative, symptoms but not tested, tested positive), and (2) mental health symptoms (depressive/anxiety symptoms, COVID-related stress). Data were drawn from Fall 2020 surveys of young adults (n = 2576; M age = 24.67; 55.8% female; 31.0% sexual minority; 5.4% Black; 12.7% Asian; 11.1% Hispanic) in six metropolitan statistical areas (MSAs) with distinct COVID-related state orders. Correlates of interest included MSA, social distancing behaviors, employment status/nature, household composition, and political orientation. Results: Overall, 3.0% tested positive for COVID-19; 7.0% had symptoms but no test; 29.1% reported at least moderate depressive/anxiety symptoms on the PHQ-4 Questionnaire. Correlates of testing positive (vs. having no symptoms) included residing in Oklahoma City vs. Boston, San Diego, or Seattle and less social distancing adherence; there were few differences between those without symptoms/negative test and those with symptoms but not tested. Correlates of greater depressive/anxiety symptoms included greater social distancing adherence, being unemployed/laid off (vs. working outside of the home), living with others (other than partners/children), and being Democrat but not Republican (vs. no lean); findings related to COVID-specific stress were similar. Conclusion: Despite curbing the pandemic, social distancing and individual (e.g., political) and environmental factors that restrict social interaction have negative implications for mental health.

Sociopolitical, mental health, and sociodemographic correlates of COVID-19 vaccine hesitancy among young adults in 6 US metropolitan areas.

Given the need to increase COVID-19 vaccine uptake among US young adults, we examined the extent of COVID-19 vaccine hesitancy in this population and related factors. We analyzed Fall 2020 survey data from 2,453 young adults (ages 18-34) across 6 US metropolitan statistical areas (MSAs; Meanage = 24.67; 55.8% female; 5.4% Black, 12.7% Asian, 11.1% Hispanic; 75.5% college degree or higher). Multivariable linear regression examined correlates of COVID-19 vaccine hesitancy (index score of willingness and likelihood of being vaccinated), including sociopolitical factors (MSA, political orientation, COVID-related news exposure), COVID-19 symptoms and testing, mental health (e.g., COVID-related stress), and sociodemographics. 45.3% were "extremely willing" to get the vaccine (19.8% very, 14.2% somewhat, 3.7% don't know, 7.0% a little, 10.1% not at all); 40.2% were "extremely likely" to get vaccinated (22.1% very, 14.2% somewhat, 5.2% don't know, 7.9% a little, 10.3% not at all). Greater vaccine hesitancy was significantly related to living in specific MSAs (i.e., Atlanta, Oklahoma City, San Diego, Seattle vs. Minneapolis or Boston), identifying as Republican or "no lean" (vs. Democrat), and reporting less COVID-related news exposure and less COVID-related stress, as well as identifying as older, female, Black or other race, having less (vs. greater) than a college education, being married/cohabitating, and having children in the home. Interventions to improve COVID-19 vaccine uptake among hesitant young adults should include communication that address concerns, particularly among women, minority groups, and those from certain geographic regions and/or differing political orientations, and require identifying communication channels that appeal to these groups.

SARS-CoV-2 surveillance and outbreak response on an urban American college campus.

OBJECTIVE: The George Washington University (GW) in Washington, D.C., USA established the Public Health Laboratory and Campus COVID-19 Support Team (CCST) to develop and implement its SARS-CoV-2 surveillance testing and outbreak response for the 2020-2021 academic year. PARTICIPANTS AND METHODS: Approximately 4,000 GW members had access to campus for living accommodations, limited in-person instruction, athletics, research, and university operations. The outbreak response included daily risk assessment surveys, weekly surveillance testing, symptomatic and voluntary testing, case investigation, and contact tracing. RESULTS: Between August 17 - November 24, 2020, 42,350 SARS-CoV-2 PCR tests were performed, and 194 (0.46%) of tests were positive. Surveillance testing identified 59 (30.4%); voluntary testing 97 (50%); and symptomatic testing 30 (15.5%) of the cases, respectively. CONCLUSIONS: Robust testing of asymptomatic people and rapid isolation and quarantine of members who are exposed or infected effectively limited the spread of SARS-CoV-2 during the Fall 2020 semester.

Adolescents in the Time of COVID: Findings from India and Nepal

Historically, epidemics and humanitarian crises have disproportionately impacted the most vulnerable, impacting mostly girls and women living in low-to-middle income countries. Entrenched inequalities in gender norms and access to education often leave young girls inadequately equipped to effectively protect themselves and their families during an outbreak. There is no exception now as the COVID-19 pandemic has yielded unintended consequences for both adolescent boys and girls. This quantitative research study explores adolescent boys’and girls’COVID-19 related perceptions of risk and related behaviors and challenges related to school closures almost one year after the start of the pandemic in India and Nepal. Males were more likely to report completing online/mobile learning and assignments provided by school, whereas females reported a higher percentage of studying with their own books, using other learning resources, or doing nothing while schools have been shut down. Girls were more likely to report wanting to return to school after the pandemic was over. Compared to girls, boys were more likely to report spending more time on household chores than they did before the pandemic. COVID-19 recovery efforts are imperative in alleviating the pandemic’s adverse consequences for adolescents’education, health well-being, and gender inequities.