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Perspectives on Politics ; : 23, 2021.
Artigo em Inglês | Web of Science | ID: covidwho-1819639


We explore the US states' evolving policy responses to the COVID-19 pandemic by examining governors' decisions to begin easing five types of social distancing policies after the initial case surge in March-April 2020. Applying event history models to original data on state COVID-19 policies, we test the relative influence of health, economic, and political considerations on their decisions. We find no evidence that differences in state economic conditions influenced when governors began easing. Governors of states with larger recent declines in COVID-19 deaths per capita and improving trends in new confirmed cases and test positivity were quicker to ease. However, politics played as powerful a role as epidemiological conditions, driven primarily by governors' party affiliation. Republican governors made the policy U-turn from imposing social distancing measures toward easing those measures a week earlier than Democratic governors, all else equal. Most troubling of all, we find that states with larger Black populations eased their social distancing policies more quickly, despite Black Americans' higher exposure to infection from SARS-CoV-2 and subsequent death from COVID-19.

Hepatology ; 74(SUPPL 1):546A-547A, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1508687


Background: Increased hepatitis C virus (HCV) testing among people in prison (PIP) is key for HCV elimination efforts to be successful. Efforts to improve health care in all British Columbia (BC) Provincial Correctional Centres (PCCs) have been made in recent years, beginning with the transfer of health services from BC Corrections to BC Provincial Health Services Authority (PHSA) in 2017. However, the state of emergency declared in BC in early 2020 in response to the COVID-19 pandemic may have undermined these efforts. This study aims to examine patterns in HCV screening and diagnosis in all 10 BC PCCs before and during the COVID-19 pandemic. Methods: Data from the BC Sexually Transmitted and Blood-Borne Infections Data Mart, which contains laboratory data accounting for >95% of all anti-HCV and >99% of all HCV RNA and genotype tests performed in BC, were used for this study. The number of anti-HCV, HCV RNA and HCV genotype tests that were ordered from BC PCCs between April 1 2011 and March 31 2021 was determined for quarterly periods. New HCV diagnoses were defined as the number of 1st-time HCV-positive test episodes (anti-HCV, RNA or genotype) among HCV tests ordered from BC PCCs. Total intake numbers were provided by BC Corrections per calendar year. Results: The number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 1st quarter of 2020 had increased by 412% (n=486), 530% (n=252) and 827% (n=139) respectively (Figure 1), compared to the 1st quarter of 2017 (prior to the transfer of health services to PHSA). Following the beginning of the COVID-19 pandemic, the number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 2nd quarter of 2020 had decreased by 66% (n=165), 67% (n=83) and 68% (n=44), respectively (Figure 1), compared to the 1st quarter of 2020. The total number of HCV tests as a proportion of intakes to BC PCCs in 2019 was 17% (2518/15303), which increased to 23% (2112/9283) in 2020. Conclusion: The transfer of health services in BC PCCs to PHSA led to increased volume of HCV screening, with concomitant increases in new HCV diagnoses among PIP in BC from 4th quarter 2017 onwards. The COVID-19 pandemic led to health care challenges in prisons in BC (including the suspension of non-urgent HCV testing in the entire province for several weeks), and at the same time, the number of HCV tests and new diagnoses decreased. This may have been partly due to reduced intakes to BC PCCs over 2020, as the total number of HCV tests ordered as a proportion of intakes increased in 2020, compared to the previous year. Those people diverted away from the correctional system due to decarceration efforts triggered by COVID-19 may have missed out on HCV screening during 2020, therefore further efforts to increase HCV screening in correctional settings and the community will be needed.

Epidemiol Infect ; 148: e124, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: covidwho-619184


The majority of available US-published reports present populations with community spread in urban areas. The objective of this report is to describe a rural healthcare system's utilisation of therapeutic options available to treat Coronavirus Disease 2019 (COVID-19) and subsequent patient outcomes. A total of 150 patients were treated for COVID-19 at three hospitals in the Dakotas from 21 March 2020 to 30 April 2020. The most common pharmacological treatment regimens administered were zinc, hydroxychloroquine plus azithromycin and convalescent plasma. Adjunctive treatments included therapeutic anticoagulation, tocilizumab and corticosteroids. As of 1 June 2020, 127 patients have survived to hospital discharge, 12 patients remain hospitalised and 11 patients have expired. The efficacy of hydroxychloroquine and azithromycin use has yet to be determined but was not without risks of corrected QT interval prolongation and arrhythmias in our cohort. We did not appreciate any adverse effects that appeared related to tocilizumab or convalescent plasma administration in those patient subsets. These findings may provide insight into disease severity and treatment options in the rural setting with limited resources to participate in clinical trials and encourage larger comparative studies evaluating treatment efficacy.

Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Criança , Pré-Escolar , Estudos de Coortes , Infecções por Coronavirus/complicações , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , North Dakota/epidemiologia , Pandemias , Pneumonia Viral/complicações , Saúde da População Rural , South Dakota/epidemiologia , Resultado do Tratamento , Adulto Jovem