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1.
Ann Med ; 53(1): 151-159, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33138653

RESUMEN

OBJECTIVE: To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA. MATERIALS AND METHODS: Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. RESULTS: A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality. CONCLUSIONS: There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.


Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Pandemias , Neumonía Viral/diagnóstico , Estados Unidos/epidemiología
2.
Clin Sports Med ; 40(1): 1-18, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33187601

RESUMEN

Sport-related concussions are common in the United States. Concussion rates have increased over time, likely due to improved recognition and awareness. Concussion rates vary across level (high school vs college), sex, and sport. Concussion rates are the highest among men, particularly in football, wrestling, ice hockey, and lacrosse where collisions and contact are inherent to the sports, although girls'/women's soccer rates are high. In gender-comparable sports, women have higher concussion rates. Continued data collection will increase understanding of sport-related concussion and provide areas for targeted prevention in the future.


Asunto(s)
Traumatismos en Atletas/epidemiología , Conmoción Encefálica/epidemiología , Distribución por Edad , Femenino , Fútbol Americano/lesiones , Hockey/lesiones , Humanos , Incidencia , Masculino , Deportes de Raqueta/lesiones , Distribución por Sexo , Fútbol/lesiones , Estados Unidos/epidemiología , Universidades , Lucha/lesiones
3.
Brasília; IPEA; 20200500. 73 p. ilus.(Texto para Discussão / IPEA, 2559).
Monografía en Portugués | LILACS, ECOS | ID: biblio-1100677

RESUMEN

Este texto apresenta um panorama internacional das medidas econômicas adotadas para reduzir os graves efeitos econômicos da pandemia de Sars-COV-2 em três países: Estados Unidos, Reino Unido e Espanha. A análise toma como base primordialmente documentos governamentais que normatizaram as medidas de política econômica. São analisados os diversos canais por meio dos quais a crise sanitária afeta a economia. Por um lado, estão os fatores de oferta: oferta de trabalho, produtividade do trabalho e funcionamento das cadeias produtivas. Por outro lado, encontram-se os fatores de demanda: consumo das famílias, investimento privado e comércio exterior. O terceiro canal diz respeito aos fatores financeiros que incidem sobre as variáveis de demanda e, principalmente, sobre o grau de liquidez das empresas financeiras e não financeiras. As medidas adotadas nos três países apresentam como características comuns a mobilização de grande volume de recursos fiscais e financeiros, a adoção de uma grande diversidade de instrumentos de política econômica e o uso de arranjos institucionais sofisticados em termos de regras de focalização e de mecanismos de operacionalização das medidas adotadas.


This text presents an international overview of the economic measures adopted to reduce the serious economic effects of the Sars-COV-2 pandemic in three countries: the USA, the United Kingdom and Spain. The analysis is based primarily on government documents that regulated economic policy measures. The various channels through which the health crisis affects the economy are analyzed. On one hand, there are the supply factors: labor supply, labor productivity and the functioning of production chains. On the other hand, there are demand factors: household consumption, private investment and foreign trade. The third channel concerns the financial factors on demand variables and, mainly, on the degree of liquidity of financial and non-financial companies. The measures adopted in the three countries have as common characteristics the mobilization of large volumes of fiscal and financial resources, the adoption of a wide range of economic policy instruments and the use of sophisticated institutional arrangements in terms of targeting rules and mechanisms for operationalizing the measures adopted.


Asunto(s)
Política Pública , Coronavirus , Pandemias , España/epidemiología , Estados Unidos/epidemiología , Reino Unido/epidemiología
4.
MMWR Morb Mortal Wkly Rep ; 69(47): 1767-1770, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33237892

RESUMEN

Breastfeeding has health benefits for both infants and mothers and is recommended by numerous health and medical organizations*,† (1). The birth hospitalization is a critical period for establishing breastfeeding; however, some hospital practices, particularly related to mother-newborn contact, have given rise to concern about the potential for mother-to-newborn transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2). CDC conducted a COVID-19 survey (July 15-August 20, 2020) among 1,344 hospitals that completed the 2018 Maternity Practices in Infant Nutrition and Care (mPINC) survey to assess current practices and breastfeeding support while in the hospital. Among mothers with suspected or confirmed COVID-19, 14.0% of hospitals discouraged and 6.5% prohibited skin-to-skin care; 37.8% discouraged and 5.3% prohibited rooming-in; 20.1% discouraged direct breastfeeding but allowed it if the mother chose; and 12.7% did not support direct breastfeeding, but encouraged feeding of expressed breast milk. In response to the pandemic, 17.9% of hospitals reported reduced in-person lactation support, and 72.9% reported discharging mothers and their newborns <48 hours after birth. Some of the infection prevention and control (IPC) practices that hospitals were implementing conflicted with evidence-based care to support breastfeeding. Mothers who are separated from their newborn or not feeding directly at the breast might need additional postdischarge breastfeeding support. In addition, the American Academy of Pediatrics (AAP) recommends that newborns discharged before 48 hours receive prompt follow-up with a pediatric health care provider.


Asunto(s)
Lactancia Materna , Infecciones por Coronavirus/prevención & control , Hospitales/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Atención Posnatal/organización & administración , Infecciones por Coronavirus/epidemiología , Femenino , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
5.
MMWR Morb Mortal Wkly Rep ; 69(47): 1782-1786, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33237895

RESUMEN

To reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) and its associated impacts on health and society, COVID-19 vaccines are essential. The U.S. government is working to produce and deliver safe and effective COVID-19 vaccines for the entire U.S. population. The Advisory Committee on Immunization Practices (ACIP)* has broadly outlined its approach for developing recommendations for the use of each COVID-19 vaccine authorized or approved by the Food and Drug Administration (FDA) for Emergency Use Authorization or licensure (1). ACIP's recommendation process includes an explicit and transparent evidence-based method for assessing a vaccine's safety and efficacy as well as consideration of other factors, including implementation (2). Because the initial supply of vaccine will likely be limited, ACIP will also recommend which groups should receive the earliest allocations of vaccine. The ACIP COVID-19 Vaccines Work Group and consultants with expertise in ethics and health equity considered external expert committee reports and published literature and deliberated the ethical issues associated with COVID-19 vaccine allocation decisions. The purpose of this report is to describe the four ethical principles that will assist ACIP in formulating recommendations for the allocation of COVID-19 vaccine while supply is limited, in addition to scientific data and implementation feasibility: 1) maximize benefits and minimize harms; 2) promote justice; 3) mitigate health inequities; and 4) promote transparency. These principles can also aid state, tribal, local, and territorial public health authorities as they develop vaccine implementation strategies within their own communities based on ACIP recommendations.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Asignación de Recursos para la Atención de Salud/ética , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vacunas Virales/administración & dosificación , Comités Consultivos , Centers for Disease Control and Prevention, U.S. , Infecciones por Coronavirus/epidemiología , Aprobación de Drogas/legislación & jurisprudencia , Humanos , Inmunización/normas , Neumonía Viral/epidemiología , Estados Unidos/epidemiología , United States Food and Drug Administration
6.
MMWR Morb Mortal Wkly Rep ; 69(47): 1792-1796, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33237898

RESUMEN

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). Although the percentage of all U.S. adults who smoke cigarettes has declined substantially since the mid-1960s (1,2), marked disparities persist, and declines have not been consistent across population groups (1,2). Studies have shown that cigarette smoking is as common, and sometimes more so, among adults with a history of epilepsy compared with those without a history of epilepsy, but reasons for this are unclear (3-6). Compared with adults without epilepsy, adults with epilepsy report lower household income, more unemployment and disability, worse psychological health, and reduced health-related quality of life (3,4,6,7). Trends in cigarette smoking among U.S. adults with epilepsy have not been previously assessed. CDC analyzed National Health Interview Survey (NHIS) data among 121,497 U.S. adults from 2010, 2013, 2015, and 2017 to assess current cigarette smoking by epilepsy status. From 2010 through 2017, the age-standardized percentages of current smoking were 24.9% among adults with active epilepsy, 25.9% among adults with inactive epilepsy, and 16.6% among adults with no history of epilepsy. After accounting for differences in data collection intervals and patterns in smoking status among subgroups, CDC found that current cigarette smoking declined significantly from 2010 to 2017 among adults with no history of epilepsy (19.3% to 14.0% [p<0.001]) and inactive epilepsy (29.2% to 16.2% [p = 0.03]), but declines among adults with active epilepsy were not statistically significant (26.4% to 21.8% [p = 0.2]). Epilepsy health and social service providers should promote smoking cessation resources to adults with active epilepsy who smoke cigarettes to help them quit smoking and to reduce their risk of smoking-related disease and death.


Asunto(s)
Fumar Cigarrillos/epidemiología , Fumar Cigarrillos/tendencias , Epilepsia/epidemiología , Adolescente , Adulto , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
7.
MMWR Morb Mortal Wkly Rep ; 69(47): 1762-1766, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33237893

RESUMEN

Most persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), develop virus-specific antibodies within several weeks, but antibody titers might decline over time. Understanding the timeline of antibody decline is important for interpreting SARS-CoV-2 serology results. Serum specimens were collected from a convenience sample of frontline health care personnel at 13 hospitals and tested for antibodies to SARS-CoV-2 during April 3-June 19, 2020, and again approximately 60 days later to assess this timeline. The percentage of participants who experienced seroreversion, defined as an antibody signal-to-threshold ratio >1.0 at baseline and <1.0 at the follow-up visit, was assessed. Overall, 194 (6.0%) of 3,248 participants had detectable antibodies to SARS-CoV-2 at baseline (1). Upon repeat testing approximately 60 days later (range = 50-91 days), 146 (93.6%) of 156 participants experienced a decline in antibody response indicated by a lower signal-to-threshold ratio at the follow-up visit, compared with the baseline visit, and 44 (28.2%) experienced seroreversion. Participants with higher initial antibody responses were more likely to have antibodies detected at the follow-up test than were those who had a lower initial antibody response. Whether decay in these antibodies increases risk for reinfection and disease remains unanswered. However, these results suggest that serology testing at a single time point is likely to underestimate the number of persons with previous SARS-CoV-2 infection, and a negative serologic test result might not reliably exclude prior infection.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Personal de Hospital/estadística & datos numéricos , Neumonía Viral/inmunología , Adulto , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
8.
Nat Commun ; 11(1): 5558, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33144575

RESUMEN

Evidence-based public health approaches that minimize the introduction and spread of new SARS-CoV-2 transmission clusters are urgently needed in the United States and other countries struggling with expanding epidemics. Here we analyze 247 full-genome SARS-CoV-2 sequences from two nearby communities in Wisconsin, USA, and find surprisingly distinct patterns of viral spread. Dane County had the 12th known introduction of SARS-CoV-2 in the United States, but this did not lead to descendant community spread. Instead, the Dane County outbreak was seeded by multiple later introductions, followed by limited community spread. In contrast, relatively few introductions in Milwaukee County led to extensive community spread. We present evidence for reduced viral spread in both counties following the statewide "Safer at Home" order, which went into effect 25 March 2020. Our results suggest patterns of SARS-CoV-2 transmission may vary substantially even in nearby communities. Understanding these local patterns will enable better targeting of public health interventions.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Genoma Viral/genética , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Infecciones por Coronavirus/prevención & control , Geografía , Humanos , Tamizaje Masivo/métodos , Epidemiología Molecular/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Dispositivos de Protección Respiratoria , Distancia Social , Estados Unidos/epidemiología , Wisconsin/epidemiología
9.
MMWR Morb Mortal Wkly Rep ; 69(44): 1635-1640, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33151917

RESUMEN

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1-3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown. Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29-October 14, 2020. Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery. Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants. These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo/epidemiología , Aborto Espontáneo/epidemiología , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Laboratorios , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Medición de Riesgo , Estados Unidos/epidemiología , Adulto Joven
10.
MMWR Morb Mortal Wkly Rep ; 69(44): 1641-1647, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33151921

RESUMEN

Studies suggest that pregnant women might be at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) (1,2). This report provides updated information about symptomatic women of reproductive age (15-44 years) with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19. During January 22-October 3, CDC received reports through national COVID-19 case surveillance or through the National Notifiable Diseases Surveillance System (NNDSS) of 1,300,938 women aged 15-44 years with laboratory results indicative of acute infection with SARS-CoV-2. Data on pregnancy status were available for 461,825 (35.5%) women with laboratory-confirmed infection, 409,462 (88.7%) of whom were symptomatic. Among symptomatic women, 23,434 (5.7%) were reported to be pregnant. After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit (ICU) (10.5 versus 3.9 per 1,000 cases; adjusted risk ratio [aRR] = 3.0; 95% confidence interval [CI] = 2.6-3.4), receive invasive ventilation (2.9 versus 1.1 per 1,000 cases; aRR = 2.9; 95% CI = 2.2-3.8), receive extracorporeal membrane oxygenation (ECMO) (0.7 versus 0.3 per 1,000 cases; aRR = 2.4; 95% CI = 1.5-4.0), and die (1.5 versus 1.2 per 1,000 cases; aRR = 1.7; 95% CI = 1.2-2.4). Stratifying these analyses by age and race/ethnicity highlighted disparities in risk by subgroup. Although the absolute risks for severe outcomes for women were low, pregnant women were at increased risk for severe COVID-19-associated illness. To reduce the risk for severe illness and death from COVID-19, pregnant women should be counseled about the importance of seeking prompt medical care if they have symptoms and measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters, including prenatal care visits. Understanding COVID-19-associated risks among pregnant women is important for prevention counseling and clinical care and treatment.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Evaluación de Síntomas , Adolescente , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Laboratorios , Pandemias , Neumonía Viral/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
12.
Neurosurg Focus ; 49(5): E8, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33130613

RESUMEN

The Emergency Medical Treatment and Active Labor Act (EMTALA) protects patient access to emergency medical treatment regardless of insurance or socioeconomic status. A significant result of the COVID-19 pandemic has been the rapid acceleration in the adoption of telemedicine services across many facets of healthcare. However, very little literature exists regarding the use of telemedicine in the context of EMTALA. This work aimed to evaluate the potential to expand the usage of telemedicine services for neurotrauma to reduce transfer rates, minimize movement of patients across borders, and alleviate the burden on tertiary care hospitals involved in the care of patients with COVID-19 during a global pandemic. In this paper, the authors outline EMTALA provisions, provide examples of EMTALA violations involving neurosurgical care, and propose guidelines for the creation of telemedicine protocols between referring and consulting institutions.


Asunto(s)
Betacoronavirus , Conmoción Encefálica/terapia , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Infecciones por Coronavirus/terapia , Servicios Médicos de Urgencia/legislación & jurisprudencia , Neumonía Viral/terapia , Telemedicina/legislación & jurisprudencia , Conmoción Encefálica/epidemiología , Centers for Medicare and Medicaid Services, U.S./tendencias , Infecciones por Coronavirus/epidemiología , Servicios Médicos de Urgencia/tendencias , Humanos , Pandemias , Neumonía Viral/epidemiología , Telemedicina/tendencias , Centros de Atención Terciaria/legislación & jurisprudencia , Centros de Atención Terciaria/tendencias , Estados Unidos/epidemiología
13.
PLoS One ; 15(11): e0241327, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33137155

RESUMEN

OBJECTIVE: Poor housing conditions have been linked with worse health outcomes and infectious disease spread. Since the relationship of poor housing conditions with incidence and mortality of COVID-19 is unknown, we investigated the association between poor housing condition and COVID-19 incidence and mortality in US counties. METHODS: We conducted cross-sectional analysis of county-level data from the US Centers for Disease Control, US Census Bureau and John Hopkins Coronavirus Resource Center for 3135 US counties. The exposure of interest was percentage of households with poor housing conditions (one or greater of: overcrowding, high housing cost, incomplete kitchen facilities, or incomplete plumbing facilities). Outcomes were incidence rate ratios (IRR) and mortality rate ratios (MRR) of COVID-19 across US counties through 4/21/2020. Multilevel generalized linear modeling (with total population of each county as a denominator) was utilized to estimate relative risk of incidence and mortality related to poor housing conditions with adjustment for population density and county characteristics including demographics, income, education, prevalence of medical comorbidities, access to healthcare insurance and emergency rooms, and state-level COVID-19 test density. We report incidence rate ratios (IRRs) and mortality ratios (MRRs) for a 5% increase in prevalence in households with poor housing conditions. RESULTS: Across 3135 US counties, the mean percentage of households with poor housing conditions was 14.2% (range 2.7% to 60.2%). On April 21st, the mean (SD) number of cases and deaths of COVID-19 were 255.68 (2877.03) cases and 13.90 (272.22) deaths per county, respectively. In the adjusted models standardized by county population, with each 5% increase in percent households with poor housing conditions, there was a 50% higher risk of COVID-19 incidence (IRR 1.50, 95% CI: 1.38-1.62) and a 42% higher risk of COVID-19 mortality (MRR 1.42, 95% CI: 1.25-1.61). Results remained similar using earlier timepoints (3/31/2020 and 4/10/2020). CONCLUSIONS AND RELEVANCE: Counties with a higher percentage of households with poor housing had higher incidence of, and mortality associated with, COVID-19. These findings suggest targeted health policies to support individuals living in poor housing conditions should be considered in further efforts to mitigate adverse outcomes associated with COVID-19.


Asunto(s)
Infecciones por Coronavirus/patología , Neumonía Viral/patología , Clase Social , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Estudios Transversales , Composición Familiar , Femenino , Vivienda , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/virología , Riesgo , Estados Unidos/epidemiología , Adulto Joven
14.
PLoS One ; 15(11): e0241468, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33166301

RESUMEN

In March of this year, COVID-19 was declared a pandemic, and it continues to threaten public health. This global health crisis imposes limitations on daily movements, which have deteriorated every sector in our society. Understanding public reactions to the virus and the non-pharmaceutical interventions should be of great help to fight COVID-19 in a strategic way. We aim to provide tangible evidence of the human mobility trends by comparing the day-by-day variations across the U.S. from January 2020 to early April 2020. Large-scale public mobility at an aggregated level is observed by leveraging mobile device location data and the measures related to social distancing. Our study captures spatial and temporal heterogeneity as well as the sociodemographic variations and teleworking trends regarding the pandemic propagation and the non-pharmaceutical mobility interventions. All metrics adapted capture decreased public movements after the national emergency declaration. The population staying home has increased in all states before the stay-at-home mandates implemented and becomes more stable after the order with a smaller range of fluctuation. The public had been taking active responses, voluntarily staying home more, to the in-state confirmed cases while the stay-at-home orders stabilize the variations. As the estimated teleworking rates also continue to incline throughout the study period, the teleworking trend can be another driving factor for the growing stay-at-home population. We confirm that there exists overall mobility heterogeneity between the income or population density groups. The study suggests that public mobility trends are in line with the government message urging to stay home. We anticipate our data-driven analysis offers integrated perspectives and serves as evidence to raise public awareness and, consequently, reinforce the importance of social distancing while assisting policymakers.


Asunto(s)
Infecciones por Coronavirus/patología , Movimiento , Neumonía Viral/patología , Betacoronavirus/aislamiento & purificación , Uso del Teléfono Celular/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Procesamiento Automatizado de Datos , Humanos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Análisis Espacio-Temporal , Estados Unidos/epidemiología
15.
PLoS One ; 15(11): e0241895, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175894

RESUMEN

Despite the profound health and economic implications of Covid-19, there is only limited knowledge to date about the role of economic concerns, health worries and social distancing for mental health outcomes during the pandemic. We analyze online survey data from the nationally representative "Understanding America Study" (UAS) covering the period of March 10-31st 2020 (sample size: 6,585). Mental health is assessed by the validated PHQ-4 instrument for measuring symptoms of depression and anxiety. About 29% (CI:27.4-.30.4%) of the US adult population reported some depression/anxiety symptoms over the study period, with symptoms deteriorating over the month of March. Worsening mental health was most strongly associated with concerns about the economic consequences of the pandemic, while concerns about the potential implications of the virus for respondents' own health and social distancing also predicted increases in symptoms of depression and anxiety during the early stages of the pandemic in the US, albeit less strongly. Our findings point towards the possibility of a major mental health crisis unfolding simultaneously with the pandemic, with economic concerns being a key driving force of this crisis. These results highlight the likely importance of economic countermeasures and social policy for mitigating the impact of Covid-19 on adult mental health in the US over and above an effective public health response.


Asunto(s)
Infecciones por Coronavirus/patología , Estatus Económico , Salud Mental , Neumonía Viral/patología , Adulto , Ansiedad/diagnóstico , Ansiedad/epidemiología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiología
16.
JAMA Netw Open ; 3(11): e2028786, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33180132

RESUMEN

Importance: United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption. Objective: To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open. Design, Setting, and Participants: This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated. Main Outcomes and Measures: Years of life lost. Results: A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.31 (95% credible interval [CI], 0.10-0.65) years of final educational attainment for boys and 0.21 (95% CI, 0.06-0.46) years for girls. Summed across the population, an estimated 5.53 million (95% CI, 1.88-10.80) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, 1.47 million (95% credible interval, 0.45-2.59) additional YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both "schools open" and "schools closed" conditions, the analysis observed a 98.1% probability that school opening would have been associated with a lower total YLL than school closure. Conclusions and Relevance: In this decision analytical model of years of life potentially lost under differing conditions of school closure, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children's health.


Asunto(s)
Salud del Niño , Infecciones por Coronavirus/prevención & control , Educación a Distancia , Escolaridad , Esperanza de Vida , Pandemias/prevención & control , Neumonía Viral/prevención & control , Instituciones Académicas , Betacoronavirus , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Masculino , Modelos Estadísticos , Método de Montecarlo , Neumonía Viral/mortalidad , Estados Unidos/epidemiología
17.
MMWR Morb Mortal Wkly Rep ; 69(45): 1675-1680, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180751

RESUMEN

Published reports suggest that the coronavirus disease 2019 (COVID-19) pandemic has had a negative effect on children's mental health (1,2). Emergency departments (EDs) are often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable (3). During March 29-April 25, 2020, when widespread shelter-in-place orders were in effect, ED visits for persons of all ages declined 42% compared with the same period in 2019; during this time, ED visits for injury and non-COVID-19-related diagnoses decreased, while ED visits for psychosocial factors increased (4). To assess changes in mental health-related ED visits among U.S. children aged <18 years, data from CDC's National Syndromic Surveillance Program (NSSP) from January 1 through October 17, 2020, were compared with those collected during the same period in 2019. During weeks 1-11 (January 1-March 15, 2020), the average reported number of children's mental health-related ED visits overall was higher in 2020 than in 2019, whereas the proportion of children's mental health-related visits was similar. Beginning in week 12 (March 16) the number of mental health-related ED visits among children decreased 43% concurrent with the widespread implementation of COVID-19 mitigation measures; simultaneously, the proportion of mental health-related ED visits increased sharply beginning in mid-March 2020 (week 12) and continued into October (week 42) with increases of 24% among children aged 5-11 years and 31% among adolescents aged 12-17 years, compared with the same period in 2019. The increased proportion of children's mental health-related ED visits during March-October 2020 might be artefactually inflated as a consequence of the substantial decrease in overall ED visits during the same period and variation in the number of EDs reporting to NSSP. However, these findings provide initial insight into children's mental health in the context of the COVID-19 pandemic and highlight the importance of continued monitoring of children's mental health throughout the pandemic, ensuring access to care during public health crises, and improving healthy coping strategies and resiliency among children and families.


Asunto(s)
Infecciones por Coronavirus/psicología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/terapia , Pandemias , Neumonía Viral/psicología , Adolescente , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
18.
MMWR Morb Mortal Wkly Rep ; 69(45): 1695-1699, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180754

RESUMEN

Coronavirus disease 2019 (COVID-19) is a complex clinical illness with potential complications that might require ongoing clinical care (1-3). Few studies have investigated discharge patterns and hospital readmissions among large groups of patients after an initial COVID-19 hospitalization (4-7). Using electronic health record and administrative data from the Premier Healthcare Database,* CDC assessed patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient's initial COVID-19 hospitalization (index hospitalization). Among 126,137 unique patients with an index COVID-19 admission during March-July 2020, 15% died during the index hospitalization. Among the 106,543 (85%) surviving patients, 9% (9,504) were readmitted to the same hospital within 2 months of discharge through August 2020. More than a single readmission occurred among 1.6% of patients discharged after the index hospitalization. Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among patients discharged to home or self-care (7%). The odds of hospital readmission increased with age among persons aged ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the index hospitalization, and if discharge from the index hospitalization was to a SNF or to home with health care assistance. These results support recent analyses that found chronic conditions to be significantly associated with hospital readmission (6,7) and could be explained by the complications of underlying conditions in the presence of COVID-19 (8), COVID-19 sequelae (3), or indirect effects of the COVID-19 pandemic (9). Understanding the frequency of, and risk factors for, readmission can inform clinical practice, discharge disposition decisions, and public health priorities such as health care planning to ensure availability of resources needed for acute and follow-up care of COVID-19 patients. With the recent increases in cases nationwide, hospital planning can account for these increasing numbers along with the potential for at least 9% of patients to be readmitted, requiring additional beds and resources.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
19.
MMWR Morb Mortal Wkly Rep ; 69(45): 1665-1670, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180755

RESUMEN

Diabetes increases the risk for developing cardiovascular, neurologic, kidney, eye, and other complications. Diabetes and related complications also pose a huge economic cost to society: in 2017, the estimated total economic cost of diagnosed diabetes was $327 billion in the United States (1). Diabetes complications can be prevented or delayed through the management of blood glucose (measured by hemoglobin A1C), blood pressure (BP), and non-high-density lipoprotein cholesterol (non-HDL-C) levels, and by avoiding smoking; these are collectively known as the ABCS goals (hemoglobin A1C, Blood pressure, Cholesterol, Smoking) (2-5). Assessments of achieving ABCS goals among adults with diabetes are available at the national level (4,6); however, studies that assess state-level prevalence of meeting ABCS goals have been lacking. This report provides imputed state-level proportions of adults with self-reported diabetes meeting ABCS goals in each of the 50 U.S. states and the District of Columbia (DC). State-level estimates were created by raking and multiple imputation methods (7,8) using data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES), 2017-2018 American Community Survey (ACS), and 2017-2018 Behavioral Risk Factor Surveillance System (BRFSS). Among U.S. adults with diabetes, an estimated 26.4% met combined ABCS goals, and 75.4%, 70.4%, 55.8%, and 86.0% met A1C <8%, BP <140/90 mmHg, non-HDL-C <130 mg/dL and nonsmoking goals, respectively. Public health departments could use these data in their planning efforts to achieve ABCS goal levels and reduce diabetes-related complications at the state level.


Asunto(s)
Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus/epidemiología , Adulto , Femenino , Objetivos , Humanos , Masculino , Prevalencia , Autoinforme , Estados Unidos/epidemiología
20.
MMWR Morb Mortal Wkly Rep ; 69(45): 1681-1685, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180758

RESUMEN

In January 2020, with support from the U.S. Department of Homeland Security (DHS), CDC instituted an enhanced entry risk assessment and management (screening) program for air passengers arriving from certain countries with widespread, sustained transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). The objectives of the screening program were to reduce the importation of COVID-19 cases into the United States and slow subsequent spread within states. Screening aimed to identify travelers with COVID-19-like illness or who had a known exposure to a person with COVID-19 and separate them from others. Screening also aimed to inform all screened travelers about self-monitoring and other recommendations to prevent disease spread and obtain their contact information to share with public health authorities in destination states. CDC delegated postarrival management of crew members to airline occupational health programs by issuing joint guidance with the Federal Aviation Administration.* During January 17-September 13, 2020, a total of 766,044 travelers were screened, 298 (0.04%) of whom met criteria for public health assessment; 35 (0.005%) were tested for SARS-CoV-2, and nine (0.001%) had a positive test result. CDC shared contact information with states for approximately 68% of screened travelers because of data collection challenges and some states' opting out of receiving data. The low case detection rate of this resource-intensive program highlighted the need for fundamental change in the U.S. border health strategy. Because SARS-CoV-2 infection and transmission can occur in the absence of symptoms and because the symptoms of COVID-19 are nonspecific, symptom-based screening programs are ineffective for case detection. Since the screening program ended on September 14, 2020, efforts to reduce COVID-19 importation have focused on enhancing communications with travelers to promote recommended preventive measures, reinforcing mechanisms to refer overtly ill travelers to CDC, and enhancing public health response capacity at ports of entry. More efficient collection of contact information for international air passengers before arrival and real-time transfer of data to U.S. health departments would facilitate timely postarrival public health management, including contact tracing, when indicated. Incorporating health attestations, predeparture and postarrival testing, and a period of limited movement after higher-risk travel, might reduce risk for transmission during travel and translocation of SARS-CoV-2 between geographic areas and help guide more individualized postarrival recommendations.


Asunto(s)
Aeropuertos , Enfermedades Transmisibles Importadas/prevención & control , Infecciones por Coronavirus/prevención & control , Tamizaje Masivo , Pandemias/prevención & control , Neumonía Viral/prevención & control , Centers for Disease Control and Prevention, U.S. , Enfermedades Transmisibles Importadas/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Medición de Riesgo , Viaje , Estados Unidos/epidemiología
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