Outbreak of COVID-19 and interventions in a large jail - Cook County, IL, United States, 2020.

BACKGROUND: Correctional and detention facilities are disproportionately affected by COVID-19 due to shared space, contact between staff and detained persons, and movement within facilities. On March 18, 2020, Cook County Jail, one of the United States' largest, identified its first suspected case of COVID-19 in a detained person. METHODS: This analysis includes SARS-CoV-2 cases confirmed by molecular detection among detained persons and Cook County Sheriff's Office staff. We examined occurrence of symptomatic cases in each building and proportions of asymptomatic detained persons testing positive, and timing of interventions including social distancing, mask use, and expanded testing and show outbreak trajectory in the jail compared to case counts in Chicago. RESULTS: During March 1-April 30, 907 symptomatic and asymptomatic cases of SARS-CoV-2 infection were detected among detained persons (n = 628) and staff (n = 279). Among asymptomatic detained persons in quarantine, 23.6% tested positive. Programmatic activity and visitation stopped March 9, cells were converted into single occupancy beginning March 26, and universal masking was implemented for staff (April 2) and detained persons (April 13). Cases at the jail declined while cases in Chicago increased. DISCUSSION/CONCLUSIONS: Aggressive intervention strategies coupled with widespread diagnostic testing of detained and staff populations can limit introduction and mitigate transmission of SARS-CoV-2 infection in correctional and detention facilities.

Network Characteristics and Visualization of COVID-19 Outbreak in a Large Detention Facility in the United States - Cook County, Illinois, 2020.

Correctional and detention facilities have been disproportionately affected by coronavirus disease 2019 (COVID-19) because of shared space and movement of staff members and detained persons within facilities (1,2). During March 1-April 30, 2020, at Cook County Jail in Chicago, Illinois, >900 COVID-19 cases were diagnosed across all 10 housing divisions, representing 13 unique buildings.† Movement within the jail was examined through network analyses and visualization, a field that examines elements within a network and the connections between them. This methodology has been used to supplement contact tracing investigations for tuberculosis and to understand how social networks contribute to transmission of sexually transmitted infections (3-5). Movements and connections of 5,884 persons (3,843 [65%] detained persons and 2,041 [35%] staff members) at the jail during March 1-April 30 were analyzed. A total of 472 (12.3%) COVID-19 cases were identified among detained persons and 198 (9.7%) among staff members. Among 103,701 shared-shift connections among staff members, 1.4% occurred between persons with COVID-19, a percentage that is significantly higher than the expected 0.9% by random occurrence alone (p<0.001), suggesting that additional transmission occurred within this group. The observed connections among detained persons with COVID-19 were significantly lower than expected (1.0% versus 1.1%, p<0.001) when considering only the housing units in which initial transmission occurred, suggesting that the systematic isolation of persons with COVID-19 is effective at limiting transmission. A network-informed approach can identify likely points of high transmission, allowing for interventions to reduce transmission targeted at these groups or locations, such as by reducing convening of staff members, closing breakrooms, and cessation of contact sports.

The Introduction to the 1965 Cuban Government's Occupational Health and Safety Manual, With a Statement From Dr. Ernesto Che Guevara.

We are presenting here a translation of the introduction to a Cuban government Manual of Safety and Hygiene for Work that was prepared for Cuban workers in 1965. The manual was written by Lic. Hugo Murua Chevesich and Dr. Antonio Granda Ibarra. The introduction includes a brief statement from Commandante Erneso Che Guevara, then Cuban Minister of Industry. Noteworthy is that Che explains that occupational health and safety was not a priority in the revolution's first years under the pressure to increase production. In fact, he says that this pressure caused a certain contempt for personal safety. He declares that this approach must change and states emphatically that protection of workers is essential and that the measures explained in the manual must be implemented immediately.

Green Commuting in the Health Care Sector: Obstacles and Best Practices.

OBJECTIVE: Fossil fuel transportation by health care providers contributes to the prevalence of diseases they treat. We conducted an exploratory study to understand obstacles to, and best practices for, greener commuting among health care providers. METHODS: We surveyed staff of three hospital clinics as to how they commute and why, and interviewed key staff of five hospital leaders in green commuting about their programs. RESULTS: Factors that might change respondents' commuting choices from driving alone included financial incentives, convenience, and solutions to crime and safety concerns. Successful green commuting programs offer benefits including free or reduced transit passes, shuttle buses to transit stations, and free emergency rides home. CONCLUSIONS: Exemplary programs throughout the country demonstrate that modifying those factors within reach can impact the amount of fossil fuel energy used for health care provider transportation.

From Extraction to Renewal: A Global Campaign for Healthy Energy.

A global movement is emerging in the health sector to engage in discourse and advocacy on the health impacts and health costs of energy choices--specifically the health harms of extractive, climate-disrupting energy sources such as coal and gas. Individuals and organizations in the health sector have begun to address climate and energy issues at multiple levels of engagement, including with others in the health sector, with pollution-affected communities, with policy makers, and with the media. We present recent examples of health sector advocacy and leadership on the health impacts of energy choices and opportunities for broadening and deepening the movement.

Integrating environmental and human health databases in the great lakes basin: themes, challenges and future directions.

Many government, academic and research institutions collect environmental data that are relevant to understanding the relationship between environmental exposures and human health. Integrating these data with health outcome data presents new challenges that are important to consider to improve our effective use of environmental health information. Our objective was to identify the common themes related to the integration of environmental and health data, and suggest ways to address the challenges and make progress toward more effective use of data already collected, to further our understanding of environmental health associations in the Great Lakes region. Environmental and human health databases were identified and reviewed using literature searches and a series of one-on-one and group expert consultations. Databases identified were predominantly environmental stressors databases, with fewer found for health outcomes and human exposure. Nine themes or factors that impact integration were identified: data availability, accessibility, harmonization, stakeholder collaboration, policy and strategic alignment, resource adequacy, environmental health indicators, and data exchange networks. The use and cost effectiveness of data currently collected could be improved by strategic changes to data collection and access systems to provide better opportunities to identify and study environmental exposures that may impact human health.

Beyond black lung: scientific evidence of health effects from coal use in electricity generation.

While access to electricity affects health positively, combustion of coal in power plants causes well-documented adverse health effects. We review respiratory, cardiovascular, reproductive, and neurologic health outcomes associated with exposure to coal-fired power plant emissions. We also discuss population-level health effects of coal combustion and its role in climate change. Our review of scientific studies suggests that those we present here can be used to inform energy policy.

Reemplazo de los termómetros y de los tensiómetros de mercurio en la atención de salud: guía técnica / Replacement of mercury thermometers sphygmomanometers in health care: technical guidance

Esta guía proporciona instrucciones paso a paso para reemplazar de manera segura los termómetros y tensiómetros con mercurio utilizados en las instituciones de la atención de salud. Identifica los recursos disponibles que respaldan la precisión y utilidad clínicaequivalentes de los productos sustitutos, al tiempo que protege a los trabajadores de la salud y al medio ambiente. Está diseñada para los profesionales responsables por las instituciones, o para los ministerios que desean cambiar a tecnologías más seguras y no contaminantes en la atención de salud.Esta guía también es el resultado de una iniciativa mundial para la atención desalud libre de mercurio, con la cual está comprometida la Organización Mundial de la Salud. Esta iniciativa global busca promover en todo el mundo la sustitución de los instrumentos médicos basados en mercurio con alternativas seguras, asequibles y precisas. La iniciativa global para la atención de salud libre de mercurio ha documentado la sustitución del mercurio en docenas de países. También ha producido una serie de recursos adicionales para los profesionales de la salud, gerentes de sistemas de salud y funcionarios del gobierno, que pueden ser útiles para el desarrollo y la implementación de políticas y estrategias de sustitución del mercurio en el sector de la salud.

Замена ртутных термометров и сфигмоманометров в системе здравоохранения: техническое руководство

Настоящее краткое руководство содержит указания по поэтапному проведению безопасной замены ртутных термометров и сфигмоманометров в учреждениях здравоохранения. В руководстве описываются имеющиеся ресурсы, позволяющие гарантировать, что альтернативные приборы обеспечат эквивалентную точность и сопоставимое клиническое применение, не оказывая при этом негативного воздействия на работников здравоохранения и окружающую среду. Руководство рассчитано на специалистов, занимающих ответственные должности в медицинских учреждениях или министерствах, которые стремятся перейти в сфере здравоохранения на безопасные технологии, не загрязняющие окружающую среду.Настоящее руководство подготовлено в рамках глобальной инициативы по замене ртутных приборов в системе здравоохранении, в осуществлении которой участвует Всемирная организация здравоохранения. Целью этой глобальной инициативы является содействие повсеместной замене медицинских инструментов, содержащих ртуть, на безопасные, доступные, точные альтернативные приборы. В рамках глобальной инициативы по замене инструментов, содержащих ртуть, уже документально подтверждены факты замены в десятках стран. В ходе осуществления инициативы медицинские специалисты, менеджеры системы здравоохранения и государственные служащие получили дополнительные ресурсы, которые могут быть эффективно использованы для разработки и осуществления политики и стратегии по замене инструментов, содержащих ртуть, в секторе здравоохранения.Настоящее руководство подготовлено в рамках глобальной инициативы по замене ртутных приборов в системе здравоохранении, в осуществлении которой участвует Всемирная организация здравоохранения. Целью этой глобальной инициативы является содействие повсеместной замене медицинских инструментов, содержащих ртуть, на безопасные, доступные, точные альтернативные приборы. В рамках глобальной инициативы по замене инструментов, содержащих ртуть, уже документально подтверждены факты замены в десятках стран. В ходе осуществления инициативы медицинские специалисты, менеджеры системы здравоохранения и государственные служащие получили дополнительные ресурсы, которые могут быть эффективно использованы для разработки и осуществления политики и стратегии по замене инструментов, содержащих ртуть, в секторе здравоохранения.

Can sustainable hospitals help bend the health care cost curve?

As policymakers seek to rein in the nation's escalating health care costs, one area deserving attention is the health system's costly environmental footprint. This study examines data from selected hospitals that have implemented programs to reduce energy use and waste and achieve operating room supply efficiencies. After standardizing metrics across the hospitals studied and generalizing results to hospitals nationwide, the analysis finds that savings achievable through these interventions could exceed $5.4 billion over five years and $15 billion over 10 years. Given the return on investment, the authors rec­ommend that all hospitals adopt such programs and, in cases where capital investments could be financially burdensome, that public funds be used to provide loans or grants, particularly to safety-net hospitals.

Alternatives to the mercury sphygmomanometer.

The mercury sphygmomanometer was introduced over 100 years ago. Mercury, however, is a potent human neurotoxin. An international effort has developed to eliminate health-care sources of mercury--the thermometer and sphygmomanometer--and replace them with less toxic alternatives. There is concern regarding the accuracy of these alternative devices. We conducted a literature review of articles published between 1995 and 2009 evaluating the accuracy of mercury, aneroid, and oscillometric blood pressure devices. Mercury sphygmomanometers fared the best although they do not always perform as expected, failing calibration tests between 1 and 28 per cent of the time. Up to 61 per cent of aneroid sphygmomanometers failed. Recently calibrated aneroid devices performed well. Oscillometric devices were less studied and their performance was variable. All three devices showed variable performance. They should be validated before purchase and calibrated on a regular basis.

Occupational injury disparities in the US hotel industry.

BACKGROUND: Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers. METHOD: OSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern. RESULTS: A total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk. CONCLUSION: Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed.

Niveles de plomo en sangre y factores asociados, en niños del municipio de Centro Habana / Blood lead levels and associated factors in children from Centro Habana municipality

La exposición al plomo y la consecuente intoxicación afecta múltiples sistemas del organismo humano y constituye un problema de salud mundial. Los niños son más vulnerables y las manifestaciones precoces de afectación se presentan con niveles de hasta 10 µg/ml. La falta de estudios recientes del problema en Cuba motivó esta investigación para evaluar los niveles elevados de plomo en sangre de niños expuestos entre 3 y 8 años de edad, e identificar factores asociados con estos. Se determinó el nivel de plomo en sangre en 85 niños residentes en casas construidas antes de 1928, en el municipio de Centro Habana. Las madres respondieron un cuestionario acerca de hábitos y conductas que exponen a los niños a la intoxicación con plomo; 40 por ciento de ellos tenían el plomo en sangre superior a 10 µg/dl. Los factores asociados fueron, entre otros: no lavarse las manos antes de alimentarse, jugar con juguetes de plomo, llevarse juguetes a la boca y comer tierra.

Niveles de plomo en sangre y factores asociados, en niños del municipio de Centro Habana / Blood lead levels and associated factors in children from Centro Habana municipality

La exposición al plomo y la consecuente intoxicación afecta múltiples sistemas del organismo humano y constituye un problema de salud mundial. Los niños son más vulnerables y las manifestaciones precoces de afectación se presentan con niveles de hasta 10 µg/ml. La falta de estudios recientes del problema en Cuba motivó esta investigación para evaluar los niveles elevados de plomo en sangre de niños expuestos entre 3 y 8 años de edad, e identificar factores asociados con estos. Se determinó el nivel de plomo en sangre en 85 niños residentes en casas construidas antes de 1928, en el municipio de Centro Habana. Las madres respondieron un cuestionario acerca de hábitos y conductas que exponen a los niños a la intoxicación con plomo; 40 por ciento de ellos tenían el plomo en sangre superior a 10 µg/dl. Los factores asociados fueron, entre otros: no lavarse las manos antes de alimentarse, jugar con juguetes de plomo, llevarse juguetes a la boca y comer tierra(AU)

Providing employer-arranged occupational medical care: conflicting interests.

It is said that ethics comprise principles of good conduct or standards governing the conduct of the members of a profession. These standards are unbending and strict, yet the reality is that occupational health professionals are subject to many conflicting pressures. Most of these stresses arise from the fact that employers and insurance companies, not worker-patients, fund OH services, and these two entities have overlapping, yet distinct, interests. OH professionals must consider the health and safety of individual workers as their top priority, while also addressing myriad other concerns. This is the moral challenge confronting practitioners.