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2.
Artigo em Inglês | MEDLINE | ID: mdl-33431724

RESUMO

Search and find methods*) such as cluster tracing1)-6) or large-scale PCR testing**) of those who exhibit no symptoms or only mild symptoms of COVID-19 is shown by data analysis to be a powerful means to suppress the spread of COVID-19 instead of, or in addition to, lockdown of the entire population. Here we investigate this issue by analyzing the data from some cities and countries and we establish that search and find method is as powerful as lockdown of a city or a country. Moreover, in contrast to lockdown, it neither causes inconvenience to citizens nor does it disrupt the economy. Generally speaking, it is advisable that both social distancing and increased test numbers be employed to suppress spread of the virus. The product of the total test number with the rate of positive cases is the crucial index.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis/métodos , África/epidemiologia , Infecções Assintomáticas/epidemiologia , Brasil/epidemiologia , /transmissão , China/epidemiologia , Controle de Doenças Transmissíveis/estatística & dados numéricos , Política de Saúde , Humanos , Imunidade Coletiva , Japão/epidemiologia , Los Angeles/epidemiologia , Modelos Biológicos , Modelos Estatísticos , New York/epidemiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Quarentena , Sensibilidade e Especificidade , Suécia/epidemiologia , Tóquio/epidemiologia , Estados Unidos/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33435462

RESUMO

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.


Assuntos
Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fumantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Humanos , New York/epidemiologia , Pandemias , Philadelphia/epidemiologia , Inquéritos e Questionários
4.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S19-S28, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33239560

RESUMO

CONTEXT: In March, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causal agent of coronavirus disease 2019 (COVID-19), was spreading in the Bay Area, especially in Santa Clara County, causing increases in cases, hospitalizations, and deaths. PROGRAM: The Association of Bay Area Health Officials (ABAHO) represents 13 Bay Area health jurisdictions. IMPLEMENTATION: On March 15, 2020, the local health officers of 7 ABAHO members (counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara and the city of Berkeley) decided to issue legal orders on March 16 for 6.7 million residents to shelter in place to prevent the spread of SARS-CoV-2, the causal agent of COVID-19. The Bay Area was the first region in the United States to shelter in place, and within days, other regions in the United States followed. EVALUATION: Subsequent comparative analyses have confirmed that acting early in issuing shelter-in-place orders prevented a large number of cases, hospitalizations, and deaths in the Bay Area throughout the United States. The quality of a decision-in this case, for crisis decision making-cannot be judged by the outcome. A good decision can have a bad outcome, and a bad decision can have a good outcome. The quality of a decision depends only on the quality of the decision-making process at the time the decision was made. DISCUSSION: In this Field Report, we review how we made this collective decision. With the benefit of hindsight and reflection, we recount our story through the lens of public health legal authority, meta-leadership, and decision intelligence. Our purpose is to improve the crisis decision-making skills of public health officials by improving how we make high-stakes decisions each day in our continuing fight to contain the SARS-CoV-2 pandemic, to save lives, and to eliminate COVID-19 racial/ethnic inequities.


Assuntos
/prevenção & controle , Guias como Assunto , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Política , Saúde Pública/legislação & jurisprudência , Saúde Pública/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Tomada de Decisões , Feminino , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias/estatística & dados numéricos , Estados Unidos/epidemiologia
5.
New Bioeth ; 26(4): 328-350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33196403

RESUMO

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.


Assuntos
Comércio/legislação & jurisprudência , Direitos Humanos , Legislação Médica/ética , Técnicas Reprodutivas/legislação & jurisprudência , Controle Social Formal , Mães Substitutas/legislação & jurisprudência , Acesso à Informação , Adulto , Criança , Bem-Estar da Criança , Comércio/ética , Infecções por Coronavirus/epidemiologia , Dissidências e Disputas , Família , Feminino , Humanos , Indústrias/ética , Indústrias/legislação & jurisprudência , Mães , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Direitos da Mulher
6.
Trials ; 21(1): 942, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225989

RESUMO

OBJECTIVES: To evaluate a therapeutic role for omega-3 fatty acid supplementation in the treatment of olfactory dysfunction associated with COVID-19 infection TRIAL DESIGN: Randomized, double-blinded, placebo-controlled trial PARTICIPANTS: Eligible patients are adults with self-reported new-onset olfactory dysfunction of any duration associated with laboratory-confirmed or clinically suspected COVID-19 patients. Exclusion criteria include patients with pre-existing olfactory dysfunction, history of chronic rhinosinusitis or history of sinus surgery, current use of nasal steroid sprays or omega-3 supplementation, fish allergy, or inability to provide informed consent for any reason. The trial is conducted at Mount Sinai Hospital INTERVENTION AND COMPARATOR: The intervention group will receive 2000 mg daily of omega-3 supplementation in the form of two "Fish Oil, Ultra Omega-3" capsules (product of Pharmavite®) daily. The comparator group will take 2 placebo capsules of identical size, shape, and odor daily for 6 weeks. MAIN OUTCOMES: Each subject will take a Brief Smell Identification Test at study enrolment and completion after 6 weeks. The primary outcome will be change in Brief Smell Identification Test over the 6-week period. RANDOMISATION: Patients will be randomized by the Investigational Drug Pharmacy at the Icahn School of Medicine at Sinai via a computer-generated sequence in a 1:1 allocation to treatment or control arms. BLINDING (MASKING): Both participants and researchers will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): There will be 88 participants randomized to each group. A total of 176 participants will be randomized. TRIAL STATUS: Protocol Version 1, 8/3/2020 Recruitment is ongoing, started 8/5/2020 with estimated completion 11/30/2020. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov with Protocol Identifier: NCT04495816 . TRIAL REGISTRATION: ClinicalTrials.gov, NCT04495816 . Registered 3 August 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1).


Assuntos
Infecções por Coronavirus/complicações , Suplementos Nutricionais/efeitos adversos , Ácidos Graxos Ômega-3/uso terapêutico , Transtornos do Olfato/tratamento farmacológico , Pneumonia Viral/complicações , Betacoronavirus/genética , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Suplementos Nutricionais/estatística & dados numéricos , Método Duplo-Cego , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , New York/epidemiologia , Transtornos do Olfato/etiologia , Pandemias , Placebos/administração & dosagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Olfato/efeitos dos fármacos , Olfato/fisiologia
9.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079852

RESUMO

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/terapia , Cuidados Críticos , Prestação Integrada de Cuidados de Saúde , Procedimentos Cirúrgicos Eletivos , Unidades de Terapia Intensiva/provisão & distribução , Admissão do Paciente , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Necessidades e Demandas de Serviços de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , New York/epidemiologia , Sistemas de Informação em Salas Cirúrgicas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Respiração Artificial , Fatores de Tempo , Ventiladores Mecânicos/provisão & distribução
11.
Oncology (Williston Park) ; 34(10): 432-441, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33058111

RESUMO

Worldwide incidence and mortality due to the coronavirus disease 2019 (COVID-19) pandemic is greatest in the United States, with the initial epicenter in New York. In Nassau County, New York, where we practice, our institution has had more than 2500 cases and has discharged from the hospital more than 1000 patients. As many academic and private institutions have swiftly shifted their clinical and research priorities to address the pandemic, data are emerging regarding both the impact of malignancy on COVID-19 outcomes as well as the challenges faced in assuring that cancer care remains unimpeded. Of concern, recent studies of cancer patients primarily in China and Italy have suggested that advanced malignancy is associated with increased susceptibility to severe COVID-19 infection. At present, more than 500 clinical trials are underway investigating the pathogenesis and treatment of COVID-19, including expanded use of oncology drugs, such as small molecular inhibitors of cytokine pathways. Here, we begin by reviewing the latest understanding of COVID-19 pathophysiology and then focus our attention on the impact of this virus on hematologic and oncologic practice. Finally, we highlight ongoing investigational treatment approaches that are so relevant to the care of oncology patients during this extraordinary pandemic.


Assuntos
Antineoplásicos , Betacoronavirus , Infecções por Coronavirus , Assistência à Saúde , Controle de Infecções , Oncologia , Neoplasias , Pandemias , Pneumonia Viral , Antineoplásicos/classificação , Antineoplásicos/farmacologia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Assistência à Saúde/tendências , Drogas em Investigação/farmacologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Oncologia/métodos , Oncologia/normas , Neoplasias/epidemiologia , Neoplasias/terapia , New York/epidemiologia , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Risco Ajustado/métodos , Medição de Risco
14.
Artigo em Inglês | MEDLINE | ID: mdl-32872174

RESUMO

The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.22; 95% CI, 0.20-0.24). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.


Assuntos
Desastres , Bombeiros/psicologia , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Trabalho de Resgate/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro , Ferimentos e Lesões/mortalidade , Feminino , Bombeiros/estatística & dados numéricos , Humanos , Masculino , New York/epidemiologia , Cidade de Nova Iorque/epidemiologia
16.
Cancer Cell ; 38(5): 661-671.e2, 2020 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-32997958

RESUMO

Patients with cancer may be at increased risk of severe coronavirus disease 2019 (COVID-19), but the role of viral load on this risk is unknown. We measured SARS-CoV-2 viral load using cycle threshold (CT) values from reverse-transcription polymerase chain reaction assays applied to nasopharyngeal swab specimens in 100 patients with cancer and 2,914 without cancer who were admitted to three New York City hospitals. Overall, the in-hospital mortality rate was 38.8% among patients with a high viral load, 24.1% among patients with a medium viral load, and 15.3% among patients with a low viral load (p < 0.001). Similar findings were observed in patients with cancer (high, 45.2% mortality; medium, 28.0%; low, 12.1%; p = 0.008). Patients with hematologic malignancies had higher median viral loads (CT = 25.0) than patients without cancer (CT = 29.2; p = 0.0039). SARS-CoV-2 viral load results may offer vital prognostic information for patients with and without cancer who are hospitalized with COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Hospitalização/estatística & dados numéricos , Neoplasias/mortalidade , Pneumonia Viral/complicações , Carga Viral , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/virologia , New York/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
18.
PLoS One ; 15(9): e0238560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877453

RESUMO

We illustrate and study the evolution of reported infections over the month of March in New York State as a whole, as well as in each individual county in the state. We identify piecewise exponential trends, and search for correlations between the timing and dynamics of these trends and statewide mandated measures on testing and social distancing. We conclude that the reports on April 1 may be dramatically under-representing the actual number of statewide infections, an idea which is supported by more recent retroactive estimates based on serological studies. A follow-up study is underway, reassessing data until June 1, using additional measures for validation and monitoring for effects of the PAUSE directive, and of the reopening timeline.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Comportamento , Betacoronavirus/isolamento & purificação , Participação da Comunidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Seguimentos , Hospitalização , Humanos , New York/epidemiologia , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia
19.
Medicine (Baltimore) ; 99(35): e21675, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871882

RESUMO

To assess the impact of allopurinol on diabetes in a retrospective cohort of Veterans' Affairs patients with gout.The New York Harbor VA computerized patient record system was searched to identify patients with an ICD-9 code for gout meeting at least 4 modified 1977 American Rheumatology Association gout diagnostic criteria. Patients were divided into subgroups based on >30 continuous days of allopurinol, versus no allopurinol. New diagnoses of diabetes, defined according to American Diabetes Association diagnostic criteria or clinical documentation explicitly stating a new diagnosis of diabetes, were identified during an observation period from January 1, 2000 through December 31, 2015.Six hundred six gout patients used allopurinol >30 continuous days, and 478 patients never used allopurinol. Over an average 7.9 ±â€Š4.8 years of follow-up, there was no significant difference in diabetes incidence between the allopurinol and non-allopurinol groups (11.7/1000 person-years vs 10.0/1000 person-years, P = .27). A lower diabetes incidence in the longest versus shortest quartiles of allopurinol use (6.3 per 1000 person-years vs 19.4 per 1000 person-years, P<.0001) was attributable to longer duration of medical follow-up.In this study, allopurinol use was not associated with decreased diabetes incidence. Prospective studies may further elucidate the relationship between hyperuricemia, gout, xanthine oxidase activity, and diabetes, and the potential impact of gout treatments on diabetes incidence.


Assuntos
Alopurinol/uso terapêutico , Diabetes Mellitus Tipo 2/epidemiologia , Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Alopurinol/administração & dosagem , Colchicina/uso terapêutico , Feminino , Seguimentos , Supressores da Gota/administração & dosagem , Humanos , Incidência , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Ácido Úrico/sangue
20.
J Med Internet Res ; 22(9): e23565, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32930099

RESUMO

BACKGROUND: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic. OBJECTIVE: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls. METHODS: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed. RESULTS: Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%. CONCLUSIONS: This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study.


Assuntos
Infecções por Coronavirus/mortalidade , Demografia , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva , Masculino , Registros Médicos , Pessoa de Meia-Idade , New York/epidemiologia , Oxigênio/metabolismo , Pandemias , Adulto Jovem
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