#Transmission of #SARS-CoV-2 Involving Residents Receiving #Dialysis in a Nursing Home — #Maryland, April 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020

Early Release / August 11, 2020 / 69

Benjamin F. Bigelow1,*; Olive Tang, PhD1,*; Gregory R. Toci1; Norberth Stracker, MS1,2; Fatima Sheikh, MD1; Kara M. Jacobs Slifka, MD3; Shannon A. Novosad, MD3; John A. Jernigan, MD3; Sujan C. Reddy, MD3; Morgan J. Katz, MD1

Corresponding author: Benjamin F. Bigelow, benbigelow@jhmi.edu.

1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland; 3CDC COVID-19 Response Team.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* These authors contributed equally to this work.

Suggested citation for this article: Bigelow BF, Tang O, Toci GR, et al. Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e4

 

Summary

  • What is already known about this topic?
    • Residents of long-term care facilities have high COVID-19–associated morbidity and mortality. More information is needed about SARS-CoV-2 introduction and transmission in nursing homes.
  • What is added by this report?
    • Investigation of a COVID-19 outbreak in a Maryland nursing home identified a significantly higher prevalence among residents receiving dialysis (47%) than among those not receiving dialysis (16%); 72% were asymptomatic at the time of testing.
  • What are the implications for public health practice?
    • Nursing home residents undergoing dialysis might be at a higher risk for SARS-CoV-2 infection because of exposures to staff members and community dialysis patients. Attention to infection control practices and surveillance in nursing homes and dialysis centers is critical to preventing nursing home COVID-19 outbreaks.

 

Abstract

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42).Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population.

(…)

Keywords: SARS-CoV-2; COVID-19; Institutional outbreaks; Maryland; USA.

——

#Facility-Wide #Testing for #SARS-CoV-2 in Nursing Homes — Seven #US Jurisdictions, March–June 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020

Early Release / August 11, 2020 / 69

Kelly M. Hatfield, MSPH1; Sujan C. Reddy, MD1; Kaitlin Forsberg, MPH1; Lauren Korhonen, MSPH1; Kelley Garner, MPH2; Trent Gulley, MPH2; Allison James, DVM, PhD2; Naveen Patil, MD2; Carla Bezold, ScD3; Najibah Rehman, MD3; Marla Sievers, MPH4; Benjamin Schram, MPH5; Tracy K. Miller, PhD5; Molly Howell, MPH5; Claire Youngblood, MA6; Hannah Ruegner, MPH6; Rachel Radcliffe, DVM6; Allyn Nakashima, MD7; Michael Torre, PhD7; Kayla Donohue, MPH8; Paul Meddaugh, MS8; Mallory Staskus, MS8; Brandon Attell, MA1; Caitlin Biedron, MD1; Peter Boersma, MPH1; Lauren Epstein, MD1; Denise Hughes1; Meghan Lyman, MD1; Leigh E. Preston, DrPH1; Guillermo V. Sanchez, MSHS, MPH1; Sukarma Tanwar, MMed1; Nicola D. Thompson, PhD1; Snigdha Vallabhaneni, MD1; Amber Vasquez, MD1; John A. Jernigan, MD1

Corresponding author: Kelly M. Hatfield, khatfield2@cdc.gov.

1CDC COVID-19 Response Team; 2Arkansas Department of Health; 3Detroit Health Department, Detroit, Michigan; 4New Mexico Department of Health; 5North Dakota Department of Health; 6South Carolina Department of Health and Environmental Control; 7Utah Department of Health; 8Vermont Department of Health.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kayla Donohue reports full-time employment at United Way of Northwest Vermont with temporary assignment to COVID-19 response at the Vermont Department of Health, which supported her work related to this publication. No other potential conflicts of interest were disclosed.

Suggested citation for this article: Hatfield KM, Reddy SC, Forsberg K, et al. Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e5

 

Summary

  • What is already known about this topic?
    • Facility-wide testing of health care personnel and nursing home residents for SARS-CoV-2 can inform strategies to prevent transmission.
  • What is added by this report?
    • In two health department jurisdictions, testing in facilities without a previous COVID-19 case identified a prevalence of 0.4%. Five health department jurisdictions that targeted facility-wide testing after identification of a case found a prevalence of 12%; for each additional day before completion of initial facility-wide testing, an estimated 1.3 additional cases were identified.
  • What are the implications for public health practice?
    • Performing facility-wide testing rapidly following identification of a case in a nursing home might facilitate control of transmission among residents and health care personnel. Strategies are needed to optimize facility-wide testing in nursing homes without a reported case.

 

Abstract

Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3–5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24–June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings.

(…)

Keywords: SARS-CoV-2; COVID-19; Diagnostic tests; Institutional outbreaks; USA.

——

#SARS-CoV-2 Neutralizing #Antibody #Titers in #Convalescent #Plasma and Recipients in New Mexico: An Open #Treatment Study in #COVID19 Patients (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

SARS-CoV-2 Neutralizing Antibody Titers in Convalescent Plasma and Recipients in New Mexico: An Open Treatment Study in COVID-19 Patients

Steven B Bradfute, PhD, Ivy Hurwitz, PhD, Alexandra V Yingling, MSc, Chunyan Ye, MSc, Qiuying Cheng, PhD, Timothy P Noonan, MD, Jay S Raval, MD, Nestor R Sosa, MD, Gregory J Mertz, MD, Douglas J Perkins, PhD, Michelle S Harkins, MD

The Journal of Infectious Diseases, jiaa505, https://doi.org/10.1093/infdis/jiaa505

Published: 11 August 2020

 

Abstract

Background

Convalescent plasma (CP) is a potentially important therapy for coronavirus disease 2019 (COVID-19). However, knowledge regarding neutralizing antibody (NAb) titers in donor plasma and their impact in acute COVID-19 patients remains largely undetermined. We measured NAb titers in CP and in acute COVID-19 patients before and after transfusion through the traditional FDA IND pathway.

Methods

We performed a single-arm interventional trial measuring NAb and total antibody titers before and after CP transfusion over a 14-day period in hospitalized patients with laboratory-confirmed severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Trial Registration: Clinicaltrials.gov identifier: NCT04434131 (https://clinicaltrials.gov/ct2/show/NCT04434131)

Results

NAb titers in the donor CP units were low (<1:40 to 1:160) and had no effect on recipient neutralizing activity one day after transfusion. NAb titers were detected in 6/12 patients upon enrollment and in 11/12 patients during at least two timepoints. Average titers peaked on day 7 and declined towards day 14 (P=0.004). NAb and IgG titers were correlated in donor plasma units (ρ=0.938, P<0.0001) and in the cumulative patient measures (ρ=0.781, P<0.0001).

Conclusions

CP infusion did not alter recipient NAb titers. Pre-screening of CP may be necessary for selecting donors with high levels of neutralizing activity for infusion into patients with COVID-19.

SARS-CoV-2, coronavirus, antibodies, neutralizing, convalescent, plasma

Issue Section: Major Article

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Keywords: SARS-CoV-2; COVID-19; Serotherapy; New Mexico; USA.

——

#COVID19–Associated Multisystem #Inflammatory #Syndrome in #Children — #USA, March–July 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Early Release / August 7, 2020 / 69

Shana Godfred-Cato, DO1; Bobbi Bryant, MPH1,2; Jessica Leung, MPH1; Matthew E. Oster, MD1; Laura Conklin, MD1; Joseph Abrams, PhD1; Katherine Roguski, MPH1; Bailey Wallace, MPH1,2; Emily Prezzato, MPH1; Emilia H. Koumans, MD1; Ellen H. Lee, MD3; Anita Geevarughese, MD3; Maura K. Lash, MPH3; Kathleen H. Reilly, PhD3; Wendy P. Pulver, MS4; Deepam Thomas, MPH5; Kenneth A. Feder, PhD6; Katherine K. Hsu, MD7; Nottasorn Plipat, MD, PhD8; Gillian Richardson, MPH9; Heather Reid10; Sarah Lim, MBBCh11; Ann Schmitz, DVM12,13; Timmy Pierce, MPH1,2; Susan Hrapcak, MD1; Deblina Datta, MD1; Sapna Bamrah Morris, MD1; Kevin Clarke, MD1; Ermias Belay, MD1; California MIS-C Response Team

Corresponding author: Shana Godfred-Cato, nzt6@cdc.gov.

1CDC COVID-19 Response Team; 2Oak Ridge Institute for Science and Education; 3New York City Department of Health and Mental Hygiene; 4New York State Department of Health; 5New Jersey Department of Health; 6Epidemic Intelligence Service, Prevention and Health Promotion Administration, Maryland Department of Health; 7Massachusetts Department of Public Health; 8Pennsylvania Department of Health; 9Louisiana Department of Health; 10Illinois Department of Public Health; 11Minnesota Department of Health; 12Florida Department of Health; 13Career Epidemiology Field Officer Program, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 7 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e2

 

Summary

  • What is already known about this topic?
    • Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition that has been reported approximately 2–4 weeks after the onset of COVID-19 in children and adolescents.
  • What is added by this report?
    • Most cases of MIS-C have features of shock, with cardiac involvement, gastrointestinal symptoms, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2. Of the 565 patients who underwent SARS-CoV-2 testing, all had a positive test result by RT-PCR or serology.
  • What are the implications for public health practice?
    • Distinguishing MIS-C from other severe infectious or inflammatory conditions poses a challenge to clinicians caring for children and adolescents. As the COVID-19 pandemic continues to expand in many jurisdictions, health care provider awareness of MIS-C will facilitate early recognition, early diagnosis, and prompt treatment.

 

Abstract

In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients’ signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2–4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition,† and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2–4), had a less severe clinical course, or had features of Kawasaki disease.§ Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.

(…)

Keywords: SARS-CoV-2; COVID-19; Multisystem Inflammatory Syndrome; Pediatrics; USA.

——-

#Hospitalization #Rates and #Characteristics of #Children Aged <18 Years Hospitalized with Laboratory-Confirmed #COVID19 — COVID-NET, 14 States, March 1–July 25, 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020

Early Release / August 7, 2020 / 69

Lindsay Kim, MD1,2; Michael Whitaker, MPH1,3; Alissa O’Halloran, MSPH1; Anita Kambhampati, MPH1,4; Shua J. Chai, MD1,5; Arthur Reingold, MD5,6; Isaac Armistead, MD7; Breanna Kawasaki, MPH8; James Meek, MPH9; Kimberly Yousey-Hindes, MPH9; Evan J. Anderson, MD10,11; Kyle P. Openo, DrPH11; Andy Weigel, MSW12; Patricia Ryan, MSc13; Maya L. Monroe, MPH13; Kimberly Fox, MPH14; Sue Kim, MPH14; Ruth Lynfield, MD15; Erica Bye, MPH15; Sarah Shrum Davis, MPH16; Chad Smelser, MD17; Grant Barney, MPH18; Nancy L. Spina, MPH18; Nancy M. Bennett, MD19; Christina B. Felsen, MPH19; Laurie M. Billing, MPH20; Jessica Shiltz, MPH20; Melissa Sutton, MD21; Nicole West, MPH21; H. Keipp Talbot, MD22; William Schaffner, MD22; Ilene Risk, MPA23; Andrea Price23; Lynnette Brammer, MPH1; Alicia M. Fry, MD1,2; Aron J. Hall, DVM1; Gayle E. Langley, MD1; Shikha Garg, MD1,2; COVID-NET Surveillance Team

Corresponding author: Lindsay Kim; LKim@cdc.gov.

1CDC COVID-NET Team; 2US Public Health Service, Rockville, Maryland; 3Eagle Global Scientific, Atlanta, Georgia; 4Cherokee Nation Assurance, Arlington, Virginia; 5California Emerging Infections Program, Oakland, California; 6School of Public Health, University of California, Berkeley, Berkeley, California; 7University of Colorado Anschutz Medical Campus, Aurora, Colorado; 8Colorado Department of Public Health & Environment, Denver, Colorado; 9Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut; 10Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia; 11Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; 12Iowa Department of Public Health, Des Moines, Iowa; 13Maryland Department of Health, Baltimore, Maryland; 14Michigan Department of Health and Human Services, Lansing, Michigan; 15Minnesota Department of Health, St. Paul, Minnesota; 16New Mexico Emerging Infections Program, Albuquerque, New Mexico; 17New Mexico Department of Health, Santa Fe, New Mexico; 18New York State Department of Health, Albany, New York; 19University of Rochester School of Medicine and Dentistry, Rochester, New York; 20Ohio Department of Health, Columbus, Ohio; 21Public Health Division, Oregon Health Authority, Portland, Oregon; 22Vanderbilt University Medical Center, Nashville, Tennessee; 23Salt Lake County Health Department, Salt Lake City, Utah.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Evan Anderson reports personal fees from AbbVie, Pfizer and Sanofi Pasteur, and grants from MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Novavax, Sanofi Pasteur, Micron, and Janssen, outside the submitted work. William Schaffner reports personal fees from Pfizer and VBI Vaccines outside the submitted work. No other potential conflicts of interest were disclosed.

Suggested citation for this article: Kim L, Whitaker M, O’Halloran A, et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020. MMWR Morb Mortal Wkly Rep. ePub: 7 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e3

 

Summary

  • What is already known about this topic?
    • Most reported SARS-CoV-2 infections in children aged <18 years are asymptomatic or mild. Less is known about severe COVID-19 in children requiring hospitalization.
  • What is added by this report?
    • Analysis of pediatric COVID-19 hospitalization data from 14 states found that although the cumulative rate of COVID-19–associated hospitalization among children (8.0 per 100,000 population) is low compared with that in adults (164.5), one in three hospitalized children was admitted to an intensive care unit.
  • What are the implications for public health practice?
    • Children are at risk for severe COVID-19. Public health authorities and clinicians should continue to track pediatric SARS-CoV-2 infections. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.

 

Abstract

Most reported cases of coronavirus disease 2019 (COVID-19) in children aged <18 years appear to be asymptomatic or mild (1). Less is known about severe COVID-19 illness requiring hospitalization in children. During March 1–July 25, 2020, 576 pediatric COVID-19 cases were reported to the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects data on laboratory-confirmed COVID-19–associated hospitalizations in 14 states (2,3). Based on these data, the cumulative COVID-19-associated hospitalization rate among children aged <18 years during March 1–July 25, 2020, was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8). During March 21–July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Overall, Hispanic or Latino (Hispanic) and non-Hispanic black (black) children had higher cumulative rates of COVID-19–associated hospitalizations (16.4 and 10.5 per 100,000, respectively) than did non-Hispanic white (white) children (2.1). Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization. Although the cumulative rate of pediatric COVID-19–associated hospitalization remains low (8.0 per 100,000 population) compared with that among adults (164.5),* weekly rates increased during the surveillance period, and one in three hospitalized children were admitted to the ICU, similar to the proportion among adults. Continued tracking of SARS-CoV-2 infections among children is important to characterize morbidity and mortality. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.

(…)

Keywords: SARS-CoV-2; COVID-19; Pediatrics; USA.

—–

#Prevalence of #SARS-CoV-2 #Antibodies in #HealthCare Personnel in the #NYC Area (JAMA, abstract)

[Source: JAMA, full page: (LINK). Abstract, edited.]

Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area

Joseph Moscola, PA, MBA1; Grace Sembajwe, DSc, MSc, CIH2; Mark Jarrett, MD, MBA, MS1; et alBruce Farber, MD3; Tylis Chang, MD4; Thomas McGinn, MD, MPH2; Karina W. Davidson, PhD, MASc2; for the Northwell Health COVID-19 Research Consortium

JAMA. Published online August 6, 2020. doi:10.1001/jama.2020.14765

___

The greater New York City (NYC) area, including the 5 boroughs and surrounding counties, has a high incidence of coronavirus disease 2019 (COVID-19),1 and health care personnel (HCP) working there have a high exposure risk. HCP have expressed concerns about access to testing so that infection spread to patients, other HCP, and their families can be minimized.2 The Northwell Health System, the largest in New York State, sought to address this concern by offering voluntary antibody testing to all HCP. We investigated the prevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among HCP and associations with demographics, primary work location and type, and suspicion of virus exposure.

(…)

Keywords: SARS-CoV-2; COVID-19; Serology; Seroprevalence; HCWs; NYC; USA.

——

#COVID19 #Outbreak Among #Employees at a #Meat Processing #Facility — #SD, March–April 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

COVID-19 Outbreak Among Employees at a Meat Processing Facility — South Dakota, March–April 2020

Weekly / August 7, 2020 / 69(31);1015–1019

Jonathan Steinberg, MPH1,2,3; Erin D. Kennedy, DVM1; Colin Basler, DVM1; Michael P. Grant, ScD1; Jesica R. Jacobs, PhD1,4; Dustin Ortbahn, MPH3; John Osburn3; Sharon Saydah, PhD1; Suzanne Tomasi, DVM1; Joshua L. Clayton, PhD3

Corresponding author: Jonathan Steinberg, pia8@cdc.gov.

1CDC COVID-19 Response Team; 2Epidemic Intelligence Service, CDC; 3South Dakota Department of Health; 4Laboratory Leadership Service, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Steinberg J, Kennedy ED, Basler C, et al. COVID-19 Outbreak Among Employees at a Meat Processing Facility — South Dakota, March–April 2020. MMWR Morb Mortal Wkly Rep 2020;69:1015–1019. DOI: http://dx.doi.org/10.15585/mmwr.mm6931a2

 

  • What is already known about this topic?
    • Persons in congregate work settings are at increased risk for infection with respiratory pathogens, including SARS-CoV-2.
  • What is added by this report?
    • During March 16–April 25, 25.6% (929) of employees at a meat processing facility in South Dakota and 8.7% (210) of their contacts were diagnosed with COVID-19; two employees died. The highest attack rates occurred among employees who worked <6 feet (2 meters) from one another on the production line.
  • What are the implications for public health practice?
    • Implementing control measures before, or soon after, SARS-CoV-2 introduction into meat processing facilities, especially in areas where employees have prolonged, close contact with others, might substantially reduce the risk for SARS-CoV-2 spread within facilities.

 

Abstract

On March 24, 2020, the South Dakota Department of Health (SDDOH) was notified of a case of coronavirus disease 2019 (COVID-19) in an employee at a meat processing facility (facility A) and initiated an investigation to isolate the employee and identify and quarantine contacts. On April 2, when 19 cases had been confirmed among facility A employees, enhanced testing for SARS-CoV-2, the virus that causes COVID-19, was implemented, so that any employee with a COVID-19–compatible sign or symptom (e.g., fever, cough, or shortness of breath) could receive a test from a local health care facility. By April 11, 369 COVID-19 cases had been confirmed among facility A employees; on April 12, facility A began a phased closure* and did not reopen during the period of investigation (March 16−April 25, 2020). At the request of SDDOH, a CDC team arrived on April 15 to assist with the investigation. During March 16–April 25, a total of 929 (25.6%) laboratory-confirmed COVID-19 cases were diagnosed among 3,635 facility A employees. At the outbreak’s peak, an average of 67 cases per day occurred. An additional 210 (8.7%) cases were identified among 2,403 contacts of employees with diagnosed COVID-19. Overall, 48 COVID-19 patients were hospitalized, including 39 employees and nine contacts. Two employees died; no contacts died. Attack rates were highest among department-groups where employees tended to work in proximity (i.e., <6 feet [2 meters]) to one another on the production line. Cases among employees and their contacts declined to approximately 10 per day within 7 days of facility closure. SARS-CoV-2 can spread rapidly in meat processing facilities because of the close proximity of workstations and prolonged contact between employees (1,2). Facilities can reduce this risk by implementing a robust mitigation program, including engineering and administrative controls, consistent with published guidelines (1).

(…)

Keywords: SARS-CoV-2; COVID-19; South Dakota; USA; Epidemiology.

——

Notes from the Field: Characteristics of #Meat #Processing #Facility #Workers with Confirmed #SARS-CoV-2 Infection — #Nebraska, April–May 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Notes from the Field: Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection — Nebraska, April–May 2020

Weekly / August 7, 2020 / 69(31);1020–1022

Matthew Donahue, MD1,2; Nandini Sreenivasan, MD3; Derry Stover, MPH2; Anu Rajasingham, MPH3; Joanna Watson, DPhil3,4,5; Andreea Bealle, MPH3; Natasha Ritchison6; Thomas Safranek, MD2; Michelle A. Waltenburg, DVM1; Bryan Buss, DVM2,7; Jennita Reefhuis, PhD3

Corresponding author: Matthew Donahue, phu0@cdc.gov.

1Epidemic Intelligence Service, CDC; 2Nebraska Department of Health and Human Services; 3CDC COVID-19 Emergency Response Team; 4Division of Global Health Protection, Center for Global Health, CDC; 5Western States Division, National Institute for Occupational Safety and Health, CDC; 6Dakota County Health Department, Dakota City, Nebraska; 7Division of State and Local Readiness, Center for Preparedness and Response, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Donahue M, Sreenivasan N, Stover D, et al. Notes from the Field: Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection — Nebraska, April–May 2020. MMWR Morb Mortal Wkly Rep 2020;69:1020–1022. DOI: http://dx.doi.org/10.15585/mmwr.mm6931a3

 

Abstract

Coronavirus disease 2019 (COVID-19) has been reported nationwide among meat processing facility workers (1). In late April 2020, through flyers and text messages, workers at a Nebraska meat processing facility were invited by the facility, in partnership with the Nebraska Department of Health and Human Services, to be tested for current SARS-CoV-2, the virus that causes COVID-19, at their worksite, free of charge. Specimens were analyzed using reverse transcription–polymerase chain reaction (RT-PCR) by a contracting laboratory. This investigation was determined by CDC to be public health surveillance.* Among 1,216 Nebraska-resident meat processing facility workers tested, 375 (31%) had positive results. During May 8–25, case investigators attempted to interview the 349 workers who had positive test results and available phone numbers; five refused, 99 were not reached after five attempts, and four did not report symptom status, leaving 241 (69%) of the attempted interviews for analysis.

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Keywords: SARS-CoV-2; COVID-19; Nebraska; USA; Epidemiology.

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Serious Adverse #Health #Events, Including #Death, Associated with #Ingesting #Alcohol-Based #HandSanitizers Containing #Methanol — #Arizona and #NewMexico, May–June 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol — Arizona and New Mexico, May–June 2020

Early Release / August 5, 2020 / 69

Luke Yip, MD1; Danae Bixler, MD1; Daniel E. Brooks, MD2; Kevin R. Clarke, MD1; S. Deblina Datta, MD1; Steven Dudley Jr., PharmD3; Kenneth K. Komatsu4; Jennifer N. Lind, PharmD1; Annaliese Mayette, PhD5; Michael Melgar, MD1; Talia Pindyck, MD1; Kristine M. Schmit, MD1; Steven A. Seifert, MD6; Farshad Mazda Shirazi, MD, PhD3; Susan C. Smolinske, PharmD7; Brandon J. Warrick, MD6; Arthur Chang, MD1

Corresponding author: Luke Yip, lyip@cdc.gov.

1CDC COVID-19 Response Team; 2Banner Poison and Drug Information Center, Phoenix, Arizona; 3Arizona Poison and Drug Information Center, Tucson, Arizona; 4Division of Public Health Preparedness, Arizona Department of Health Services; 5Epidemiology and Response Division, New Mexico Department of Health; 6University of New Mexico School of Medicine, Albuquerque, New Mexico; 7New Mexico Poison and Drug Information Center, Albuquerque, New Mexico.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Steven Seifert reports personal fees from Taylor & Francis as Editor-in-Chief of Clinical Toxicology and from UpToDate as a paid author. Susan Smolinske reports grants from Health Resources and Services Administration for poison centers. No other potential conflicts of interest were disclosed.

Suggested citation for this article: Yip L, Bixler D, Brooks DE, et al. Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol — Arizona and New Mexico, May–June 2020. MMWR Morb Mortal Wkly Rep. ePub: 5 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e1

 

Summary

  • What is already known about this topic?
    • Alcohol-based hand sanitizers should only contain ethanol or isopropanol, but some products imported into the United States have been found to contain methanol.
  • What is added by this report?
    • From May 1 through June 30, 2020, 15 cases of methanol poisoning were reported in Arizona and New Mexico, associated with swallowing alcohol-based hand sanitizers. Four patients died, and three were discharged with visual impairment.
  • What are the implications for public health practice?
    • Alcohol-based hand sanitizer products should never be ingested. In patients with compatible signs and symptoms or after having swallowed hand sanitizer, prompt evaluation for methanol poisoning is required. Health departments in all states should coordinate with poison centers to identify cases of methanol poisoning.

 

 

Abstract

Alcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or isopropanol used to disinfect hands. Hand hygiene is an important component of the U.S. response to the emergence of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). If soap and water are not readily available, CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings (1); in health care settings, CDC recommendations specify that alcohol-based hand sanitizer products should contain 60%–95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient. Cases of ethanol toxicity following ingestion of alcohol-based hand sanitizer products have been reported in persons with alcohol use disorder (3,4). On June 30, 2020, CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, 2020, warning about specific hand sanitizers that contain methanol. Whereas early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (6). CDC and state partners established a case definition of alcohol-based hand sanitizer–associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. Medical records were reviewed to abstract details missing from poison center call records. During this period, 15 adult patients met the case definition, including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis.

(…)

Keywords: SARS-CoV-2; COVID-19; Toxic chemicals; Arizona; New Mexico; USA.

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Relationship of #GeorgeFloyd #protests to increases in #COVID19 cases using event study methodology (J Pub Health, abstract)

[Source: Journal of Public Health, full page: (LINK). Abstract, edited.]

Relationship of George Floyd protests to increases in COVID-19 cases using event study methodology

Randall Valentine, Dawn Valentine, Jimmie L Valentine

Journal of Public Health, fdaa127, https://doi.org/10.1093/pubmed/fdaa127

Published: 05 August 2020

 

Abstract

Background

Protests ignited by the George Floyd incident were examined for any significant impact on COVID-19 infection rates in select US cities.

Methods

Eight US cities were studied in which protestors in the tens of thousands were reported. Only cities that reside in states whose stay-at-home orders had been rescinded or expired for a minimum of 30 days were included in the sample to account for impact of growth rates solely due to economies reopening. Event study methodology was used with a 30-day estimation period to examine whether growth in COVID-19 infection rates was significant.

Results

In the eight cities analyzed, all had positive abnormal growth in infection rate. In six of the eight cities, infection rate growth was positive and significant.

Conclusions

In this study, it was apparent that violations of Centers for Disease Control and Prevention (CDC)-recommended social distancing guidelines caused a significant increase in infection rates. The data suggest that to slow the spread of COVID-19, CDC guidelines must be followed in protest situations.

COVID-19, public health, social distancing

Topic:  infections – growth rate – covid-19

Issue Section:  Original Article

Keywords: SARS-CoV-2; COVID-19; Society; Civil unrests; Epidemiology; USA.

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