Preliminary #Estimates of #Prevalence of Selected Underlying Health #Conditions Among Patients with #COVID19 — #USA, Feb. 12–Mar. 28 ’20 (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.]

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020

Early Release / March 31, 2020 / 69

CDC COVID-19 Response Team

CDC COVID-19 Response Team: Nancy Chow, CDC; Katherine Fleming-Dutra, CDC; Ryan Gierke, CDC; Aron Hall, CDC; Michelle Hughes, CDC; Tamara Pilishvili, CDC; Matthew Ritchey, CDC; Katherine Roguski, CDC; Tami Skoff, CDC; Emily Ussery, CDC.

Corresponding author: Katherine Fleming-Dutra, for the CDC COVID-19 Response Team, eocevent294@cdc.gov, 770-488-7100.

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: Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep. ePub: 31 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e2external icon.

 

Summary

  • What is already known about this topic?
    • Published reports from China and Italy suggest that risk factors for severe COVID-19 disease include underlying health conditions, but data describing underlying health conditions among U.S. COVID-19 patients have not yet been reported.
  • What is added by this report?
    • Based on preliminary U.S. data, persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions.
  • What are the implications for public health practice?
    • Strategies to protect all persons and especially those with underlying health conditions, including social distancing and handwashing, should be implemented by all communities and all persons to help slow the spread of COVID-19.

 

Abstract

On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic (1). As of March 28, 2020, a total of 571,678 confirmed COVID-19 cases and 26,494 deaths have been reported worldwide (2). Reports from China and Italy suggest that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions (3,4). U.S. older adults, including those aged ≥65 years and particularly those aged ≥85 years, also appear to be at higher risk for severe COVID-19–associated outcomes; however, data describing underlying health conditions among U.S. COVID-19 patients have not yet been reported (5). As of March 28, 2020, U.S. states and territories have reported 122,653 U.S. COVID-19 cases to CDC, including 7,162 (5.8%) for whom data on underlying health conditions and other known risk factors for severe outcomes from respiratory infections were reported. Among these 7,162 cases, 2,692 (37.6%) patients had one or more underlying health condition or risk factor, and 4,470 (62.4%) had none of these conditions reported. The percentage of COVID-19 patients with at least one underlying health condition or risk factor was higher among those requiring intensive care unit (ICU) admission (358 of 457, 78%) and those requiring hospitalization without ICU admission (732 of 1,037, 71%) than that among those who were not hospitalized (1,388 of 5,143, 27%). The most commonly reported conditions were diabetes mellitus, chronic lung disease, and cardiovascular disease. These preliminary findings suggest that in the United States, persons with underlying health conditions or other recognized risk factors for severe outcomes from respiratory infections appear to be at a higher risk for severe disease from COVID-19 than are persons without these conditions.

Keywords: SARS-CoV-2; COVID-19; USA; Intensive Care.

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#Feeding Low-Income #Children during the #Covid19 #Pandemic (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Feeding Low-Income Children during the Covid-19 Pandemic

Caroline G. Dunn, Ph.D., R.D., Erica Kenney, Sc.D., M.P.H., Sheila E. Fleischhacker, J.D., Ph.D., and Sara N. Bleich, Ph.D.

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As Covid-19 spreads throughout the United States, schools and child care facilities are balancing their role of helping to prevent disease transmission with ensuring access to food for children who rely on the federal nutrition safety net. Together, the U.S. Department of Agriculture (USDA) National School Lunch Program, School Breakfast Program, and Child and Adult Care Food Program serve nearly 35 million children daily, delivering vital nutrition and financial assistance to families in need.1 With such programs interrupted, an essential element of the Covid-19 response will be feeding children from low-income families.

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Keywords: SARS-CoV-2; COVID-19; Poverty; Society; Pediatrics.

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#SARS-CoV-2 #Testing: #Trials and #Tribulations (Am J Clin Pathol., summary)

[Source: American Journal of Clinical Pathology, full page: (LINK). Summary, edited.]

SARS-CoV-2 Testing: Trials and Tribulations

Ahmed Babiker, MD, Charlie W Myers, MD, Charles E Hill, MD, PhD, Jeannette Guarner, MD

American Journal of Clinical Pathology, aqaa052, https://doi.org/10.1093/ajcp/aqaa052

Published: 30 March 2020

Issue Section: Editorial

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Coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), started in the Wuhan province of China and is now a pandemic that has caused a great number of deaths across the globe.1,2 The number of cases in the United States is increasing steadily, and the epidemic curve mimics the start of the infection in both China and Italy. Due to challenges associated with ramping up testing capacity, reliable estimates of the number of infections in the United States are not available. Multiple people, including Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, have stated that testing for COVID-19 has been problematic,3 with some dubbing the situation “testgate.” Below we will explore the evolution of tests in the United States, alternative tests, the logistics of increasing testing, and issues regarding laboratory staffing in response to the increased demands of testing.

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

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#Epidemiology of #Covid19 in a Long-Term Care Facility in King County, #Washington (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M. McMichael, Ph.D., Dustin W. Currie, Ph.D., Shauna Clark, R.N., Sargis Pogosjans, M.P.H., Meagan Kay, D.V.M., Noah G. Schwartz, M.D., James Lewis, M.D., Atar Baer, Ph.D., Vance Kawakami, D.V.M., Margaret D. Lukoff, M.D., Jessica Ferro, M.P.H., Claire Brostrom-Smith, M.S.N., et al., for the Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team*

 

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

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

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#Spotlight on #Jails: #COVID19 #Mitigation Policies Needed Now (Clin Infect Dis., summary)

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

Spotlight on Jails: COVID-19 Mitigation Policies Needed Now

Alysse G. Wurcel MD MS1, Emily Dauria PhD MPH 2,3, Nicholas Zaller PhD4, Ank
Nijhawan MD5, Curt Beckwith MD6, Kathryn Nowotny PhD7, Lauren Brinkley-Rubinstein PhD8

1 Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and
Infectious Diseases, Boston MA 02111; 2 Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco; 401 Parnassus Avenue, San Francisco, CA, 94143; 3 Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry; 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110; 4 University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, 4301 West Markham #820, Little Rock, AR 72205; 5 University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, TX.; 6 Department of Medicine, Division of Infectious Diseases, The Miriam Hospital & Rhode Island Hospital; 7 Departner of Sociology, University of Miami 5202 University Drive, Merrick Building, Room 120D Coral Gables, FL 33146; 8 Department of Social Medicine, Center for Health Equity Research, University of North Carolina, Chapel Hill, 333 S. Columbia Street MacNider Hall #341 Chapel Hill, NC 27599

Corresponding Author: Alysse G. Wurcel MD MS, 800 Washington Street, Boston MA 02111, awurcel@tuftsmedicalcenter.org – 617 974 2799

Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa346/5812998 by guest on 28 March 2020

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Dear Editor, In response to the COVID-19 pandemic, healthcare institutions and public health experts are mobilizing to develop mitigation protocols based on the experiences of other countries, including China, South Korea, and Italy. Compared to these countries, the US has a higher incarceration rate, with 10.6 million people booked into jails each year.2 Jails pose a unique set of challenges to COVID-19 prevention, detection, and management mitigation that deserves immediate attention.

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

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#Asymptomatic and #Presymptomatic #SARS-CoV-2 #Infections in Residents of a Long-Term Care Skilled #Nursing #Facility — King County, #Washington, March 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.]

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

Early Release / March 27, 2020 / 69

Anne Kimball, MD1,2; Kelly M. Hatfield, MSPH1; Melissa Arons, MSc1,2; Allison James, PhD1,2; Joanne Taylor, PhD1,2; Kevin Spicer, MD1; Ana C. Bardossy, MD1,2; Lisa P. Oakley, PhD1,2; Sukarma Tanwar, MMed1,2; Zeshan Chisty, MPH1; Jeneita M. Bell, MD1; Mark Methner, PhD1; Josh Harney, MS1; Jesica R. Jacobs, PhD1,3; Christina M. Carlson, PhD1,3; Heather P. McLaughlin, PhD1; Nimalie Stone, MD1; Shauna Clark4; Claire Brostrom-Smith, MSN4; Libby C. Page, MPH4; Meagan Kay, DVM4; James Lewis, MD4; Denny Russell5; Brian Hiatt5; Jessica Gant, MS5; Jeffrey S. Duchin, MD4; Thomas A. Clark, MD1; Margaret A. Honein, PhD1; Sujan C. Reddy, MD1; John A. Jernigan, MD1; Public Health – Seattle & King County; CDC COVID-19 Investigation Team

Corresponding author: Anne Kimball, opu7@cdc.gov, 770-488-7100.

1 CDC COVID-19 Investigation Team; 2 Epidemic Intelligence Service, CDC; 3 Laboratory Leadership Service, CDC; 4 Public Health – Seattle & King County; 5 Washington State Public Health Laboratory.

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: Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. ePub: 27 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e1external icon.

 

Summary

  • What is already known about this topic?
    • Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.
  • What is added by this report?
    • Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
  • What are the implications for public health practice?
    • Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.

 

Abstract

Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription–polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).

(…)

Keywords: SARS-CoV-2; COVID-19; USA; Nosocomial Outbreaks.

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#Undocumented #US #Immigrants and #Covid19 (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Undocumented U.S. Immigrants and Covid-19

Kathleen R. Page, M.D., Maya Venkataramani, M.D., Chris Beyrer, M.D., M.P.H., and Sarah Polk, M.D., M.H.S.

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In 2019, as the “public charge” rule made its way through the U.S. court system, many low-income immigrant parents of American children in the Johns Hopkins pediatric practice asked our case managers to disenroll their children from the Supplemental Nutrition Assistance Program (SNAP), fearing it would affect their chances of obtaining legal status in the future or lead to deportation. The new public charge rule, which went into effect on February 24, 2020, states that “aliens are inadmissible to the United States if they are unable to care for themselves without becoming public charges” (www.uscis.gov/greencard/public-charge. opens in new tab).

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Disclosure forms provided by the authors are available at NEJM.org.

This article was published on March 27, 2020, at NEJM.org.

Author Affiliations: From Johns Hopkins University School of Medicine (K.R.P., M.V., S.P.), and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (C.B.) — both in Baltimore.

Keywords: USA; Migrants; COVID-19.

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