Initial economic damage from the COVID-19 pandemic in the United States is more widespread across ages and geographies than initial mortality impacts

The economic and mortality impacts of the COVID-19 pandemic have been widely discussed, but there is limited evidence on their relationship across demographic and geographic groups. We use publicly available monthly data from January 2011 through April 2020 on all-cause death counts from the Centers for Disease Control and Prevention and employment from the Current Population Survey to estimate excess all-cause mortality and employment displacement in April 2020 in the United States. We report results nationally and separately by state and by age group. Nationally, excess all-cause mortality was 2.4 per 10,000 individuals (about 30% higher than reported COVID deaths in April) and employment displacement was 9.9 per 100 individuals. Across age groups 25 y and older, excess mortality was negatively correlated with economic damage; excess mortality was largest among the oldest (individuals 85 y and over: 39.0 per 10,000), while employment displacement was largest among the youngest (individuals 25 to 44 y: 11.6 per 100 individuals). Across states, employment displacement was positively correlated with excess mortality (correlation = 0.29). However, mortality was highly concentrated geographically, with the top two states (New York and New Jersey) each experiencing over 10 excess deaths per 10,000 and accounting for about half of national excess mortality. By contrast, employment displacement was more geographically spread, with the states with the largest point estimates (Nevada and Michigan) each experiencing over 16 percentage points employment displacement but accounting for only 7% of the national displacement. These results suggest that policy responses may differentially affect generations and geographies.

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Severity of the COVID-19 pandemic assessed with all-cause mortality in the United States during 2020.

10.22541/au.163251778.80333904/v1 ◽

2021 ◽

Author(s):

Fredrick Dahlgren ◽

Lauren Rossen ◽

Alicia Fry ◽

Carrie Reed

Keyword(s):

United States ◽

New York ◽

Age Groups ◽

The United States ◽

Mortality Data ◽

Demographic Groups ◽

High Severity ◽

All Cause Mortality ◽

The Impact ◽

Very High

Background. In the United States, infection with SARS-CoV-2 caused 380,000 reported deaths from March to December 2020. Methods. We adapted the Moving Epidemic Method to all-cause mortality data from the United States to assess the severity of the COVID-19 pandemic across age groups and all 50 states. By comparing all-cause mortality during the pandemic with intensity thresholds derived from recent, historical all-cause mortality, we categorized each week from March to December 2020 as either low severity, moderate severity, high severity, or very high severity. Results. Nationally for all ages combined, all-cause mortality was in the very high severity category for 9 weeks. Among people 18 to 49 years of age, there were 29 weeks of consecutive very high severity mortality. Forty-seven states, the District of Columbia, and New York City each experienced at least one week of very high severity mortality for all ages combined. Conclusions. These periods of very high severity of mortality during March through December 2020 are likely directly or indirectly attributable to the COVID-19 pandemic. This method for standardized comparison of severity over time across different geographies and demographic groups provides valuable information to understand the impact of the COVID-19 pandemic and to identify specific locations or subgroups for deeper investigations into differences in severity.

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The Under-Enrollment of HIV-infected Foster Children in Clinical Trials and Protocols and the Need for Corrective State Action

American Journal of Law & Medicine ◽

10.1017/s0098858800007164 ◽

1994 ◽

Vol 20 (3) ◽

pp. 231-249

Author(s):

Briar McNutt

Keyword(s):

United States ◽

New York ◽

Hiv Infection ◽

The United States ◽

Hiv And Aids ◽

Medical Community ◽

State Action ◽

Pediatric Aids ◽

Control And Prevention ◽

Year 2000

The incidence of HIV infection and AIDS in children has grown at an alarming rate. Approximately one million children worldwide have HIV infection. By the year 2000, an estimated ten million children will suffer from the disease. Currently, the United States has a population of an estimated 10,000 to 20,000 HIV-infected children. As of June 30, 1993, the Centers for Disease Control and Prevention (CDC) reported 4,710 known AIDS cases in children twelve years-old and younger. At that point, New York City reported 1,124 pediatric AIDS cases which represented twenty-four percent of all cases in the United States.With the rising number of HIV-infected children, the medical community in the United States has begun to search for HIV-and AIDS-related treatments particularized for children. In addition to establishing guidelines for HIV-infected children's frequent check-ups and timely immunizations, the medical community has initiated research studies involving HIV-infected children.

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2765. Pediatric Mumps during the 2015–2017 Mumps Resurgence in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2442 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S975-S975

Author(s):

Mariel Marlow ◽

John Zhang ◽

Nakia S Clemmons ◽

Mona Marin ◽

Manisha Patel ◽

...

Keyword(s):

United States ◽

Children And Adolescents ◽

Surveillance System ◽

Pediatric Patients ◽

Age Groups ◽

Exposure Period ◽

The United States ◽

College Campuses ◽

Control And Prevention ◽

Low Rate

Abstract Background Numerous mumps outbreaks occurred in the United States over the last decade, with outbreaks affecting young adults on college campuses being among the largest and most widely publicized. However, at least half of mumps cases and outbreaks occurred in other age-groups and settings. We describe reported mumps cases among children and adolescents during 2015 through 2017. Methods The Centers for Disease Control and Prevention (CDC) analyzed reports of confirmed and probable mumps cases in persons aged ≤18 years (defined here as pediatric mumps) transmitted electronically through the Nationally Notifiable Diseases Surveillance System (NNDSS) by the 52 reporting jurisdictions. Results Between January 1, 2015 and December 31, 2017, 49 jurisdictions reported 4,886 pediatric mumps cases (35% of all US reported cases, 13,807); 8 jurisdictions reported >100 cases each, representing 82% of all pediatric cases. Overall, 29 (1%) cases were in infants <1 yr, 406 (8%) were in children aged 1–4 years, 1,408 (29%) in children aged 5–10 years, 1,365 (28%) in adolescents aged 11–14 years, and 1,678 (34%) in adolescents aged 15–18 years. Most (3,548, 73%) cases did not travel outside the state during their exposure period; only 37 (1%) traveled outside the country. Cases in patients aged 1–4 years were more frequently non-outbreak associated (38%) than those in patients <1 years and 5–18 years (24% and 9%, respectively). Among 3,309 (68%) patients with known number of MMR doses received, 81% of those 5–18 years had ≥2 MMR doses, while 67% of those 1–4 years had ≥1 dose. Median time since last MMR dose for patients with 2 doses was 8 years (IQR: 4, 11 years). Four patients had meningitis and 1 had encephalitis; all were ≥10 years old and previously received 2 MMR doses. Of male mumps patients older than 10 years of age (2,113), 46 (2%) reported having orchitis; of these, 33 (72%) had 2 MMR doses. Sixty-four patients were hospitalized and there were no deaths. Conclusion About one-third of cases reported during the recent US mumps resurgence were in children and adolescents. The low rate of mumps complications compared with previous studies suggests mumps complications may not be adequately captured in national surveillance or identified by providers. Providers should remain vigilant that mumps can still occur among fully vaccinated pediatric patients, even those recently vaccinated. Disclosures All authors: No reported disclosures.

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Trends in incidence and epidemiologic characteristics of cerebral venous thrombosis in the United States

Neurology ◽

10.1212/wnl.0000000000010598 ◽

2020 ◽

Vol 95 (16) ◽

pp. e2200-e2213 ◽

Cited By ~ 1

Author(s):

Fadar Oliver Otite ◽

Smit Patel ◽

Richa Sharma ◽

Pushti Khandwala ◽

Devashish Desai ◽

...

Keyword(s):

United States ◽

New York ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Census Data ◽

Age Groups ◽

The United States ◽

Joinpoint Regression ◽

Over Time ◽

Age And Sex

ObjectiveTo test the hypothesis that race-, age-, and sex-specific incidence of cerebral venous thrombosis (CVT) has increased in the United States over the last decade.MethodsIn this retrospective cohort study, validated ICD codes were used to identify all new cases of CVT (n = 5,567) in the State Inpatients Databases (SIDs) of New York and Florida (2006–2016). A new CVT case was defined as first hospitalization for CVT in the SID without prior CVT hospitalization. CVT counts were combined with annual Census data to compute incidence. Joinpoint regression was used to evaluate trends in incidence over time.ResultsFrom 2006 to 2016, annual age- and sex-standardized incidence of CVT in cases per 1 million population ranged from 13.9 to 20.2, but incidence varied significantly by sex (women 20.3–26.9, men 6.8–16.8) and by age/sex (women 18–44 years of age 24.0–32.6, men 18–44 years of age 5.3–12.8). Incidence also differed by race (Blacks: 18.6–27.2; Whites: 14.3–18.5; Asians: 5.1–13.8). On joinpoint regression, incidence increased across 2006 to 2016, but most of this increase was driven by an increase in all age groups of men (combined annualized percentage change [APC] 9.2%, p < 0.001), women 45 to 64 years of age (APC 7.8%, p < 0.001), and women ≥65 years of age (APC 7.4%, p < 0.001). Incidence in women 18 to 44 years of age remained unchanged over time.ConclusionCVT incidence is disproportionately higher in Blacks compared to other races. New CVT hospitalizations increased significantly over the last decade mainly in men and older women. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or an artifactual increase from improved detection.

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COVID-19 and Treatment and Immunization of Children—The Time to Redefine Pediatric Age Groups is Here

Rambam Maimonides Medical Journal ◽

10.5041/rmmj.10433 ◽

2021 ◽

Vol 12 (2) ◽

pp. e0010

Author(s):

Klaus Rose ◽

◽

Jane M. Grant-Kels ◽

Earl B. Ettienne ◽

Oishi Tanjinatus ◽

...

Keyword(s):

United States ◽

Age Groups ◽

Drug Approval ◽

The United States ◽

The Body ◽

Kawasaki Syndrome ◽

Pediatric Age ◽

Prevention And Treatment ◽

Control And Prevention ◽

Inflammatory Syndrome

Children are infected with coronavirus disease 2019 (COVID-19) as often as adults, but with fewer symptoms. During the first wave of the COVID-19 pandemic, multisystem inflammatory syndrome (MIS) in children (MIS-C), with symptoms similar to Kawasaki syndrome, was described in young minors testing positive for COVID-19. The United States (US) Centers for Disease Control and Prevention (CDC) defined MIS-C as occurring in <21-year-olds, triggering hundreds of PubMed-listed papers. However, postpubertal adolescents are no longer children biologically; the term MIS-C is misleading. Furthermore, MIS also occurs in adults, termed MIS-A by the CDC. Acute and delayed inflammations can be triggered by COVID-19. The 18th birthday is an administrative not a biological age limit, whereas the body matures slowly during puberty. This blur in defining children leads to confusion regarding MIS-C/MIS-A. United States and European Union (EU) drug approval is handled separately for children, defined as <18-year-olds, ascribing non-existent physical characteristics up to the 18th birthday. This blur between the administrative and the physiological meanings for the term child is causing flawed demands for pediatric studies in all drugs and vaccines, including those against COVID-19. Effective treatment of all conditions, including COVID-19, should be based on actual physiological need. Now, the flawed definition for children in the development of drugs and vaccines and their approval is negatively impacting prevention and treatment of COVID-19 in minors. This review reveals the necessity for redefining pediatric age groups to rapidly establish recommendations for optimal prevention and treatment in minors.

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COVID-19 and excess mortality in the United States: A county-level analysis

PLoS Medicine ◽

10.1371/journal.pmed.1003571 ◽

2021 ◽

Vol 18 (5) ◽

pp. e1003571

Author(s):

Andrew C. Stokes ◽

Dielle J. Lundberg ◽

Irma T. Elo ◽

Katherine Hempstead ◽

Jacob Bor ◽

...

Keyword(s):

United States ◽

Formal Education ◽

Excess Mortality ◽

Time Lag ◽

The United States ◽

County Level ◽

Level Variation ◽

Cross Sectional ◽

All Cause Mortality ◽

Excess Deaths

Background Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. Methods and findings In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. Conclusions In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.

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Modeling of COVID-19 Transmission Dynamics on US Population: Inter-transfer Infection in Age Groups, Mutant Variants, and Vaccination Strategies

10.1101/2021.09.25.21264118 ◽

2021 ◽

Author(s):

Jyotirmoy Roy ◽

Samuel Heath ◽

Doraiswami Ramkrishna ◽

Shiyan Wang

Keyword(s):

United States ◽

Large Fraction ◽

Age Groups ◽

The United States ◽

Vaccination Strategies ◽

Health Authorities ◽

Mutant Variant ◽

High Infection ◽

Control And Prevention ◽

Vaccine Distribution

The in-depth understanding of the dynamics of COVID-19 transmission among different age groups is of great interest for governments and health authorities so that strategies can be devised to reduce the pandemic's detrimental effects. We developed the SIRDV-Virulence epidemiological model based on a population balance equation to study the effect of mutants of the virus and the effect of vaccination strategies on mitigating the transmission among the population in the United States. Based on the available data from the Centers for Disease Control and Prevention (CDC), we obtain the key parameters governing the dynamic evolution of the spread of the COVID-19 pandemic. In the context studied, the results show that a large fraction of infected cases comes from the adult and children populations in the presence of a mutant variant of COVID-19 with high infection rates. We further investigate the optimum vaccine distribution strategy among different age groups. Given the current situation in the United States, the results show that prioritizing children and adult vaccinations over that of seniors can contain the spread of the active cases, thereby preventing the healthcare system from being overwhelmed and minimizing subsequent deaths. The model suggests that the only option to curb the effects of this pandemic is to reduce the population of unvaccinated individuals. A higher fraction of 'Anti/Non-vaxxers' can lead to the resurgence of the pandemic.

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Relative disease burdens of COVID-19 and seasonal influenza in New York City, February 1 - April 18, 2020

10.1101/2020.04.22.20073551 ◽

2020 ◽

Author(s):

Jeremy Samuel Faust ◽

Carlos del Rio

Keyword(s):

New York ◽

New York City ◽

York City ◽

Seasonal Influenza ◽

The United States ◽

Time Interval ◽

Time Period ◽

All Cause Mortality ◽

Control And Prevention ◽

Mortality Estimates

AbstractComparisons between the mortality burdens of COVID-19 and seasonal influenza often fail to account for the fact that the United States Centers for Disease Control and Prevention (CDC) reports annual influenza mortality estimates which are calculated based upon a series of assumptions about the underreporting of flu deaths. COVID-19 deaths, in contrast, are being reported as raw counts. In this report, we compare COVID-19 death counts to seasonal influenza death counts in New York City during the interval from February 1 - April 18, 2020. Using this approach, COVID-19 appears to have caused 21.4 times the number of deaths as seasonal influenza during the same period. We also assessed excess mortality in order to verify this finding. New York City has had approximately 13,032 excess all-cause mortality deaths during this time period. We assume that most of these deaths are COVID-19 related. We therefore calculated the ratio of excess deaths (i.e. assumed COVID-19 deaths) to seasonal influenza deaths during the same time interval and found a similar ratio of 21.1 COVID-19 to seasonal influenza deaths. Our findings are consistent with conditions on the ground today. Comparing COVID-19 deaths with CDC estimates of yearly influenza-related deaths would suggest that, this year, seasonal influenza has killed approximately the same number of Americans as COVID-19 has. This does not comport with the realities of the pandemic we see today.

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Mortality among Adults Ages 25-44 in the United States During the COVID-19 Pandemic

10.1101/2020.10.21.20217174 ◽

2020 ◽

Author(s):

Jeremy Samuel Faust ◽

Harlan M. Krumholz ◽

Katherine L. Dickerson ◽

Zhenqiu Lin ◽

Cleavon Gilman ◽

...

Keyword(s):

United States ◽

New York ◽

The United States ◽

Relative Increase ◽

Opioid Overdose ◽

Public Data ◽

Control And Prevention ◽

Incident Rate ◽

Opioid Deaths ◽

Overdose Deaths

AbstractIntroductionCoronavirus disease-19 (COVID-19) has caused a marked increase in all-cause deaths in the United States, mostly among adults aged 65 and older. Because younger adults have far lower infection fatality rates, less attention has been focused on the mortality burden of COVID-19 in this demographic.MethodsWe performed an observational cohort study using public data from the National Center for Health Statistics at the United States Centers for Disease Control and Prevention, and CDC Wonder. We analyzed all-cause mortality among adults ages 25-44 during the COVID-19 pandemic in the United States. Further, we compared COVID-19-related deaths in this age group during the pandemic period to all drug overdose deaths and opioid-specific overdose deaths in each of the ten Health and Human Services (HHS) regions during the corresponding period of 2018, the most recent year for which data are available.ResultsAs of September 6, 2020, 74,027 all-cause deaths occurred among persons ages 25-44 years during the period from March 1st to July 31st, 2020, 14,155 more than during the same period of 2019, a 23% relative increase (incident rate ratio 1.23; 95% CI 1.21–1.24), with a peak of 30% occurring in May (IRR 1.30; 95% CI 1.27-1.33). In HHS Region 2 (New York, New Jersey), HHS Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), and HHS Region 9 (Arizona, California, Hawaii, Nevada), COVID-19 deaths exceeded 2018 unintentional opioid overdose deaths during at least one month. Combined, 2,450 COVID-19 deaths were recorded in these three regions during the pandemic period, compared to 2,445 opioid deaths during the same period of 2018.MeaningWe find that COVID-19 has likely become the leading cause of death—surpassing unintentional overdoses—among young adults aged 25-44 in some areas of the United States during substantial COVID-19 outbreaks.NoteThe data presented here have since been updated. As a result, an additional 1,902 all-cause deaths occurring among US adults ages 25-44 during the period of interest are not accounted for in this manuscript.

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Anthrax in the United States – summary of cases confirmed by CDC

Weekly releases (1997–2007) ◽

10.2807/esw.05.44.02046-en ◽

2001 ◽

Vol 5 (44) ◽

Author(s):

Keyword(s):

United States ◽

New York ◽

New York City ◽

New Jersey ◽

Disease Control ◽

York City ◽

The United States ◽

Case Definition ◽

Washington Dc ◽

Control And Prevention

On the basis of a rigorous case definition (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a1.htm), the Centers for Disease Control and Prevention (CDC) in Atlanta has reported 16 confirmed cases of anthrax: two in Florida, four in New York City, five in New Jersey, and five in Washington DC. CDC is also reporting four suspect cases: three in New York City and one in New Jersey. The table below summarises the numbers of cases reported by 30 October 2001 (6pm ET).

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