Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study

ABSTRACTBackgroundThe United States is now the country reporting the highest number of 2019 coronavirus disease (COVID-19) cases and deaths. However, little is known about the epidemiology and burden of severe COVID-19 to inform planning within healthcare systems and modeling of intervention impact.MethodsWe assessed incidence, duration of hospitalization, and clinical outcomes of acute COVID-19 inpatient admissions in a prospectively-followed cohort of 9,596,321 individuals enrolled in comprehensive, integrated healthcare delivery plans from Kaiser Permanente in California and Washington state. We also estimated the effective reproductive number (RE) describing transmission in the study populations.ResultsData covered 1277 hospitalized patients with laboratory- or clinically-confirmed COVID-19 diagnosis by April 9, 2020. Cumulative incidence of first COVID-19 acute inpatient admission was 10.6-12.4 per 100,000 cohort members across the study regions. Mean censoring-adjusted duration of hospitalization was 10.7 days (2.5-97.5%iles: 0.8-30.1) among survivors and 13.7 days (2.5-97.5%iles: 1.7-34.6) among non-survivors. Among all hospitalized confirmed cases, censoring-adjusted probabilities of ICU admission and mortality were 41.9% (95% confidence interval: 34.1-51.4%) and 17.8% (14.3-22.2%), respectively, and higher among men than women. We estimated RE was 1.43 (1.17-1.73), 2.09 (1.63-2.69), and 1.47 (0.07-2.59) in Northern California, Southern California, and Washington, respectively, for infections acquired March 1, 2020. RE declined to 0.98 (0.76-1.27), 0.89 (0.74-1.06), and 0.92 (0.05-1.55) respectively, for infections acquired March 20, 2020.ConclusionsWe identify high probability of ICU admission, long durations of stay, and considerable mortality risk among hospitalized COVID-19 cases in the western United States. Reductions in RE have occurred in conjunction with implementation of non-pharmaceutical interventions.

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Hospitalization and mortality trends among patients with confirmed COVID-19 in the United States, April through August 2020

Journal of Public Health Research ◽

10.4081/jphr.2021.2244 ◽

2021 ◽

Author(s):

Jennifer L. Nguyen ◽

Michael Benigno ◽

Deepa Malhotra ◽

Maya Reimbaeva ◽

Ziphora Sam ◽

...

Keyword(s):

United States ◽

New England ◽

Clinical Outcomes ◽

Race And Ethnicity ◽

The United States ◽

Older Individuals ◽

Inpatient Mortality ◽

Mortality Trends ◽

Healthcare Database ◽

Icu Admission

Background: The United States has experienced high COVID-19 case counts, hospitalizations, and death rates. This retrospective analysis reports changing trends in the demographics and clinical outcomes of hospitalized US COVID-19 patients between April and August 2020.Design and Methods: The Premier Healthcare Database Special Release was used to examine patient demographics of hospitalized COVID-19 patients from all US Census Bureau divisions. Demographics included age, sex, race, and ethnicity. Clinical outcomes included in-hospital mortality, intensive care unit (ICU) admission, and receipt of invasive mechanical ventilation.Results: Overall, 146,491 hospitalized COVID-19 patients were included (mean [SD] age, 61.0 [18.4] years; 51.7% male; 29.6% White non-Hispanic). Monthly total hospitalizations decreased from 44,854 in April to 18,533 in August; ICU admissions increased from 19.8% to 23.6%, and ventilator use and inpatient mortality decreased from 18.6% to 14.5% and 21.0% to 11.4%, respectively. Inpatient mortality was highest in the Middle Atlantic division (20.3%), followed by the New England (19.0%), East North Central (14.2%), and Mountain (13.7%) divisions. Black non-Hispanic patients were overrepresented among hospitalizations (19.0%); this group comprises 12.2% of the US population. Patients aged <65 years made up 53% of hospitalizations and had lower inpatient mortality than those aged ≥65 years.Conclusions: Hospitalizations, ventilator use, and mortality decreased, while ICU admission rates increased from April to August 2020. Older individuals and Black non-Hispanics were found to be at elevated risk of severe outcomes. These trends could inform ongoing patient care and US public health policies to limit the further spread of SARS-CoV-2.

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Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the MAAGE Study in the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciab033 ◽

2021 ◽

Author(s):

Rachel M Burke ◽

Claire Mattison ◽

Zachary Marsh ◽

Kayoko Shioda ◽

Judy Donald ◽

...

Keyword(s):

United States ◽

Active Surveillance ◽

Acute Gastroenteritis ◽

Stool Specimen ◽

Healthcare Delivery ◽

Healthcare Setting ◽

The United States ◽

Healthcare Delivery System ◽

Kaiser Permanente ◽

Antibiotics Use

Abstract Background Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus. Methods Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014 – June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into one episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping. Results The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged <5 years (20.4 episodes per 1000 PY), followed by adults aged ≥65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY, astrovirus: 1.3 per 1000 PY, rotavirus: 0.5 per 1000 PY). Conclusions Viral enteropathogens, particularly norovirus, are an important contributor to MAAGE, especially among children <5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.

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Faculty Opinions recommendation of Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States: findings from the nationwide inpatient sample.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161903.623526 ◽

2009 ◽

Author(s):

Imre Noth

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Resource Utilization ◽

Nationwide Inpatient Sample ◽

The United States ◽

Recent Trends

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Faculty Opinions recommendation of Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14029956.15487056 ◽

2012 ◽

Author(s):

Gregory Hawkins ◽

Rebecca Slager

Keyword(s):

United States ◽

Clinical Outcomes ◽

Acute Asthma ◽

The United States ◽

Age Related

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Understanding and Promoting Racial Diversity in Healthcare Settings to Address Disparities in Pandemic Crisis Management

Journal of Primary Care & Community Health ◽

10.1177/21501327211018354 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110183

Author(s):

Azza Sarfraz ◽

Zouina Sarfraz ◽

Alanna Barrios ◽

Kuchalambal Agadi ◽

Sindhu Thevuthasan ◽

...

Keyword(s):

United States ◽

Health Disparities ◽

Racial Discrimination ◽

Clinical Training ◽

Minority Groups ◽

Mental Health Problems ◽

Minority Group ◽

Healthcare Delivery ◽

The United States ◽

Majority Group

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

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Is Distance to Drop Box an Appropriate Proxy for Drop Box Treatment? A Case Study of Washington State

American Politics Research ◽

10.1177/1532673x211022192 ◽

2021 ◽

pp. 1532673X2110221

Author(s):

Loren Collingwood ◽

Benjamin Gonzalez O’Brien

Keyword(s):

United States ◽

Voter Turnout ◽

The United States ◽

Washington State ◽

Individual Level ◽

Primary 52 ◽

The One ◽

Vote By Mail

In the United States, drop box mail-in voting has increased, particularly in the all vote by mail (VBM) states of Washington, Colorado, Utah, and Oregon. To assess if drop boxes improve voter turnout, research proxies box treatment by voters’ residence distance to nearest drop box. However, no research has tested the assumption that voters use drop boxes nearest their residence more so than they do other drop boxes. Using individual-level voter data from a 2020 Washington State election, we show that voters are more likely to use the nearest drop box to their residence relative to other drop boxes. In Washington’s 2020 August primary, 52% of drop box voters in our data used their nearest drop box. Moreover, those who either (1) vote by mail, or (2) used a different drop box from the one closest to their residence live further away from their closest drop box. Implications are discussed.

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Effect of specific non-pharmaceutical intervention policies on SARS-CoV-2 transmission in the counties of the United States

Nature Communications ◽

10.1038/s41467-021-23865-8 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Bingyi Yang ◽

Angkana T. Huang ◽

Bernardo Garcia-Carreras ◽

William E. Hart ◽

Andrea Staid ◽

...

Keyword(s):

United States ◽

Home Visiting ◽

Leisure Activities ◽

The United States ◽

Causal Effects ◽

Basic Reproductive Number ◽

Reproductive Number ◽

County Level ◽

Metapopulation Model ◽

Pharmaceutical Interventions

AbstractNon-pharmaceutical interventions (NPIs) remain the only widely available tool for controlling the ongoing SARS-CoV-2 pandemic. We estimated weekly values of the effective basic reproductive number (Reff) using a mechanistic metapopulation model and associated these with county-level characteristics and NPIs in the United States (US). Interventions that included school and leisure activities closure and nursing home visiting bans were all associated with a median Reff below 1 when combined with either stay at home orders (median Reff 0.97, 95% confidence interval (CI) 0.58–1.39) or face masks (median Reff 0.97, 95% CI 0.58–1.39). While direct causal effects of interventions remain unclear, our results suggest that relaxation of some NPIs will need to be counterbalanced by continuation and/or implementation of others.

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A scoping review of female drowning: an underexplored issue in five high-income countries

BMC Public Health ◽

10.1186/s12889-021-10920-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kym Roberts ◽

Ogilvie Thom ◽

Susan Devine ◽

Peter A. Leggat ◽

Amy E. Peden ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

United Kingdom ◽

New Zealand ◽

Clinical Outcomes ◽

Scoping Review ◽

The United States ◽

Clinical Treatment ◽

High Income ◽

Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

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