scholarly journals Implementation of Rapid and Frequent SARS-CoV2 Antigen Testing and Response in Congregate Homeless Shelters

2021 ◽  
Author(s):  
Andrés Aranda-Díaz ◽  
Elizabeth Imbert ◽  
Sarah Strieff ◽  
Dave Graham-Squire ◽  
Jennifer L Evans ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
San Francisco ◽  
Viable Alternative ◽  
Homeless Shelters ◽  
Minimal Support ◽  
Antigen Testing ◽  
Current Screening

AbstractBackgroundPeople experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses.MethodsWe piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation.ResultsReachWe offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study.Effectiveness2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters.AdoptionWe offered testing to all eligible participants within weeks of the project’s initiation.ImplementationAdaptations made to increase reach and improve consistency were promptly implemented.MaintenanceSan Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot.ConclusionRapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.

Complaint-Oriented “Services”: Shelters as Tools for Criminalizing Homelessness

2021 ◽  
Vol 693 (1) ◽  
pp. 264-283
Author(s):  
Chris Herring
Keyword(s):  
Public Health ◽  
San Francisco ◽  
Homeless People ◽  
Public Spaces ◽  
Health Initiatives ◽  
Public Health Initiatives

This article argues that the expansion of shelter and welfare provisions for the homeless can lead to increased criminalization of homeless people in public spaces. First, I document how repression of people experiencing homelessness by the police in San Francisco neighborhoods increased immediately after the opening of new shelters. Second, I reveal how shelter beds are used as a privileged tool of the police to arrest, cite, and confiscate property of the unhoused, albeit in the guise of sanitary and public health initiatives. I conclude by considering how shelters increasingly function as complaint-oriented “services,” aimed at addressing the interests of residents, businesses, and politicians, rather than the needs of those unhoused.

Screening at ports of entry for Ebola Virus Disease in England—a descriptive analysis of screening assessment data, 2014–2015

2020 ◽  
Author(s):  
Nicki L Boddington ◽  
Sophia Steinberger ◽  
Richard G Pebody
Keyword(s):  
Public Health ◽  
High Risk ◽  
Secondary Care ◽  
Ebola Virus ◽  
Virus Disease ◽  
Descriptive Analysis ◽  
Health Assessment ◽  
Ebola Virus Disease ◽  
Screening Assessment

Abstract Background In response to the outbreak of Ebola Virus Disease (EVD) in West Africa in 2014 and evidence of spread to other countries, pre-entry screening was introduced by PHE at five major ports of entry in the England. Methods All passengers that entered the England via the five ports returning from Liberia, Guinea and Sierra Leonne were required to complete a Health Assessment Form and have their temperature taken. The numbers, characteristics and outcomes of these passengers were analysed. Results Between 14 October 2014 and 13 October 2015, a total of 12 648 passengers from affected countries had been screened. The majority of passengers were assessed as having no direct contact with EVD cases or high-risk events (12 069, 95.4%), although 535 (4.2%) passengers were assessed as requiring public health follow-up. In total, 39 passengers were referred directly to secondary care, although none were diagnosed with EVD. One high-risk passenger was later referred to secondary care and diagnosed with EVD. Conclusions Collection of these screening data enabled timely monitoring of the numbers and characteristics of passengers screened for EVD, facilitated resourcing decisions and acted as a mechanism to inform passengers of the necessary public health actions.

scholarly journals Mask-Ematics: Modeling the Effects of Masks in COVID-19 Transmission in High-Risk Environments

Epidemiologia ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 207-226
Author(s):  
Anthony Morciglio ◽  
Bin Zhang ◽  
Gerardo Chowell ◽  
James M. Hyman ◽  
Yi Jiang
Keyword(s):  
Public Health ◽  
High Risk ◽  
Disease Transmission ◽  
Large Fraction ◽  
Critical Mass ◽  
Transmission Model ◽  
Reproductive Number ◽  
High Quality ◽  
Moderate Quality ◽  
Epidemic Size

The COVID-19 pandemic has placed an unprecedented burden on public health and strained the worldwide economy. The rapid spread of COVID-19 has been predominantly driven by aerosol transmission, and scientific research supports the use of face masks to reduce transmission. However, a systematic and quantitative understanding of how face masks reduce disease transmission is still lacking. We used epidemic data from the Diamond Princess cruise ship to calibrate a transmission model in a high-risk setting and derive the reproductive number for the model. We explain how the terms in the reproductive number reflect the contributions of the different infectious states to the spread of the infection. We used that model to compare the infection spread within a homogeneously mixed population for different types of masks, the timing of mask policy, and compliance of wearing masks. Our results suggest substantial reductions in epidemic size and mortality rate provided by at least 75% of people wearing masks (robust for different mask types). We also evaluated the timing of the mask implementation. We illustrate how ample compliance with moderate-quality masks at the start of an epidemic attained similar mortality reductions to less compliance and the use of high-quality masks after the epidemic took off. We observed that a critical mass of 84% of the population wearing masks can completely stop the spread of the disease. These results highlight the significance of a large fraction of the population needing to wear face masks to effectively reduce the spread of the epidemic. The simulations show that early implementation of mask policy using moderate-quality masks is more effective than a later implementation with high-quality masks. These findings may inform public health mask-use policies for an infectious respiratory disease outbreak (such as one of COVID-19) in high-risk settings.

scholarly journals Implications of Recent Revelations from Basic and Clinical Studies of Barrett’s Esophagus for Screening and Surveillance Strategies

2021 ◽  
Vol 1 (1) ◽  
pp. 86-92
Author(s):  
Stuart Jon Spechler ◽  
Rhonda F. Souza
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Prevention Strategies ◽  
Endoscopic Screening ◽  
Screening Practices ◽  
The Past ◽  
Screening And Surveillance ◽  
Gerd Symptoms ◽  
Current Screening

During the past several decades, while the incidence of esophageal adenocarcinoma (EAC) has risen dramatically, our primary EAC-prevention strategies have been endoscopic screening of individuals with GERD symptoms for Barrett’s esophagus (BE), and endoscopic surveillance for those found to have BE. Unfortunately, current screening practices have failed to identify most patients who develop EAC, and the efficacy of surveillance remains highly questionable. We review potential reasons for failure of these practices including recent evidence that most EACs develop through a rapid genomic doubling pathway, and recent data suggesting that many EACs develop from segments of esophageal intestinal metaplasia too short to be recognized as BE. We highlight need for a biomarker to identify BE patients at high risk for neoplasia (who would benefit from early therapeutic intervention), and BE patients at low risk (who would not benefit from surveillance). Promising recent efforts to identify such a biomarker are reviewed herein.

scholarly journals Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040817
Author(s):  
Patrick O'Byrne ◽  
Amanda Vandyk ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Outcome ◽  
Bivariate Analysis ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Risk Criteria

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

scholarly journals 448. Disproportionate Burden of COVID-19 on Latinx Residents among Hospitalized Patients at San Francisco’s Public Health Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S292-S292
Author(s):  
Vivek Jain ◽  
Lillian B Brown ◽  
Carina Marquez ◽  
Luis Rubio ◽  
Natasha Spottiswoode ◽  
...  
Keyword(s):  
Public Health ◽  
African American ◽  
San Francisco ◽  
Ethnic Disparities ◽  
Food Service ◽  
Lengths Of Stay ◽  
Hospital Deaths ◽  
Health Hospital ◽  
Disproportionate Burden ◽  
Overall Mortality

Abstract Background San Francisco implemented one of the earliest shelter-in-place public health mandates in the U.S., with flattened curves of diagnoses and deaths. We describe demographics, clinical features and outcomes of COVID-19 patients admitted to a public health hospital in a high population-density city with an early containment response. Methods We analyzed inpatients with COVID-19 admitted to San Francisco General Hospital (SFGH) from 3/5/2020–5/11/2020. SFGH serves a network of >63,000 patients (32% Latinx/24% Asian/19% African American/19% Caucasian). Demographic and clinical data through 5/18/2020 were abstracted from hospital records, along with ICU and ventilator utilization, lengths of stay, and in-hospital deaths. Results Of 157 admitted patients, 105/157 (67%) were male, median age was 49 (range 19-96y), and 127/157 (81%) of patients with COVID-19 were Latinx. Crowded living conditions were common: 60/157 (38%) lived in multi-family shared housing, 12/1578 (8%) with multigenerational families, and 8/157 (5%) were homeless living in shelters. Of 102 patients with ascertained occupations, most had frontline essential jobs: 23% food service, 14% construction/home maintenance, and 10% cleaning. Overall, 86/157 (55%) of patients lived in neighborhoods home to majority Latinx and African-American populations. Overall, 45/157 (29%) of patients needed ICU care, and 26/157 (17%) required mechanical ventilation; 20/26 (77%) of ventilated patients were successfully extubated, and 137/157 (87%) were discharged home. Median hospitalization duration was 4 days (IQR, 2–10), and only 6/157 (4%) patients died in hospital. Conclusion In San Francisco, where early COVID-19 mitigation was enacted, we report a stark, disproportionate COVID-19 burden on Latinx patients, who accounted for 81% of hospitalizations despite making up only 32% of the patient base and 15% of San Francisco’s total population. Latinx inpatients frequently lived in high-density settings, increasing household risk, and frequently worked essential jobs, potentially limiting the opportunity to effectively distance from others. We also report here favorable clinical outcomes and low overall mortality. However, an effective COVID-19 response must urgently address racial and ethnic disparities. Disclosures All Authors: No reported disclosures

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