Population immunity to SARS-CoV-2 in US states and counties due to infection and vaccination, January 2020-November 2021

Importance: Prior infection and vaccination both contribute to population-level SARS-CoV-2 immunity. Population-level immunity will influence future transmission and disease burden. Objective: For each US county and state, we estimated the fraction of the population with prior immunological exposure to SARS-CoV-2 (ever infected with SARS-CoV-2 and/or received one or more doses of a COVID-19 vaccine) as well as the fraction with effective protection against infection and severe disease from prevalent SARS-CoV-2 variants, from January 1st, 2020, to October 31st, 2021. Design, settings, participants: We used daily SARS-CoV-2 infection estimates for each US state and county, derived based on reported data on COVID-19 cases and deaths. We collated county-level vaccination coverage data and estimated the fraction of individuals both vaccinated and previously infected using the Census Bureau Household Pulse Survey. We used published evidence on natural and vaccine-induced immunity, and how protection wanes over time. We used a Bayesian model to synthesize evidence and estimate population immunity outcomes. Main Outcomes and Measures: Primary outcomes were the fraction of the population with (i) a history of exposure to SARS-CoV-2 infection or COVID-19 vaccination or both, (ii) effective protection against infection, and (iii) effective protection against severe disease. We estimated outcomes for each US state and county from January 1st, 2020, to October 31st, 2021. Results: The estimated percentage of the US population with a history of SARS-CoV-2 infection or vaccination, as of October 31, 2021, was 86.2% (95%CrI: 82.2%-93.0%), compared to 24.9% (95%CrI: 18.5%-34.1%) on January 1, 2021. State-level estimates for October 31, 2021, ranged between 72.2% (95%CrI: 62.5%-83.3%, West Virginia) and 92.3% (95%CrI: 88.6%-96.1%, Florida). Accounting for waning, the effective protection against infection with prevalent strains as of October 31 was 49.9% (95%CrI: 45.4%-56.6%) nationally and ranged between 37.2% (95%CrI: 33.4%-44.7%, Vermont) and 59.5% (95%CrI: 56.4%-66.0%, Florida). Effective protection against severe disease was 77.4% (95%CrI: 73.7%-83.4%) nationally and ranged between 62.9% (95%CrI: 55.2%-73.3%, West Virginia) and 83.8% (95%CrI: 80.7%-88.0%, Florida). Conclusions and Relevance: The fraction of the population with effective protection against SARS-CoV-2 infection and severe COVID-19 varies across the United States, but a substantial proportion of the population remains susceptible.

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Personalized stratification of back to work risk amidst COVID-19: A machine learning approach (Preprint)

10.2196/preprints.22030 ◽

2020 ◽

Author(s):

Carson Lam ◽

Jacob Calvert ◽

Gina Barnes ◽

Emily Pellegrini ◽

Anna Lynn-Palevsky ◽

...

Keyword(s):

Machine Learning ◽

High Risk ◽

Learning Algorithm ◽

Severe Disease ◽

High Specificity ◽

Population Level ◽

The United States ◽

Health Condition ◽

Available P ◽

Severe Illness

BACKGROUND In the wake of COVID-19, the United States has developed a three stage plan to outline the parameters to determine when states may reopen businesses and ease travel restrictions. The guidelines also identify subpopulations of Americans that should continue to stay at home due to being at high risk for severe disease should they contract COVID-19. These guidelines were based on population level demographics, rather than individual-level risk factors. As such, they may misidentify individuals at high risk for severe illness and who should therefore not return to work until vaccination or widespread serological testing is available. OBJECTIVE This study evaluated a machine learning algorithm for the prediction of serious illness due to COVID-19 using inpatient data collected from electronic health records. METHODS The algorithm was trained to identify patients for whom a diagnosis of COVID-19 was likely to result in hospitalization, and compared against four U.S policy-based criteria: age over 65, having a serious underlying health condition, age over 65 or having a serious underlying health condition, and age over 65 and having a serious underlying health condition. RESULTS This algorithm identified 80% of patients at risk for hospitalization due to COVID-19, versus at most 62% that are identified by government guidelines. The algorithm also achieved a high specificity of 95%, outperforming government guidelines. CONCLUSIONS This algorithm may help to enable a broad reopening of the American economy while ensuring that patients at high risk for serious disease remain home until vaccination and testing become available.

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American Policy in Gifted Education

Gifted Child Today ◽

10.1177/1076217517753020 ◽

2018 ◽

Vol 41 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

Joyce VanTassel-Baska

Keyword(s):

Education Policy ◽

Gifted Education ◽

National Level ◽

State Level ◽

The United States ◽

Specific Aspect ◽

Policy And Practice ◽

Case Examples ◽

Gifted Program ◽

History Of

This article explores the history of gifted education policy and practice in the United States over the last five decades, documenting the lack of sustained progress in obtaining sustained federal support. It also highlights two case examples, one at the state level and a second at the national level of where a policy in a specific aspect of gifted program development has been successfully advanced. Implications of the article suggest that gifted education policy is not coherent across the country, is controlled by state legislatures, and subject to annual scrutiny for continued and new funding.

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Looking for Rights in All the Wrong Places

10.23943/princeton/9780691155777.001.0001 ◽

2013 ◽

Cited By ~ 1

Author(s):

Emily Zackin

Keyword(s):

State Level ◽

The United States ◽

State Governments ◽

Constitutional Rights ◽

State Constitutions ◽

Positive Rights ◽

History Of ◽

Constitutional Tradition ◽

Fundamental Values ◽

The U.S

Unlike many national constitutions, which contain explicit positive rights to such things as education, a living wage, and a healthful environment, the U.S. Bill of Rights appears to contain only a long list of prohibitions on government. American constitutional rights, we are often told, protect people only from an overbearing government, but give no explicit guarantees of governmental help. This book argues that we have fundamentally misunderstood the American rights tradition. The United States actually has a long history of enshrining positive rights in its constitutional law, but these rights have been overlooked simply because they are not in the U.S. Constitution. The book shows how they instead have been included in America's state constitutions, in large part because state governments, not the federal government, have long been primarily responsible for crafting American social policy. Although state constitutions, seemingly mired in trivial detail, can look like pale imitations of their federal counterpart, they have been sites of serious debate, reflect national concerns, and enshrine choices about fundamental values. This book looks in depth at the history of education, labor, and environmental reform, explaining why America's activists targeted state constitutions in their struggles for government protection from the hazards of life under capitalism. Shedding light on the variety of reasons that activists pursued the creation of new state-level rights, the book challenges us to rethink our most basic assumptions about the American constitutional tradition.

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A People’s History of American Prohibition

10.1093/oso/9780190841577.003.0016 ◽

2021 ◽

pp. 450-486

Author(s):

Mark Lawrence Schrad

Keyword(s):

Native Americans ◽

American South ◽

Good Governance ◽

State Level ◽

The United States ◽

Black Communities ◽

Upton Sinclair ◽

History Of ◽

The American South ◽

Elected Representatives

Chapter 16 examines the predations of the parasitic Gilded Age “liquor trusts”--akin to the big railroad, steel, and financial trusts--including the United States Brewers’ Association and the Liquor Dealers’ Association, which corrupted law enforcement and government representatives. Unlike these trusts, the Anti-Saloon League (ASL) could not buy off politicians, but relied on agitation and publicity—ensuring that constituents were fully informed as to their elected representatives’ voting records on temperance. Progressive prohibitionists made common cause with good-governance “muckrakers” like Pussyfoot Johnson and Upton Sinclair. The chapter turns to the wave of state-level prohibitions, beginning with the Oklahoma’s prohibition statehood in 1907, drawing on the long-standing prohibitionism of Native Americans. From there, the “dry wave” swept the American South, where the liquor traffic was more diffused and less organized, and temperance sentiment was strong among both white and black communities.

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Age and product dependent vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adults in Norway: a national cohort study, January to September 2021.

10.1101/2021.11.12.21266222 ◽

2021 ◽

Author(s):

Jostein Starrfelt ◽

Eirik Alnes Buanes ◽

Lene Kristine Juvet ◽

Trude Marie Lyngstad ◽

Gunnar Oyvind Isaksson Ro ◽

...

Keyword(s):

Severe Disease ◽

Population Level ◽

Vaccine Effectiveness ◽

Proportional Hazard ◽

Icu Admission ◽

Cox Proportional Hazard ◽

National Cohort ◽

Cox Proportional Hazard Models ◽

Using Data ◽

Protection Against Infection

Background: SARS-CoV-2 vaccines show high effectiveness against infection and (severe) disease. However, few studies estimate population level vaccine effectiveness against multiple COVID-19 outcomes, by age and including homologous and heterologous vaccine regimens. Methods: Using Cox proportional hazard models on data from 4 293 544 individuals (99% of Norwegian adults), we estimated overall, age-, and product-specific vaccine effectiveness against SARS-CoV-2 infection, hospitalisation, ICU admission and death in Norway, using data from national registries. Vaccine status was included as time-dependent variable and we adjusted for sex, pre-existing medical conditions, country of birth, county of residence, and crowded living conditions. Results: Adjusted vaccine effectiveness among fully vaccinated is 72.1% (71.2-73.0) against SARS-CoV-2 infection, 92.9% (91.2-94.2) against hospitalisation, 95.5% (92.6-97.2) against ICU admission, and 88.0% (82.5-91.8) against death. Among partially vaccinated, the effectiveness is 24.3% (22.3-26-2) against infection and 82.7% (77.7-86.6) against hospitalisation. Vaccine effectiveness against infection is 84.7% (83.1-86.1) for heterologous mRNA vaccine regimens, 78.3% (76.8-79.7) for Spikevax (Moderna; mRNA-1273), 69.7% (68.6-70.8) for Comirnaty (Pfizer/BioNTech; BNT162b2), and 60.7% (57.5-63.6) for Vaxzevria (AstraZeneca; ChAdOx nCoV-19; AZD1222) with a mRNA dose among fully vaccinated. Conclusion: We demonstrate good protection against SARS-CoV-2 infection and severe disease in fully vaccinated, including heterologous vaccine regimens, which could facilitate rapid immunization. Partially vaccinated were less likely to get severe disease than unvaccinated, though protection against infection was not as high, which could be essential in making vaccine prioritisation policies especially when availability is limited.

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Estimates of presumed population immunity to SARS-CoV-2 by state in the United States, August 2021

10.1101/2021.09.17.21263759 ◽

2021 ◽

Author(s):

Marie C.D. Stoner ◽

Frederick J. Angulo ◽

Sarah Rhea ◽

Linda Morris Brown ◽

Jessica E. Atwell ◽

...

Keyword(s):

United States ◽

Natural Infection ◽

Population Level ◽

The United States ◽

Viral Transmission ◽

Population Immunity ◽

Seroprevalence Data ◽

The Us ◽

Control And Prevention ◽

Waning Immunity

ABSTRACTBackgroundInformation is needed to monitor progress toward a level of population immunity to SARS-CoV-2 sufficient to disrupt viral transmission. We estimated the percentage of the United States (US) population with presumed immunity to SARS-CoV-2 due to vaccination, natural infection, or both as of August 26, 2021.MethodsPublicly available data as of August 26, 2021, from the Centers for Disease Control and Prevention (CDC) were used to calculate presumed population immunity by state. Seroprevalence data were used to estimate the percentage of the population previously infected with SARS-CoV-2, with adjustments for underreporting. Vaccination coverage data for both fully and partially vaccinated persons were used to calculate presumed immunity from vaccination. Finally, we estimated the percentage of the total population in each state with presumed immunity to SARS-CoV-2, with a sensitivity analysis to account for waning immunity, and compared these estimates to a range of population immunity thresholds.ResultsPresumed population immunity varied among states (43.1% to 70.6%), with 19 states with 60% or less of their population having been infected or vaccinated. Four states have presumed immunity greater than thresholds estimated to be sufficient to disrupt transmission of less infectious variants (67%), and none were greater than the threshold estimated for more infectious variants (78% or higher).ConclusionsThe US remains a distance below the threshold sufficient to disrupt viral transmission, with some states remarkably low. As more infectious variants emerge, it is critical that vaccination efforts intensify across all states and ages for which the vaccines are approved.SummaryAs of August 26, 2021, no state has reached a population level of immunity thought to be sufficient to disrupt transmission. (78% or higher), with some states having remarkably low presumed immunity.

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Abstract P559: National Burden & Cardiovascular Risk Factor Profile of Stroke Among Young Adults in The United States

Circulation ◽

10.1161/circ.141.suppl_1.p559 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Javier Valero Elizondo ◽

Rohan Khera ◽

Farhaan S Vahidy ◽

Prachi Dubey ◽

Haider Warraich ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Young Adults ◽

Cardiovascular Health ◽

Population Level ◽

The United States ◽

Cvd Risk ◽

Representative Study ◽

Insufficient Physical Activity ◽

History Of

Introduction: Stroke is a leading cause of death and disability worldwide. While most prevalent in elderly, it’s not uncommon in the non-elderly (<65), who also experience many more years of living with disability. In this study, we aimed to describe the scope and CVD determinants of stroke among young (18-44 years) adults in a US representative population. Methods: We analyzed the National Health Interview Survey (2012-2018), a nationally representative study sample. Stroke, as well as CVD risk factors (CRF) [diabetes, hypertension, ever-smoker, insufficient physical activity, obesity and high cholesterol] were self-reported. A CRF profile was then created, with the following categories: “Optimal”, “Average” and “Poor” (0-1, 2-3 & ≥ 4 CRFs, respectively). All analyses took into consideration the survey’s complex design. Results: The 2012-2018 survey population consisted of 224,638 adults ≥ 18 yrs, ≈ 242 million US adults annually. Overall 2.8% (≈ 7 million) reported ever having history of stroke, with 45% noted in the non-elderly (< 65). Among non-elderly, 21% of stroke-history was allocated among the young (18-44 years) adults, translating to nearly 642,810 individuals reporting ever having history of stroke per year. The most common risk factors noted in these patients were insufficient physical activity (56%), current/past smoking (48%), obesity (45%), and hypertension (44%). Overall among the young (<45 years), stroke prevalence was 10-fold higher among those with poor (≈ 3.9 million young adults) vs optimal CRF profile (3.5% vs 0.3%, p < 0.001). Adjusting for demographics, all CVD risk were significantly associated with history of stroke, with participants with poor CRF reporting a 7-fold higher history of stroke (Table). Conclusion: More than half a million adults 18-44 years of age reported a history stroke in US. Individuals with sub-optimal CRF profiles are highly susceptible, and population-level strategies emphasizing cardiovascular health may significantly reduce risk of stroke among young adults in US.

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Votes for Women: An Economic Perspective on Women’s Enfranchisement

The Journal of Economic Perspectives ◽

10.1257/jep.34.2.3 ◽

2020 ◽

Vol 34 (2) ◽

pp. 3-23 ◽

Cited By ~ 1

Author(s):

Carolyn M. Moehling ◽

Melissa A. Thomasson

Keyword(s):

United States ◽

Black Women ◽

Empirical Studies ◽

State Level ◽

Voting Rights ◽

Theoretical Models ◽

The United States ◽

Nineteenth Amendment ◽

History Of ◽

The Right

The ratification of the Nineteenth Amendment in 1920 officially granted voting rights to women across the United States. However, many states extended full or partial suffrage to women before the federal amendment. In this paper, we discuss the history of women's enfranchisement using an economic lens. We examine the demand side, discussing the rise of the women's movement and its alliances with other social movements, and describe how suffragists put pressure on legislators. On the supply side, we draw from theoretical models of suffrage extension to explain why men shared the right to vote with women. Finally, we review empirical studies that attempt to distinguish between competing explanations. We find that no single theory can explain women's suffrage in the United States and note that while the Nineteenth Amendment extended the franchise to women, state-level barriers to voting limited the ability of black women to exercise that right until the Voting Rights Act of 1965.

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The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa223 ◽

2020 ◽

Vol 7 (7) ◽

Author(s):

Eili Y Klein ◽

Emily Schueller ◽

Katie K Tseng ◽

Daniel J Morgan ◽

Ramanan Laxminarayan ◽

...

Keyword(s):

United States ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

State Level ◽

Population Level ◽

Antibiotic Use ◽

The United States ◽

Vaccine Effectiveness ◽

Severe Illness ◽

Antibiotic Prescribing

Abstract Background Influenza, which peaks seasonally, is an important driver for antibiotic prescribing. Although influenza vaccination has been shown to reduce severe illness, evidence of the population-level effects of vaccination coverage on rates of antibiotic prescribing in the United States is lacking. Methods We conducted a retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness. Using data from IQVIA’s Xponent database and the US Centers for Disease Control and Prevention’s FluVaxView, we employed fixed-effects regression analysis to analyze the relationship between influenza vaccine coverage rates and the number of antibiotic prescriptions per 1000 residents from January to March of each year. Results We observed that, controlling for socioeconomic differences, access to health care, childcare centers, climate, vaccine effectiveness, and state-level differences, a 10–percentage point increase in the influenza vaccination rate was associated with a 6.5% decrease in antibiotic use, equivalent to 14.2 (95% CI, 6.0–22.4; P = .001) fewer antibiotic prescriptions per 1000 individuals. Increased vaccination coverage reduced prescribing rates the most in the pediatric population (0–18 years), by 15.2 (95% CI, 9.0–21.3; P < .001) or 6.0%, and the elderly (aged 65+), by 12.8 (95% CI, 6.5–19.2; P < .001) or 5.2%. Conclusions Increased influenza vaccination uptake at the population level is associated with state-level reductions in antibiotic use. Expanding influenza vaccination could be an important intervention to reduce unnecessary antibiotic prescribing.

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HISTORY OF CAREGIVING SURVEILLANCE AT THE CDC, 2005 TO PRESENT

Innovation in Aging ◽

10.1093/geroni/igz038.674 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S188-S188

Author(s):

Erin D Bouldin

Keyword(s):

North Carolina ◽

State Level ◽

Population Level ◽

Evidence Base ◽

Community Dwelling ◽

Systematic Data ◽

Level Data ◽

History Of ◽

Screening Question ◽

Systematic Data Collection

Abstract Research on caregiving has been ongoing for decades, but little systematic data collection at the population level occurred until relatively recently. Surveillance data is critical because it provides an evidence base upon which to make informed decisions about allocating resources, targeting programs, and developing policy. In 2005, CDC and the Association for Prevention Teaching and Research funded Dr. Elena Andresen’s proposal to develop a set of questions about caregiving to be used on the BRFSS. This Caregiver Module was piloted in North Carolina and has been used – with some modifications – ever since as an optional module. The Caregiver Module has provided state-level data on the prevalence and types of caregiving provided by community-dwelling adults age 18 and older to people with a variety of conditions and needs. In 2009, the caregiver screening question was included on the BRFSS core, yielding a national estimate of caregiving prevalence of 24.7%.

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