COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January‒July 2020

2021 ◽  
pp. e1-e8
Author(s):  
Joseph Friedman ◽  
Samir Akre
Keyword(s):  
Public Health ◽  
United States ◽  
Drug Overdose ◽  
The United States ◽  
Monthly Data ◽  
The Us ◽  
Control And Prevention ◽  
Pandemic Response ◽  
Overdose Mortality ◽  
Monthly Drug

Objectives. To determine the magnitude of increases in monthly drug-related overdose mortality during the COVID-19 pandemic in the United States. Methods. We leveraged provisional records from the Centers for Disease Control and Prevention provided as rolling 12-month sums, which are helpful for smoothing, yet may mask pandemic-related spikes in overdose mortality. We cross-referenced these rolling aggregates with previous monthly data to estimate monthly drug-related overdose mortality for January through July 2020. We quantified historical errors stemming from reporting delays and estimated empirically derived 95% prediction intervals (PIs). Results. We found that 9192 (95% PI = 8988, 9397) people died from drug overdose in May 2020—making it the deadliest month on record—representing a 57.7% (95% PI = 54.2%, 61.2%) increase over May 2019. Most states saw large-magnitude increases, with the highest in West Virginia, Kentucky, and Tennessee. We observed low concordance between rolling 12-month aggregates and monthly pandemic-related shocks. Conclusions. Unprecedented increases in overdose mortality occurred during the pandemic, highlighting the value of presenting monthly values alongside smoothed aggregates for detecting shocks. Public Health Implications. Drastic exacerbations of the US overdose crisis warrant renewed investments in overdose surveillance and prevention during the pandemic response and postpandemic recovery efforts. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e8. https://doi.org/10.2105/AJPH.2021.306256 )

scholarly journals The Check and Report Ebola (CARE+) Program to Monitor Travelers for Ebola After Arrival to the United States, 2014-2016

2019 ◽  
Vol 134 (6) ◽  
pp. 592-598 ◽  
Author(s):  
Heather A. Joseph ◽  
Abbey E. Wojno ◽  
Kelly Winter ◽  
Onalee Grady-Erickson ◽  
Erin Hawes ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
West Africa ◽  
Emerging Infectious Diseases ◽  
Care Program ◽  
The United States ◽  
The Us ◽  
Us Government ◽  
Public Health Authorities ◽  
Control And Prevention

The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public’s concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers’ knowledge of Ebola symptoms and how to seek medical care safely, increase travelers’ awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring.

Preparing for SARS-CoV-2 Vaccines in US Immigrant Communities: Strategies for Allocation, Distribution, and Communication

2020 ◽  
pp. e1-e5
Author(s):  
Eva H. Clark ◽  
Karla Fredricks ◽  
Laila Woc-Colburn ◽  
Maria Elena Bottazzi ◽  
Jill Weatherhead
Keyword(s):  
Public Health ◽  
United States ◽  
Department Of Defense ◽  
Population Level ◽  
The United States ◽  
Immigrant Communities ◽  
Private Partnership ◽  
The Us ◽  
Us Government ◽  
Control And Prevention

Widely administered efficacious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are the safest and most efficient way to achieve individual- and population-level immunity, making SARS-CoV-2 vaccination the most viable strategy for controlling the coronavirus disease 2019 (COVID-19) pandemic in the United States. To this end, the US government has invested more than $10 billion in “Operation Warp Speed,” a public-private partnership including the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and the US Department of Defense. Operation Warp Speed funded the development of several SARS-CoV-2 vaccines and aimed to deliver 300 million doses of a vaccine by the ambitious date of January 2021. (Am J Public Health. Published online ahead of print December 22, 2020: e1–e5. https://doi.org/10.2105/AJPH.2020.306047 )

scholarly journals Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns

2019 ◽  
Vol 8 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Gopal K Singh ◽  
Isaac E. Kim, Jr. ◽  
Mehrete Girmay ◽  
Chrisp Perry ◽  
Gem P. Daus ◽  
...  
Keyword(s):  
Pain Management ◽  
Social Determinants ◽  
Drug Overdose ◽  
The United States ◽  
Opioid Epidemic ◽  
The Us ◽  
Drug Overdoses ◽  
Race Ethnicity ◽  
Overdose Mortality ◽  
Racial Ethnic

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peerreviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioidepidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction. Key words: • Opioids • Drug overdose • Mortality • Pain management • Treatment • Race/Ethnicity • Social determinants • Health disparities Copyright © 2019 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Age-Standardized Mortality of Persons on Probation, in Jail, or in State Prison and the General Population, 2001-2012

2019 ◽  
Vol 134 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Christopher Wildeman ◽  
Alyssa W. Goldman ◽  
Emily A. Wang
Keyword(s):  
Public Health ◽  
United States ◽  
Age Distribution ◽  
Correctional Facility ◽  
Well Being ◽  
The United States ◽  
Mortality Rates ◽  
State Prison ◽  
Control And Prevention ◽  
Standardized Mortality Ratios

Objectives: The number of adults in the United States being held on probation—persons convicted of crimes and serving their sentence in the community rather than in a correctional facility—approached 4 million at the end of 2016 and continues to grow, yet little is known about the health and well-being of this population. We compared the standardized mortality ratios of persons on probation in the United States with persons in jail, persons in state prison, and the general US population. Methods: We used administrative data from 2001-2012 from the Bureau of Justice Statistics and the Centers for Disease Control and Prevention WONDER database and indirect standardization techniques to compare the mortality rates of persons on probation in 15 states with the mortality rates of persons in jail, persons in state prison, and the general US population. We applied the age-specific mortality rates of 3 populations (general US population, persons in jail, and persons in state prison) to the age distribution of persons on probation to estimate standardized mortality ratios. Results: Persons on probation died at a rate 3.42 times higher than persons in jail, 2.81 times higher than persons in state prison, and 2.10 times higher than the general US population, after standardizing the age distribution of persons on probation relative to the other 3 groups. Conclusions: Public health interventions should target persons on probation, who have received less attention from the public health community than persons serving sentences in jails and prisons.

scholarly journals Exploring Drug Overdose Mortality Data in Harris County, Texas

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric V. Bakota ◽  
Deborah Bujnowski ◽  
Larissa Singletary ◽  
Sherry Onyiego ◽  
NAdia Hakim ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Abuse ◽  
Drug Overdose ◽  
The United States ◽  
Mortality Data ◽  
Harris County ◽  
Death Rates ◽  
Overdose Death ◽  
The Past ◽  
Overdose Mortality

ObjectiveIn this session, we will explore the results of a descriptive analysis of all drug overdose mortality data collected by the Harris County Medical Examiner's Office and how that data can be used to inform public health action.IntroductionDrug overdose mortality is a growing problem in the United States. In 2017 alone over 72,000 deaths were attributed to drug overdose, most of which were caused by fentanyl and fentanyl analogs (synthetic opioids)1. While nearly every community has seen an increase in drug overdose, there is considerable variation in the degree of increase in specific communities. The Harris County community, which includes the City of Houston, has not seen the massive spikes observed in some communities, such as West Virginia, Kentucky, and Ohio. However, the situation in Harris County is complicated in mortality and drug use. From 2010 - 2016 Harris County has seen a fairly stable overdose-related mortality count, ranging from 450 - 618 deaths per year. Of concern, the last two years, 2015-2016, suggest a sharp increase has occurred. Another complexity is that Harris County drug related deaths seem to be largely from polysubstance abuse. Deaths attributed to cocaine, methamphetamine, and benzodiazipine all have risen in the past few years. Deaths associated with methamphetamine have risen from approximately 20 per year in 2010 - 2012 to 119 in 2016. This 6-fold increase is alarming and suggests a large-scale public health response is needed.MethodsData were collected by the Harris County Institute of Forensic Sciences (IFS), which is part of the Harris County Medical Examiner's Office. IFS is the agency responsible for collecting and analyzing human tissue of the deceased for toxicological information about the manner and cause of death. IFS is able to test for the presence of multiple substances, including opioids, benzodiazepines, methamphetamines, cocaine, ethanol, and many others.These data were cleaned and labeled for the presence of opioids, cocaine, benzodiazepine, Z-drug (novel drug), amphetamines, ethanol, and carisoprodol. Explorative descriptive analyses were then completed in R (version 3.4) to identify trends. An RShiny app was created to further explore the data by allowing for rapid filtering and/or subsetting based on various demographic characteristics (e.g., age, sex, race).ResultsWe found that Harris County is experiencing a modest upward trend of drug related overdoses, with 529 observed in 2010 and 618 in 2016. We also found that the increase was not uniform across all classified drugs: amphetamines, cocaine, and ethanol all saw increases. Deaths involving amphetamine increased substantially from 21 in 2010 to 119 in 2016 (Figure 1). Deaths involving cocaine saw the next sharpest increase with 144 in 2010 and 237 in 2016. Deaths associated with opioids remained fairly constant, with 291 deaths in 2010 and 271 deaths in 2016.Differences in mortality across race and sex groups were also observed. The proportion of amphetamine deaths among whites jumped sharply, while the proportion of opioid and benzodiazepine deaths among whites decreased in recent years. The proportion of amphetamine and cocaine deaths among men rose more sharply than with women in the past three years, whereas for opioids, the proportion of women dying has dropped.ConclusionsIt is undeniable that the opioid epidemic is a true public health emergency for the nation. New surveillance tools are needed to better understand the impact and nature of this threat. Additionally, as we have found in Harris County, the threat may be polysubstance in nature.Our report offers two important insights: 1) that mortality data is a useful and actionable surveillance resource in understanding the problem of substance abuse; and 2) public health needs to look at substance abuse from a holistic and comprehensive perspective. Keeping the purview limited to opioids alone may create significant blind spots to the public health threat facing us.References1. National Institute of Health. (2018) Overdose Death Rates. Retreived from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

scholarly journals Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States

2020 ◽  
Author(s):  
Xiaoshuang Liu ◽  
Xiao Xu ◽  
Guanqiao Li ◽  
Xian Xu ◽  
Yuyao Sun ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
The United States ◽  
School Closure ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Health Crisis ◽  
The Us ◽  
Individualized Decision

Abstract Background: The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs), such as non-essential business closures and gathering bans, to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is greatly needed to assist in guiding individualized decision making for adjustment of interventions in the US and around the world. However, the impacts of these approaches remain uncertain.Methods: Based on the reported cases, the effective reproduction number (Rt) of COVID-19 epidemic for 50 states in the US was estimated. Measurements on the effectiveness of nine different NPIs were conducted by assessing risk ratios (RRs) between R t and NPIs through a generalized linear model (GLM). Results: Different NPIs were found to have led to different levels of reduction in Rt. Stay-at-home contributed approximately 51% (95% CI 46%-57%), wearing (face) masks 29% (15%-42%), gathering ban (more than 10 people) 19% (14%-24%), non-essential business closure 16% (10%-21%), declaration of emergency 13% (8%-17%), interstate travel restriction 11% (5%-16%), school closure 10% (7%-14%), initial business closure 10% (6%-14%), and gathering ban (more than 50 people) 7% (2%-11%).Conclusions: This retrospective assessment of NPIs on Rt has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.

scholarly journals The US Public Health Service House-to-House Canvass Survey of the Morbidity and Mortality of the 1918 Influenza Pandemic

2020 ◽  
pp. e1-e8
Author(s):  
Alfredo Morabia
Keyword(s):  
Public Health ◽  
United States ◽  
Health Service ◽  
Cumulative Incidence ◽  
Public Health Service ◽  
San Antonio ◽  
Influenza Pandemic ◽  
The United States ◽  
Population Based ◽  
The Us

Between November 20, 1918, and March 12, 1919, the US Public Health Service carried out a vast population-based survey to assess the incidence rate and mortality of the influenza pandemic among 146 203 persons in 18 localities across the United States. The survey attempted to retrospectively assess all self-reported or diagnosed cases of influenza since August 1, 1918. It indicated that the cumulative incidence of symptomatic influenza over 6 months had been 29.4% (range = 15% in Louisville, KY, to 53.3% in San Antonio, TX). The overall case fatality rate (CFR) was 1.70%, and it ranged from 0.78% in San Antonio to 3.14% in New London, Connecticut. Localities with high cumulative incidence were not necessarily those with high CFR. Overall, assuming the survey missed asymptomatic cases, between August 1, 1918, and February 21, 1919, maybe more than 50% of the population was infected, and about 1% of the infected died. Eight months into the COVID-19 pandemic, the United States has not yet launched a survey that would provide population-based estimates of incidence and CFRs analogous to those generated by the 1918 US Public Health Service house-to-house canvass survey of influenza. Published online ahead of print December 8, 2020: 1–8. https://doi.org/10.2105/AJPH.2020.306025 )

scholarly journals Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States

2020 ◽  
Author(s):  
Xiaoshuang Liu ◽  
Xiao Xu ◽  
Guanqiao Li ◽  
Xian Xu ◽  
Yuyao Sun ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
The United States ◽  
School Closure ◽  
Health Interventions ◽  
Public Health Interventions ◽  
The Us ◽  
The Impact ◽  
Individualized Decision

Abstract The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs) to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is in great need to assist in guiding the individualized decision making for adjustment of interventions in the US and around the world. However, the impact of these approaches remain uncertain. Based on the reported cases, the effective reproduction number of COVID-19 epidemic for 50 states in the US was estimated. The measurement on the effectiveness of eight different NPIs was conducted by assessing risk ratios (RRs) between and NPIs through a generalized linear model (GLM). Different NPIs were found to have led to different levels of reduction in. Stay-at-home contributed approximately 51% (95% CI 46%-57%), gathering ban (more than 10 people) 19% (14%-24%), non-essential business closure 16% (10%-21%), declaration of emergency 13% (8%-17%), interstate travel restriction 11% (5%-16%), school closure 10% (7%-13%), initial business closure 10% (6%-14%), and gathering ban (more than 50 people) 6% (2%-11%). This retrospective assessment of NPIs on has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.

scholarly journals Understanding Implementation Challenges to Genetic Testing for Familial Hypercholesterolemia in the United States

2019 ◽  
Vol 9 (1) ◽  
pp. 9 ◽  
Author(s):  
Rachele Hendricks-Sturrup ◽  
Christine Lu
Keyword(s):  
United States ◽  
Genetic Testing ◽  
Familial Hypercholesterolemia ◽  
Ethnic Diversity ◽  
Heart Association ◽  
The United States ◽  
Cvd Risk ◽  
Implementation Challenges ◽  
The Us ◽  
Control And Prevention

Cardiovascular disease (CVD) is the leading cause of death in the United States (US), with familial hypercholesterolemia (FH) being a major inherited and genetic risk factor for premature CVD and atherosclerosis. Genetic testing has helped patients and providers confirm the presence of known pathogenic and likely pathogenic variations in FH-associated genes. Key organizations, such as the Centers for Disease Control and Prevention (CDC), American Heart Association (AHA), FH Foundation, and National Lipid Association (NLA), have recognized the clinical utility of FH genetic testing. However, FH genetic testing is underutilized in clinical practice in the US for reasons that are underexplored through the lens of implementation science. In this commentary, we discuss seven key implementation challenges that must be overcome to strengthen the clinical adoption of FH genetic testing in the US. These implementation challenges center on evidence of cost-effectiveness, navigating patient and provider preferences and concerns, gender and ethnic diversity and representation in genetic testing, and establishing clinical consensus around FH genetic testing based on the latest and most relevant research findings. Overcoming these implementation challenges is imperative to the mission of reducing CVD risk in the US.

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