Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

2020 ◽  
Author(s):  
Ruoyan Sun ◽  
Henna Budhwani
Keyword(s):  
Public Health ◽  
United States ◽  
Cumulative Incidence ◽  
Hot Spots ◽  
Adult Population ◽  
State Level ◽  
The United States ◽  
Education Attainment ◽  
Public Health Systems ◽  
Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

scholarly journals Cracks in the System: The Effects of the Coronavirus Pandemic on Public Health Systems

2020 ◽  
Vol 50 (6-7) ◽  
pp. 455-466 ◽  
Author(s):  
Kate Tulenko ◽  
Dominique Vervoort
Keyword(s):  
Public Health ◽  
United States ◽  
Health Systems ◽  
Disease Outbreaks ◽  
State Level ◽  
The United States ◽  
Public Health Services ◽  
Health Security ◽  
Public Health Systems ◽  
The Impact

The novel coronavirus disease 2019 (COVID-19) pandemic has rapidly wrought havoc on the world, exposing the gaps in public health systems of countries that were previously considered most prepared for infectious disease outbreaks. Notably, despite being ranked highest on the Global Health Security Index, the United States has been severely hit with nearly two million confirmed cases and one hundred thousand deaths by the end of May 2020. In addition to the public health fragmentation from the federal to the state level and lagging regulations, early reports highlight substantial socioeconomic disparities and health system barriers contributing to the spread and impact of the pandemic in the United States. In this review, we explore the impact of COVID-19 on public health systems by assessing systems through the lens of the Centers for Disease Control and Prevention’s Ten Essential Public Health Services. Building on prepandemic and COVID-19 observations and lessons, we propose recommendations moving forward to prepare for future waves and other disease outbreaks.

scholarly journals Patterns and correlates of mis-implementation in state chronic disease public health practice in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Margaret M. Padek ◽  
Stephanie Mazzucca ◽  
Peg Allen ◽  
Emily Rodriguez Weno ◽  
Edward Tsai ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Public Health Practice ◽  
State Level ◽  
The United States ◽  
Organizational Level ◽  
Effective Programs

Abstract Background Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

scholarly journals Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

2021 ◽  
Author(s):  
Margaret Padek ◽  
Stephanie Mazzucca ◽  
Peg Allen ◽  
Emily Rodriguez Weno ◽  
Edward Tsai ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Decision Making ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Public Health Practice ◽  
State Level ◽  
The United States ◽  
Organizational Level ◽  
Effective Programs

Abstract Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results: Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

scholarly journals Feeding the disparities: the geography and trends of breastfeeding in the United States

2018 ◽  
Author(s):  
Romain Garnier ◽  
Ana I. Bento ◽  
Pejman Rohani ◽  
Saad B. Omer ◽  
Shweta Bansal
Keyword(s):  
Public Health ◽  
United States ◽  
Breast Milk ◽  
Low Income ◽  
Temporal Trends ◽  
State Level ◽  
The United States ◽  
Poverty Level ◽  
Future Health ◽  
Breastfeeding Rates

AbstractThere is scientific consensus on the importance of breastfeeding for the present and future health of newborns, in high- and low-income settings alike. In the United States, improving breast milk access is a public health priority but analysis of secular trends are largely lacking. Here, we used data from the National Immunization Survey of the CDC, collected between 2003 and 2016, to illustrate the temporal trends and the spatial heterogeneity in breastfeeding. We also considered the effect sizes of two key determinants of breastfeeding rates. We show that, while access to breast milk both at birth and at 6 months old has steadily increased over the past decade, large spatial disparities still remain at the state level. We also find that, since 2009, the proportion of households below the poverty level has become the strongest predictor of breastfeeding rates. We argue that, because variations in breastfeeding rates are associated with socio-economic factors, public health policies advocating for breastfeeding are still needed in particular in underserved communities. This is key to reducing longer term health disparities in the U.S., and more generally in high-income countries.

scholarly journals 1.E. Workshop: Comparative Public Health: Politics, science, and professionalism

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
United States ◽  
United Kingdom ◽  
Occupational Health ◽  
Case Studies ◽  
Health Systems ◽  
Health And Safety ◽  
Occupational Health And Safety ◽  
The United States ◽  
Public Health Systems

Abstract Look around EUPHA, or any other public health conference. Public health is difficult to define, in theory and in practice. Its boundaries are all blurred, whether with medicine, schools, environmental protection or workplace safety inspectorates. Too often, we overstate the similarities between public health systems among countries. Efforts to promote networks, good practice, and even basic coordination have been undermined for decades by misunderstandings born of different educational, organizational, financial and political systems. The lack of comparison, and comparative political analysis in particular, also means that countries can have very similar debates about the proper nature and scope of public health, an about who is to blame for deficiencies, without awareness of when they are distinctive and when they are actually part of larger trends. This project aims to identify and explain variation in the scope and organization of public health systems in selected high-income countries. Based on a formalized comparative historical analysis of Austria, France, Germany, Poland, the United Kingdom and the United States, researchers in the study first mapped the various axes of divergence: workforce composition, organization, levels of government, relationship to medicine, and the extent to which public health encompassed adjacent areas such as environmental health and occupational health and safety. For each country we then followed both case studies (communicable disease control including vaccines, HIV/AIDS, tobacco control, diet and nutrition, occupational health and safety) as well as the legislative history of the public health field in order to identify its changing organization and scope. It then identifies the relative role of historical legacies, changing science, burden of disease and politics in explaining patterns of both divergence and convergence. This workshop presents four country specific case studies (France, Germany, United Kingdom and the United States) that identify the most important forms of variation and the political, scientific and professional drivers of convergence and divergence. Key messages Political organization and scope as images of public health are grossly under-researched and nonexistent in a comparative nature. Understanding the scope and organization of public health in different countries will permit better lesson-drawing and identification of relevant and effective levers of change.

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 COVID-19 scenarios for the United States

2020 ◽  
Author(s):  
◽  
Simon I Hay
Keyword(s):  
United States ◽  
Model Performance ◽  
State Level ◽  
The United States ◽  
Economic Damage ◽  
Reference Scenario ◽  
Level Model ◽  
Per Capita ◽  
Novel Coronavirus ◽  
The Impact

The United States (US) has not been spared in the ongoing pandemic of novel coronavirus disease. COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to cause death and disease in all 50 states, as well as significant economic damage wrought by the non-pharmaceutical interventions (NPI) adopted in attempts to control transmission. We use a deterministic, Susceptible, Exposed, Infectious, Recovered (SEIR) compartmental framework to model possible trajectories of SARS-CoV-2 infections and the impact of NPI at the state level. Model performance was tested against reported deaths from 01 February to 04 July 2020. Using this SEIR model and projections of critical driving covariates (pneumonia seasonality, mobility, testing rates, and mask use per capita), we assessed some possible futures of the COVID-19 pandemic from 05 July through 31 December 2020. We explored future scenarios that included feasible assumptions about NPIs including social distancing mandates (SDMs) and levels of mask use. The range of infection, death, and hospital demand outcomes revealed by these scenarios show that action taken during the summer of 2020 will have profound public health impacts through to the year end. Encouragingly, we find that an emphasis on universal mask use may be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Masks may save as many as 102,795 (55,898-183,374) lives, when compared to a plausible reference scenario in December. In addition, widespread mask use may markedly reduce the need for more socially and economically deleterious SDMs.

scholarly journals Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012–2018

2021 ◽  
Vol 15 (10) ◽  
pp. e0009878
Author(s):  
Erin R. Whitehouse ◽  
Marissa K. Person ◽  
Catherine M. Brown ◽  
Sally Slavinski ◽  
Agam K. Rao ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Surveillance Data ◽  
Human Rabies ◽  
Accurate Assessment ◽  
Postexposure Prophylaxis ◽  
Ed Visits

Background An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. Methodology/Principle findings To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012–2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012–2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. Conclusions Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.

scholarly journals Effects of Government Mandated Social Distancing Measures on Cumulative Incidence of COVID-19 in the United States and its Most Populated Cities

2020 ◽  
Author(s):  
Bhuma Krishnamachari ◽  
Alexander Morris ◽  
Diane Zastrow ◽  
Andrew Dsida ◽  
Brian Harper ◽  
...  
Keyword(s):  
United States ◽  
Population Density ◽  
Cumulative Incidence ◽  
Negative Binomial ◽  
State Level ◽  
The United States ◽  
Reverse Causality ◽  
Social Distancing ◽  
School Closing ◽  
Adjusted Rate

AbstractCOVID-19, caused by the SARS-CoV-2 virus, has quickly spread throughout the world, necessitating assessment of the most effective containment methods. Very little research exists on the effects of social distancing measures on this pandemic. The purpose of this study was to examine the effects of government implemented social distancing measures on the cumulative incidence rates of COVID-19 in the United States on a state level, and in the 25 most populated cities, while adjusting for socio-demographic risk factors. The social distancing variables assessed in this study were: days to closing of non-essential business; days to stay home orders; days to restrictions on gathering, days to restaurant closings and days to school closing. Using negative binomial regression, adjusted rate ratios and 95% confidence intervals were calculated comparing two levels of a binary variable: “above median value,” and “median value and below” for days to implementing a social distancing measure. For city level data, the effects of these social distancing variables were also assessed in high (above median value) vs low (median value and below) population density cities. For the state level analysis, days to school closing was associated with cumulative incidence, with an adjusted rate ratio of 1.59 (95% CI:1.03,2.44), p=0.04 at 35 days. Some results were counterintuitive, including inverse associations between cumulative incidence and days to closure of non-essential business and restrictions on gatherings. This finding is likely due to reverse causality, where locations with slower growth rates initially chose not to implement measures, and later implemented measures when they absolutely needed to respond to increasing rates of infection. Effects of social distancing measures seemed to vary by population density in cities. Our results suggest that the effect of social distancing measures may differ between states and cities and between locations with different population densities. States and cities need individual approaches to containment of an epidemic, with an awareness of their own structure in terms of crowding and socio-economic variables. In an effort to reduce infection rates, cities may want to implement social distancing in advance of state mandates.

scholarly journals Estimating the Early Outbreak Cumulative Incidence of COVID-19 in the United States: Three Complementary Approaches

2020 ◽  
Author(s):  
Fred S. Lu ◽  
Andre T. Nguyen ◽  
Nicholas B. Link ◽  
Marc Lipsitch ◽  
Mauricio Santillana
Keyword(s):  
United States ◽  
Cumulative Incidence ◽  
State Level ◽  
The United States ◽  
Positive Test ◽  
Influenza Surveillance ◽  
Accurate Estimation ◽  
Surveillance Systems ◽  
Influenza Like Illness ◽  
The Us

AbstractEffectively designing and evaluating public health responses to the ongoing COVID-19 pandemic requires accurate estimation of the weekly incidence of COVID-19. Unfortunately, a lack of systematic testing across the United States (US) due to equipment shortages and varying testing strategies has hindered the usefulness of the reported positive COVID-19 case counts. We introduce three complementary approaches to estimate the cumulative incidence of symptomatic COVID-19 during the early outbreak in each state in the US as well as in New York City, using a combination of excess influenza-like illness reports, COVID-19 test statistics, and COVID-19 mortality reports. Instead of relying on an estimate from a single data source or method that may be biased, we provide multiple estimates, each relying on different assumptions and data sources. Across our three approaches, there is a consistent conclusion that estimated state-level COVID-19 symptomatic case counts from March 1 to April 4, 2020 varied from 5 to 50 times greater than the official positive test counts. Nationally, our estimates of COVID-19 symptomatic cases in the US as of April 4 have a likely range of 2.2 to 5.1 million cases, with possibly as high as 8.1 million cases, up to 26 times greater than the cumulative confirmed cases of about 311,000. Extending our method to May 16, 2020, we estimate that cumulative symptomatic incidence ranges from 6.0 to 12.2 million, which compares with 1.5 million positive test counts. Our approaches demonstrate the value of leveraging existing influenza-like-illness surveillance systems during the flu season for measuring the burden of new diseases that share symptoms with influenza-like-illnesses. Our methods may prove useful in assessing the burden of COVID-19 during upcoming flu seasons in the US and other countries with comparable influenza surveillance systems.

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