Divergence and Curl of COVID19 Spreading in the Lower Peninsula of Michigan

This paper explores the COVID19 transmission pattern and circulation dynamics in the Euclidean space at the lower peninsula of Michigan by using the divergence and curl concept in vector field. The COVID19 transmission volume flux can be calculated for each county by using vector divergence. The results shows Wayne county had the highest divergence (162660), the Kent county had the second highest divergence (152540), and the Saginaw county had the third highest divergence (103240), the divergence is positive which means the COVID19 virus was transmitted from these counties to other places. The results also shows Monroe county had the lowest divergence (-187843), the Allegan county had the second lowest number in divergence (-90824), the divergence is negative which means the COVID19 virus was transmitted from other places to these counties. The circulation of the virus is also calculated by using vector curl. The positive curl means that the virus has circulated in a counter-clockwise direction, and the negative curl means the virus has circulated in a clockwise direction. The divergence is an operator of the COVID19 transmission vector field, which produces a scalar field giving the quantity of the transmission vector field’s source at each location. The COVID19 spreading volume density of the outward flux of transmission field is represented by divergence around a given location. The curl is an operator of the COVID19 transmission field, which describes the circulation of a transmission vector field. The curl at a location in COVID19 transmission field is represented by a vector whose length and direction denote the magnitude and axis of the maximum circulation. The curl of a transmission field is formally defined as the circulation density at each location of COVID19 transmission field.

Demand Responsive Transit Simulation of Wayne County, Michigan

Demand responsive transit (DRT) can provide an alternative to private cars and complement existing public transport services. However, the successful implementation of DRT services remains a challenge as both researchers and policy makers can struggle to determine what sorts of places or cities are suitable for it. Research into car-dependent cities with poor transit accessibility is sparse. This study addresses this problem, investigating the potential of DRT service in Wayne County, U.S.A., whose dominant travel mode is private car. Using an agent-based approach, DRT is simulated as a new mobility option for this region, thereby providing insights into its impact on operational, user, and system-level performance indicators. DRT scenarios are tested for different fleet sizes, vehicle occupancy, and cost policies. The results show that a DRT service in Wayne County has a certain potential, especially to increase the mobility of lower-income individuals. However, introducing the service may slightly increase the overall vehicle kilometers traveled. Specific changes in service characteristics, like service area, pricing structure, or preemptive relocation of vehicles, might be needed to fully realize the potential of pooling riders in the proposed DRT service. The authors hope that this study serves as a starting point for understanding the impacts and potential benefits of DRT in Wayne County and similar low-density and car-dependent urban areas, as well as the service parameters needed for its successful implementation.

Prenatal IgE as a Risk Factor for the Development of Childhood Neurodevelopmental Disorders

Background: Few studies have examined if maternal allergic disease is associated with an offspring's neurodevelopment. We hypothesized that Th-2 biased maternal immune function assessed as total serum immunoglobulin (Ig) E is associated with attention deficit hyperactivity disorder (ADHD).Methods: Data are from the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS), a racially and socioeconomically diverse birth cohort in metropolitan Detroit, Michigan. Maternal total IgE was measured prenatally and at 1-month postpartum. Child total IgE was assessed at birth, 6 months, and 2 years of age. ADHD diagnosis was based on the parental report at the 10–12-year study visits or medical chart abstraction. Total IgE was log2 transformed. Poisson regression models with robust error variance were used to calculate the risk ratios (RR). Inverse probability weighting was used to correct for potential bias due to a loss to follow-up and non-response.Results: Of the 636 maternal-child pairs in the analysis, 513 children were neurotypical and 123 had ADHD. Maternal prenatal total IgE was significantly associated with ADHD even after adjustment for potential confounders (RR = 1.08, 95% CI 1.03–1.13). Maternal and child IgE measures were positively and significantly correlated, but child total IgE was not associated with ADHD at any time point.Conclusions: Maternal prenatal IgE may influence neurodevelopment, but additional studies are needed to confirm and expand these findings.

COVID-19 Impact on Pediatric Health: A survey of families in Wayne County, MI

Background. In response to the novel coronavirus disease (COVID-19), the state mandated “Stay At Home” order included closure of schools and public places and physical distancing measures. As a result, social interactions among children were significantly impaired and pediatric outpatient offices and vaccination rates declined. We sought to determine the impact of the COVID-19 pandemic on mental health as well as access to health care in our pediatric population in Wayne County, Michigan. Design/Methods. We conducted a survey through the Wayne County Public School Districts to elicit information regarding subjects’ access to pediatric health care as well as experiences pertinent to their child(ren)’s mental health. Results. Approximately 8500 surveys were sent to families and 278 responses were received. Responses revealed that 46% of children spent more time alone during the pandemic, 36.9% had changes in sleep, 25.6% had little pleasure in doing things, and 32.5% were unhappy or sad. 66.2% were able to make new visits during the pandemic, however, 20.1% missed their child’s doctors’ visits for reasons including clinic cancellations and fear of entering a healthcare setting. Conclusions. The results of this survey demonstrate significant mental health concerns among our pediatric population as approximately 1/3 of families reported changes in behavior or mental health. As school closures persist in response to the ongoing pandemic and social interactions remain limited, it is imperative that pediatricians screen for depression, behavioral problems and other mental health concerns and offer families help to identify appropriate community mental health resources.

Abstract 106: Covid-19 Pandemic Impact on Ems Runs and Resuscitation Attempts

Background: The frequency of EMS runs, resuscitation attempts, & out of hospital cardiac arrest survival within a pandemic period has not been studied within the Detroit and metro Detroit region in Michigan. To analyze and study the consequences associated with the spread of COVID-19 within two Michigan counties, a retrospective review from two different medical control authorities (MCA) was completed. We hypothesized the number of out of hospital cardiac arrests and EMS runs to increase during the COVID-19 pandemic, while resuscitation attempts to decrease. Methods: This is a retrospective review study. Records from two MCAs, the Detroit East Medical Control Authority (DEMCA) and the Macomb County Medical Control Authority (MCMCA), were utilized and data was extracted and extrapolated. Each of these MCAs oversee Emergency Medical Services (EMS) within their respective counties. DEMCA provides coverage for the eastern region of Wayne County and MCMCA serves all of Macomb County. Runs, dead-on-scene numbers, & resuscitation attempts were each assessed from March through May of 2019 & 2020. Results: There were nearly double the number of EMS runs for out of hospital cardiac arrest during the 3 main months of the pandemic. In March through May 2020 there were 1756 runs with a mean age of 62.7 years vs. 988 runs during the same period in 2020 with a higher mean age of 65.1 years (p<0.01). This difference was most pronounced in April, which was the height of the pandemic in Michigan (782 vs. 312). The higher number of EMS runs was also more pronounced in Wayne county (1.86 times 2019 numbers) compared to Macomb County (1.65 times 2019 numbers). Resuscitation was attempted on 566 (32.2%) during the pandemic compared to 222 (22.5%) during the same period in the prior year (OR 0.61, 95% CI 0.51 - 0.73, p<0.01). The proportion of patients transferred from the field to an ED did not change significantly (2.6% in the control period vs. 2.1% during the pandemic, p=0.325). Conclusion: There was a 1.78 fold rise in out of hospital cardiac arrest EMS runs during the peak months of the pandemic in metro Detroit compared to the same period in 2019. Despite national concerns on the safety of resuscitation with Covid-19, a higher proportion of patients had resuscitation attempted during the pandemic.

SARS-CoV-2 surveillance in decedents in a large, urban medical examiner’s office

Background SARS-CoV-2 has become a global pandemic. Given the challenges in implementing widespread SARS-CoV-2 testing, there is increasing interest in alternative surveillance strategies. Methods We tested nasopharyngeal swabs from 1094 decedents in the Wayne County Medical Examiner’s office for SARS-CoV-2. All decedents were assessed by a COVID-19 checklist, and decedents flagged by the checklist (298) were preferentially tested. A random sample of decedents not flagged by the checklist were also tested (796). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged by the checklist and not and between those SARS-CoV-2 positive and not. Results A larger percentage of decedents overall were male (70% vs 48%) and Black (55% vs 36%) compared to the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results: despite no statistical difference in the racial distribution between those flagged and not, SARS-CoV-2 positive decedents were substantially more likely to be Black (82% vs 51%). SARS-CoV-2 positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease. Conclusions Disease surveillance through medical examiners and coroners could supplement other forms of surveillance and may serve as a possible early outbreak warning sign.

SARS-CoV-2 surveillance in decedents in a large, urban medical examiner's office

Background: SARS-CoV-2 has become a global pandemic. Given the challenges in implementing widespread SARS-CoV-2 testing, there is increasing interest in alternative surveillance strategies. Methods: We tested nasopharyngeal swabs from 821 decedents in the Wayne County Medical Examiner's office for SARS-CoV-2. All decedents were assessed by a COVID-19 checklist, and decedents flagged by the checklist (237) were preferentially tested. A random sample of decedents not flagged by the checklist were also tested (584). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged by the checklist and not and between those SARS-CoV-2 positive and not. Results: Decedents were more likely to be male (70% vs 48%) and Black (55% vs 36%) than the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results: despite no statistical difference in the racial distribution between those flagged and not, SARS-CoV-2 positive decedents were substantially more likely to be Black (89% vs 51%). SARS-CoV-2 positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease. Conclusions: Disease surveillance through medical examiners and coroners could supplement other forms of surveillance and may serve as a possible early outbreak warning sign.