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COVID-19 Intelligence Report: Epidemiology

June 29, 2020

Updates for the District of Columbia:

● As of June 28th , the District’s overall positive case total was 10,248 with 550 deaths.

  • DC’s positivity rate has risen from low of 2% on 6/12 to 4.4% on 6/20. However, this may be a reflection of the drop in number of residents tested: 3498 on 6/12 down to only 745 on 6/20.
  • Hospital occupancy is 78 % in DC; the proportion of occupancy due to COVID-19 continues to decrease (126 of 1,944 total) and ventilator utilization remains below 50%. ● Sharp increases in cases in the Latino community: 42.6% of Latinos in the Baltimore-DC metro area who were tested for SARS-CoV-2 were positive- a much higher proportion than for any other racial/ethnic group possibly reflecting higher exposure rates and/or barriers to testing. 

​​​​​​​​Sharp increases in cases in the Latino community: 42.6% of Latinos in the Baltimore-DC metro area who were tested for SARS-CoV-2 were positive- a much higher proportion than for any other racial/ethnic group possibly reflecting higher exposure rates and/or barriers to testing.

 

Other Epidemiology

  • Multiple states set single day records as case counts and positivity rates increase:
    • Florida breaks single day record for third day in a row
    • In Arizona, health officials also reported a record, with 2,577 current hospitalizations
    • Texas set a record for coronavirus-related hospitalizations for the 16th day in a row on Saturday, with 5,523 patients being treated. Following a record single-day increase of COVID-19 cases in the state, TX Gov. Greg Abbott has paused further phases of the state's reopening plan and halted elective surgeries in four counties. 

June 22, 2020

Updates for the District of Columbia: 

June 15, 2020

Updates for the District of Columbia:  

  • After decreases in community spread in May and early June, recent increases in cases have been reported in the District and in Maryland. It remains to be seen if this trend continues, and whether it will affect DC’s ability to enter Phase 2 (currently scheduled for 19JUNE).  
  • Following mass demonstrations for racial justice and police reform, the Mayor recommended attendees self-isolate at home and seek testing. Long waits are reported and new sites have opened
  • Hospital occupancy is at 80.5% in DC, the highest since April, but the proportion of occupancy due to COVID-19 is down and ventilator utilization remains <50%.  
  • Disease burden continues to disproportionately affect Black residents (50% of cases, 74% of deaths). 

Key updates in prevention of COVID-19:

June 1, 2020

Title: COVID-19: in the footsteps of Ernest Shackleton

Publisher: British Medical Journal: Thorax Publication Date: May 27, 2020

URL: https://thorax.bmj.com/content/thoraxjnl/early/2020/05/27/thoraxjnl-2020- 215091.full.pdf

Key Takeaway: This is an epi study of all 217 passengers and crew on board a cruise ship (on a cruise to Antarctica – thus the reference to Shackleton) found 81% of Covid-19 positive passengers had no symptoms. Of the 217 passengers, 128 (59%) were positive for COVID- 19 on RT–PCR. Of the COVID-19-positive patients, 24 (19% ) were symptomatic; and 8 (6.2%) required medical evacuation; 4 (3.1%) were intubated and ventilated; and the mortality was 1 (0.8%. The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients).

 

Title: Research Letter: Comparison of Clinical Characteristics of Patients with Asymptomatic vs Symptomatic Coronavirus Disease 2019 in Wuhan, China [clinician]

Publisher: JAMA

Publication Date: May 27, 2020

URL:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766237

Key Takeaway: This epi study traced close contacts of Covid-19 patients from the Wuhan Seafood Market and found of the 78 close contacts who tested RT-PCR positive for SARS CoV-2, 33 (42%) had no symptoms. If confirmed, this very high rate of asymptomatic infection could represent an important vector for secondary transmission and for prevention strategies.

 

Title: Features of 20,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

Publisher: BMJ

Publication Date: May 22 2020

URL: https://www.bmj.com/content/369/bmj.m1985

Key Takeaway: Prospective observational cohort study across 208 hospitals reporting on over 20,000 patients. Overall, the authors concluded in study participants, mortality was high, independent risk factors were increasing age, male sex, and chronic comorbidity, including obesity. NB: this ongoing prospective cohort study will likely produce important findings on the epidemiology, natural history and clinical management of patients with Covid-19 infection.

 

Title: Hospitalization and Mortality among Black Patients and White Patients with Covid-19

Publisher: NEJM

Publication Date: May 27, 2020

URL: https://www.nejm.org/doi/full/10.1056/NEJMsa2011686

Key Takeaway: In a large retrospective cohort study (over 3600 patients) from Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.

 

Title: Morbid Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50

Publisher: Obesity

Publication Date: May 23, 2020

URL: https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.22913

Key Takeaway: Retrospective analysis of 3,406 COVID-19 patients in NYC.

For the younger population (572 patients), BMI above 40 kg/m2 was independently associated with mortality. For the older population (1,076 patients), BMI above 40 kg/m2 was also independently associated with mortality to a lesser extent. This study demonstrates that hospitalized patients younger than 50 with morbid obesity are more likely to die from COVID-19.

May 25, 2020

EPIDEMIOLOGY (FOCUS ON DC METRO AREA)

 

Title: Severe COVID-19 in Children and Young Adults in the Washington, DC Metropolitan Region

Publisher: Journal of Pediatrics

Publication Date: May 2020

URL: https://www.jpeds.com/article/S0022-3476(20)30581-3/fulltext

Key Takeaway:  177 infected children and adolescents, including 44 hospitalized and

9 critically ill (3/15 4/30/2020). Twenty-five (25) percent of patients presenting with symptoms required hospitalization and 5% required critical care. Children <1 year of age and children/young adults >15 years of age each represented 32% (14/44) of all hospitalized patients and combined total of 64% of hospitalizations (p=0.07). Adolescents and young adults > 15 years of age represented 66% (6/9) of critical care admissions (p=0.02). Underlying medical conditions represented 27/44 (63%) of hospitalized patients: Asthma (20%), neurologic disease (6%), diabetes (3%), obesity (2%), cardiac (3%), hematologic (3%) and malignancy (1%). Many (134/177, 76%) came with respiratory symptoms, fever. However, only 85/177 (48%) had both fever and respiratory symptoms. Co-infection was uncommon (6%; ½ of these with entero /rhinovirus). One critically ill patient with Kawasaki like syndrome. No deaths have been reported to date.

 

EPIDEMIOLOGY AND PUBLIC HEALTH

 

Title: The Time Sequences of Oral and Fecal Viral Shedding of Coronavirus Disease 2019 (COVID-19) Patients

Publisher: Gastroenterology

Publication Date: May 16, 2020

URL: https://www.sciencedirect.com/science/article/pii/S0016508520306636

Key Takeaway:  Retrospective cohort study of 401 laboratory-confirmed COVID-19 patients -admitted to Shenzhen Third People's Hospital in China were included in this study. Viral RNAs of SARS-CoV-2 were tested by quantitative RT-PCR in both the respiratory and rectal specimens.

  • Pediatric (< 18 years-old) patients possessed a positive rate of 56.67%, compared to 16.98% in adult (≥18 years-old) patients.
  • 58 (11.8%) pairs were positive in both rectal and respiratory samples, 112 (21.7%) pairs were positive in rectal while negative in respiratory samples, 40 (7.7%) pairs were positive in respiratory while negative in rectal swabs.
  • SARS-CoV-2 RNA in fecal samples remained for an unexpected long period, with higher positive rate and higher viral load than the paired respiratory samples. The longest duration observed was 43 days.

Note: Viral culture results needed to evaluate infectivity were not reported.

 

      Title: Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study

Publisher: The Lancet

Publication Date: May 19, 2020

URL: https://doi.org/10.1016/S0140-6736(20)31189-2

Key Takeaway:  This prospective observational cohort study of 1150 hospitalized patients with Covid-19 in New York City documents the critical illnesses, laboratory markers, clinical course, diagnoses and  high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality.

 

May 18, 2020

Title: WHO - Policy Brief on Covid-19 and Mental Health

Publisher: World Health Organization

Publication Date: May 13, 2020

URL: https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf

Key Takeaway:  The mental health impact of the Covid-19 pandemic will be profound. It will have impact on all sectors particularly those with preexisting mental health diagnoses and also will precipitate an unprecedented need for evaluation and treatment among those most impacted; newly unemployed, loved ones of those with COVID-19 disease and related death, and the health workforce. Policy, institutional, community and clinical programs must be initiated now to address these health concerns.

 

Title: Low-Income Children and Coronavirus Disease 2019 (COVID-19) in the US

Publisher: JAMA Pediatrics

Publication Date: May 13, 2020

URL: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766115

Key Takeaway:  GW affiliated authors. Perspective piece regarding the significant public health issues facing low-income children that have been uncovered and exacerbated by the pandemic, many of these issues will have long-standing ramifications as these children grow.

May 11 2020

Title: Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods Before and After Symptom Onset

Publisher: JAMA

Publication Date: 1 May 2020

URL: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2765641

doi:10.1001/jamainternmed.2020.2020

Key Takeaways:  This is a well conducted epidemiological study quantifying the asymptomatic transmissibility of COVID-19. High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.

 

Title: Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 — Georgia, March 2020

Publisher: Morbidity and Mortality Weekly Report (MMWR) / CDC

Publication Date: 29 April 2020

URL: https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e1.htm

Key Takeaways: In a cohort of 305 hospitalized adults with COVID-19 in Georgia (primarily metropolitan Atlanta), Black patients were overrepresented, and their clinical outcomes were similar to those of non-Black patients.  Prevention activities should prioritize communities and racial groups most affected by severe COVID-19. Increased awareness of the risk for serious illness among all adults, regardless of underlying medical conditions or age, is needed.  Additionally, one in four hospitalized patients had no identified risk factors for COVID-19.

 

Title: Obesity could shift severe COVID-19 disease to younger ages

Publisher: The Lancet

Publication Date: 04 May 2020

URL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31024-2/fulltext

DOI: https://doi.org/10.1016/S0140-6736(20)31024-2

Key Takeaways: In a dataset of five university hospital ICUs that included 265 COVID-positive patients (58% male), a significant inverse correlation was observed between age and BMI - younger individuals admitted to hospital were more likely to be obese.

 

Title: SARS-COV-2 was already spreading in France in late December 2019

Publisher: International Journal of Microbial Agents (Elsevier)

Publication Date: 3 May 2020

URL: https://www.sciencedirect.com/science/article/pii/S0924857920301643

Doi: https://www.sciencedirect.com/science/article/pii/S0924857920301643

Key Takeaways:  Retrospective PCR testing has identified that a hospitalized patient with no travel history has been determined to have likely had COVID-19 illness in France in December, 2019. The authors suggest that COVID-19 was already spreading in France a month before the official first cases in the country were otherwise reported.

May 4, 2020

Title: Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China 

Publisher: Lancet

Publication Date: April 27, 2020

URLhttps://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext    

Key Takeaway: Active contact tracing allowed earlier identification (by ~2 days) compared to passive surveillance. 11% of household contacts became infected. 5% of cases developed symptoms more than 14 days after exposure.

April 27, 2020

Title:  Population-Based Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States

Publisher: Emerging Infectious Diseases 

Publication: April 23, 2020

URL: https://wwwnc.cdc.gov/eid/article/26/8/20-0679_article

Key Takeaway: 

● Over 45% of US adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or other conditions which predispose to more severe disease. Rates of co-morbidities increase by age, from 19.8% for persons 18–29 years of age to 80.7% for persons >80 years of age, and vary by state, race/ethnicity, health insurance status, and employment.

April 20, 2020

Title:  Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period
Publication: Science Magazine, April 14, 2020
Key Takeaway: Authors of this article 
1) identify viral, environmental, and immunologic factors to determine the dynamics of SARS-CoV-2;
2) integrate findings in a mathematical model to project potential scenarios for SARS-CoV-2 transmission through the pandemic and post-pandemic periods; 
3) identify key data still needed to determine which scenarios are likely to play out; and
4) assess the duration and intensity of social distancing measures that might be needed to maintain control of SARS-CoV-2 in the coming months under both existing and expanded critical care capacities. 
The authors conclude: recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022.
 
Title: WHO is Investigating Reports of Recovered COVID Patients Testing Positive Again Publication: Reuters, April 14, 2020
Key Takeaway: Possibility of re-infection with another strain or reactivation of virus vs. longer period needed before retesting for clearance. 
 
Title: Policy and Public Health Recommendations for Easing COVID-19 Distancing Restrictions
Publication: Infectious Disease Society of America, April 16, 2020
Key Takeaway: IDSA recommendations for incremental steps to ease physical distancing

April 9, 2020

Title: What We Need to Understand About Asymptomatic Carriers

Web address: https://www.propublica.org/article/what-we-need-to-understand-about-asymptomatic-carriers-if-were-going-to-beat-coronavirus

Key Takeaway: A thoughtful article about the importance of disease control for asymptomatic carriers of Covid-19.

 

Title:  Respiratory virus shedding in exhaled breath and efficacy of face masks, April 3, 2020

Web address: https://www.nature.com/articles/s41591-020-0843-2

Key Takeaway: A study of 246 individuals with seasonal respiratory virus infections randomized to wear or not wear a surgical face mask showed that masks can significantly reduce detection of coronavirus and influenza virus in exhaled breath and may help interrupt virus transmission.

 

Title: Is the coronavirus airborne? Experts can’t agree, April 2, 2020

Web address: https://www.nature.com/articles/d41586-020-00974-w

Key Takeaway: A scientific brief posted to its website on March 27 (and updated on March 29, see below) reports that the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient.  Experts that work on airborne respiratory illnesses and aerosols say that gathering unequivocal evidence for airborne transmission could take years and cost lives. 

 

Title: WHO – Modes of Transmission of virus causing Covid-19: Implication for IPC precaution recommendations, March 29, 2020

Web address: https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Key Takeaway: This Scientific Brief outlines the position, based on the available evidence, that WHO continues to recommend droplet and contact precautions for those people caring for COVID-19 patients. WHO continues to recommend airborne precautions for circumstances and settings in which aerosol generating procedures and support treatment are performed, according to risk assessment.

 

Title: Washington Post - The coronavirus is infecting and killing black Americans at an alarmingly high rate – April 7, 2020

Web address: https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/?arc404=true

Key Takeaway: Report of the alarming trend of excess Covid-19 mortality among African Americans.

 

Title: Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020

Website: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

Key Takeaway: Updated April 8, 2020 this documents the demographics of persons hospitalized with Covid-19 infection in the US.

 

Title: The Coronavirus epidemic curve is already flattening in New York City

Website:  https://www.nber.org/papers/w26917

Key takeaway: There appears to be sufficient evidence to conclude that the curve in New York City is indeed flattening. The purpose of this report is to set forth the evidence for – and against – this preliminary but potentially important conclusion. Having examined the evidence, we then inquire: if the curve is indeed flattening, do we know what caused it to level off?

 

April 4, 2020

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019,United States, Feb 12–March 28, 2020

  • https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm 
  • This analysis of preliminary US COVID-19 data, indicates that persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions. April 3, 2020

April 2, 2020

University of Virginia Covid-19 Dashboard

  • UVA Covid-19 Dashboard (county level data). This dashboard is interactive, detailed to a county level with incidence and prevalence of disease, and has advantages and updates that exceed the other dashboards available online  

March 31, 2020

Aerosol and Surface Stability of Covid-19 virus                                

  • NEJM Letter: Stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated decay rates.  van Doremalen N, Bushmaker T, Morris DH, et al. “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1” [published online ahead of print, 2020 Mar 17]. N Engl J Med. 2020;10.1056/NEJMc2004973. doi:10.1056/NEJMc2004973 
  • Note from submitter: Good evidence base for aerosolized Covid 19 

DC DOH – Testing in DC                   

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