COVID-19 Intelligence Report: Public Health Interventions

• A JAMA article studying health disparities found that African American participants, men, and people younger than 55 years were less likely to know how the disease is spread, were less likely to know the symptoms of coronavirus disease 2019, washed their hands less frequently, and left the home more often.
• A JAMA Cardiology study found out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly increased compared with the same period the previous year and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms
• A telemedicine system reduced the risks of delayed hospitalization for COVID-19 patients quarantined at home due to disease progression. Through the comparison of monitored symptoms between hospitalized and non-hospitalized patients, this study found the prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic for identifying patients for hospitalization.

Preventing transmission of COVID-19:

• As more states and locales are opening, comprehensive guidance is available for employers on how to prevent transmission of COVID-19 in the workplace. Suggested public health measures include use of PPE, reducing the density/segmenting the workforce, environmental controls and testing.
• The Centers for Disease Control and Prevention has released guidance for businesses, as well as considerations and guidance for institutions of higher learning.

Title: COVID-19 Contact Tracing Course

Publisher: Johns Hopkins University and Coursera

Publication Date: May 11, 2020

URL: https://www.coursera.org/learn/covid-19-contact-tracing?edocomorp=covid-19-contact-tracing

Key Takeaway: This is a 5-hour online beginner contact tracer course teaching about COVID-19 infection, transmission, utility of contact tracing, how contact tracing is done, communication skills, ethical considerations and challenges to contact tracing. Available for free to audit the course, not available for CME. This may be relevant for primary care providers performing follow-up with COVID+ patients or other providers performing telephone follow-up after discharge from ED or hospital.

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

URL: https://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.

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.

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?

Ten Weeks to Crush the Curve

• This is an editorial on the steps the US needs to take to crush the coronavirus pandemic.

Health Informatics Support for Outbreak Management in an Academic Health System

• https://doi.org/10.1093/jamia/ocaa037
• Note from submitter: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic.

Interim Guidance for Risk Assessment and Monitoring

Schools, Workplaces, and Community Locations

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