Background

Testing pooled wastewater samples to monitor community health has been used frequently during the COVID-19 pandemic to track SARS-CoV-2 RNA shed by infected individuals. However, statistical associations have been too weak to reliably predict reported case counts and prevalence.

Objectives

The objective of the study was to determine the association between SARS-CoV-2 concentrations in wastewater and reported COVID-19 cases and community prevalence estimated from multiple randomized household surveys in Oregon, respectively.

Methods

Eight SARS-CoV-2 prevalence surveys were conducted in six communities in Oregon from May 2020 to March 2021. A two-stage cluster sampling scheme was used to identify participants who provided self-collected nasal swab samples that were tested for the presence of SARS-CoV-2 using a reverse transcription polymerase chain reaction (RT-PCR) test. Weighted prevalence estimates were calculated to account for the probability of selection and adjusted for test characteristics. During each survey, composite samples (24-h time-weighted) were taken from the influent of each community’s wastewater treatment plant, filtered, and analyzed for SARS-CoV-2 RNA using reverse-transcriptase droplet digital PCR (RT-ddPCR). Pearson correlation coefficients were calculated to examine the respective associations.

Results

The correlation (Pearson’s r) between SARS-CoV-2 concentration in city wastewater treatment plant influent (Log10 gc/L) and reported cases (Log₁₀) and estimated prevalence (Log₁₀) was 0.71 (RMSLE=.14 and MAPE= 0.29) and 0.96 (RMSLE=0.03 and MAPE=0.17), respectively.

Conclusions

SARS-CoV-2 viral load in wastewater is a significantly better predictor of COVID-19 community prevalence than reported COVID-19 case counts despite inherent biological and physical variability in wastewater testing.

Background

SARS-CoV-2 was first discovered in Wuhan, China in December 2019. It spread to a global pandemic and affecting more than 220 countries and territories worldwide. It is responsible for more than 33.7 million illnesses and 605,000 deaths in the United States. The number of cases reported in the state of Maine is approaching 70,000.

Objectives

Our objective is to prospectively capture patient and safety data including protocolized use of off-label or investigational therapies in the treatment of COVID-19 to determine trends among risk factors, disease severity, and outcomes.

Methods

We began a prospective registry with pre-defined retrospective chart review of admissions from March 2020 – July 2020. Study sites included Northern Light Health Hospitals and Maine Medical Center. Comparisons were made to Maine U.S. Census Bureau reported COVID-19 and health data. The target population included all hospitalized patients with suspected or laboratory confirmed SARS-COV-2.

Results

The registry captured 290 hospitalizations representing 75% of all COVID-19 hospitalizations statewide. Average age and length of stay was 66 years and 7 days respectively. Overall day 28 mortality was 12%. Patient demographics and outcomes were very similar between sites. Compared to State population values, there was a greater proportion of African Americans (11% vs. 1.7%) diabetes (29% vs. 10.6%) and COPD (18% vs. 9.2%).

Conclusion

Establishing a local pandemic registry provides greater insight into disease understanding, patient care, and safety of therapeutics during the pandemic. Improving our understanding of effectiveness of local response and policies better prepares Maine for future infectious disease crises.

Background:

Older adults have an increased risk for COVID-19, but no research has analyzed the relationship between race/ethnicity, COVID-19 risk, and COVID-19 public health recommendations (PHRs) such as handwashing, masking, and social distancing for this population.

Objectives:

Examine racial/ethnic differences in COVID-19 risk and adherence to COVID-19 PHRs among older adults.

Methods:

Data were retrieved from the National Health and Aging Trends Study, a nationally-representative sample of older adults age 65 or older. COVID-19 variables were collected in 2020, while all other data were collected in 2019. Our sample included 3,257 respondents who self-identified as non-Hispanic White, non-Hispanic Black, Hispanic, Asian, or Other race/ethnicity. We utilized logistic regression to analyze racial/ethnic differences in COVID-19 risk and adherence to COVID-19 PHRs. We identified racial/ethnic differences in mediators for COVID-19 risk by using the Karlson-Holm-Breen statistical test. All models applied survey sampling weights.

Results:

Compared to White older adults, only Hispanics had a significantly higher odds of COVID-19 by 212%, after adjusting for sociodemographics, health, and COVID-19 PHRs (OR=3.12, p=.005). Only Blacks had a significantly higher odds of masking (OR=13.58, p<.001) and higher odds of social distancing (OR=2.18, p=.031) compared to Whites, after adjusting for sociodemographics and health. COVID-19 risk was primarily mediated by income for Whites, Blacks, and Hispanics; however, household size was the primary mediator for Asians.

Conclusion:

Racial/ethnic minority older adults, particularly Hispanics, have an elevated COVID-19 risk. Mediators for COVID-19 risk vary by race/ethnicity, but the disease can generally be mitigated though interventions focusing on low-income older adults.

Background: Deaf communities experience injustices, exclusions, language deprivation, structural barriers, and marginalization that compromise their social and health experiences.

Objectives: We compared COVID-19 experiences of people identifying as deaf (“PD”) with people identifying as hearing (“PH”) to assess COVID-19 outcome differences.

Methods: We ascertained COVID-19-related variables for 7411 participants in 175 countries using an analytic cross-sectional design. Participants self-identified as “deaf,” “Deaf,” “DeafBlind,” “Hard of hearing,” and “Hearing/Non-deaf.” We assessed self-reported COVID-19 infection, testing, knowledge, psychosocial indices, personal impact, and potential confounders. We compare PD (first three categories above) and PH outcomes for the USA-resident subsample only. Logistic regressions estimated unadjusted/adjusted odds ratios (OR/aOR) with 95% confidence intervals (95%CI) to ascertain magnitude and significance.

Results: 106 PD and 549 PH participated. PD were more likely than PH to report COVID-19 infection (aOR: 2.03; 95% CI: 1.11, 3.73; p=0.023), and higher non-medical personal impact (aOR: 1.82; 95%CI: 1.10, 3.01). BIPOC-deaf intersection was significant: BIPOC PD were more likely than non-BIPOC PH to report infection (OR: 4.01; 95%CI: 2.16, 7.81;p<.001) and higher personal impact (OR: 2.38; 95%CI: 1.33, 4.25;p=0.004). PD were more likely to report obtaining COVID-19 testing (OR: 4.31; 95%CI: 2.41, 7.70;p<.001), though the 60% of PD not tested were less likely to believe they could obtain a test if needed (OR: 3.13; 95%CI: 1.70, 5.74; p<.001).

Conclusion: The historical exclusion of people who are deaf through language deprivation, distrustful healthcare systems, and intersectionalities that compound BIPOC access to healthcare may underlie foundational inequities that endure, including during the COVID-19 pandemic.