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Hall EW, Sarwary S, Reynolds A, Przedworski J, Newby-Kew A, Camp K, Ku JH, Snowden JM. Development of a University-Government Partnership for Public Health Response and Workforce Development in the State of Oregon. J Community Health 2024:10.1007/s10900-024-01352-7. [PMID: 38491319 DOI: 10.1007/s10900-024-01352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Abstract
The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.
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Affiliation(s)
- Eric W Hall
- School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA.
| | - Shabir Sarwary
- School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
| | - Amelia Reynolds
- Health Security, Preparedness and Response Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Abigail Newby-Kew
- School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
| | - Karen Camp
- School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
| | - Jennifer H Ku
- Department of Research & Evaluation, Kaiser Permanente Southern California, California, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
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Jacobs ET, Cordova-Marks FM, Farland LV, Ernst KC, Andrews JG, Vu S, Heslin KM, Catalfamo C, Chen Z, Pogreba-Brown K. Understanding low COVID-19 booster uptake among US adults. Vaccine 2023; 41:6221-6226. [PMID: 37666694 DOI: 10.1016/j.vaccine.2023.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort. METHODS A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. RESULTS The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11-0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03-0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08-4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69-3.43). CONCLUSIONS Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.
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Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Felina M Cordova-Marks
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leslie V Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jennifer G Andrews
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sage Vu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kelly M Heslin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Collin Catalfamo
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Zweigenthal V, Perez G, Wolmarans K, Olckers L. Health Sciences students' experience of COVID-19 case management and contact tracing in Cape Town, South Africa. BMC MEDICAL EDUCATION 2023; 23:238. [PMID: 37046295 PMCID: PMC10092931 DOI: 10.1186/s12909-023-04205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND COVID-19 has challenged health and higher education systems globally. Managing the epidemic in Cape Town, South Africa (SA), required partnerships with universities and setting up of de novo systems for mass case and contact tracing (C&CT). Health sciences, predominantly medical students, as well as social work and psychology students formed the core of this telephone-based work over the 18 months when SARS-CoV-2 caused severe disease. METHODS This qualitative study aimed to elicit students' motivations for becoming involved in C&CT, their experiences, and recommendations for C&CT and curricula. After Cape Town's first COVID-19 wave, six on-line focus groups comprising 23 students were conducted, and a further four were conducted with 13 students after the second wave. As the researchers were predominantly educators previously involved in undergraduate health sciences education, the study's purpose was to reflect on students' experiences to make educational and health system recommendations. RESULTS Students were largely motivated to mitigate the impact of the epidemic on society and support people affected by COVID-19, as well as hone their professional skills. While these motivations were realised, students also needed to learn new skills - to autonomously work remotely, using novel communication strategies to engage those affected and use virtual groups to connect with colleagues. They managed responsibilities within the healthcare systems that did not always work smoothly, distressed cases who were financially insecure, difficult employers, and language barriers. They were prepared through training, and supported by virtual, yet effective teamwork and debriefing opportunities. Although the work was sometimes physically and emotionally exhausting, students found the work personally meaningful. They embraced public health's role to protect population and individuals' health. CONCLUSION New teaching and learning practices adopted due to Covid-19 lockdowns enabled this digital C&CT project. It facilitated students to become confident, work autonomously and navigate challenges they will encounter as young professionals. The programme demonstrated that novel opportunities for rich student learning, such as in telehealth, can be embedded into public health and clinical functions of health services in contexts such as in SA, deepening partnerships between the health services and universities, to mutual benefit.
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Affiliation(s)
- Virginia Zweigenthal
- School of Public Health, Faculty of Health Sciences, University of Cape Town, Town, South Africa.
| | - Gonda Perez
- School of Public Health, Faculty of Health Sciences, University of Cape Town, Town, South Africa
| | - Karen Wolmarans
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Town, South Africa
| | - Lorna Olckers
- School of Public Health, Faculty of Health Sciences, University of Cape Town, Town, South Africa
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Hoang PA, Tran NT, Nguyen THH, Nguyen TTH. Barriers to COVID-19 contact tracing: View from frontline healthcare students in Vietnam. Public Health Nurs 2023. [PMID: 36938938 DOI: 10.1111/phn.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/21/2023]
Abstract
In the context of the complicated continuous waves of the COVID-19 pandemic in Vietnam, contact tracing, along with social distancing and lock-down, proved its crucial role in the suppression of epidemic spreading and management. With the high demand for responsiveness, healthcare students were constantly involved in the process, and challenges have emerged along the way. This study aims to identify the barriers faced by healthcare students while performing the contact tracing task at the frontline of the pandemic. A qualitative study was conducted in July 2021 in a health center in Binh Duong province, Vietnam. A total of 20 healthcare students were invited through random recruitment of participants and interviewed until the principle of saturation was reached. Three main barriers were identified including ineffective work management of local managers, lack of capability of human resources and facilities, and uncooperative attitude of local residents. Given the existing barriers, cooperative, innovative strategies, shared data systems, and timely public awareness campaigns, especially among primary health centers of the healthcare system, are imperative to reduce the workload and optimize the efficacy of healthcare students' support.
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Affiliation(s)
- Phuong Anh Hoang
- College of Health Sciences, VinUniversity, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Ngoc Tran Tran
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
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Pre-existing conditions associated with post-acute sequelae of COVID-19. J Autoimmun 2023; 135:102991. [PMID: 36634460 PMCID: PMC9816074 DOI: 10.1016/j.jaut.2022.102991] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/17/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
Post-acute sequelae of COVID-19 (PASC) are conditions that occur or remain at least 28 days after SARS-CoV-2 infection. While some risk factors for PASC have been identified, little is known about pre-existing conditions that render one susceptible to developing PASC. Data from participants (n = 1224) in a longitudinal COVID-19 cohort study in Arizona were used to investigate comorbid conditions associated with PASC. After adjustment of the models for age, BMI, gender, race, and smoking, the following pre-existing conditions were statistically significantly associated with the development of PASC: asthma (OR = 1.54; 95% CI = 1.10-2.15); chronic constipation (OR = 4.29; 95% CI = 1.15-16.00); reflux (OR = 1.54; 95% CI = 1.01-2.34); rheumatoid arthritis (OR = 3.69; 95%CI = 1.15-11.82); seasonal allergies (OR = 1.56; 95% CI = 1.22-1.98); and depression/anxiety (OR = 1.72; 95% CI = 1.17-2.52). When grouping conditions together, statistically significant associations with PASC were observed for respiratory (OR = 1.47; 95% CI = 1.06-2.14); gastrointestinal (OR = 1.62; 95% CI = 1.16-2.26), and autoimmune conditions (OR = 4.38; 95% CI = 1.59-12.06). After adjustment for severity of acute SARS-CoV-2 infection and depression/anxiety, seasonal allergies (OR = 1.48; 95% CI 1.15-1.91) and autoimmune disease (OR = 3.78; 95% CI - 1.31-10.91) remained significantly associated with risk for PASC. These findings indicate that numerous pre-existing conditions may be associated with an increased risk for the development of PASC. Patients with these conditions should consider taking extra steps to avoid infection.
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Fenton T, Brown T, Bastida E. Lessons Learned From Contact Tracing During the COVID-19 Pandemic: Public Health Students' Experiences in the Field. J Prim Care Community Health 2023; 14:21501319231196427. [PMID: 37649406 PMCID: PMC10472824 DOI: 10.1177/21501319231196427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Contact tracing is a cornerstone in public health practice, providing an effective response to infectious disease outbreaks. Beginning in April 2020, as the COVID-19 pandemic spread quickly in the United States, public health departments increasingly relied on contact tracers to control disease spread and reduce the impact on the community. The Florida Department of Health (DOH) employed hundreds of public health students to pursue transmission control statewide as contact tracers. This study employed a qualitative thematic approach to capture 11 graduate-level public health students' experiences, motivations, challenges, and recommendations on contact tracing procedures as DOH contract tracers. In-depth interview questions focused on students' interest in public health, experiences as a contact tracer, patient/case interactions, and personal outlook on the COVID-19 pandemic. The COVID-19 pandemic brought new experiences and challenges for public health students employed by local health departments as contact tracers. Three categories and subthemes emerged from interviews: (1) motivations to work as a contact tracer, (2) challenges faced throughout employment, and (3) overall assessment of the contact tracing process. Identifying and understanding the work of contact tracers from the system-level perspective is vital as they contribute to improving training and working relationships with management and ultimately extend to the community. Lessons learned during the early months of the COVID-19 pandemic should help inform public health practice, especially when considering recruitment, curricula, training, and retention of the public health workforce in the face of current and emerging public health emergencies.
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Haddad MB, McLean JE, Feldman SS, Sizemore EE, Taylor MM. Innovative Approaches to COVID-19 Case Investigation and Contact Tracing. Public Health Rep 2022; 137:5S-10S. [PMID: 36113066 PMCID: PMC9483134 DOI: 10.1177/00333549221120454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Maryam B. Haddad
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jody E. McLean
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sue S. Feldman
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin E. Sizemore
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melanie M. Taylor
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Silverstein SM, Jenkins W, Orlowski M, Paton S. Pandemic response across Ohio's public universities: Novel approaches, emergent challenges and future opportunities. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-10. [PMID: 36084278 DOI: 10.1080/07448481.2022.2121923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Objective: We describe and analyze case investigation and contact tracing (CICT) efforts across Ohio's public universities in response to COVID-19 to distill challenges and lessons learned and suggest future opportunities for universities to mobilize in the face of emergent public health crises. Participants: Faculty, staff, and graduate students from Ohio's fourteen public universities. Methods: In-depth, semi-structured interviews were conducted with representatives from nine of the 14 universities; representatives from the remaining five universities completed a brief questionnaire. Interviews were transcribed in their entirety and thematically analyzed. Results: Emergent themes include the significance of local relationships for implementing locally tailored solutions; the presence of discrete challenges in doing CICT work with university and local communities, and the importance of university students in pandemic response. Conclusions: There are unique challenges associated with disease control across university populations and surrounding communities, but students from diverse academic background are a potential source of assistance.
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Affiliation(s)
- Sydney M Silverstein
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Center for Interventions, Treatment, and Addictions Research, Dayton, Ohio, USA
| | - Whitney Jenkins
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Marietta Orlowski
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Sara Paton
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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9
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Feuerstein-Simon R, Strelau KM, Naseer N, Claycomb K, Kilaru A, Lawman H, Watson-Lewis L, Klusaritz H, Van Pelt AE, Penrod N, Srivastava T, Nelson HC, James R, Hall M, Weigelt E, Summers C, Paterson E, Aysola J, Thomas R, Lowenstein D, Advani P, Meehan P, Merchant RM, Volpp KG, Cannuscio CC. Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center. JAMA Netw Open 2022; 5:e2232110. [PMID: 36149656 PMCID: PMC9508658 DOI: 10.1001/jamanetworkopen.2022.32110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities. OBJECTIVE To investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies. DESIGN, SETTING, AND PARTICIPANTS This case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine. RESULTS Of 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25). CONCLUSIONS AND RELEVANCE These findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Katherine M. Strelau
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
- Biomedical Graduate Studies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nawar Naseer
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
- Biomedical Graduate Studies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kierstyn Claycomb
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Austin Kilaru
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hannah Lawman
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
- Now with Novo Nordisk, Plainsboro, New Jersey
| | | | - Heather Klusaritz
- Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Amelia E. Van Pelt
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nadia Penrod
- Penn Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tuhina Srivastava
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
- Biomedical Graduate Studies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hillary C.M. Nelson
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Richard James
- School of Nursing, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Moriah Hall
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Elaine Weigelt
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Courtney Summers
- Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Emily Paterson
- Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center For Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rosemary Thomas
- Center For Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Deborah Lowenstein
- Center For Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Preeti Advani
- Center For Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Patricia Meehan
- Center For Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia
| | - Carolyn C. Cannuscio
- Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
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Harrington KR, Siira MR, Rothschild EP, Rabinovitz SR, Shartar S, Clark D, Isakov A, Chamberlain A, Gelaye E, Cegielski JP, Gandhi NR. A University-Led Contact Tracing Program Response to a COVID-19 Outbreak Among Students in Georgia, February-March 2021. Public Health Rep 2022; 137:61S-66S. [PMID: 35989589 PMCID: PMC9678788 DOI: 10.1177/00333549221113866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Few reports have described how university programs have controlled COVID-19 outbreaks. Emory University established a case investigation and contact tracing program in June 2020 to identify and mitigate transmission of SARS-CoV-2 in the Emory community. In February 2021, this program identified a surge in COVID-19 cases. In this case study, we present details of outbreak investigation, construction of transmission networks to assess clustering and identify groups for targeted testing, and program quality metrics demonstrating the efficiency of case investigation and contact tracing, which helped bring the surge under control. During February 10-March 5, 2021, Emory University identified 265 COVID-19 cases confirmed by nucleic acid testing in saliva or nasopharyngeal samples. Most students with COVID-19 were undergraduates (95%) and were affiliated with Greek life organizations (70%); 41% lived on campus. Network analysis identified 1 epidemiologically linked cluster of 198 people. Nearly all students diagnosed with COVID-19 (96%) were interviewed the same day as their positive test result. Of 340 close contacts, 90% were traced and 89% were tested. The median time from contact interview to first test was 2 days (interquartile range, 0-6 days); 43% received a positive test result during their quarantine. The surge was considered under control within 17 days, after which new cases were no longer epidemiologically linked. Early detection through systematic testing protocols and rapid and near-complete contact tracing, paired with isolation and quarantine measures, helped to contain the surge. Our approach emphasizes the importance of early preparation of adequate outbreak response infrastructure and staff to implement interventions appropriately and consistently during a pandemic.
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Affiliation(s)
- Kristin R.V. Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Meron R. Siira
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Samuel Shartar
- Office of Critical Event Preparedness and Response, Emory University, Atlanta, GA, USA
| | - David Clark
- Division of Campus Life, Emory University, Atlanta, GA, USA
| | - Alexander Isakov
- Office of Critical Event Preparedness and Response, Emory University, Atlanta, GA, USA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Enku Gelaye
- Division of Campus Life, Emory University, Atlanta, GA, USA
| | - J. Peter Cegielski
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Neel R. Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, GA, USA
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11
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Woodard L, Liaw W, Adepoju OE, Prabhu S, Chae M, Matuk-Villazon O, Beech BM. Evaluating a contact tracing course: How universities can develop the public health workforce. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-7. [PMID: 35981316 DOI: 10.1080/07448481.2022.2103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To describe the participants of a university-based COVID-19 contact tracing course and determine whether the course changed knowledge, attitudes, and intention to participate in contact tracing. PARTICIPANTS Faculty, staff, and students were eligible. METHODS Surveys evaluated the impact of the course on participant intentions to engage in contact tracing. Logistic regression identified characteristics associated with increased likelihood of participating in contact tracing. RESULTS Nearly 800 individuals participated, of whom 26.2% identified as Hispanic/Latino and 14.0% as Black. Nearly half (48.8%) planned to conduct contact tracing. While attitudes did not change, knowledge improved (67.9% vs. 93.8% scores on assessments; p < 0.001). Younger participants and Black individuals were more more likely to be confident that they would participate in contact tracing. CONCLUSIONS Course completion was associated with increased knowledge. Participants were racially and ethnically diverse, highlighting how universities can partner with health departments to develop workforces that reflect local communities.
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Affiliation(s)
- LeChauncy Woodard
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
- Humana Integrated Health System Sciences Institute, University of Houston, Houston, Texas, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
| | - Omolola E Adepoju
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
| | | | - Minji Chae
- Department of Biostatistics and Data Science, University of Texas Health Science Center School of Public Health, Houston, Texas, USA
| | - Omar Matuk-Villazon
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX, USA
| | - Bettina M Beech
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
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12
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Ruebush E, Dennison A, Lane J, Harper-Hardy P, Poulin A, Prather B, Wright S, Harvey D, Fraser MR. Implementation of a Nationwide Knowledge-Based COVID-19 Contact Tracing Training Program, 2020. Public Health Rep 2022; 137:11S-17S. [PMID: 35786097 PMCID: PMC9357820 DOI: 10.1177/00333549221101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In the United States, the public health response to control COVID-19 required rapid expansion of the contact tracing workforce from approximately 2200 personnel prepandemic to more than 100 000 during the pandemic. We describe the development and implementation of a free nationwide training course for COVID-19 contact tracers that launched April 28, 2020, and summarize participant characteristics and evaluation findings through December 31, 2020. Uptake of the online asynchronous training was substantial: 90 643 registrants completed the course during the first 8 months. In an analysis of a subset of course participants (n = 13 697), 7724 (56.4%) reported having no prepandemic public health experience and 7178 (52.4%) reported currently serving as case investigators, contact tracers, or both. Most participants who completed a course evaluation reported satisfaction with course utility (94.8%; 59 497 of 62 753) and improved understanding of contact tracing practice (93.0%; 66 107 of 71 048). These findings suggest that the course successfully reached the intended audience of new public health practitioners. Lessons learned from this implementation indicate that an introductory course level is appropriate for a national knowledge-based training that aims to complement jurisdiction-specific training. In addition, offering a range of implementation options can promote course uptake among public health agency staff. This course supported the emerging needs of the public health practice community by training a workforce to fill an important gap during the COVID-19 pandemic and could serve as a feasible model for enhancing workforce knowledge for future and ongoing public health threats.
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Affiliation(s)
- Elizabeth Ruebush
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | | | - J.T. Lane
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Paris Harper-Hardy
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Amelia Poulin
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Bill Prather
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Shauntā Wright
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Harvey
- National Coalition of STD Directors, Washington, DC, USA
| | - Michael R. Fraser
- Association of State and Territorial Health Officials, Arlington, VA, USA
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13
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Ledesma D, Maroofi H, Sabin S, Dennehy TJ, Truong JM, Meyer LG, Salik M, Scott S, White JR, Collins J, Mrukowicz C, Charifson M, Shafer MS, Jehn M. Design and Implementation of a COVID-19 Case Investigation Program: An Academic-Public Health Partnership, Arizona, 2020. Public Health Rep 2022; 137:213-219. [PMID: 35060793 DOI: 10.1177/00333549211068495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
From May through July 2020, Arizona was a global hotspot for new COVID-19 cases. In response to the surge of cases, local public health departments looked for innovative ways to form external partnerships to address their staffing needs. In collaboration with the Maricopa County Department of Public Health, the Arizona State University Student Outbreak Response Team (SORT) created and implemented a virtual call center to conduct public health case investigations for COVID-19. SORT officially launched a dedicated COVID-19 case investigation program after 3 weeks of program design and training. From June 29 through November 8, 2020, SORT recruited and trained 218 case investigators, completed 5000 case patient interviews, and closed 10 000 cases. Our team also developed process improvements to address disparities in case investigation timeliness. A strong infrastructure designed to accommodate remote case investigations, paired with a large workforce, enabled SORT to provide additional surge capacity for the county's high volume of cases. University-driven multidisciplinary case investigator teams working in partnership with state, tribal, and local public health staff members can be an effective tool for supporting a diverse and growing public health workforce. We discuss the essential design factors involved in building a university program to complement local COVID-19 response efforts, including workflows for case management, volunteer case investigator recruitment and training, secure technology platforms for conducting case investigations remotely, and robust data-tracking procedures for maintaining quality control and timely case reporting.
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Affiliation(s)
- Daniela Ledesma
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hanna Maroofi
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Susanna Sabin
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
| | - Timothy J Dennehy
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Jasmine M Truong
- Health and Clinical Partnerships, Arizona State University, Tempe, AZ, USA
| | - Laura G Meyer
- School of Social Work, Arizona State University, Tempe, AZ, USA
| | - McMillan Salik
- School of Social Work, Arizona State University, Tempe, AZ, USA
| | - Sarah Scott
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - Jessica R White
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | | | | | - Mia Charifson
- Vilcek Institute of Biomedical Graduate Studies, New York University School of Medicine, New York, NY, USA
| | | | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
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14
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Riza E, Kakalou E, Nitsa E, Hodges-Mameletzis I, Goggolidou P, Terzidis A, Cardoso E, Puchner KP, Solomos Z, Pikouli A, Stoupa EP, Kakalou C, Karamagioli E, Pikoulis E. Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9257. [PMID: 34501844 PMCID: PMC8431650 DOI: 10.3390/ijerph18179257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Eleni Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evangelia Nitsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Ioannis Hodges-Mameletzis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Paraskevi Goggolidou
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Agis Terzidis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni Cardoso
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Karl Philipp Puchner
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | | | - Anastasia Pikouli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni-Panagiota Stoupa
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Christina Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evika Karamagioli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Emmanouil Pikoulis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
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15
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Bell ML, Catalfamo CJ, Farland LV, Ernst KC, Jacobs ET, Klimentidis YC, Jehn M, Pogreba-Brown K. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PLoS One 2021; 16:e0254347. [PMID: 34347785 PMCID: PMC8336814 DOI: 10.1371/journal.pone.0254347] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.
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Affiliation(s)
- Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Collin J. Catalfamo
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Yann C. Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
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