The effectiveness of COVID deaths to COVID policies: A robust conditional approach

This paper examines the effectiveness of four major COVID-19 social distancing policies, (i) shelter-in-place orders (SIPO), (ii) non-essential business closures, (iii) mandatory quarantine for travelers, and (iv) bans on large gatherings, on both COVID cases and COVID deaths. Results indicate that states are highly ineffective in producing the fraction of the population that does not have COVID-19 or the fraction of the population that does not die from COVID-19. We find that having any form of social distancing policies increases the fraction of the population not considered a positive COVID-19 case by 23.5 percentage points. Results also show that having any of the four major social distancing policies reduces the fraction of the population who has died of COVID-19 by 1.3 percentage points between March 1, 2020 and September 1, 2020; during the first 100 days, effectiveness would improve by 2.1 percentage points. Evidence suggests that there is no effective uniform national COVID-19 social distancing policy. Furthermore, conditional efficiency regressions after 100 days suggest that behavioral noncompliance and premature expiration of social distancing policies both negatively impact effectiveness. Partial regression plots suggest that bans on large gatherings and the closure of non-essential businesses were the two most impactful COVID-19 social distancing policies.

Toxic Exposures Among Young Children One Year into the COVID-19 Pandemic: A Retrospective Review of Three San Francisco Bay Area Emergency Departments

BACKGROUND

Daycare and school closures prompted by shelter-in-place orders may have increased opportunities for unintentional ingestions among young children.

OBJECTIVES

We examined emergency department (ED) presentations for toxic exposures among young children during the COVID-19 pandemic in the San Francisco Bay Area, which had some of the strictest and most prolonged shelter-in-place policies in the United States.

METHODS

We performed a retrospective cross-sectional study of children 0 to 5 years of age who presented with an ED International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis code of toxic exposure within a tertiary care hospital system between March 16, 2016 and March 15, 2021. We considered the period after March 16, 2020 to represent the pandemic.

RESULTS

During the pandemic, the absolute number of poisonings among young children remained stable. Overall, ED encounters within this cohort decreased by 55%, which doubled the relative toxic exposure rate per 1000 ED encounters from 4.99 (95% confidence interval [CI] 3.19-5.90) to 9.79 (95% CI 8.09-11.49). Rates of admission, severe medical complications, operating room case requests, and length of stay were not significantly different. Shelter-in-place was associated with significantly higher odds of cannabis ingestion (odds ratio = 2.70, 95% CI 1.60-4.49).

CONCLUSION

Despite dramatic decreases in overall ED patient volumes, the absolute number and severity of toxic exposures were similar during the pandemic compared with previous years. © 2022 Elsevier Inc.

Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic

BACKGROUND

The impact of the coronavirus on hospitalizations for gastrointestinal (GI) disease, particularly at a population level is understudied.

AIM

To investigate trends in hospitalizations, inpatient endoscopy resource utilization, and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.

METHODS

Using the California State Inpatient Database for 2018-2020, we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality (all-cause & viral pneumonia-specific) for common inpatient GI diagnoses including acute pancreatitis, diverticulitis, cholelithiasis, non-infectious gastroenteritis, upper and lower GI bleeding (LGIB), Clostridium difficile, viral gastroenteritis, inflammatory bowel disease, and acute cholangitis.

RESULTS

Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding (NVUGIB), LGIB, and ulcerative colitis (UC) (ptrend < 0.0001). All-cause inpatient mortality was higher in 2020 vs 2019, for acute pancreatitis (P = 0.029), diverticulitis (P = 0.04), NVUGIB (P = 0.003), and Crohn’s disease (P = 0.004). In 2020, hospitalization rates were lowest in April, November, and December. There was no significant corresponding increase in inpatient mortality except in UC (ptrend = 0.048). Viral pneumonia and viral pneumonia complicated by respiratory failure increased (P < 0.001) among GI hospitalizations. Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB (P < 0.001).

CONCLUSION

Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic, particularly in April, November and December 2020. All-cause mortality was significantly higher among acute pancreatitis, diverticulitis, NVUGIB, and Crohn’s disease hospitalizations. Emergency endoscopy rates were mostly comparable between 2020 and 2019.

"Are you safe to talk?": Perspectives of Service Providers on Experiences of Domestic Violence During the COVID-19 Pandemic

This study aimed to better understand the factors driving reported trends in domestic violence during the COVID-19 pandemic, particularly the effect of the pandemic on survivors' experiences of violence and ability to seek support. We conducted semi-structured qualitative interviews with 32 DV service providers operating in organizations across 24 U.S. cities. The majority of providers described a decrease in contact volume when shelter-in-place orders were first established, which they attributed to safety concerns, competing survival priorities, and miscommunication about what resources were available. For most organizations, this decrease was followed by an increase in contacts after the lifting of shelter-in-place orders, often surpassing typical contact counts from the pre-pandemic period. Providers identified survivors' ability to return to some aspects of their pre-pandemic lives, increased stress levels, and increased lethality of cases as key factors driving this increase. In addition, providers described several unique challenges faced by DV survivors during the pandemic, such as the use of the virus as an additional tool for control by abusers and an exacerbated lack of social support. These findings provide insight into the lived experiences driving observed trends in DV rates during COVID-19. Understanding the impact of the pandemic on survivors can help to shape public health and policy interventions to better support this vulnerable population during future crises.

Impact on neurosurgical management in a Level 1 trauma center post COVID-19 shelter-in-place restrictions

The stringent restrictions from shelter-in-place (SIP) policies placed on hospital operations during the COVID-19 pandemic led to a sharp decrease in planned surgical procedures. This study quantifies the surgical rebound experienced across a neurosurgical service post SIP restrictions in order to guide future hospital programs with resource management. We conducted a retrospective review of all neurosurgical procedures at a public Level 1 trauma center between February 15th to August 30th for the years spanning 2018-2020. We categorized patient procedures into four comparative one-month periods: pre-SIP; SIP; post-SIP; and late recovery. Patient procedures were designated as either cranial; spinal; and other; as well as Elective or Add-on (Urgent/Emergent). Categorical variables were analyzed using χ2 tests and Fisher's exact tests. A total of 347 cases were reviewed across the four comparative periods and three years studied; with 174 and 152 spinal and cranial procedures; respectively. There was a proportional increase; relative to historical controls; in total spinal procedures (p-value < 0.001) and elective spinal procedures (p-value < 0.001) in the 2020 SIP to Post-SIP. The doubling of elective spinal cases in the Post-SIP period returned to historical baseline levels in three months after SIP restrictions were lifted. Total cranial procedures were proportionally increased during the SIP period relative to historical controls (p-value = 0.005). We provide a census on the post-pandemic neurosurgical operative demands at a major public Level 1 trauma hospital, which can potentially be applied for resource allocations in other disaster scenarios.

The efficiency of COVID cases to COVID policies: a robust conditional approach

This paper examines the efficiency of four major COVID-19 social distancing policies: (i) shelter-in-place orders (SIPO), (ii) non-essential business closures, (iii) mandatory quarantine for travelers, and (iv) bans on large gatherings. Results suggest that the average US state is highly inefficient in producing the fraction of the population that does not have COVID-19 without social distancing policies put in place. We find that having any of the four major social distancing policies increases conditional efficiency by 9.7 (9.5) percentage points in the first 100 days (full sample). This corresponds to 57 (172) fewer total COVID-19 cases per 100,000 population in the first 100 days (full sample). We also find that population density accounts for a majority of unconditional state inefficiency. Evidence suggests considerable heterogeneity in conditional efficiency improvement, indicating that no uniform national social distancing policy would have been more effective; more effective strategies would have been to target more densely populated areas. Conditional efficiency regressions suggest that bans on large gatherings were the most effective policies, with SIPOs and non-essential business closures having smaller impacts. States that implemented social distancing policies except mandatory quarantine for traveler policies were highly effective for the first 100 days, but had less effectiveness over the full sample. There is also preliminary evidence that premature revocations of social distancing policies reduced conditional efficiency, leading to COVID-19 case spikes.

Compact development and adherence to stay-at-home order during the COVID-19 pandemic: A longitudinal investigation in the United States

In the absence of a vaccine and medical treatments, social distancing remains the only option available to governments in order to slow the spread of global pandemics such as COVID-19 and save millions of lives. Despite the scientific evidence on the effectiveness of social distancing measures, they are not being practiced uniformly across the U.S. Accordingly, the role of compact development on the level of adherence to social distancing measures has not been empirically studied. This longitudinal study employs a natural experimental research design to investigative the impacts of compact development on reduction in travel to three types of destinations representing a range of essential and non-essential trips in 771 metropolitan counties in the U.S during the shelter-in-place order amid the COVID-19 pandemic. We employed Multilevel Linear Modeling (MLM) for the three longitudinal analyses in this study to model determinants of reduction in daily trips to grocery stores, parks, and transit stations; using travel data from Google and accounting for the hierarchical (two-level) structure of the data. We found that the challenges of practicing social distancing in compact areas are not related to minimizing essential trips. Quite the opposite, residents of compact areas have significantly higher reduction in trips to essential destinations such as grocery stores/pharmacies, and transit stations. However, residents of compact counties have significantly lower reduction in their trips to parks possibly due to the smaller homes, lack of private yards, and the higher level of anxiety amid the pandemic. This study offers a number of practical implications and directions for future research.

The impact of mask-wearing and shelter-in-place on COVID-19 outbreaks in the United States

OBJECTIVES

A hasty reopening has led to a resurgence of the novel coronavirus disease 2019 (COVID-19) in the United States (US). We aimed to quantify the impact of several public health measures including non-medical mask-wearing, shelter-in-place, and detection of silent infections to help inform COVID-19 mitigation strategies.

METHODS

We extended a previously established agent-based disease transmission model and parameterized it with estimates of COVID-19 characteristics and US population demographics. We implemented non-medical mask-wearing, shelter-in-place, and case isolation as control measures, and quantified their impact on reducing the attack rate and adverse clinical outcomes.

RESULTS

We found that non-medical mask-wearing by 75% of the population reduced infections, hospitalizations, and deaths by 37.7% (interquartile range (IQR): 36.1-39.4%), 44.2% (IQR: 42.9-45.8%), and 47.2% (IQR: 45.5-48.7%), respectively, in the absence of a shelter-in-place strategy. Sheltering individuals aged 50 to 64 years of age was the most efficient strategy, decreasing attack rate, hospitalizations, and deaths by over 82% when combined with mask-wearing. Outbreak control was achieved in the simulated scenarios and the attack rate was reduced to below 1% when at least 33% of silent pre-symptomatic and asymptomatic infections were identified and isolated.

CONCLUSIONS

Mask-wearing, even with the use of non-medical masks, has a substantial impact on outbreak control. A judicious implementation of shelter-in-place strategies remains an important public health intervention amid ongoing outbreaks.

Poverty and economic dislocation reduce compliance with COVID-19 shelter-in-place protocols

Shelter-in-place ordinances were the first wide-spread policy measures aimed to mitigate the spread of COVID-19. Compliance with shelter-in-place directives is individually costly and requires behavioral changes across diverse sub-populations. Leveraging county-day measures on population movement derived from cellphone location data and the staggered introduction of local mandates, we find that economic factors have played an important role in determining the level of compliance with local shelter-in-place ordinances in the US. Specifically, residents of low income areas complied with shelter-in-place ordinances less than their counterparts in areas with stronger economic endowments, even after accounting for potential confounding factors including partisanship, population density, exposure to recent trade disputes, unemployment, and other factors. Novel results on the local impact of the 2020 CARES Act suggest stimulus transfers that addressed economic dislocation caused by the COVID-19 pandemic significantly increased social distancing.

Early evidence of the impacts of COVID-19 on minority unemployment

This paper provides early evidence of the impacts of the COVID-19 pandemic on minority unemployment in the United States. In the first month following March adoptions of social distancing measures by states, unemployment rose to 14.5% but a much higher 24.4% when we correct for potential data misclassification noted by the BLS. Using the official definition, unemployment in April 2020 among African-Americans rose by less than what would have been anticipated (to 16.6%) based on previous recessions, and the long-term ordering of unemployment across racial/ethnic groups was altered with Latinx unemployment (18.2%) rising for the first time to the highest among major groups. Difference-in-difference estimates confirm that the initial gap in unemployment between whites and blacks in April was not different than in periods prior to the pandemic; however, the racial gap expanded as unemployment for whites declined in the next two months but was largely stagnant for blacks. The initially large gap in unemployment between whites and Latinx in April was sustained in May and June as unemployment declined similarly for both groups. Non-linear decompositions show a favorable industry distribution partly protected black employment during the early stages of the pandemic, but that an unfavorable occupational distribution and lower average skills levels placed them at higher risk of job losses. An unfavorable occupational distribution and lower skills contributed to a sharply widened Latinx-white unemployment gap that moderated over time as rehiring occurred. These findings of disproportionate impacts on minority unemployment raise important concerns regarding lost earnings and wealth, and longer-term consequences of the pandemic on racial inequality in the United States.

COVID-19 related admissions to a regional burn center: The impact of shelter-in-place mandate

The ramifications from the 2019 severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic caused by the novel corona virus will be felt globally for years to come. Mandates to shelter-in-place were called in nearly every state to limit viral exposure. The impact of the mandate on acute burn admissions was unknown. Our objective was to assess the impact of a shelter-in-place order on acute burn admissions at our burn center. All patients admitted to the burn center with burn injuries- including inhalation injury only- and desquamating skin disorders between March 10th to May 22nd, 2020 were eligible for inclusion. We compared all burn center admissions to a month-matched historical cohort from 2019, and summertime admissions for the last five years. Statistical significance was accepted as p < 0.05. There was a 9% increase in pediatric admissions after the shelter-in-place order. Compared to the 2019 cohort, there was a 28% increase in admissions of school aged children in 2020. This was not statistically significant. While the purpose of the "shelter-in-place" mandate was to reduce viral transmission of COVID-19, it consequently led to an increased percentage of admissions of school age children- comparable to our summertime numbers. More outreach and education are needed to provide safe resources for families during this pandemic.

COVID-19 related admissions to a regional burn center: The impact of shelter-in-place mandate

The ramifications from the 2019 severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic caused by the novel corona virus will be felt globally for years to come. Mandates to shelter-in-place were called in nearly every state to limit viral exposure. The impact of the mandate on acute burn admissions was unknown. Our objective was to assess the impact of a shelter-in-place order on acute burn admissions at our burn center. All patients admitted to the burn center with burn injuries– including inhalation injury only– and desquamating skin disorders between March 10th to May 22nd, 2020 were eligible for inclusion. We compared all burn center admissions to a month-matched historical cohort from 2019, and summertime admissions for the last five years. Statistical significance was accepted as p < 0.05. There was a 9% increase in pediatric admissions after the shelter-in-place order. Compared to the 2019 cohort, there was a 28% increase in admissions of school aged children in 2020. This was not statistically significant. While the purpose of the “shelter-in-place” mandate was to reduce viral transmission of COVID-19, it consequently led to an increased percentage of admissions of school age children- comparable to our summertime numbers. More outreach and education are needed to provide safe resources for families during this pandemic.

Examining the effect of social distancing on the compound growth rate of COVID-19 at the county level (United States) using statistical analyses and a random forest machine learning model

OBJECTIVES

The goal of the present work is to investigate trends among US counties and coronavirus disease 2019 (COVID-19) growth rates in relation to the existence of shelter-in-place (SIP) orders in that county.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Compound growth rates were calculated using cumulative confirmed COVID-19 cases from January 21, 2020, to March 31, 2020, in all 3139 US counties. Compound growth was chosen as it gives a single number that can be used in machine learning to represent the speed of virus spread during defined time intervals. Statistical analyses and a random forest machine learning model were used to analyze the data for differences in counties with and without SIP orders.

RESULTS

Statistical analyses revealed that the March 16 presidential recommendation (limiting gatherings to ≤10 people) lowered the compound growth rate of COVID-19 for all counties in the US by 6.6%, and the counties that implemented SIP after March 16 had a further reduction of 7.8% compared with the counties that did not implement SIP after March 16. A random forest machine learning model was built to predict compound growth rate after a SIP order and was found to have an accuracy of 92.3%. The random forest found that population, longitude, and population per square mile were the most important features when predicting the effect of SIP.

CONCLUSIONS

SIP orders were found to be effective at reducing the growth rate of COVID-19 cases in the US. Counties with a large population or a high population density were found to benefit the most from a SIP order.

Preparation and Response for Flooding Events in Beef Cattle

Flooding appears to be occurring at an increased frequency and severity, resulting in significant losses to the beef cattle industry. Responding to the needs of beef cattle is a resource-intense occurrence and beyond that provided by most local jurisdictions. It is incumbent on livestock producers to develop continuity of operations or emergency plans designed to limit the financial losses and compromised animal welfare that occur when livestock are exposed to flood conditions. Livestock producers and the veterinary medical profession should also encourage and participate in the development of public emergency plans focused on limiting losses in this critical industry.