County Public Health Research Articles

COVID-19 outbreak in a state prison: a case study on the implementation of key public health recommendations for containment and prevention

BackgroundPeople incarcerated in US prisons have been disproportionately harmed by the COVID-19 pandemic. That prisons are such efficient superspreading environments can be attributed to several known factors: small, communal facilities where people are confined for prolonged periods of time; poor ventilation; a lack of non-punitive areas for quarantine/medical isolation; and staggeringly high numbers of people experiencing incarceration, among others. While health organizations have issued guidance on preventing and mitigating COVID-19 infection in carceral settings, little is known about if, when, and how recommendations have been implemented. We examined factors contributing to containment of one of the first California prison COVID-19 outbreaks and remaining vulnerabilities using an adapted multi-level determinants framework to systematically assess infectious disease risk in carceral settings.MethodsCase study employing administrative data; observation; and informal discussions with: people incarcerated at the prison, staff, and county public health officials.ResultsOutbreak mitigation efforts were characterized by pre-planning (e.g., designation of ventilated, single-occupancy quarantine) and a quickly mobilized inter-institutional response that facilitated systematic, voluntary rapid testing. However, several systemic- and institutional-level vulnerabilities were unaddressed hindering efforts and posing significant risk for future outbreaks, including insufficient decarceration, continued inter-facility transfers, incomplete staff cohorting, and incompatibility between built environment features (e.g., dense living conditions) and public health recommendations.ConclusionsOur adapted framework facilitates systematically assessing prison-based infectious disease outbreaks and multi-level interventions. We find implementing some recommended public health strategies may have contributed to outbreak containment. However, even with a rapidly mobilized, inter-institutional response, failure to decarcerate created an overreliance on chance conditions. This left the facility vulnerable to future catastrophic outbreaks and may render standard public health strategies - including the introduction of effective vaccines - insufficient to prevent or contain those outbreaks.

Plastic Handling and Pollution, a Study on the Effect of “Polluter Pays” Principle in Lodwar Town, Turkana County, Kenya

International Journal of Medicine and Public Health,2022,12,2,39-45.DOI:10.5530/ijmedph.2022.2.9Published:April 2022Type:Review ArticlePlastic Handling and Pollution, a Study on the Effect of “Polluter Pays” Principle in Lodwar Town, Turkana County, KenyaNakusi Peter, Stanslaus Kiilu Musyoki, and Alexander M Mbeke Nakusi Peter1,*, Stanslaus Kiilu Musyoki1, Alexander M Mbeke2 1School of Health Sciences, Kisii University, Kisii, KENYA. 2School of Health Sciences, Laikipia University, KENYA. Abstract:Aim/Background: The rapid growth of population in many developing countries has led to an increased generation of waste notably plastic and this has led to a serious environmental problem, which is of great public health concern. Unacceptable plastic waste disposal, due to insufficient human and financial capacity, is a challenge facing Kenya and other developing countries. This study investigated the effect of “polluter pay” principle on plastic handling and pollution in Lodwar town Turkana County. Materials and Methods: A cross-sectionaldescriptive study design targeting residents of Lodwar town, municipal workers, county National Environment Management Authority officers and public health department officers at the county was adopted. Data were then analyzed with descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 26. Results: The findings reveal that majority (48.1%) of the residents disagreed that the municipality sets certain fee and charges to the residents for residual waste per household, per square metre living space. In addition, majority (53.9%) also disagreed that Tax system has been put in place for landfill tax for contaminated site remediation. Majority (71.9%) of the residents agreed that Deposit System has been put in place waste types (for example glass bottles, plastic bottles. However, majority (43.2%) of the residents disagreed that there is producer responsibility driven systems for packaging, electric/electronic waste. From the chi-square analysis the “Polluter Pays” Principle is statistically significantly (X2=93.572) associated with plastic waste handling. Conclusion: The study concludes that “polluter pays” principle have a significant effect on plastic waste handling in Lodwar municipality. Contrary the municipality has not put in place for landfill tax for contaminated site remediation. Recommendation: The study recommends that County administration should put in place mechanisms to attract and leverage public private partnership as a vehicle to mobilize resources and enhance private sector participation in sustainable waste management and circular economy development activities. Keywords:Financial resources, Influence, Lodwar municipality, Plastic waste, Waste handlingView:PDF (131.03 KB)

Flattening the quality of life curve? A prospective person-centred study from Norway amid COVID-19

PurposeWe examined multidimensional, heterogeneous reactions to the COVID-19 pandemic and associated measures to provide further insights into the developmental processes of risk and adaptation.MethodWe used three-wave questionnaire data from 8156 individuals participating in the Norwegian County Public Health Survey assessed 1–5 months before and three (June 2020) and nine (December 2020) months after the outbreak. Latent profile and latent transition analyses were used to identify latent quality of life (QoL) classes and multiform changes, their probabilities, and predictors.ResultsWe identified five distinct QoL classes of varying proportions, namely Flourishing (i.e. 24–40%), Content (31–46%), Content-Symptomatic (8–10%), Languishing (14–20%), and Troubled (2–5%). Despite higher levels of negative affect and lower levels of life satisfaction and positive emotions, most individuals remained in their pre-pandemic QoL profiles. Yet, changes occurred for a meaningful proportion, with transition to a less favourable class more common than to a favourable. Between time 1 and 3, the flourishing and troubled groups decreased by 40% and 60%, while the content and languishing groups increased by 48% and 43%, respectively. Favourable pre-pandemic relational (marital status, support, interpersonal trust, and belonging), health, and economy-related status predicted significantly lower odds of belonging to the high-risk groups both pre-pandemic and during the pandemic.ConclusionsOverall, this study shows lower levels of QoL amid the COVID-19 pandemic, but substantial stability in the QoL distribution, and an overall levelling of the QoL distribution. Our findings also underscore the importance of financial, health-related, and social capital to QoL.

Epidemiology of Coronavirus Disease 2019 at a County Jail-Alameda County, California, March 2020-March 2021.

Coronavirus disease 2019 (COVID-19) incidence rates are 2- to 5-fold higher among persons incarcerated in the United States than in the general population. We describe an outbreak investigation of COVID-19 at a jail (jail A) in Alameda County during March 2020-March 2021. To prevent COVID-19 cases among incarcerated persons and employees, staff at jail A and the county public health department worked to develop and recommend infection control measures implemented by jail A including, but not limited to, face covering use among incarcerated persons and staff; cohorting incarcerated persons at a higher risk of severe COVID-19 in dedicated housing units; quarantining all newly detained individuals for 14 days; and offering testing for all symptomatic incarcerated persons, newly incarcerated persons at day 2 and day 10, and all persons who resided in a housing unit where a COVID-19 case was detected. A total of 571 COVID-19 cases were detected among incarcerated persons at jail A during March 2020-March 2021, which represented a total incidence of 280 per 1000 population, 5 times higher than the rate in Alameda County. Of the 571 cases among incarcerated persons, 557 (98%) were male; 415 (73%) were aged 18 to 40 years; 249 (44%) were Latino; and 180 (32%) were African American; 354 (62%) were not symptomatic; and 220 (39%) had no comorbidities. Less than 2% of infected incarcerated persons were hospitalized, and no deaths were reported. COVID-19 disproportionately impacted persons incarcerated at jail A, with higher numbers among Latinos and African Americans. Implementation of COVID-19 infection control and testing measures, and collaboration between public health, law enforcement, and health care providers may have, in part, led to reductions in morbidity and mortality associated with COVID-19 at jail A.

A Replicable, Solution-Focused Approach to Cross-Sector Data Sharing for Evaluation of Community Violence Prevention Programming.

Community violence is a public health problem that erodes social infrastructure. Structural racism contributes to the disparate concentration of violence in communities of color. In Mecklenburg County, North Carolina, increasing trends in community violence show racial and geographic disparities that emphasize the need for cross-sector, data-driven approaches to program and policy change. Cross-sector collaborations are challenged by data sharing barriers that hinder implementation. In response to community advocacy, Mecklenburg County Public Health (MCPH) launched a Community Violence Prevention Plan with evidence-based programming. The Cure Violence (CV) model, a public health approach to disrupting violence through equitable resource provision, network building, and changing norms, was implemented at the community level. The Health Alliance for Violence Intervention (HAVI) model, a hospital-based screening and case management intervention for victims of violence, was implemented at Carolinas Medical Center in Charlotte, the region's only level I trauma center. A data collaborative was created to optimize evaluation of CV and HAVI programs including MCPH, the city of Charlotte, Atrium Health, Charlotte-Mecklenburg Schools, Johnson C. Smith University, and the University of North Carolina Charlotte. A comprehensive approach to facilitate data sharing was designed with a focus on engaging stakeholders and generating solutions to commonly reported barriers. Structured interviews were used to inform a solution-focused strategy. Stakeholders reported perceptions of their organization's barriers and facilitators to cross-sector data sharing. Common technology, legal, and governance barriers were addressed through partnership with a local integrated data system. Solutions for trust and motivational challenges were built into ongoing collaborative processes. Data silos inhibit the understanding of complex public health issues such as community violence, along with the design and evaluation of collective impact efforts. This approach can be replicated and scaled to support cross-sector collaborations seeking to influence social and health inequities stemming from structural racism.

1407. The Latent Tuberculosis Infection Cascade of Care during the COVID-19 Pandemic Response in a Mid-Sized US City

BackgroundThe COVID-19 pandemic response may unintendedly disrupt multiple public health services, including tuberculosis control programs. We aimed to assess the cascade of care of latent tuberculosis infection (LTBI) in an urban US city during the COVID-19 pandemic response.MethodsWe conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. We defined 01/2019 to 02/2020 as the pre-COVID-19 response period, and 04/2020 to 12/2020 as the COVID-19 pandemic response period. We reviewed electronic medical records and extracted sociodemographic information, medical history, and follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period.ResultsData from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p=0.02) and LTBI evaluations (median, 17.5 vs. 7, p< 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p< 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p< 0.01) during COVID-19. The proportion of people who were recommended LTBI treatment was similar before and during COVID-19 (76% vs. 81%, p=0.41), as well as the LTBI treatment acceptance rates (56% vs. 64%, p=0.28), and LTBI treatment completion rates (65% vs. 63%, p=0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA use, no comorbidities, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period.ConclusionWe observed a significant decline in the number of monthly LTBI referrals and evaluations during COVID-19. Our findings indicate an unintended negative impact of the COVID-19 response in LTBI screening efforts in our region. LTBI treatment acceptance and completion rates were not affected during COVID-19.Disclosures All Authors: No reported disclosures

Phased Return of Students to 77 Transitional Kindergarten-8th Grade Schools With Cohesive Mitigation Strategies Serving as Protective Factors Against the Increase of COVID-19 Cases in Marin County: September 2020-January 2021.

Background and objectiveEarlier uncertain implications of the coronavirus disease 2019 (COVID-19) pandemic on the pediatric population prompted the authorities to close schools worldwide under the premise that school settings would serve as drivers of an increase in the cases of COVID-19. Safe and equitable full-in-person school instruction is a critical factor in the continued educational gains of children and for their general well-being. The objective of this study was to report epidemiological trends related to the increasing percentage of students returning to in-person instruction, the suspected in-school transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the virus that causes COVID-19, and countywide COVID-19 case rates during the first 21 weeks of school reopening in Marin County, CA, in the fall of 2020.Materials and methodsThe institutional review board (IRB) approval was waived for this study as it did not involve any identifiable human subjects data. Retrospective electronic reviews of countywide COVID-19 daily case count and COVID-19-related reports associated with in-person school participants from 77 schools in Marin County, CA, from September 8, 2020, to January 29, 2021, were conducted. The data were made available in collaboration with the Marin County Office of Education (MCOE) and Marin County Department of Health and Human Services (Marin HHS). Descriptive trends analyses were performed to determine whether the phased increase of students attending in-person learning was a significant contributor to countywide COVID-19 incidence rate, crude rate, and in-school COVID-19 viral transmission. This is the first long retrospective study of COVID-19 data among the reopened school population during the second half of the first pandemic year. It was conducted in a 21-week surveillance period involving an immense collaboration between Marin County’s public health officials and school administrators.ResultsOver the 21-week observational period involving 17,639 students, 4,938 school staff, and 899,175 student days, the countywide COVID-19 crude rate decreased (from 89.9 to 35.89 per 10,000) as more students returned to in-person learning. The schools’ strict adherence to public health guidance and site-specific safety plans against COVID-19 yielded a significantly reduced incidence rate of 0.84% among in-person learning participants; only nine cases were traced to suspected in-school SARS-CoV-2 transmission by way of rigorous contact tracing. The countywide COVID-19 incidence rate was 2.09%.ConclusionsIt is possible to minimize COVID-19 transmissions in in-person learning settings with cohesive mitigation strategies, specifically strict adherence to proper masking by students and staff while on school grounds. There is no clear correlation that the increasing phased return of students to in-person school drove an increase in countywide COVID-19 cases in Marin County, CA. Our findings revealed that schools were capable of safely resuming operations by following public health orders and recommendations. The increasing percentage of students returning to in-person school did not drive an increased COVID-19 case rate in the community. On the contrary, this analysis revealed that there was a drop in countywide COVID-19 cases as the phased student return percentage increased.

CPESN California Update

CPESN California has been busy these past few months. Our local network has increased to over 100 independent pharmacies that have delivered on clinical services from COVID vaccine to Point of Care testing. Many of our independent pharmacies have collaborated with their local county health departments, fire departments, schools, employer groups, and long-term care facilities to vaccinate thousands of patients against COVID-19.CPESN California pharmacies have worked tirelessly to ensure that all those that wished to get vaccinated did. Haller’s Pharmacy in Fremont, California, under the direction of Dr. Sanjay Patel, partnered with local fire departments to host many clinics. Pucci’s Pharmacy in Sacramento, California, led by Dr. Clint Hopkins, partnered with Sacramento Public Health Departments to host onsite high school clinics. San Joaquin Drug in Planada owned by Dr. Katie Bass not only worked with her public health department to secure vaccines early but also held clinics every weekend to ensure their community had the opportunity to get vaccinated. Manor Drug and Barr Pharmacy in Fresno California held an onsite COVID clinic in Sanger, California to promote wellness through vaccination. Dr. Michael Ohashi led this effort with strong collaboration from Pam Yoshikawa both are owners of CPESN pharmacies. In Southern California, Western University School of Pharmacy has been working with college students and the underserved in their community. Dr. Bruno Tching at Inland Pharmacy has been collaborating with both local providers and Riverside County Public Health to identify patients with access disparities, such as home bound patients in need of vaccinations, and to provide remote clinics in HPI quartile 1 and 2 areas of the county. They have also been working with local advocacy organizations like the NAACP to promote vaccinations and help tackle disparity issues in low vaccination areas.However, delivering COVID vaccine was not the only thing our CPESN California Networks did. Our Flip the Pharmacy teams led by Dr. Karl Hess from Chapman University transformed their traditional dispensing pharmacy to one that integrates clinical services as part of their daily workload. They began to offer services that centered around diabetes care and social determinants of health. Each providing necessary education and screening to prevent any mishaps in care.It is through these partnerships, community relationships, and focus on providing outstanding individualized care that our CPESN California stores are breaking boundaries to elevate the care they give. Being a part of this community of forward-thinking pharmacists who are willing to think beyond the bottle and focusing on the patient allows our network to be highly successful in delivering exceptional care. If you are interested in learning more about how CPESN California can improve your practice and your relationships with community leaders contact us at www.cpesn.com.

Supporting Health Equity Through Data-Driven Decision-Making: A Local Health Department Response to COVID-19.

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197-S200. https://doi.org/10.2105/AJPH.2021.306421).

Incident command system: Situation unit leader and county public health liaison roles during the federal medical station, Santa Clara, during the COVID-19 response

Federal medical stations (FMS) and alternative care sites are used to provide surge capability and capacity for short-term inpatients with healthcare needs that cannot be accommodated or provided for in a general shelter or general acute care facilities. In March and April 2020, an FMS was deployed to support the management of the COVID-19 pandemic in the ‘hotspot’ of Santa Clara County, CA. This paper describes how the flexibility of the incident command system allowed for the positions of situation unit leader and liaison officer to be combined at the FMS, supporting the effectiveness and efficiency of the FMS through comprehensive situational awareness, information-sharing and collaboration. This method of combining closely related roles is not suitable for all healthcare emergencies, but as this paper demonstrates, it is well worth considering in circumstances where competences and capacity align.

Human urinary biomonitoring in Western Kenya for micronutrients and potentially harmful elements.

Spot urinary elemental concentrations are presented for 357 adults from Western Kenya collected between 2016 and 2019 as part of a wider environmental geochemical survey. The aim of this study was to establish population level urinary elemental concentrations in Western Kenya for micronutrients and potentially harmful elements for inference of health status against established thresholds. For elements where thresholds inferring health status were not established in the literature using urine as a non-invasive matrix, this study generated reference values with a 95% confidence interval (RV95s) to contextualise urinary elemental data for this population group. Data are presented with outliers removed based upon creatinine measurements leaving 322 individuals, for sub-categories (e.g. age, gender) and by county public health administrative area. For Western Kenya, reference values with a 95% confidence interval (RV95s) were calculated as follows (μg/L): 717 (I), 89 (Se), 1753 (Zn), 336 (Mo), 24 (Cu), 15.6 (Ni), 22.1 (As), 0.34 (Cd), 0.47 (Sn), 0.46 (Sb), 7.0 (Cs), 13.4 (Ba and 1.9 (Pb). Urinary concentrations at the 25th/75th percentiles were as follows (μg/L): 149/368 (I), 15/42 (Se), 281/845 (Zn), 30/128 (Mo), 6/13 (Cu), 1.7/6.1 (Ni), 2.0/8.2 (As). 0.1/0.3 (Cd), 0.05/0.22 (Sn), 0.04/0.18 (Sb), 1.2/3.6 (Cs), 0.8/4.0 (Ba) and 0.2/0.9 (Pb). Urinary concentrations at a population level inferred excess intake of micronutrients I, Se, Zn and Mo in 38, 6, 57 and 14% of individuals, respectively, versus a bioequivalent (BE) upper threshold limit, whilst rates of deficiency were relatively low at 15, 15, 9 and 18%, respectively. Each of the administrative counties showed a broadly similar range of urinary elemental concentrations, with some exceptions for counties bordering Lake Victoria where food consumption habits may differ significantly to other counties e.g. I, Se, Zn. Corrections for urinary dilution using creatinine, specific gravity and osmolality provided a general reduction in RV95s for I, Mo, Se, As and Sn compared to uncorrected data, with consistency between the three correction methods.

Health Impacts of Perchlorate and Pesticide Exposure: Protocol for Community-Engaged Research to Evaluate Environmental Toxicants in a US Border Community.

BackgroundThe Northern Arizona University (NAU) Center for Health Equity Research (CHER) is conducting community-engaged health research involving “environmental scans” in Yuma County in collaboration with community health stakeholders, including the Yuma Regional Medical Center (YRMC), Regional Center for Border Health, Inc. (RCBH), Campesinos Sin Fronteras (CSF), Yuma County Public Health District, and government agencies and nongovernmental organizations (NGOs) working on border health issues. The purpose of these efforts is to address community-generated environmental health hazards identified through ongoing coalitions among NAU, and local health care and research institutions.ObjectiveWe are undertaking joint community/university efforts to examine human exposures to perchlorate and agricultural pesticides. This project also includes the parallel development of a new animal model for investigating the mechanisms of toxicity following a “one health” approach. The ultimate goal of this community-engaged effort is to develop interventions to reduce exposures and health impacts of contaminants in Yuma populations.MethodsAll participants completed the informed consent process, which included information on the purpose of the study, a request for access to health histories and medical records, and interviews. The interview included questions related to (1) demographics, (2) social determinants of health, (3) health screening, (4) occupational and environmental exposures to perchlorate and pesticides, and (5) access to health services. Each participant provided a hair sample for quantifying the metals used in pesticides, urine sample for perchlorate quantification, and blood sample for endocrine assays. Modeling will examine the relationships between the concentrations of contaminants and hormones, demographics and social determinants of health, and health status of the study population, including health markers known to be impacted by perchlorate and pesticides.ResultsWe recruited 323 adults residing in Yuma County during a 1-year pilot/feasibility study. Among these, 147 residents were patients from either YRMC or RCBH with a primary diagnosis of thyroid disease, including hyperthyroidism, hypothyroidism, thyroid cancer, or goiter. The remaining 176 participants were from the general population but with no history of thyroid disorder. The pilot study confirmed the feasibility of using the identified community-engaged protocol to recruit, consent, and collect data from a difficult-to-access, vulnerable population. The demographics of the pilot study population and positive feedback on the success of the community-engaged approach indicate that the project can be scaled up to a broader study with replicable population health findings.ConclusionsUsing a community-engaged approach, the research protocol provided substantial evidence regarding the effectiveness of designing and implementing culturally relevant recruitment and dissemination processes that combine laboratory findings and public health information. Future findings will elucidate the mechanisms of toxicity and the population health effects of the contaminants of concern, as well as provide a new animal model to develop precision medicine capabilities for the population.International Registered Report Identifier (IRRID)DERR1-10.2196/15864

Imipenem-Relebactam Susceptibility and Genotypic Characteristics of Carbapenem-Resistant Enterobacterales Identified during Population-Based Surveillance.

Laboratories submit all carbapenem-resistant Enterobacter, Escherichia coli, and Klebsiella species to the Alameda County Public Health Department (ACPHD). ACPHD evaluated 75 isolates submitted during 9 months for susceptibility to imipenem-relebactam (I-R) and, using whole-genome sequencing, identified β-lactamase genes. Of 60 (80%) isolates susceptible to I-R, 8 (13%) had detectable carbapenemase genes, including 4 KPC, two NDM, and two OXA-48-like; we described the relationship between the presence of β-lactamase resistance genes and susceptibility to I-R.

SCHOOL HYGIENE PROMOTION APPROACHES AND THEIR INFLUENCE ON PUPIL’S HYGIENE PRACTICES IN PUBLIC PRIMARY SCHOOLS IN DAGORETTI, NAIROBI CITY COUNTY, KENYA

Purpose: The purpose of this study was to examine hygiene promotion approaches that were being employed by public primary schools in Dagoretti North and South Sub Counties in Nairobi City County and whether the approaches influenced hygiene behaviors that were practiced by pupils.&#x0D; Methodology: The study applied a descriptive cross-sectional design. Questionnaires were administered to 384 pupils with the aim of collecting data on hygiene knowledge and practices. A questionnaire was also used to collect data on hygiene promotion approaches from 32 school health teachers. Pupils’ demographic data was collected from school head teachers. Five key informant interviews were conducted with Nairobi City County public health and education officers and a staff from a non-governmental organization that was implementing school hygiene activities in Dagoretti South and North Sub Counties. Observation checklists were used to triangulate information on hygiene practices by pupils. Analysis was done using SPSS software.&#x0D; Findings: Results indicate that 95.6% of the pupils practiced hand washing at critical times, 98.7% used the toilet while 85.4% safely disposed solid waste. The study reveals that water, sanitation and hygiene in schools approach is implemented by 31.3% of the school health teachers. There was a significant relationship between school health clubs approach and hand washing at critical times (p=0.04) and proper solid waste disposal (p=0.02). One way analysis of variance established that there is a significant difference among hygiene promotion approaches and pupils hygiene knowledge, F(5, 162) = 6.41, p &lt;.05 ƞ²p = 0.076.&#x0D; Unique contribution to theory, practice and policy: The study establishes that different hygiene promotion approaches have the potential to influence hygiene practices and in particular, hand washing at critical times and proper solid waste disposal amongst pupils. The study recommends the use of school health clubs approach for hygiene promotion at public primary schools

Incidentally Detected SARS-COV-2 Among Hospitalized Patients in Los Angeles County, August to October 2020.

We aimed to determine the percentage of COVID-19- associated hospitalizations reported to Los Angeles County (LAC) Public Health that might have been misclassified because of incidentally detected SARS-CoV-2. We retrospectively reviewed medical records from a randomly selected set of hospital discharges reported to LAC Public Health from August to October 2020 for a clinical diagnosis of COVID-19 or a positive SARS-CoV-2 test result. Among the 13,813 discharges from 85 hospitals reported to LAC Public Health as COVID-19-associated hospitalizations from August to October 2020, 346 were randomly selected and reviewed. SARS-CoV-2 detection was incidental to the reason for hospitalization in 12% (95% confidence limit, 9%-16%) of COVID-19 classified hospital discharges. Adjusting COVID-19-associated hospitalization rates to account for incidental SARS-CoV-2 detection could help public health policymakers and emergency preparedness personnel improve resource planning.

Reactivating Therapeutic Activities in an Acute Care Group Setting During a Pandemic

<h3>Background</h3> In March 2020, when COVID-19 was declared a pandemic, county public health restricted all group activities, including within the healthcare setting. A university children's hospital's comprehensive eating disorders program was forced to stop its inpatient group and environmental treatments. Inpatient group settings can pose different risks for infection prevention and control (IPC) and guidance is often lacking for this healthcare environment. <h3>Methods</h3> Six months later, when IPC measures were in place and the prevalence of COVID-19 was decreasing, plans to safely reactivate group treatment were developed in alignment with public health guidance. Nursing, IPC, Nutrition, Occupational Therapy, Child Life, Psychiatry, Psychology and Space Planning collaborated on plans for group activities including meals, relaxation, psychology, nutrition, art therapy, music therapy, cinematherapy, recreation and schooling. Maps indicating social distancing were developed. <h3>Results</h3> Plans were divided into phases of reactivation based on county guidelines and adherence to IPC measures. They included patient, caregiver, and staff social distancing requirements, along with maps of each room and where tables, chairs and yoga mats would be placed. They also incorporated IPC guidelines: hand hygiene for all before and after the activity/session, daily symptom screening for all, COVID-19 testing of patient admissions, universal masking for all and eye protection for staff. Additionally, requirements for cleaning and disinfection were increased for both the environment and any supplies that were not disposable. Documentation of which patients, caregivers and staff participated in activities was also included in the plans to allow for contact tracing in the event of a possible COVID-19 exposure. <h3>Conclusions</h3> As hospitals begin to reactivate group therapies and activities, it is important to create a plan that considers the amount of extra time and space needed for proper cleaning and disinfection, setting up the room to maintain social distancing, symptom screening and increased documentation. Plans must follow public health guidelines.

An Academic-Health Department Community Partnership to Expand Disease Investigation and Contact Tracing Capacity and Efficiency During the COVID-19 Pandemic.

Disease investigation and contact tracing are long-standing public health strategies used to control the spread of infectious disease. Throughout the COVID-19 pandemic, health departments across the country have lacked the internal workforce capacity and technology needed to efficiently isolate positive cases and quarantine close contacts to slow the spread of SARS-CoV-2. This article describes an innovative disease investigation and contact tracing program developed through a formalized community partnership between a local county health department and local university. This innovative new program added 108 contact tracers to the county's public health workforce, as well as enabled these contact tracers to work remotely using a call center app and secure cloud-based platform to manage the county's caseload of cases and contacts. An overview of the requirements needed to develop this program (eg, hiring, health data security protocols, data source management), as well as lessons learned is discussed.

Public Health Expenditures and Clinical and Social Complexity of Tuberculosis Cases-Alameda County, California, July-December 2017.

Alameda County, California, is a high tuberculosis (TB) burden county that reported a TB incidence rate of 8.1 per 100 000 during 2017. It is the only high TB burden California county that does not have a public health-funded TB clinic. To describe TB public health expenditures and clinical and social complexities of TB case-patients. Public health surveillance of confirmed and possible TB case-patients reported to Alameda County Public Health Department during July 1, 2017, to December 31, 2017. Social complexity status was categorized for all case-patients using surveillance data; clinical complexity status, either by surveillance definition or by the Charlson Comorbidity Index (CCI), was categorized only for confirmed TB case-patients. Total public health and per patient expenditures were stratified by insurance status. Cohen's kappa assessed concordance between clinical complexity definitions. All comparisons were conducted using Fisher's exact or Kruskal-Wallis tests. Of 81 case-patients reported, 68 (84%) had confirmed TB, 29 (36%) were socially complex, and 15 (19%) were uninsured. Total public health expenditures were $487 194, and 18% of expenditures were in nonlabor domains, 57% of which were for TB treatment, diagnostics, and insurance, with insured patients also incurring such expenditures. Median per patient expenditures were significantly higher for uninsured and government-insured patients than for privately insured patients ($7007 and $5045 vs $3704; P = .03). Among confirmed TB case-patients, 72% were clinically complex by surveillance definition and 53% by the CCI; concordance between definitions was poor (κ = 0.25; 95% confidence interval, 0.03-0.46). Total public health expenditures approached $500 000. Most case-patients were clinically complex, and about 20% were uninsured. While expenditures were higher for uninsured case-patients, insured case-patients still incurred TB treatment, diagnostic, and insurance-related expenditures. State and local health departments may be able to use our expenditure estimates by insurance status and description of clinically complex TB case-patients to inform efforts to allocate and secure adequate funding.

COVID-19 Outbreak Among Farmworkers - Okanogan County, Washington, May-August 2020.

Okanogan County, Washington, experienced increased community transmission of SARS-CoV-2, the virus that causes COVID-19, during summer 2020 (1). Multiple COVID-19 outbreaks occurred in agricultural settings, including a large outbreak among employees of a fruit grower during May-August. Because of this outbreak, Okanogan County Public Health and the Washington State Department of Health initiated one-time, on-site screening testing (2) of all orchard and warehouse employees in August 2020 and assessed risk factors for SARS-CoV-2 infection. Among 3,708 known orchard employees, a valid SARS-CoV-2 test result or information on COVID-19-like symptoms in the absence of a test was available for 3,013 (81%). Cumulative incidence of SARS-CoV-2 infection during approximately 3 months among tested orchard employees was 6%. Cumulative incidence was 12% in employees residing in the community, compared with 4% in employees residing in farmworker housing (p<0.001); point prevalence during the single screening testing event was 1% in both groups. Among 1,247 known warehouse employees, a valid result was available for 726 (58%). Cumulative incidence over approximately 3 months among tested warehouse employees was 23%, with substantial variation across job roles. Positive test results were received by 28% of employees who worked packing and sorting fruit, 24% of those in other roles in the packing and sorting area, 10% of forklift operators, 7% of employees in other warehouse roles, and 6% of office employees. Point prevalence among all warehouse workers was 1% at the screening testing event. Collaboration among employers, community groups, and public health authorities can reveal risk factors and help decrease farmworkers' risk for SARS-CoV-2 infection in the community and the workplace. Creation of a COVID-19 assessment and control plan by agricultural employers, with particular focus on indoor workers whose jobs limit physical distancing, could reduce workplace transmission.

Impact Evaluation of the Kenya Frontline Field Epidemiology Training Program: Repeated-Measures Study.

BackgroundIn 2014, Kenya’s Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers.ObjectiveThis study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR).MethodsBetween February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions.ResultsIn total, 103 (47%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods.ConclusionsFETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR.