Number Of Coronavirus Disease 2019 Cases Research Articles

New Nosocomephobia? Changes in Hospitalizations during the COVID-19 Pandemic

While the coronavirus disease-2019 (COVID-19) pandemic directly caused millions of hospitalizations and deaths, its indirect impacts on people with other illnesses can be of equal importance. Using discharge records in a major Chinese megacity where there was a limited number of COVID-19 cases, we find significant declines in the number of hospital admissions for a whole spectrum of disease categories during the pandemic. The declines were larger in COVID-19 designated hospitals and top-grade hospitals. In-hospital mortality and length of stay (LOS) were higher for stroke, ischaemic heart diseases, and malignant neoplasms, while women delivering in hospitals had fewer C-sections and shorter LOS. Our results suggest that people avoided necessary hospitalization out of fear of being infected by COVID-19. To prevent the adverse impacts of delaying health care, policymakers should establish clear guidelines encouraging people to seek necessary care, especially during the reopening period.

Towards A Strategic Approach Of Covid-19 Cluster Web Mapping In Malaysia

The world was shocked by an unprecedented outbreak caused by coronavirus disease 2019 (COVID-19). In Malaysia, it started with the largest number of COVID-19 cases with the first wave of infection on 25 January 2020. The objectives of this paper are to obtain the perspective of the respondents about the need for web-mapping in the form of mapping the geospatial data in Malaysia and to visualize the current online datasets of COVID-19 disease case clusters. The study area would cover the entire Malaysia since a rapidly increasing number of citizens were affected by this virus. To be specific, this study focused on the active clusters of COVID-19 in Malaysia. The data were freely shared in real-time by referring to the Ministry of Health (MOH) channel. The hotspots map were explored using the Map Editor by Cloud GIS. The approach has been illustrated using a dataset of whole Malaysia which are locally transmitted confirmed cases in four phases of COVID-19 wave in Malaysia. This study is significant to raise public awareness of the virus, especially among Malaysian citizens. It can provide an accurate estimation of the cluster tracking of the COVID-19 system by using geospatial technology. Therefore, people are more concerned and followed all the Standard Operating Procedure (SOP) provided by the government to prevent the spread of COVID-19.

Laypeople's activity for seeking telephone number of EMS before and during the COVID-19 outbreak: An analysis of web search data.

ObjectiveTo explore trends and patterns of laypeople's activity for seeking telephone number of emergency medical services (EMS) based on analysis of online search traffic, including changes of the search activity with onset of the coronavirus disease 2019 (COVID-19) outbreak, in five countries – the United States of America (USA), India, Brazil, the United Kingdom (UK) and Russia.MethodsGoogle Trends (GT) country-level data on weekly relative search volumes (RSV) for top queries to seek EMS number were examined for January 2018–October 2021, including a comparison of RSVs between pre-COVID-19 period (January 2018–October 2019) and COVID-19 period (January 2020–October 2021), and evaluation of temporal associations of RSVs with weekly numbers of new COVID-19 cases.ResultsThe countries demonstrated diverse patterns of the search activity with significantly different mean RSVs (the USA 1.76, India 10.20, Brazil 2.51, the UK 6.42, Russia 56.79; p < 0.001). For all countries excepting the USA mean RSVs of the COVID-19 period were significantly higher compared with the pre-COVID-19 ones (India +74%, Brazil +148%, the UK +22%, Russia +9%; p ≤ 0.034), and exhibited positive correlations with numbers of new COVID-19 cases, more pronounced for 2021 (India rS = 0.538, Brazil 0.307, the UK 0.434, Russia 0.639; p ≤ 0.045).ConclusionLaypeople's activity for seeking EMS telephone number greatly varies between countries. It clearly responds to the spread of COVID-19 and could be reflective of public need for obtaining emergency help. Further studies are required to establish the role of GT for conducting real-time surveillance of population demand for EMS.

Pembagian Hand Sanitizer Berbahan Dasar Kitosan Kulit Udang Sebagai Upaya Pencegahan Penyebaran COVID-19 Di Kabupaten Pulau Morotai

The outbreak of Corona Virus Disease 2019 (COVID-19) in many countries is increasingly troubling the community. The number of COVID-19 cases in Indonesia continues to increase, including in North Maluku. The virus that causes COVID-19 is transmitted through direct hand touch, communication, and other fluid exchanges. Various efforts are being made to reduce the spread of this disease. One of the COVID-19 prevention efforts carried out is the use of hand sanitizer. Hand sanitizers generally contain 62% alcohol, softeners, and moisturizers. The benefits of hand sanitizer made from shrimp skin chitosan can microbiologically prevent bacteria, fungi, and viruses that affect the health of the skin and body. The purpose of this activity is to answer community unrest faced by the scarcity of hand sanitizer products in the market and help prevent the transmission of COVID-19 around the Morotai community. The manufacture of hand sanitizer is carried out at the FPIK Unipas Morotai Laboratory. On March 23, 2020, hand sanitizer distribution in Unipas Morotai Campus Environment, City Park, Imam Lastori Port, and Morotai Police Office Environment. Based on the results of this Community Service activity, hand sanitizer is available to the community. It is expected that this activity can be helpful to support people who do not have access to handwashing with water and soap at all times

Negative-Binomial and quasi-poisson regressions between COVID-19, mobility and environment in São Paulo, Brazil

Brazil, the country most impacted by the coronavirus disease 2019 (COVID-19) on the southern hemisphere, use intensive care admissions per day, mobility and other indices to monitor quarantines and prevent the transmissions of SARS-CoV-2. In this study we quantified the associations between residential mobility index (RMI), air pollution, meteorology, and daily cases and deaths of COVID-19 in São Paulo, Brazil. We applied a semiparametric generalized additive model (GAM) to estimate: 1) the association between RMI and COVID-19, accounting for ambient particulate matter (PM2.5), ozone (O3), relative humidity, temperature and delayed exposure between 4 and 21 days, and 2) the association between COVID-19 and exposure to for ambient particulate matter (PM2.5), ozone (O3), accounting for relative humidity, temperature and mobility. We found that an RMI of 45.28% results in 1212 cases (95% CI: 1189 to 1235) and 44 deaths (95% CI: 40 to 47). Increasing the isolation from 45.28% to 50% would avoid 438 cases and 21 deaths. Also, we found that an increment of 10 μg⋅m−³ of PM2.5 results in a risk of 1.140 (95% CI: 1.021 to 1.274) for cases and 1.086 (95% CI: 1.008 to 1.170) for deaths, while O3 produces a relative risk of 1.075 (95% CI: 1.006 to 1.150) for cases and 1.063 (95% CI: 1.006 to 1.124) for deaths, respectively. We compared our results with observations and literature review, finding well agreement. Policymakers can use such mobility indices as tools to control social distance activities. Spatial distancing is an important factor to control COVID-19, however, measuring face-mask usage would enhance the understanding the pandemic dynamic. Small increments of air pollution result in an increased number of COVID-19 cases and deaths.

Spatial autocorrelation analysis of Covid-19 cases in South Kalimantan, Indonesia

Coronavirus Disease 2019 (COVID-19) is a new coronavirus that was discovered in Wuhan, China, at the end of 2019. In March 2020, the outbreak extended throughout the world, including Indonesia and one of its provinces, South Kalimantan. This rapid expansion should belinked to people’s mobility between regions, hence the linkage across regions must be examined. In South Kalimantan Province, the purpose of this research is to evaluate the distribution and relationship across regions in terms of the number of positive COVID-19 cases, the number of additional positive COVID-19 cases, and the number of COVID-19 patients under treatment. The spatial autocorrelation analysis with the Moran Index and Local Indicator of Spatial Autocorrelation (LISA) tests were used to determine the spatial autocorrelation between what and what using what data/where the data obtained? from March 22 to September 30, 2020. Based on the results of the Moran Index test, it is known that there is a spatial autocorrelation in the number of cases, the number of additional cases and the number of positive confirmed COVID-19 patients in treatment between one region and another neighboring area. While the results of the LISA Index test show that Balangan Regency, Hulu Sungai Tengah Regency, Hulu Sungai Utara Regency, Banjarmasin City, Tabalong Regency and Banjar Regency affect the level of COVID-19 cases in their respective neighboring areas. Therefore, there is a need for policies to control community mobility in those spatially correlated areas and increase testing and tracing to control the spread of COVID-19 cases in South Kalimantan Province.

Impact on Mental Well-Being and Resilience of Patients with Multiple Chronic Conditions in Different Periods during the Coronavirus Disease 2019 Outbreak in Taiwan.

Concerns over the coronavirus disease 2019 (COVID-19) pandemic and control measures have affected the routine outpatient visits of individuals with comorbidities and their mental well-being. From October 2019 to August 2020, this cross-sectional study enrolled 135 patients who sought medical attention at a medical center in Taiwan. This period covered the early (October to December 2019), peak (January to April 2020), and late (May to August 2020) periods of the COVID-19 outbreak in Taiwan. The demographic data, social support data, activities of daily living (ADL), resilience scale scores, and mental well-being scale scores of the participants were compared. There were no statistically significant differences in the participation rate, demographic data, and social support data between the three periods. The correlation analysis confirmed significant negative relationships between the number of COVID-19 cases and outpatient department visits per month (r = −0.764, p < 0.001), emergency department visits per month (r = −0.023, p < 0.001), ADL (r = −0.257, p = 0.03), resilience scale (r = −0.390, p < 0.001), and mental well-being scale (r = −0.475, p < 0.001). In conclusion, the severity of the COVID-19 outbreak in Taiwan was associated with declines in the ADL, mental well-being, and resilience of patients who sought medical attention.

Wastewater surveillance of SARS-CoV-2 corroborates heightened community infection during the initial peak of COVID-19 in Bexar County, Texas.

The purpose of this study was to conduct a preliminary assessment of the levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater at the Salitrillo Wastewater Treatment Plant in Texas during the initial peak of coronavirus disease 2019 (COVID-19) outbreak. Raw wastewater influent (24h composite, time-based 1L samples, n = 13) was collected weekly during June-August 2020. We measured SARS-CoV-2 RNA in wastewater by reverse transcription droplet digital PCR using the same N1 and N2 primer sets as employed in COVID-19 clinical testing. Virus RNA copies for positive samples (77%) ranged from 1.4 × 102to 4.1 × 104copies per liter of wastewater, and exhibited both increasing and decreasing trends, which corresponded well with the COVID-19 weekly infection rate (N1: ρ = 0.558, P = 0.048; N2: ρ = 0.487, P = 0.092). A sharp increase in virus RNA concentrations was observed during July sampling dates, consistent with the highest number of COVID-19 cases reported. This could be attributed to an increase in the spread of COVID-19 infection due to the Fourth of July holiday week gatherings (outdoor gatherings were limited to 100 people during that time). Our data show that wastewater surveillance is an effective tool to determine trends in infectious disease prevalence, and provide complementary information to clinical testing.

Delay Time Parameter and Its Confidence Interval of Predictive Time Series of COVID-19 Outbreak Between the First and the Second Wave

The outbreak of coronavirus disease 2019 (COVID-19) has become a major problem facing humans all around the world. For governments, in order to deal with the outbreak and protect the population, it is important to predict the number of infectious cases in the future to monitor the COVID-19 situation. This research aimed to compare the effectiveness of the logistic and the delay logistic time series in predicting the total number of infectious cases by using actual data from four countries, i.e. Thailand, South Korea, Egypt, and Nigeria. The total number of COVID-19 cases was collected during the first and the second wave of the COVID-19 outbreak. The validation and accuracy of the predictive growth curve time series were determined based on statistical values, i.e. the coefficient of determination and the root mean squared percentage error. It was found that the logistic time series was more appropriate for predicting the first wave in the four countries. For the second wave, the delay logistic time series was preferable. Moreover, the confidence interval based on Chebyshev’s inequality of delay time between the first and the second wave of the COVID-19 outbreak is also proposed.

A global assessment of distance pharmacy education amid COVID-19: teaching, assessment and experiential training.

To explore pharmacy colleges' experiences and challenges worldwide with the transition to online teaching during the coronavirus disease 2019 (COVID-19) pandemic. From the six World Health Organization regions, 28 countries with the highest number of COVID-19 cases were identified, and 111 pharmacy colleges were randomly selected from these countries. Two online surveys were sent to faculty members and senior administrators. They assessed changes in teaching and learning, experiential training, assessment, readiness for and challenges with distance e-learning and work-related stress. Data were collected from 46 colleges. The majority (80.4%) of colleges transitioned to distance e-learning. On-site experiential training was discontinued in 55.5% of colleges and 25.0% redesigned on-site training into remote learning experiences. Assessments were modified in 75.9% of colleges. Assuring the integrity of assessments and delivering practical classes were the most prominent faculty challenges. The majority of faculty (75.0%) and administrators (61.9%) reported moderate work-related stress. Nevertheless, most academics felt that they received adequate support from their institutions and had positive perceptions of the transition to distance e-learning during the pandemic. The COVID-19 pandemic required drastic changes for most programs' teaching methods. Our results showed that educational institutions were somewhat able to support faculty and the needs of educational programs were largely met. However, academic rigour and provision of experiential training can be improved. Faculty emotional support and training needs were not fully addressed in these difficult times. These results shed light on how the global pharmacy academy has addressed the COVID-19 pandemic and help rethink crisis response models.

Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors.

ObjectiveOlder people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors.MethodsWe conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged ≥60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021.ResultsIn total, we interviewed 282 participants aged 60–93 years (mean age 73.0±7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system’s ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day.ConclusionThe prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand’s senior citizens.

Health Disparities of Coronavirus Disease 2019 in Texas, March-July 2020.

Although disparities in coronavirus disease 2019 (COVID-19) prevalence are known, knowledge of the recent surge of COVID-19 in Texas and factors affecting fatality rates is limited. Understanding the health disparities associated with COVID-19 can help healthcare professionals determine the populations that are most in need of COVID-19 preventive care and treatment. The aim of this study was to assess COVID-19-related case and mortality rates. Our cross-sectional analysis used Texas Department of State Health Services COVID-19 case surveillance counts. Case, hospitalization, and mortality counts were obtained from March to July 2020. From March to July 2020, there were 420,397 COVID-19-related cases and 6954 deaths in Texas. There were 3277 new cases and 104 deaths in March, and 261,876 new cases and 3660 deaths in July. The number of new COVID-19 cases was the highest from March to April (relative risk 1.77, 95% confidence interval [CI] 1.76-1.78). Although the death rate in June was a 30% increase over the rate in May, death rates nearly tripled by the end of July, for a total of 3660 deaths. Of the 3958 deaths, demographic data were available for 753 deaths. Of these, 440 were male, 16 Asian, 95 Black, 221 Hispanic, 325 White, and 96 were "Other" or "Unknown." Males were associated with a slightly higher chance of acquiring COVID-19 than females (odds ratio [OR] 1.11, 95% CI 1.09-1.14) and nearly a 29% higher chance of dying of COVID-19 compared with females (OR 1.29, 95% CI 1.11-1.49). Bivariate analysis revealed that the probability of acquiring COVID-19 was 12% higher in older adults compared with individuals younger than 65 years old (OR 1.12, 95% CI 1.08-1.16), and older adults had an 18.8 times higher risk of death when compared with the rate of younger individuals (OR 18.79, 95% CI 15.93-22.15). Hispanics and Blacks were 70% and 48%, respectively, more likely to contract COVID-19 than Whites. All races had lower significant chance of death when compared with Whites. At the end of July, there was a total of 430,485 Texas COVID-19 cases and 6387 fatalities (8.8% of all cases and 4% of all deaths in the United States.). Case fatality ratios were the highest in older adults. As we continued to observe data, in contrast to previous study time points, we found that Asians and Hispanics had no significant difference in COVID mortality rates and were comparable in terms of mortality odds and death case ratios when compared with Whites. This time period represents the highest COVID-19 surge time in Texas. Although our data consist of a short time period of population-level data in an ongoing pandemic and are limited by information reported to the Texas Department of State Health Services, older age, male sex, Hispanics, and Blacks are currently associated with higher infection rates, whereas older age, male sex, and Whites are associated with higher mortality rates. Clinicians and decision makers should be aware of the COVID-19 health disparities and risk factors for mortality to better promote targeted interventions and allocate resources accordingly.

How Iwate Prefecture in Japan maintained a low COVID-19 infection rate.

The first case of coronavirus disease 2019 (COVID-19) in Japan was confirmed on 16 January 2020. The first wave of cases peaked on 10 April 2020 (n = 710) and the second on 7 August 2020 (n = 1595). Iwate Prefecture in north-eastern Japan was the last prefecture to confirm a case of COVID-19, on 29 July 2020, 110 days after all other prefectures had confirmed cases. No cases were reported during the first wave.1 As of 21 September 2021, there had been 3469 cases (282.8/100 000 population) and 52 deaths (1.50% fatality rate) in Iwate and 1.7 million cases (1333.2/100 000 population) and 17 294 deaths (1.03% fatality rate) in Japan overall. This article discusses possible reasons for the low number of COVID-19 cases in Iwate.

Protective Role of pre-existing cerebrovascular diseases in local spread of COVID-19 infection in Japan

It is proposed that various pre-existing medical conditions, including cerebrovascular diseases, might increase a risk for severity of coronavirus disease 2019 (COVID-19). The cumulative number of COVID-19 cases in Japan is relatively low, therefore the effect by cerebrovascular diseases can be distinct from that in Western countries. We analyzed the relationship between the local number of patients with pre-existing cerebrovascular diseases per population and local prevalence of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Clinical Characteristics, Seasonal Variation, Outcome and Disturbance of Taste and Smell in Cases of COVID-19

Objective: To assess the various clinical characteristics, seasonal variation, outcome and disturbance of taste(aguesia) and smell (anosmia) in cases of COVID-19.Study Design: Cross sectional study.Place and Duration of Study: The study was carried out in the Department of COVID-19 at Combined MilitaryHospital (CMH), Mardan from March 2020 to February 2021.Materials and Methods: Suspected case of corona virus disease-2019 (COVID-19) admitted and managed atCMH Mardan from March 2020 to February 2021 were included in the study and their nasopharyngeal swabswere sent for COVID-19 polymerase chain reaction (PCR) test. Only those clinically suspected cases withpositive PCR for COVID-19 were considered as cases of COVID-19. Demographic and clinical data includinggender, age, result of COVID-19 PCR test, symptoms, severity of disease, body system affected with COVID andoutcome, were recorded and entered in SPSS 21. Chi square was used to analyze qualitative variables and T testwas used for quantitative variables. P value less than 0.05 was considered significant.Results: The reported clinically suspected cases of COVID-19 were 1552. Positive PCR test for COVID-19 were221 (14.2%) with mean age 37.53 +11.05. The highest number of COVID-19 cases were seen from May 2020 toJuly 2020. The positivity ratio of COVID-19 was highest during May 2020 (29.9%). Majority of COVID-19 caseswere asymptomatic (45.7%) and only ten cases died of COVID-19, i.e. mortality was 4.5%.Out of 221 COVID-19patients, 38.5% cases had olfactory and taste dysfunction.Conclusion: COVID-19 surged during the months of May to July 2020 followed by a downhill course. Majority ofCOVID-19 cases were asymptomatic. Respiratory system of body was most common system involved followedby gastrointestinal and combination of respiratory and gastrointestinal system. Olfactory and taste dysfunction(anosmia and aguesia) was seen commonly in COVID-19 patients.

Community Health Workers Connecting Communities During COVID-19: A Case Study From Chicago.

Coronavirus disease-2019 (COVID-19) has adversely impacted vulnerable communities. Community health workers (CHWs) are an evidence-based solution for helping communities navigate challenges and barriers. This case study describes the work of CHWs in a large Hispanic Chicago neighborhood who experienced a disproportionate number of COVID-19 cases. Methods included semistructured interviews and conventional qualitative content analysis. Results describe the problem; the situation; CHWs' roles, motivations and actions; outcomes; lessons learned; and recommendations. The case study concludes with a discussion of effective CHW engagement-particularly for underresourced communities-and presents recommendations for CHW workforce development and policies to strengthen the health care and public health systems.

Analyzing the Impact of Demographic Variables on Spreading and Forecasting COVID-19.

The aim of this study is to analyse the coronavirus disease 2019 (COVID-19) outbreak in Bangladesh. This study investigates the impact of demographic variables on the spread of COVID-19 as well as tries to forecast the COVID-19 infected numbers. First of all, this study uses Fisher’s Exact test to investigate the association between the infected groups of COVID-19 and demographical variables. Second, it exploits the ANOVA test to examine significant difference in the mean infected number of COVID-19 cases across the population density, literacy rate, and regions/divisions in Bangladesh. Third, this research predicts the number of infected cases in the epidemic peak region of Bangladesh for the year 2021. As a result, from the Fisher’s Exact test, we find a very strong significant association between the population density groups and infected groups of COVID-19. And, from the ANOVA test, we observe a significant difference in the mean infected number of COVID-19 cases across the five different population density groups. Besides, the prediction model shows that the cumulative number of infected cases would be raised to around 500,000 in the most densely region of Bangladesh, Dhaka division.

A survey of a COVID-19 cluster of charter flight importation

ObjectivesAlthough a number of cases of importation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, there are still no data available concerning the characteristics in the coronavirus disease 2019 (COVID-19) cluster of charter flight importation. Here, we provide an analysis of COVID-19 cases and their close contacts who worked for the same company on a project in Karbala, Iraq, and returned back to Chengdu, China, by a charter flight. MethodsThe data of imported COVID-19 cases and their close contacts were obtained from National Notifiable Disease Report System of Chinese Center for Disease Control and Prevention and field epidemiological investigation reports by Centers for Disease Control and Prevention (CDCs) in Chengdu. The information of general characteristics and laboratory findings of this cluster were collected and summarized. ResultsOne hundred and six (66.67%) of 159 charter flight passengers tested positive for COVID-19 before entry. Through treatment, all 159 people tested negative and meet the requirements of taking flights bound for China before boarding. However, there has been still 36 (22.64%) of them tested positive after entry. The median time from entry to confirmation was 1.0 day (Interquartile Range (IQR): 0–4.3). The Cycle threshold value (Ct value) of 36 patients’ positive samples are all above 30 and most values are above 35. ConclusionsIn conclusion, there is still a risk that a number of COVID-19 cases can be imported through charter flight. However, the infectivity of confirmed patients of the charter flight was considered to be low.

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

PurposeTo assess whether intensive care unit (ICU) outcomes for patients not affected by coronavirus disease 2019 (COVID-19) worsened during the COVID-19 pandemic.MethodsRetrospective cohort study including prospectively collected information of patients admitted to 165 ICUs in a hospital network in Brazil between 2011 and 2020. Association between admission in 2020 and worse hospital outcomes was performed using different techniques, including assessment of changes in illness severity of admitted patients, a variable life-adjusted display of mortality during 2020, a multivariate mixed regression model with admission year as both fixed effect and random slope adjusted for SAPS 3 score, an analysis of trends in performance using standardized mortality ratio (SMR) and standardized resource use (SRU), and perturbation analysis.ResultsA total of 644,644 admissions were considered. After excluding readmissions and patients with COVID-19, 514,219 patients were available for analysis. Non-COVID-19 patients admitted in 2020 had slightly lower age and SAPS 3 score but a higher mortality (6.4%) when compared with previous years (2019: 5.6%; 2018: 6.1%). Variable-adjusted life display (VLAD) in 2020 increased but started to decrease as the number of COVID-19 cases increased; this trend reversed as number of COVID cases reduced but recurred on the second wave. After logistic regression, being admitted in 2020 was associated with higher mortality when compared to previous years from 2016 and 2019. Individual ICUs standardized mortality ratio also increased during 2020 (higher SMR) while resource use remained constant, suggesting worsening performance. A perturbation analysis further confirmed changes in ICU outcomes for non-COVID-19 patients.ConclusionHospital outcomes of non-COVID-19 critically ill patients worsened during the pandemic in 2020, possibly resulting in an increased number of deaths in critically ill non-COVID patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06528-6.

The Effectiveness and Durability of Stay‐at‐Home Orders on Reducing the Spread of COVID ‐19 in Rural and Urban America

Research ObjectiveThroughout the spring of 2020, stay‐at‐home orders were imposed to curb the spread of the coronavirus disease 2019 (COVID‐19) in the United States. However, there is limited data and evidence on their effectiveness, especially in rural areas as compared to urban areas. Therefore, we examined the association between stay‐at‐home order implementation and the incidence of COVID‐19 cases in rural and urban counties.Study DesignWe conducted an interrupted time series analysis using a mixed effects zero‐inflated Poisson model with random intercept by county and standardized by population, which examined the association between stay‐at‐home orders and 14‐day lagged county‐level counts of daily new COVID‐19 cases in rural vs. urban counties between 1/22/2020 and 6/10/2020. To further bolster our findings, the association between stay‐at‐home orders and mobility in rural vs. urban counties was assessed using Google Community Mobility Reports.Population StudiedWe examined the COVID‐19 daily incident and stay‐at‐home orders for all 3142 United States counties. Each county was categorized as urban or rural using the 2013 county‐level Rural–Urban Continuum Codes per federal standards. There are 1976 rural and 1166 urban counties in the United States.Principal FindingsAs of June 10, 2020, there were 1,786,886 cases of COVID‐19 in the U.S., of which 9.0% (N = 161,452) were in rural counties. During the study period, 1854 (93.8%) rural counties and 1075 (92.2%) urban counties were covered by a stay‐at‐home order. Stay‐at‐home orders were implemented later (median March 30 vs. March 28) and were shorter (median 35 vs. 54 days) in rural than urban counties. Indoor mobility was, on average, 2.6–6.9% higher in rural than urban counties during and after stay‐at‐home orders. Compared to the pre‐stay‐at‐home baseline period, the number of new COVID‐19 cases increased under stay‐at‐home by IRR 1.60 (95% CI, 1.57–1.64) in rural and 1.36 (95% CI, 1.30–1.42) in urban counties. For each day under stay‐at‐home orders, the number of new cases changed by a factor of 0.982 (95% CI, 0.981–0.982) in rural and 0.952 (95% CI, 0.951–0.953) in urban counties. Each day after stay‐at‐home orders expired, the number of new cases changed by a factor of 0.995 (95% CI, 0.994–0.995) in rural and 0.997 (95% CI, 0.995–0.999) in urban counties.ConclusionsStay‐at‐home orders decreased mobility and slowed the spread of COVID‐19 less effectively in rural than urban counties.Implications for Policy or PracticeAs states are considering implementing a new round of stay‐at‐home orders, our findings reveal several ways to improve the implementation, enforcement, and adherence. First, they should be implemented earlier and maintained longer for optimal effectiveness. There was marked heterogeneity in the timing and duration of stay‐at‐home orders and our data reinforces the need for multi‐jurisdictional, ideally federal, infection control mandates. Any new stay‐at‐home orders should be gradually implemented to avoid the pre‐stay‐at‐home surge of mobility and subsequent spike in COVID‐19 cases. To better encourage and facilitate compliance, leaders at all levels need to use scientific evidence to advocate for the importance of stay‐at‐home orders, set personal examples, and develop employment, housing, educational, and healthcare assistance for the most vulnerable.Primary Funding SourceNational Institutes of Health.