US Territories Research Articles

Modeling the change in European and US COVID-19 death rates.

Motivated by several possible differences in Covid-19 virus strains, age demographics, and face mask wearing between continents and countries, we focussed on changes in Covid death rates in 2020. We have extended our Covid-19 multicompartment model (Khan et al., 2020) to fit cumulative case and death data for 49 European countries and 52 US states and territories during the recent pandemic, and found that the case mortality rate had decreased by at least 80% in most of the US and at least 90% in most of Europe. We found that death rate decreases do not have strong correlations to other model parameters (such as contact rate) or other standard state/national metrics such as population density, GDP, and median age. Almost all the decreases occurred between mid-April and mid-June 2020, which corresponds to the time when many state and national lockdowns were relaxed resulting in surges of new cases. We examine here several plausible causes for this drop—improvements in treatment, face mask wearing, new virus strains, testing, potentially changing demographics of infected patients, and changes in data collection and reporting—but none of their effects are as significant as the death rate changes suggest. In conclusion, this work shows that a two death rate model is effective in quantifying the reported drop in death rates.

Expanding Licensure Portability And Access To Care: Lessons Learned During COVID-19.

Regulatory flexibility by US states and territories during the COVID-19 pandemic rapidly facilitated the practice of medicine across state lines by physicians and other health care professionals, both in person and via telehealth, and greatly expanded access to care. Policy makers and health care leaders at the state and federal levels need to better understand which of these efforts (temporary expedited licenses, licensing waivers, interstate licensure compacts, and data credentialing platforms) worked well, under which circumstances, and how they might complement one another to facilitate more rapid and widespread adoption of measures to improve access to care in times of crisis and beyond. Lessons learned during this global public health crisis should better inform the nation's emergency preparedness efforts ahead of the next calamity.

Analyzing Recharge Dynamics and Storage in a Thick, Karstic Vadose Zone

AbstractKarst vadose zone heterogeneity creates complex transmission and storage dynamics that affect the timing and magnitude of aquifer recharge. Young, high‐matrix permeability eogenetic karst aquifers may have significantly higher matrix storage than older, lower matrix permeability counterparts. In vulnerable and water‐limited karst regions, the timescales of storage may be important for seasonal and sub‐seasonal water resource management. We create a framework to quantify storage dynamics in karst aquifers using high‐resolution precipitation and groundwater levels from the Northern Guam Lens Aquifer in the US territory of Guam. We estimate recharge using the Water Table Fluctuation method, and then develop transfer functions between precipitation and recharge to quantify storage and release of water from the vadose zone. The transfer functions are partitioned into different flow pathways including conduit, conduit/matrix, and slowly draining matrix. Probability distributions are fit to each pathway to determine the average travel times of infiltrated waters. The results show that aquifer recharge through secondary porosity features typically occurs within a few hours of a rainfall event, but this rapid recharge accounts for only 12%–28% of total recharge. The majority of aquifer recharge (>70%) occurs within a month of a contributing storm event. An additional 10% of recharge, on average, took longer than a month to reach the water table. The framework established can help improve the hydrological modeling and freshwater management for karst aquifers.

Giving Birth During the COVID-19 Pandemic: Changes in Confusion, Anxiety, and Breastfeeding Self-Efficacy From Pregnancy to Six-Weeks Postpartum

ObjectivesTo assess differences in the level of anxiety, confusion, and changes in the level of breastfeeding self-efficacy from pregnancy to 6-weeks postpartum among a sample of persons who gave birth from 2020–2021.MethodsA sample of 180 persons, representing 44 states and 4 US territories, were recruited via social media advertisements to first take a 78-item web-based survey between May and December of 2020. Participants were contacted again at 6 weeks postpartum to complete a follow-up survey assessing the same variables as survey one. The surveys assessed breastfeeding self-efficacy using the valid PREP to BF scale, breastfeeding intention (and subsequent actual feeding method), anxiety surrounding having a newborn during COVID-19, and confusion with WHO and CDC COVID-19 breastfeeding recommendations.ResultsThe sample, mean age 30.2 years, maintained a relatively high PREP to BF score at 6-weeks postpartum (pre = 309.27 ± 56.74; post = 305.57 ± 63.40). Over 95% intended to include breastmilk in some way and at 6-weeks postpartum, 95.2% were either exclusively breastfeeding or combination feeding. The sample experienced a significant decrease in confusion (p ≤ .001) with safe breastfeeding information and a significant decrease in anxiety with managing a newborn baby whilst the pandemic still occurring at high rates in the US (p ≤ .001).ConclusionsThis sample was able to maintain their planned infant feeding decisions while maintaining a high breastfeeding self-efficacy score despite the COVID-19 pandemic continuing in the US. The increasing availability of the COVID-19 vaccine may have helped to ease anxiety among new mothers. Prenatal healthcare teams should continue to work with pregnant persons to ensure they are informed of the most up-to-date information on COVID-19 to have a safe pregnancy and birth experience.Funding SourcesThis material is based upon work supported by the National Institute of Food and Agriculture, US Department of Agriculture, Hatch project LAB94426.

Using life-history trait variation to inform ecological risk assessments for threatened and endangered plant species.

Developing population models for assessing risks to terrestrial plant species listed as threatened or endangered under the Endangered Species Act (ESA) is challenging given a paucity of data on their life histories. The purpose of this study was to develop a novel approach for identifying relatively data-rich nonlisted species that could serve as representatives for species listed under the ESA in the development of population models to inform risk assessments. We used the USDA PLANTS Database, which provides data on plants present in the US territories, to create a list of herbaceous plants. A total of 8742 species was obtained, of which 344 were listed under the ESA. Using the most up-to-date phylogeny for vascular plants in combination with a database of matrix population models for plants (COMPADRE) and cluster analyses, we investigated how listed species were distributed across the plant phylogeny, grouped listed and nonlisted species according to their life history, and identified the traits distinguishing the clusters. We performed elasticity analyses to determine the relative sensitivity of population growth rate to perturbations of species' survival, growth, and reproduction and compared these across clusters and between listed and nonlisted species. We found that listed species were distributed widely across the plant phylogeny as well as clusters, suggesting that listed species do not share a common evolution or life-history characteristics that would make them uniquely vulnerable. Lifespan and age at maturity were more important for distinguishing clusters than were reproductive traits. For clusters that were intermediate in their lifespan, listed and nonlisted species responded similarly to perturbations of their life histories. However, for clusters at either extreme of lifespan, the response to survival perturbations varied depending on conservation status. These results can be used to guide the choice of representative species for population model development in the context of ecological risk assessment. Integr Environ Assess Manag 2023;19:213-223. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

CDC COVID-19 healthcare infection prevention and control assistance to health departments, January 2020–December 2021

Background: Throughout the COVID-19 pandemic, CDC Division of Healthcare Quality Promotion (DHQP) has provided technical assistance in support of state, tribal, local, and territorial health departments for COVID-19 healthcare outbreak management and infection prevention and control (IPC). We characterized the volume and trends of technical assistance provided during the pandemic to inform the future needs of health departments for COVID-19 healthcare IPC and DHQP resources required to meet these needs. Methods: In January 2020, DHQP began receiving COVID-19 IPC TA requests directly from health departments for remote assistance or from CDC staff on field deployments providing onsite support. DHQP subject-matter experts provided responses via e-mail or, for more complex inquiries, outbreaks, or field deployments, via phone consultations. Records of e-mail communications and phone consultations were entered into an inquiry database for tracking. We calculated the number, mean, and range of technical-assistance responses by jurisdiction and by month from January 2020 through December 2021. We designated months as high-volume periods for technical assistance if inquiries surpassed the 75th percentile. Results: In total, 1,869 IPC technical-assistance responses were provided. Of all technical-assistance responses, 1,725 (92%) were to state or local health departments, 115 (6%) were tribal nations, and 28 (2%) were US territories. IPC technical assistance was provided to all 50 states and the District of Columbia, 16 tribal nations, and 5 US territories. The average total number of technical assistance responses per site during the 24-month period was 34 to state and local HDs (range, 2–111), 6 to tribal nations (when tribal nation was specified; range, 1–17), and 6 to US territories (range, 1–15). E-mail communications comprised 1,164 responses (62%); phone consultations made up the remaining 705 responses (38%). Of phone consultations, 350 (50%) were with CDC field deployers providing onsite support to health departments. The average number of technical-assistance responses provided each month across all jurisdictions was 78 (range, 0–334); months with high volumes included April–August 2020 and January 2021. Conclusions: These findings highlight the high-level collaboration between federal and state, tribal, local, and territorial health department partners in remote and onsite support of COVID-19 prevention and response efforts in healthcare settings. Variations in monthly volumes of health-department COVID-19 healthcare IPC technical assistance requests may reflect factors such as fluctuations in community infection rates and changes in CDC IPC guidance. The ability to provide effective technical assistance during pandemic response depends on the CDC maintaining sufficient healthcare IPC staffing and expertise.Funding: NoneDisclosures: None

New insights from the virome of Halyomorpha halys (Stål, 1855)

Halyomorpha halys (Stål, 1855) (Hemiptera: Pentatomidae), the brown marmorated stink bug, is an invasive pentatomid native to East-Asia, and introduced worldwide in recent times. It is a polyphagous pest with approximately 300 host plants, which, due to its plasticity, reproductive and feeding behavior, long-distance flight, and walking as well as human-mediated dispersal ability, is able to cause significant economic and ecological damage. In several cases pest control mediated by insecticide treatments leads to unsatisfactory efficacy, mostly due to insect recovery ability. Thus, the most promising method for the long-term management of this pest has been focused with growing emphasis on classical biological control strategies. In this framework, viruses have untill now been poorly investigated in H. halys with only a single virus described from the US territory. For this reason we investigated the virome associated with a small and well described population of H. halys from Piedmont (Italy) describing for the first time 7 new viral sequences belonging to different taxonomical groups. Further studies will be necessary to assess the biological and ecological effects the viruses have on their host. Due to the agricultural importance of this insect, the biological characterization of these viruses would give important information on the possibility to exploit viral entities as biological control agents. Finally, the presence of a such relevant number of viruses from a small population suggests a wide association between the brown marmorated stink bug and viral entities. Further studies to determine the possible exploitation of viral sequences to trace different populations are ongoing.

The Child Opportunity Index and Pediatric Emergency Medical Services Utilization

Background: The delivery of emergency medical services (EMS) is a resource-intensive process, and prior studies suggest that EMS utilization in children may vary by socioeconomic status. The Child Opportunity Index (COI) provides a multidimensional measure of neighborhood-level resources and conditions that affect the health of children. We evaluated EMS utilization and measures of acuity among children by COI. Methods: We performed a cross-sectional study using encounters for patients less than 18 years of age from 10,067 EMS agencies in 47 US states and territories contributing to the National Emergency Medical Services Information System 2019 dataset. We compared patient demographics, EMS encounter characteristics, and care provided to children stratified by ZIP code using the COI 2.0. Results: We included 1,293,038 EMS encounters (median age 10 years, IQR 3–15 years). The distributions of encounters in the five tiers of COI were 30.6%, 20.1%, 18.0%, 16.3% and 15.1%, (from Very Low to Very High, respectively). The distribution of diagnoses between groups was similar. Most measures of EMS acuity/resource use were similar between groups, including non-transport status, cardiac arrest, vital sign abnormalities, and EMS-administered procedures and medications. Among children with respiratory-related encounters, children in the Very Low group had a greater need for nebulized medications (26.4% vs 18.3% in Very High COI children). Among children with trauma, a lower proportion in the Very Low group were given analgesia (4.0% vs 7.4% in the Very High group), though pain scores were similar in all groups. Conclusion: Pediatric EMS encounters from lower COI neighborhoods occur more frequently relative to encounters from higher COI neighborhoods. Despite these differences, children from lower COI strata generally have similar encounter characteristics to those in other COI strata, suggestive of a greater number of true out-of-hospital emergencies among children from these areas. Notable differences in care included use of respiratory medication to children with respiratory diagnoses, and administration of pain medication to children with trauma.

Dengue: A Growing Problem With New Interventions.

Dengue is the disease caused by 1 of 4 distinct, but closely related dengue viruses (DENV-1-4) that are transmitted by Aedes spp. mosquito vectors. It is the most common arboviral disease worldwide, with the greatest burden in tropical and sub-tropical regions. In the absence of effective prevention and control measures, dengue is projected to increase in both disease burden and geographic range. Given its increasing importance as an etiology of fever in the returning traveler or the possibility of local transmission in regions in the United States with competent vectors, as well as the risk for large outbreaks in endemic US territories and associated states, clinicians should understand its clinical presentation and be familiar with appropriate testing, triage, and management of patients with dengue. Control and prevention efforts reached a milestone in June 2021 when the Advisory Committee on Immunization Practices (ACIP) recommended Dengvaxia for routine use in children aged 9 to 16 years living in endemic areas with laboratory confirmation of previous dengue virus infection. Dengvaxia is the first vaccine against dengue to be recommended for use in the United States and one of the first to require laboratory testing of potential recipients to be eligible for vaccination. In this review, we outline dengue pathogenesis, epidemiology, and key clinical features for front-line clinicians evaluating patients presenting with dengue. We also provide a summary of Dengvaxia efficacy, safety, and considerations for use as well as an overview of other potential new tools to control and prevent the growing threat of dengue .

Marijuana use among US adults with cancer: findings from the 2018-2019 Behavioral Risk Factor Surveillance System.

This study aimed to assess the prevalence of current marijuana use and to identify the factors associated with its use among US adults with cancer living in 17 US states and territories. Data from the2018-2019 Behavioral Risk Factor Surveillance System Marijuana Use module were analyzed. The analytic sample included 13,174 adults with cancer. The primary outcome was current marijuana use. Weighted, multivariable logistic regression was used to identify sociodemographic, health, and healthcare factors associated with marijuana use. Overall, 9.2% of adult cancer survivors (n = 13,174; weighted 5.7 million) reported marijuana current use, 51.3% of whom used it for medical reasons only, with 65.2% reporting smoking as the main method of administration. Adult cancer survivors were significantly more likely to use marijuana if they were younger (odds ratio [OR] for 55-64years old, 0.60; 95% CI, 0.38-0.93, vs. 18-44); male (OR for female, 0.65; 95% CI, 0.48-0.87, vs. male); non-Hispanic black (OR, 2.00; 95% CI, 1.21-3.33; P < 0.01, vs. non-Hispanic white); living with depression (OR, 1.58; 95% CI, 1.17-2.14); and current (OR, 3.23; 95% CI, 2.20-4.74) or former tobacco smoker (OR, 2.40; 95% CI, 1.70-3.38, vs. never smoker) and binge drinker (OR, 2.25; 95% CI, 1.53-3.29, vs. non-binge drinker). Among a large cohort of US adults with cancer, marijuana use was commonly reported, and certain subgroups were at increased likelihood of marijuana use. Health professionals should identify the risk factors for marijuana use, especially as more states legalize medical and recreational marijuana use.

Does market power converge among the US states? Evidence from the natural gas sector

The scope of this study is to investigate the convergence pattern of market power in two retail natural gas markets, namely residential and commercial, across the US states over the period Jan 1997–Dec 2020. Our analysis identifies one non-convergence and several spatial sub-convergence clubs within the US territory for both market segments. Several reasons such as demand characteristics and geographic proximity may explain the different clustering patterns among the spatial units.

Get Us PPE: A Self-Organizing Platform Ecosystem for Supply Chain Optimization during COVID-19

The COVID-19 pandemic caused a global health emergency that triggered an acute shortage of Personal Protective Equipment (PPE), putting essential healthcare workers at risk. Starting March 2020, given the skyrocketing prices of PPE in the open market, healthcare institutions were confronted with the dire need to reshape their PPE procurement strategy. One avenue that financially constrained healthcare institutions pursued were donation platforms that offered access to donated PPE by individuals and organizations. We document a real-life case study of one of the most prominent donor platforms that emerged during this period: Get Us PPE. From 20 March 2020 to 2 July 2021, Get Us PPE received 23,001 total individual requests for PPE from every US state and some US territories. In response to these 23,001 requests, Get Us PPE delivered 17,540,571 units of PPE. The number of PPE units delivered was still less than 25% of the total units of PPE requested, indicating the enormity of the PPE shortage. Using this case study, we identify key supply chain issues that manifest during emergencies and highlight the formation of a platform ecosystem to resolve these issues. We also observed a robust supply chain network design that addresses key supply chain sustainability metrics such as minimizing material waste and transportation miles, while balancing other stakeholder factors such as donor and recipient characteristics as well as shipment complexity. We argue that the roadmap followed by Get Us PPE could serve as a template for organizations that emerge in the context of future humanitarian crises.

Cannabis use prevalence among Baby Boomers before and after implementation of recreational retail sales in California

BackgroundAs of 2021, 21 US states and territories allowed recreational cannabis use. Although previous research has identified an overall increase in prevalence of cannabis use after legalization, it has been less clear how this change will affect different parts of the population, including older adults, and specifically Baby Boomers, born 1946–1964, given their historically higher rates of use and a higher prevalence of comorbid conditions that could be either exacerbated or addressed by cannabis use. In this study we assessed whether implementation of recreational retail sales in California was associated with increased prevalence of cannabis use among Baby Boomers.MethodsWe conducted a retrospective study of cannabis use prevalence one year before and after the implementation of recreational retail sales in California using the California Health Interview Survey (CHIS), a statewide public health surveillance dataset.ResultsWe found that cannabis use prevalence did not change among Baby Boomers but increased among non-Baby Boomers. Most of the factors found to be predictive of cannabis use in past research did not predict cannabis use among Baby Boomers.ConclusionsBaby Boomers did not change their consumption of cannabis in the first year after opening the retail market, despite previous research suggesting that cannabis consumption increases with access, and most previously identified predictors of use did not identify people who use cannabis in this generation. Further research is needed to determine whether these effects persist over time.

Investigating SARS-CoV-2 Test Positivity Calculations Across US Jurisdictions

PurposeThroughout the COVID-19 pandemic, many US epidemiologists and policymakers turned to an indicator called test positivity, or the percent of tests coming back positive for SARS-CoV-2, to contextualize COVID-19 case counts with testing volume. But the nation's patchworked health data infrastructure, composed of 56 systems managed by each state and territory, complicated efforts to calculate the metric in a comparable way across US jurisdictions. We set out to map jurisdictional reporting differences in test positivity and investigate whether they interfered with its effectiveness and comparability as an indicator. Understanding these differences is important because jurisdictional test positivity informed consequential policy and individuals’ understanding of risk in their communities.Methods & MaterialsWe surveyed the health department websites of all US states and territories to examine how these jurisdictions were presenting test positivity on COVID-19 dashboards. When details about definitions were unavailable on jurisdictional websites, we reached out to jurisdictional public health officials for clarification. We also scored jurisdictions' presentations against best practices we identified for calculating the metric.ResultsAmong the 48 states and territories posting test positivity values, we observed no consensus on how to calculate the metric—jurisdictions used different units, test types, averaging techniques, and dating schemes. By looking at data for jurisdictions that posted multiple test positivity metrics, we observed that these definitional differences could result in variations from 31% to 300%. Only four states were following all ten of the best practices for reporting test positivity.ConclusionThe sheer number of ways states and territories define test positivity is alarming, given how much the indicator influenced US COVID-19 policy. Based on our survey, we believe the confidence of regulators in the precision and national comparability of test positivity is misplaced: The metric's value reflects state and territorial reporting decisions as much as actual viral prevalence. These findings underscore the need to invest in centralized public health infrastructure and create national reporting standards to improve unity of state reporting.

Methods for Counting COVID-19 Deaths in US States and Territories

PurposeThe US Centers for Disease Control and Prevention (CDC) never issued guidelines on how states should publicly report COVID-19 deaths, and as a result, states ended up settling on different methods. Critics have claimed that some methods, such as counting “deaths with COVID-19” rather than “deaths from COVID-19”, resulted in overcounts of COVID-19 deaths. While it is clear from alternate measures like excess mortality that all states undercounted COVID-19 deaths, we investigated whether different methods had any effect on state death reporting.Methods & MaterialsWe identified the methods states use to report COVID-19 deaths on their dashboards, then compared state-reported data collected by CDC in its COVID Data Tracker against data from the CDC's National Center for Health Statistics (NCHS)’s national review of death certificates measuring deaths from COVID-19. Comparing state data against this standardized national dataset allowed us to see if state definitions affected their reporting.ResultsContrary to critics’ claims, few states have definitions that could systematically include individuals who died of causes unrelated to COVID-19. State death definitions instead vary along two lines: whether positive PCR tests were required to count COVID-19 deaths—with states requiring tests having cumulative totals 9.03% lower than NCHS data, while states not requiring them had totals 10.21% higher (p=.06)—and whether states exclusively used death certificates to measure COVID-19 deaths, with these states’ totals coming in 27.63% higher than NCHS data, compared to 3.26% higher for states using additional information (p=.11).ConclusionRather than certain methods leading to systematic overcounts of COVID-19 deaths, it appears some methods could be especially prone to undercounts. Only states using death certificate reviews had counts substantially higher than NCHS data, and since NCHS also uses death certificates, the difference appears to be a matter of the faster speed of state review. Meanwhile, many states using different methods have discovered they missed large quantities of COVID-19 deaths in their counts. The CDC should have provided leadership to states on how they should report COVID-19 deaths to avoid any preventable undercounts, and public communication to quell misinformation about overcounts.

Decreases in smoking and vaping during COVID-19 stay-at-home orders among a cohort of young adults in the United States

In Spring 2020, most US states and territories implemented stay-at-home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of COVID-19. Little is known about the impact of stay-at-home orders on tobacco and nicotine use including among young adults. The current study examined participants (N = 1727) completing three recent survey waves from a longitudinal cohort of young adults recruited in 2010 from North Carolina and Virginia, USA: Wave 13 (Spring 2019), Wave 14 (Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette use. We conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use pre-pandemic. Then, we conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of COVID-19 stay-at-home orders. When comparing the odds of reporting tobacco use at Wave 14 to Wave 13, no differences emerged (p > 0.05). However, when comparing tobacco use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p < 0.01). The current study provides initial evidence that young adults may have reduced their tobacco and nicotine use during the stay-at-home orders. However, more work is needed to determine the long-term impact of the COVID-19 pandemic on tobacco use and cessation in this population.

Unethical medical treatment and research in US territories

ABSTRACT In 1898, the Treaty of Paris agreement concluding the Spanish-American War gave the US rights to claim and colonize Puerto Rico, the Philippines, and Guam. Along with the many consequences of such colonization came reports of significant harm to the native populations in healthcare and medical research by the occupying forces. Reports about unethical medical treatment and research on Puerto Ricans and Filipinos have existed but are often ignored, yet they include experiments and treatment with Total Body Irradiation (TBI), research on oral contraception leading (for some) to sterilization, and careless use of contaminated vaccines on humans. Researchers failed to protect their subjects; shining a light on these unethical cases could help to further the process of moral reckoning with past abuses, encourage political reforms improving health and welfare, and promote higher ethical standards in healthcare and research on those with diminished autonomy/self-determination.

Ethno-territorial features of social inequality in the USA

The social fragmentation of the US population has pronounced ethno-territorial features. On the example of ten ethnic groups of Americans of various ancestry (German, Italian, Polish, Russian, Chinese, Asian Indian, Filipino, Mexican, Cuban, Salvadoran), the spatial features of social inequality are examined. Six indicators of social well-being were considered in three areas: education, employment status and earnings. The indicators under consideration include: 1) the proportion of individuals without a high school diploma; 2) the proportion of individuals with a bachelor's degree or higher; 3) the proportion of individuals who are not in the labor force; 4) the unemployment rate; 5) median annual earnings; 6) the proportion of individuals with income below poverty level. The states and the District of Columbia were taken as the spatial unit for analyzing the ethno-territorial heterogeneity of social inequality in the United States. The study revealed the socio-spatial heterogeneity of the US territory, determined the hierarchy of ethnic groups in terms of social well-being, and identified states that have the highest deviations from the "normal" distribution of the indicators under consideration. The results obtained make it possible to judge both the influence of ethnic origin and a specific territory on the level of social well-being of the US population. The existing social hierarchy of the considered ethnic groups is highly stable in most states. More often than not, members of a particular ethnic group living in more socially wealthy states will outperform members of the same group living in less socially wealthy states in terms of social well-being. However, this feature is not typical for all states and ethnic groups equally. This allows us to assert that in the United States, inequality between ethnic groups can acquire its own specific characteristics depending on a particular territory.

Оценка дифференциации этнодемографического фактора культурной эволюции в США: региональное исследование

An assessment of the differentiation of the ethnodemographic factor combining the spatial and temporal development of interrelated processes of population movement and ethnodemographic heterogeneity, cultural evolution in the United States of America for the period 1981-2020 in the context of individual territories is carried out. The empirical results obtained indicate an ever-increasing, but multidirectional change in the regional interaction of demographic, ethnic and cultural processes in the space - time continuum of the United States. As a result of the comparative analysis, the conclusion is made about the «American specificity» and at the same time the typicality (in comparison with other countries) of the studied spatial and temporal dynamics of the influence of the ethnodemographic factor on the nature of cultural evolution observed in different groups of US territories over the past 40 years. The presence of a qualitative transition is empirically substantiated - a cultural shift characterized by the achievement of a certain quantitative limit of the linear development of cultural values to democracy, tolerance, freedom, national unity. The noted shift «highlighted» the critical essence (threshold values) of the multidirectional evolution of the American nation over the past 20 years, determined by the predominance of factional or polarization trends in population development, migration, and localization «pressure» on the concentration of carriers of different cultures

190. Epidemiology of COVID-19 Breakthrough Infections in Dallas County, Texas, 2021

BackgroundFrom March 2020 through May 2021, Dallas County reported a total of 304,056 cases of COVID-19, including 4,073 deaths. During the month of December 2020, a post-holiday surge of cases led to peak daily average case rates of over 50 cases per 100,000. COVID-19 cases and deaths have since declined substantially following the rollout of COVID-19 vaccine delivery. As of June 8, 2021, about 1,831,588 Dallas County residents have received at least one COVID-19 vaccine dose and 910,067 are fully vaccinated. Recent county integration of immunization and case databases enabled identification and analysis of COVID-19 breakthrough infections.MethodsA COVID-19 breakthrough infection was defined as a positive test (PCR or antigen) collected from an individual ≥ 14 days after receiving the full series of an FDA-authorized COVID-19 vaccine. Nationally, 10,262 vaccine breakthrough infections had been reported from 46 US states and territories, through April 2021. Vaccine breakthrough cases were reviewed and medical records abstracted to collect demographic information, clinical characteristics, and medical conditions. Data analysis was performed using R, version 4.0.2 (2020). ResultsOf the 700 vaccine breakthrough cases reported in Dallas County residents as of June 8, 2021, 304 (43%) were male and 396 (57%) female, with an average age of 53 years. The majority of the vaccine breakthrough cases were White (42%); 25% were Hispanic/Latino; and 20% were Black. Almost all breakthrough cases were confirmed with PCR testing, with 451 (64%) cases receiving the Pfizer vaccine. Of breakthrough cases, 49% were symptomatic; 52% (358) had underlying conditions including: tobacco use, obesity, or immunocompromised state; 68 (10%) were hospitalized; and 11 (1.6%) died. Whole genome sequencing was performed on 51 cases, with 14 (27.5%) variants identified, including: eight B.1.1.7, two B.1.429 and one P.1 variants. ConclusionDespite the high levels of vaccine efficacy documented in US vaccine trials, COVID-19 breakthrough infections, though currently uncommon, do occur and are important to investigate. Ongoing close public health surveillance of variants is needed to discern changes in patterns of vaccine efficacy and characteristics of populations at greatest risk of severe disease from COVID-19.Disclosures All Authors: No reported disclosures