JAMA: "State control over health outcomes shows no signs of waning"

"The COVID-19 pandemic removed any doubt that state policies can affect health outcomes. East Coast states (eg, New York, New Jersey) that responded to the first wave of the pandemic in the spring of 2020 with strict protective measures achieved relatively quick control of community spread within as much as 8 weeks,9 and they blunted subsequent surges by reinstating those policies. 

In contrast, states that had spent decades opposing public health provisions were among the most resistant to COVID-19 guidelines and took active measures to resist restrictions. Some elected officials made a political issue out of challenging scientific evidence, embracing dubious theories, and labeling public health safeguards as infringements on personal freedom. Conservative governors used preemption to reverse efforts by mayors and school districts to control local transmission rates.

These policy choices may have been associated with increased COVID-19–related morbidity and mortality. States that rushed to curtail lockdowns in the spring of 2020 experienced more protracted surges in infections and disruptions to their economies.9 In 2021, excess deaths were disproportionately concentrated in states where resistance to COVID-19 vaccination was prevalent. 

For example, excess death rates in Florida and Georgia (more than 200 deaths per 100 000) were much higher than in states with largely vaccinated populations such as New York (112 per 100 000), New Jersey (73 deaths per 100 000), and Massachusetts (50 per 100 000). States that resisted public health protections experienced higher numbers of excess deaths during the Delta variant surge in the fall of 2021 (Figure). Between August and December 2021, Florida experienced more than triple the number of excess deaths (29 252) as New York (8786), despite both states having similar population counts (21.7 million and 19.3 million, respectively).10"

Continue reading the report in the Journal of American Medicine (JAMA) 
 https://jamanetwork.com/journals/jama/article-abstract/2790238

Figure.  Weekly Excess Death Rate (per 100 000) in Selected States, 2021

"COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life"

While COVID-19 restrictions are easing, the disease and lasting effects remain to be reckoned with. 

Via Nature.com:  "Count the cost of disability caused by COVID-19

"The COVID-19 pandemic is well into its second year, but countries are only beginning to grapple with the lasting health crisis. In March, a UK consortium reported that 1 in 5 people who were hospitalized with the disease had a new disability after discharge1. A large US study found similar effects for both hospitalized and non-hospitalized people2. Among adults who were not hospitalized, 1 in 10 have ongoing symptoms 12 weeks after a positive test3. Treatment services for the long-term consequences of COVID-19 are already having to be absorbed into health and care systems urgently. Tackling this requires a much clearer picture of the burden of the disease than currently exists.

Tracking disease cases and deaths has advantages in a health emergency — they are easily collated, and, to some extent, trends can be compared across countries. But continuing the use of such simplified metrics heightens the risks of underestimating the true health impact on a population. It focuses policy and public discourse on the immediate prevention of deaths and on the economic impact of lockdown policies, ignoring the long-term disease-related disabilities that will also affect well-being and productivity."

Continue reading the article online 

https://www.nature.com/articles/d41586-021-01392-2 

Via Journal of American Medical Association (JAMA): "Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19"

Question  What are the frequency and variety of persistent symptoms after COVID-19 infection?

Findings  In this systematic review of 45 studies including 9751 participants with COVID-19, the median proportion of individuals who experienced at least 1 persistent symptom was 73%; symptoms occurring most frequently included shortness of breath or dyspnea, fatigue or exhaustion, and sleep disorders or insomnia. However, the studies were highly heterogeneous and needed longer follow-up and more standardized designs.

Meaning  This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life; however, methodological improvements are needed to reliably quantify these risks.

Continue reading the article online 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780376

JAMA Insights: "Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2"

Here's the data: 

"Prior to the coronavirus disease 2019 (COVID-19) pandemic, the efficacy of community mask wearing to reduce the spread of respiratory infections was controversial because there were solid relevant data to support their use. During the pandemic, the scientific evidence has increased. Compelling data now demonstrate that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected persons, but also as protection to reduce wearers’ exposure to infection.

COVID-19 spreads primarily through respiratory droplets exhaled when infected people breathe, talk, cough, sneeze, or sing. Most of these droplets are smaller than 10 μm in diameter, often referred to as aerosols. The amount of small droplets and particles increases with the rate and force of airflow during exhalation (eg, shouting, vigorous exercise). Exposure is greater the closer a person is to the source of exhalations. Larger droplets fall out of the air rapidly, but small droplets and the dried particles formed from them (ie, droplet nuclei) can remain suspended in the air. In circumstances with poor ventilation, typically indoor enclosed spaces where an infected person is present for an extended period, the concentrations of these small droplets and particles can build sufficiently to transmit infection."'

Continue reading the Article in the Journal of  American Medicine Association (JAMA)  https://t.co/x8sTs9y8Rw

Shared from Twitter:  (https://twitter.com/celinegounder/status/1359604817161773065?s=03)

Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2

"asymptomatic and infectious before developing their symptoms"

Via The Hill comes a CDC study showing focus should include asymptomatic individuals as they contribute to more than 50% of the cases.

Question  
What proportion of coronavirus disease 2019 (COVID-19) spread is associated with transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from persons with no symptoms? 

Findings  
In this decision analytical model assessing multiple scenarios for the infectious period and the proportion of transmission from individuals who never have COVID-19 symptoms, transmission from asymptomatic individuals was estimated to account for more than half of all transmission. 

Meaning  
The findings of this study suggest that the identification and isolation of persons with symptomatic COVID-19 alone will not control the ongoing spread of SARS-CoV-2.

Continue reading the article in The Hill

https://thehill.com/policy/healthcare/533421-more-than-half-of-coronavirus-cases-spread-by-people-without-symptoms-cdc

Go direct to JAMA for the CDC study details

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707

“Almost everyone has a story or a close call like this"

From the Milford Daily News, articles of interest for Franklin:

"The first sexual experience for 1 in 16 U.S. women was forced or coerced intercourse in their early teens, encounters that for some may have had lasting health repercussions, a study suggests.

The experiences amount to rape, the authors say, although they relied on a national survey that didn’t use the word in asking women about forced sex.

Almost 7 percent of women surveyed said their first sexual intercourse experience was involuntary; it happened at age 15 on average and the man was often several years older.

Almost half of those women who said intercourse was involuntary said they were held down and slightly more than half of them said they were verbally pressured to have sex against their will."

Continue reading the article online (subscription may be required)
https://www.milforddailynews.com/zz/news/20190916/many-us-women-say-1st-sexual-experience-was-forced-in-teens


JAMA Research  
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2751247

JAMA Commentary 
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2751244 

Forced and Coerced Sexual Initiation in Women New Insights, Even More Questions