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Characteristics of Hospitalized #COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6945e2.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6945e2_HospitalReadmissionsCOVID19_IMAGE_09Nov20_1200x627.jpg

What is already known about this topic?

Evidence suggests that potential health #complications after COVID-19 illness might require ongoing clinical care.

What is added by this report?

After discharge from an initial COVID-19 hospitalization, 9% of patients were readmitted to the same hospital within 2 months of discharge. Multiple readmissions occurred in 1.6% of patients. Risk factors for #readmission included age ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the first COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.

Au sein du foyer, enfants comme adultes peuvent rapidement transmettre le coronavirus
▻https://www.numerama.com/sciences/662910-a-quel-point-le-coronavirus-se-transmet-il-dans-un-foyer-enfants-y-

Le taux moyen des infections secondaires à l’échelle de tous les groupes étudiés est de 53 %. Concernant les enfants et jeunes adultes qui faisaient partie des patients index, le taux d’infections secondaires qu’ils ont générées est également élevé (53 % pour les moins de 12 ans ; 38 % pour les 12-17 ans), tout comme les infections générées à leur tour par les cas contact contaminés.

Les chiffres sont toujours légèrement inférieurs à ceux des tranches d’âge supérieures, mais également très proches, et à un taux suffisamment important pour jouer un rôle.

C’est donc là l’autre conclusion que les auteurs veulent mettre en évidence : « une transmission importante a eu lieu que le patient index soit un adulte ou un enfant ». En clair, le potentiel de transmission d’un enfant et d’un adulte est quasiment équivalent.

En référence à l’étude du CDC référencée par Kassem :
►https://seenthis.net/messages/884090

Après, on a des pourcentages à l’unité près pour les enfants : sachant que l’étude ne comporte que 5 enfants de moins de 12 ans, et 9 ados entre 12 et 17 ans. Je ne suis pas statisticien*, mais ça ne m’a pas l’air énorme pour produire des « 38% » et des « 53% ».

* « Je ne suis pas statisticien » is the new « I’m not a doctor ».

#Transmission of #SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020 | MMWR
►https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e1.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6944e1_TransmissionInHouseholdsCOVID19_IMAGE_30Oct20_1200x627.jpg

Étude prospective (et en cours) sur la transmission du virus dans les foyers familiaux,

– proportion de contacts contaminés : étonnamment élevée

Among these 191 contacts, 102 had SARS-CoV-2 detected in either nasal or saliva specimens during follow-up, for a secondary infection rate of 53% (95% confidence interval [CI] = 46%–60%).

– #contagiosité en fonction de l’âge : les #enfants ne sont pas en reste et pas seulement les adolescents,

Among fourteen households in which the index patient was aged <18 years, the secondary infection rate from index patients aged <12 years was 53% (95% CI = 31%–74%) and from index patients aged 12–17 years was 38% (95% CI = 23%–56%).

– délai de positivité du PCR chez les personnes contaminées : court

Approximately 75% of secondary infections were identified within 5 days of the index patient’s illness onset, and substantial transmission occurred whether the index patient was an adult or a child.

– proportion de personnes #asymptomatiques au moment de la positivité du PCR (60%) et combien le restent (33%- sur un suivi de 7 jours) :

Forty percent (41 of 102) of infected household members reported symptoms at the time SARS-CoV-2 was first detected by RT-PCR. During 7 days of follow-up, 67% (68 of 102) of infected household members reported symptoms, which began a median of 4 days (IQR = 3–5) after the index patient’s illness onset.

Proportion de personnes PCR positifs asymptomatiques pour l’ensemble des contacts : 18%

The rates of symptomatic and asymptomatic laboratory-confirmed SARS-CoV-2 infection among household members was 36% (95% CI = 29%–43%) and 18% (95% CI = 13%–24%), respectively.

Enseignements :

These findings suggest that transmission of SARS-CoV-2 within households is high, occurs quickly, and can originate from both children and adults.

An important finding of this study is that fewer than one half of household members with confirmed SARS-CoV-2 infections reported symptoms at the time infection was first detected, and many reported no symptoms throughout 7 days of follow-up, underscoring the potential for transmission from asymptomatic secondary contacts and the importance of quarantine. Persons aware of recent close contact with an infected person, such as a household member, should quarantine in their homes and get tested for SARS-CoV-2

#COVID-19 in a Correctional Facility Employee Following Multiple Brief Exposures to Persons with COVID-19 — Vermont, July–August 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e1.htm

Although the correctional officer never spent 15 consecutive minutes within 6 feet of an IDP with COVID-19, numerous brief (approximately 1-minute) encounters that cumulatively exceeded 15 minutes did occur.

During his 8-hour shift on July 28, the correctional officer was within 6 feet of an infectious IDP an estimated 22 times while the cell door was open, for an estimated 17 total minutes of cumulative exposure. IDPs wore microfiber cloth masks during most interactions with the correctional officer that occurred outside a cell; however, during several encounters in a cell doorway or in the recreation room, IDPs did not wear masks. During all interactions, the correctional officer wore a microfiber cloth mask, gown, and eye protection (goggles). The correctional officer wore gloves during most interactions. The correctional officer’s cumulative exposure time is an informed estimate; additional interactions might have occurred that were missed during this investigation.

#contamination

Excess Deaths Associated with #COVID-19, by #Age and Race and Ethnicity — United States, January 26–October 3, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e2.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6942e2_ExcessDeathsCOVID19_IMAGE_20Oct20_1200x627.jpg

Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons.

#surmortalité

#COVID research updates: Teenager spreads coronavirus on family holiday
►https://www.nature.com/articles/d41586-020-00502-w

https://media.nature.com/lw1024/magazine-assets/d41586-020-00502-w/d41586-020-00502-w_18451492.jpg

A 13-year-old girl gave the new #coronavirus to her grandparents and 9 other relatives who occupied the same holiday house for up to 3½ weeks, confirming that adolescents can seed #clusters of COVID-19 cases.

▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6940e2.htm?s_cid=mm6940e2_w

Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6937e3.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6937e3_COVID19OutbreaksChildCare_IMAGE_11Sept20_1200x675-medium.jpg

What is already known about this topic?

Children aged ≥10 years have been shown to transmit SARS-CoV-2 in school settings.

What is added by this report?

Twelve children acquired COVID-19 in child care facilities. Transmission was documented from these children to at least 12 (26%) of 46 nonfacility contacts (confirmed or probable cases). One parent was hospitalized. Transmission was observed from two of three children with confirmed, asymptomatic COVID-19.

What are the implications for public health practice?

SARS-CoV-2 Infections among young children acquired in child care settings were transmitted to their household members. Testing of contacts of laboratory-confirmed COVID-19 cases in child care settings, including children who might not have symptoms, could improve control of transmission from child care attendees to family members.

Hospitalization Rates and Characteristics of Children Aged 18 Years Hospitalized with Laboratory-Confirmed #COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6932e3_PediatricHospitalizationsCOVID19_IMAGE_07Aug20_1200x627.jpg

Bien que l’#enfant ait beaucoup moins souvent besoin d’être hospitalisé que l’adulte, 1/3 des enfants hospitalisés le sont en soins intensifs.

Summary
What is already known about this topic?

Most reported SARS-CoV-2 infections in children aged <18 years are asymptomatic or mild. Less is known about severe COVID-19 in children requiring hospitalization.

What is added by this report?

Analysis of pediatric COVID-19 hospitalization data from 14 states found that although the cumulative rate of COVID-19–associated hospitalization among children (8.0 per 100,000 population) is low compared with that in adults (164.5), one in three hospitalized children was admitted to an intensive care unit.

What are the implications for public health practice?

Children are at risk for severe COVID-19. Public health authorities and clinicians should continue to track pediatric SARS-CoV-2 infections. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.

#enfants

#Coronavirus : des centaines d’enfants américains infectés en colonie de vacances
►https://www.sciencesetavenir.fr/sante/coronavirus-des-centaines-d-enfants-americains-infectes-en-colonie-

Une enquête lancée le 25 juin a découvert que 260 des 344 personnes pour lesquelles des résultats étaient disponibles avaient été testées positives.

Parmi elles, 74% avaient des symptômes légers comme de la fièvre, des maux de tête et un mal de gorge. Les autres n’avaient pas de symptômes.

Ces données viennent s’ajouter aux preuves croissantes « démontrant que les enfants de tous âges sont susceptibles d’être infectés par le Sars-CoV-2 et, contrairement aux premières informations, pourraient jouer un rôle important dans la transmission », selon les auteurs du rapport des CDC.

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6930e1_SymptomsRiskFactorsOutpatientsCOVID19_IMAGE_24July20_1200x627.jpg

Durée des symptômes

Summary
What is already known about this topic?

Relatively little is known about the clinical course of COVID-19 and return to baseline health for persons with milder, outpatient illness.

What is added by this report?

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for #SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

What are the implications for public health practice?

#COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions. Effective public health messaging targeting these groups is warranted.

SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members — USS Theodore Roosevelt, April 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e4.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6923e4_SailorsTestResultsCOVID19_IMAGE_09June20_1200x627.jpg

Among a convenience sample of 382 young adult U.S. service members aboard an aircraft carrier experiencing a COVID-19 outbreak, [...] [o]ne fifth of infected participants reported no symptoms.

Impact of the #COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e1.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6923e1_EDVisitDeclinesCOVID19_IMAGE_03June20_1200x627.jpg

#Etats-Unis : Fréquentation des #urgences « substantiellement moindre » par rapport à la même période de l’année précédente ; le nombre d’arrêts cardiaques est par contre plus élevé.

During an early 4-week interval in the COVID-19 pandemic, ED visits were substantially lower than during the same 4-week period during the previous year; these decreases were especially pronounced for children and females and in the Northeast. In addition to diagnoses associated with lower respiratory disease, pneumonia, and difficulty breathing, the number and ratio of visits (early pandemic period versus comparison period) for cardiac arrest and ventricular fibrillation increased. The number of visits for conditions including nonspecific chest pain and acute myocardial infarction decreased, suggesting that some persons could be delaying care for conditions that might result in additional mortality if left untreated. Some declines were in categories including otitis media, superficial injuries, and sprains and strains that can often be managed through primary or urgent care. Future analyses will help clarify the proportion of the decline in ED visits that were not preventable or avoidable such as those for life-threatening conditions, those that were manageable through primary care, and those that represented actual reductions in injuries or illness attributable to changing activity patterns during the pandemic (such as lower risks for occupational and motor vehicle injuries or other infectious diseases).

Plus près de toi mon Dieu : c’est un excellente idée de réexpédier les vieux qu’on n’a pas eu choper avec la première vague dans les églises.

High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e2.htm

Among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). An additional 26 cases linked to the church occurred in the community, including one death.

Universal and Serial Laboratory Testing for #SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6921e1.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6921e1_TestingAtAVeteransFacilityCA_IMAGE_22May20_1200x627.jpg

What is already known about this topic?

Long-term care skilled nursing facilities (SNFs) are at high risk for COVID-19 outbreaks. Many SNF residents and staff members identified with COVID-19 are asymptomatic and presymptomatic.

What is added by this report?

After identification of two cases of COVID-19 in an SNF in Los Angeles, universal, serial reverse transcription–polymerase chain reaction (RT-PCR) testing of residents and staff members aided in rapid identification of additional cases and isolation and cohorting of these residents and interruption of transmission in the facility.

What are the implications for public health practice?

Universal and serial RT-PCR testing in SNFs can identify cases during an outbreak, and rapid isolation and cohorting can help interrupt #transmission.

#tests #isolement

Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e6.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6915e5e6_USHealthCarePersonnelCOVID19_IMAGE_14April20_1200x627.jpg

During February 12–April 9, [..,] 49,370 [COVID-19 cases] included data on whether the patient was a health care worker in the United States; including 9,282 (19%) who were identified as HCP. Among HCP patients with data available [...] 1,779 (38%) reported at least one underlying health condition. Among HCP patients with data on health care, household, and community exposures, 780 (55%) reported contact with a COVID-19 patient only in health care settings.

[...] Most HCP with #COVID-19 (6,760, 90%) were not hospitalized; however, severe outcomes, including 27 deaths, occurred across all age groups; deaths most frequently occurred in HCP aged ≥65 years. These preliminary findings highlight that whether HCP acquire infection at work or in the community, it is necessary to protect the health and safety of this essential national workforce.

#soignants #etats-unis

Pourcentage de PCR SARS-Cov2 positif dans les syndromes grippaux: 5% dans les cas légers.

Community Prevalence of #SARS-CoV-2 Among Patients With Influenzalike Illnesses Presenting to a Los Angeles Medical Center in March 2020 | Geriatrics | JAMA | JAMA Network
▻https://jamanetwork.com/journals/jama/fullarticle/2764137

(”These patients had sufficiently mild illness to be active in the community throughout their illness, increasing the possibility of #transmission.”)

(PCR for influenza, respiratory syncytial virus and SARS-CoV-2)

One hundred thirty-one tests for SARS-CoV-2 were obtained and 7 were positive ( 5.3% ; 95% CI, 2.2%-10.7%). The median age of patients who tested positive was 38 years (range, 34-44 years), 3 were male (43%), and the median duration of symptoms was 4 days (range, 2-4 days) at presentation. Six of 7 patients presented with fever, 5 with myalgias, and only 1 with cough. Only 1 patient had a travel history (returned from Miami, Florida). All patients had mild illnesses, and all tested negative for influenza and respiratory syncytial virus.

#covid-19 #coronavirus #etats-unis

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e1.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6913e1_AsymptomaticSNFWACOVID-19_IMAGE_27March20_1200x627.jpg

Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom [13] were asymptomatic or presymptomatic on the day of testing.

[...]

One week after testing, the 13 residents who had positive test results and were asymptomatic on the date of testing were reassessed; 10 had developed symptoms and were recategorized as presymptomatic at the time of testing [...] Three residents with positive test results remained asymptomatic.

Premiers résultats préliminaires (et incomplets) des sujets porteurs de SARS-CoV2 aux #États-Unis

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6909e1_COVID-19ActiveMonitoring_IMAGE_03Mar20_1200x675.jpg

69% des 2449 cas dont l’âge est connu (4226 cas diagnostiqués au total dans la période concernée) ont moins de 65 ans, 52% moins de 55 ans, 34% moins de 45 ans, 5% moins de 19 ans,

Among 2,449 patients with known age, 6% were aged ≥85, 25% were aged 65–84 years, 18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years (Figure 2). Only 5% of cases occurred in persons aged 0–19 years.

Concernant la tranche d’âge des cas dont on sait qu’ils ont été hospitalisés, certains en soins intensifs (508 patients) :

Nearly 40 Percent of U.S. Hospitalized Coronavirus Patients Are Age 20 to 54 - The New York Times
▻https://www.nytimes.com/2020/03/18/health/coronavirus-young-people.html

https://static01.nyt.com/images/2020/03/19/science/19VIRUS-p1/18VIRUS-AMERICANS-facebookJumbo.jpg

In the C.D.C. report, 20 percent of the hospitalized patients and 12 percent of the intensive care patients were between the ages of 20 and 44, basically spanning the millennial generation.

#coronavirus