New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections. This report describes cases of laboratory-confirmed COVID-19 among NYC residents diagnosed during February 29-June 1, 2020, that were reported to DOHMH. DOHMH began COVID-19 surveillance in January 2020 when testing capacity for SARS-CoV-2 (the virus that causes COVID-19) using real-time reverse transcription-polymerase chain reaction (RT-PCR) was limited by strict testing criteria because of limited test availability only through CDC. The NYC and New York State public health laboratories began testing hospitalized patients at the end of February and early March. DOHMH encouraged patients with mild symptoms to remain at home rather than seek health care because of shortages of personal protective equipment and laboratory tests at hospitals and clinics. Commercial laboratories began testing for SARS-CoV-2 in mid-to late March. During February 29-March 15, patients with laboratory-confirmed COVID-19 were interviewed by DOHMH, and close contacts were identified for monitoring. The rapid rise in laboratory-confirmed cases (cases) quickly made interviewing all patients, as well as contact tracing, unsustainable. Subsequent case investigations
Introduction: Antimicrobial resistance (AMR) among pathogens is an increasing concern that could lead to increased morbidity, mortality, and costs. Irrational use of antimicrobial agents is one of the leading causes of AMR. Periodic surveillance of antimicrobial consumption in the form of point prevalence surveys is a quick and robust methodology to evaluate prescribing trends in hospital or community settings, usually conducted to develop future strategies, including antimicrobial stewardship programs (ASPs). The current survey was undertaken to document antimicrobial consumption among neonates and children from public sector hospitals in Pakistan. Methods:A cross-sectional study, completed between October and November 2020, examined antimicrobial consumption for suspected bacterial infection among neonates and children admitted to 16 primary and secondary care hospitals in Punjab, Pakistan. World Health Organization (WHO) methodology and AWaRe (Access, Watch, and Reserve) classification were applied.Results: A total of 708 beds of children wards of the 16 health facilities were surveyed. Almost all (97%) hospitalized children were prescribed antimicrobials on the day of the survey-a total of 1,224 antimicrobials to 592 hospitalized neonates and children, with 2.6 antimicrobials per patient.The three most common indications among the surveyed population were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis (10.30%). The three most frequently prescribed antimicrobials were ceftriaxone, amikacin, and ampicillin. Almost half of the antimicrobials were prescribed from the "Access" (49.5%) and "Watch" (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the "Reserved" category. All antimicrobials were prescribed as empirical therapy without any culture or sensitivity testing. There were also concerns with extended antimicrobial prophylaxis among the small minority of children to prevent surgical site infections. Conclusion:Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of the "Watch" category of antimicrobials is frequent, stressing the need to enhance the rational use of antimicrobials under the ASPs.
Objective New York City (NYC) experienced a large first wave of COVID-19 in the spring of 2020, but the Health Department lacked tools to easily visualize and analyze incoming surveillance data to inform response activities. To streamline ongoing surveillance, a group of infectious disease epidemiologists built an interactive dashboard using open-source software to monitor demographic, spatial, and temporal trends in COVID-19 epidemiology in NYC in near-real time for internal use by other surveillance and epidemiology experts. Materials and methods Existing surveillance databases and systems were leveraged to create daily analytic datasets of COVID-19 case and testing information, aggregated by week and key demographics. The dashboard was developed iteratively using R, and includes interactive graphs, tables, and maps summarizing recent COVID-19 epidemiologic trends. Additional data and interactive features were incorporated to provide further information on the spread of COVID-19 in NYC. Results The dashboard allows key staff to quickly review situational data, identify concerning trends, and easily maintain granular situational awareness of COVID-19 epidemiology in NYC. Discussion The dashboard is used to inform weekly surveillance summaries and alleviated the burden of manual report production on infectious disease epidemiologists. The system was built by and for epidemiologists, which is critical to its utility and functionality. Interactivity allows users to understand broad and granular data, and flexibility in dashboard development means new metrics and visualizations can be developed as needed. Conclusions Additional investment and development of public health informatics tools, along with standardized frameworks for local health jurisdictions to analyze and visualize data in emergencies, are warranted. Lay Summary New York City (NYC) experienced a large first wave of COVID-19 in the spring of 2020, but the Health Department lacked tools to easily visualize and analyze incoming surveillance data to inform response activities. To streamline ongoing surveillance, a group of infectious disease epidemiologists built an interactive dashboard using open-source software to monitor demographic, spatial, and temporal trends in COVID-19 epidemiology in NYC in near-real time for internal use by other surveillance and epidemiology experts. The dashboard allows key staff to quickly identify concerning trends and easily maintain granular situational awareness of COVID-19 epidemiology in NYC, and has alleviated the burden of manual report production on infectious disease epidemiologists. The system was built by and for epidemiologists, which is critical to its utility and functionality. Interactivity allows users to understand broad and granular data, and flexibility in dashboard development means new metrics and visualizations can be developed as needed. Additional investment and development of public health informatics tools, along with standardized frameworks for local health jurisdictions to analyze and visualize data in emergencies, are warranted.
The CDC recommended active monitoring of travelers potentially exposed to Ebola virus during the 2014 West African Ebola virus disease outbreak, which involved daily contact between travelers and health authorities to ascertain the presence of fever or symptoms for 21 days after the travelers' last potential Ebola virus exposure. From October 25, 2014, to December 29, 2015, the New York City Department of Health and Mental Hygiene (DOHMH) monitored 5,359 persons for Ebola virus disease, corresponding to 5,793 active monitoring events. Most active monitoring events were in travelers classified as low (but not zero) risk (n = 5,778; 99%). There were no gaps in contact with DOHMH of ≥2 days during 95% of active monitoring events. Instances of not making any contact with travelers decreased after CDC began distributing mobile telephones at the airport. Ebola virus disease-like symptoms or a temperature ≥100.0°F were reported in 122 (2%) active monitoring events. In the final month of active monitoring, an optional health insurance enrollment referral was offered for interested travelers, through which 8 travelers are known to have received coverage. Because it is possible that active monitoring will be used again for an infectious threat, the experience we describe might help to inform future such efforts.
Over the previous few months, COVID-19 and the corona virus have become the key words in every medium of the world. Our TV screens show the ever-riding number of fresh cases and the latest mortality figures. The pandemic has affected every aspect of the human life, but it has had one positive effect; it dragged the specialty of anesthesiology and its practitioners into limelight as never before. This editorial highlights the diverse nature of the anesthesiologists’ role in confronting COVID-19 and management of the patients from emergency room (ER), to intensive care units (ICUs) to operating rooms (ORs). Key words: Anesthesiologist; Perioperative physician; Pain managers; Intensivists; COVID-19; Pandemic Citation: Iqbal MK. The world knows the real heroes after the outbreak of COVID-19 pandemic! Anaesth. pain intensive care 2020;24(5):484-486 Received: 2 September 2020, Reviewed: 4 September 2020, Accepted: 30 September 2020
During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen.
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