Covid-19 NotesTo rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series.
Purpose This paper aims to review the information management aspects of the early months of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus 19 outbreak. It shows that the transition from epidemic to the pandemic was caused partly by poor management of information that was publicly available in January 2020. Design/methodology/approach The approach combines public domain epidemic data with economic, demographic, health, social and political data and investigates how information was managed by governments. It includes case studies of early-stage information management, from countries with high and low coronavirus disease 2019 impacts (as measured by deaths per million). Findings The reasons why the information was not acted upon appropriately include “dark side” information behaviours (Stone et al., 2019). Many errors and misjudgements could have been avoided by using learnings from previous epidemics, particularly the 1918-1919 flu epidemic when international travel (mainly of troops in First World War) was a prime mode of spreading. It concludes that if similar outbreaks are not to turn into pandemics, much earlier action is needed, mainly closing borders and locking-down. Research limitations/implications The research is based on what was known at the time of writing, when the pandemic’s exact origin was uncertain, when some statistics about actions and results were unavailable and when final results were unknown. Practical implications Governments faced with early warning signs or pandemics must act much faster. Social implications If the next virus is as infectious as SARS-CoV-2 but much more fatal, the world faces disastrous consequences if most governments act as slowly as this time. Originality/value This is one of the first analyses of information management practices relating to the pandemic’s early stages.
Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. Published online ahead of print October 14, 2021:e1–e3. https://doi.org/10.2105/AJPH.2021.306472 )
Background COVID-19 continues to threaten public health, particularly in Native American (NA) communities, which experienced some of the highest rates of COVID-19 infection and mortality in the US. Although the risk factors and clinical characteristics of COVID-19 are well documented in the general population, there has been little research on NA patients. Methods We present descriptive data based on chart reviews of COVID-19 patients hospitalized between April 1 and July 31, 2020 at the Whiteriver Service Unit (WRSU), an Indian Health Service site on the Fort Apache Reservation. Results Of the 2,262 COVID-19 cases during the observation period, 490 (22%) were hospitalized and 35 (1.6%) died within 28 days. Compared to previous reports, hospitalized patients at WRSU were younger (median age 54), more likely to be female (55% female), and more likely to have comorbidities (92% at least 1, median 2). Patients under 50 (n=200) often had a history of alcohol abuse (51%) or polysubstance abuse (20%). One third of hospitalized patients (34%) were monitored at home and referred for treatment through a high-risk outreach program. Patients were admitted much earlier at WRSU than in other locations, with a median interval of 4 days from symptom onset to hospitalization compared to 7 days reported elsewhere, but over half were still transferred to higher care. Although WRSU patients had higher rates of comorbidities, the 28-day hospital mortality rate from COVID-19 was nearly half of what has been previously reported (35/490, 7% vs 15-20% reported elsewhere, p < 0.001). This trend persisted after controlling for age. Multivariate logistic regression showed that increasing age, male sex, and high BMI were significantly associated with higher risk of death from COVID-19 (overall model p < 0.001). Characteristics and outcomes of hospitalized COVID-19 patients at WRSU Conclusion Hospitalized patients at WRSU tended to be younger but with more comorbidities than previous studies. This may reflect the fact that NAs tend to acquire comorbidities at younger ages than the general population. This may also reflect the high rates of substance abuse in younger patients, which could be an additional risk factor for severe COVID-19. We believe that the low mortality rates at WRSU are a result of our outreach program, which likely decreased the interval between symptom onset and medical treatment. Disclosures All Authors: No reported disclosures
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