CDC Coronavirus Disease 2019 Response Epidemiology of COVID-19 in - PowerPoint PPT Presentation

CDC Coronavirus Disease 2019 Response Epidemiology of COVID-19 in Essential Workers, including Healthcare Personnel Sara Oliver MD, MSPH ACIP Meeting July 29, 2020 cdc.gov/coronavirus

Outline  Overview of U.S. COVID-19 Epidemiology  Epidemiology among Essential Workers – Healthcare Personnel • Workers at Long Term Care Facilities – Workers in Food Processing and Agriculture – Workers in Correctional Facilities – Military Personnel 2

Overview of U.S. COVID-19 Epidemiology

United States COVID-19 Cases by County January 21 to July 27, 2020 https://www.cdc.gov/covid-data-tracker/index.html

Trends in Number of COVID-19 Cases in the US January 22 to July 27, 2020 5 https://www.cdc.gov/covid-data-tracker/index.html#trends

Public Health Laboratories Reporting to CDC March 1 to July 18, 2020 Spec. tested: Age Unk 350,000 30 Spec. tested: 65+ yrs Spec. tested: 50-64 yrs Spec. tested: 18-49 yrs Spec. tested: 5-17 yrs 300,000 Spec. tested: 0-4 yrs 25 % pos.: overall 8.0% % pos.: 0-4 yrs % pos.: 5-17 yrs 250,000 % pos.: 18-49 yrs % pos.: 50-64 yrs 20 Percentage testing Specimens Tested % pos.: 65+ yrs Percent Positive positive is higher in 200,000 15 children and adults 150,000 18-49 years of age, 10 compared to older 100,000 adults 5 50,000 0 0 Week 6 https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Commercial Laboratories Reporting to CDC March 1 to July 18, 2020 3,000,000 30 Spec. tested: Age Unk Spec. tested: 65+ yrs Spec. tested: 50-64 yrs Spec. tested: 18-49 yrs 10.4% 2,500,000 25 Spec. tested: 5-17 yrs Percentage positiv e Spec. tested: 0-4 yrs % pos.: overall increasing % pos.: 0-4 yrs % pos.: 5-17 yrs 2,000,000 20 % pos.: 18-49 yrs since June, Specimens Tested Percent Positive % pos.: 50-64 yrs % pos.: 65+ yrs peak in early July 9.1% 1,500,000 15 1,000,000 10 500,000 5 0 0 Week 7 https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Pneumonia, Influenza and COVID-19 Mortality NCHS Mortality Reporting System 28 Through July 18, 2020 26 % of Deaths Due to Pneumonia, Influenza or COVID- 24 22 20 18 % of Deaths due to PIC 16 14 19 12 9.1% 10 8 6 4 2 2019 2020 2018 0 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 8 https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html NCHS = National Center for Health Statistics MMWR Week

Seroprevalence of Antibodies to SARS-CoV-2  Cross-sectional study performing serologic testing on a convenience sample of residual sera – March 23 through May 12 – Estimates standardized to site populations by age and sex  Serum samples tested from 16,025 persons 9 Havers FP, et al. JAMA IM 2020

Seroprevalence of Antibodies to SARS-CoV-2  Seroprevalence estimates ranged from 1.0 % to 6.9 %  Estimated greater than 10 times more SARS-CoV-2 infections occurred than the number of reported cases – By site, the estimated number of infections ranged from 6 to 24 times the number of reported cases 10 Havers FP, et al. JAMA IM 2020

Large Scale SARS-CoV-2 Serologic Studies in Health Care Workers and First Responders— New York City and Detroit Metro Area  May 18 to June 13 (Detroit) and July 2 (NYC)  Questionnaire gathered information about demographics, previous COVID-19 testing and symptoms, previous medical conditions  Eligibility: No COVID-like illness or +NAAT within previous 2 weeks  Presence and risk factors for IgG antibody: – Testing with ORTHO IgG test (S1 target) 11

Seroprevalence at 27 Hospitals*, Detroit Metro Area, May 18-June 13, 2020 (N=16,403) 12

Seroprevalence by Agency, New York City, May 18-July 2, 2020 (N=24,682) 13

Seroprevalence among healthcare workers: 13 hospitals in April-May  Objective: – Estimate seroprevalence of SARS-CoV-2 infection among healthcare workers (e.g. MDs, RN, respiratory therapists, phlebotomists) working in COVID-19 care areas – Explore risk factors for infection and immune response  Design: Convenient sample of ~3250 HCWs across ~13 hospitals (250 per site)  Assay: CDC Pan-Ig ELISA against spike protein  Data sources: – Interviews from enrolled HCWs – Serum collection at baseline and 60 days after enrollment 14

Seroprevalence among healthcare workers: 13 hospitals in April-May Location Seroprevalence NY 31.2% Seroprevalence ranged from 0.8 % to 31 % MA 10.0% TN 7.6% CO 6.0% MA 4.8% CA 4.0% WA 3.6% MN 3.6% MD 2.8% OR 1.6% OH 0.8% UT 0.8% NC 0.8% 15

COVID-19 Epidemiology among Healthcare Personnel

Healthcare Personnel  Healthcare Personnel (HCP) are essential workers defined as paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials 17

Cases among Healthcare Personnel  CDC reports and routinely updates cases and deaths among healthcare personnel on the CDC website – Likely an underestimate As of July 27 th 18 https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

EIP COVID-19 Tracking in Healthcare Personnel  Emerging Infections Program (EIP): network of 10 state health departments and local public health and academic partners  Sentinel or population-based surveillance for COVID-19 in healthcare personnel 7 sites (Connecticut, Colorado, Maryland, Minnesota, New Mexico, Oregon, Tennessee) – conducting sentinel surveillance – 2 sites (California, Georgia) conducting population-based surveillance – 1 site (New York—Rochester) using hybrid approach: sentinel hospitals, with population- based surveillance for nursing home HCP with COVID-19  >1100 HCP COVID-19 cases reported; >500 interviewed – 464 HCP COVID-19 cases with complete data as of 6/25 – ~70% from CA or NY 19 https://www.cdc.gov/ncezid/dpei/eip/index.html

EIP COVID-19 Tracking in Healthcare Personnel 20 https://www.cdc.gov/ncezid/dpei/eip/index.html

EIP COVID-19 Tracking in Healthcare Personnel 21 https://www.cdc.gov/ncezid/dpei/eip/index.html

EIP COVID-19 Tracking in Healthcare Personnel 22 https://www.cdc.gov/ncezid/dpei/eip/index.html

EIP COVID-19 Tracking in Healthcare Personnel 23 https://www.cdc.gov/ncezid/dpei/eip/index.html

EIP COVID-19 Tracking in Healthcare Personnel 24 https://www.cdc.gov/ncezid/dpei/eip/index.html

Project COVERED: COVID-19 Evaluation of Risk in Emergency Departments 25 https://medicine.uiowa.edu/content/covid-evaluation-risk-emergency-departments-covered-project

Project COVERED: COVID-19 Evaluation of Risk in Emergency Departments  At baseline, 29 (2%) had positive serologies (none had PCR positivity) • 22 (75%) had symptoms compatible with COVID-19 • 19 (90%) had worked in the ED with symptoms (1-16 days)  9 COVID-19 HCP incident cases in 7,700 person-weeks of observation – None of the participants who developed infection participated in intubation of COVID-19-positive patient  Projected 2.4% infection rate over 20-week observation period – Preliminary findings 26 https://medicine.uiowa.edu/content/covid-evaluation-risk-emergency-departments-covered-project

COVID-NET: Hospitalization Surveillance from 14 States Surveillance network collecting hospitalization data States participating in COVID-NET • Catchment area ~10% of US population • Patients must be a resident of the surveillance area and have a positive SARS-CoV-2 test within 14 days prior to or during hospitalization • Charts reviewed by trained surveillance officers COVID-NET = COVID-19-Associated Hospitalization Surveillance Network MMWR April 17, 2020 27 https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

Healthcare Personnel within COVID-NET March 1 to July 11, 2020 Healthcare Personnel  36,426 hospitalizations within COVID-NET Non-Hispanic White Non-Hispanic Black 9,195 (25%) cases with data on HCP status Hispanic or Latino 512 (5.6%) Healthcare Personnel Non-Hispanic Asian or Pacific Islander American Indian or Alaska Native Other  Median age: 48 years (IQR: 38-57 years) Overall Hospitalized Adults Non-Hispanic White  Among Healthcare Personnel, higher proportion Non-Hispanic Black of Non-Hispanic Black persons and lower Hispanic or Latino proportion of Hispanic persons Non-Hispanic Asian or Pacific Islander American Indian or Alaska Native Other 0 10 20 30 40 50 28 1 HCP status unknown for 399 (1.1%)

Healthcare Personnel within COVID-NET March 1 to July 11, 2020  Healthcare Personnel Type: N=512 Hospital-based patient care support 73 (e.g. nursing assistant) – Respiratory Therapist: 3 (<1%) Other patient care 21 – Physician: 23 (5%) Housekeeping/Environmental Services 20 Other nursing home/LTCF staff 17 – Nurse: 125 (24%) Technicians 15 – Other: 276 (54%) Management 12 – Not specified: 85 (17%) Home health worker 12 Emergency medical personnel 10 Social work/counselor 10 Pharmacy 9 Food Services 8 Dentistry 6 Laboratory 6 Other 57 29

Healthcare Personnel within COVID-NET March 1 to July 11, 2020 Underlying Medical Conditions  87 % of Hospitalized HCP 91 % of Hospitalized Adults Diabetes Hypertension Obesity CKD COPD HCP Asthma Overall 0 10 20 30 40 50 60 70 Percent 30