cord-002095-47dbqu2r	2016	The clinician triggers the illness scripts of familiar diseases such as viral or bacterial respiratory infections and tick-borne infections to compare to his problem representation. While disseminated endemic fungal infections can cause fever, rash, lymphadenopathy, and pulmonary disease, an acute presentation with widespread skin lesions would be more likely in an immunocompromised patient. The problem representation is now fever, hypotension (resolved), diffuse pulmonary infiltrates, widespread lymphadenopathy, disseminated rash (resolved), leukopenia, thrombocytopenia, DIC, severe AKI, and mild hepatitis with no evident infection. It is the mismatch between common illness scripts (pleural) 5 and a patient''s presentation that prompts diagnosticians to consider rare diseases. Rare diseases such as HLH were considered only after the discussant found irreconcilable mismatches with the illness scripts of more common conditions. When clinicians know the illness scripts of common diseases well enough to recognize telltale deviations from the norm, they can trigger the consideration of rare conditions and request help from colleagues and other resources that will ultimately lead to a diagnosis.
cord-259952-58q4ma92	2020	Since the outbreak of the novel coronavirus disease 2019 (COVID-19) pandemic, emergency health care utilization has acutely declined by 23% for heart attacks, 20% for strokes, and 10% for hyperglycemic crises. We fitted modified multivariable Poisson regression models to estimate the associations between four mental health symptoms (nervous, anxious, or on edge; not being able to stop or control worrying; little interest or pleasure in doing things; feeling down, depressed, or hopeless) in the past 7 days and medical care avoidance (delayed medical care; needed non-coronavirus medical care but did not get it) due to the coronavirus pandemic in the past 4 weeks. Individuals who experience all four symptoms of anxiety and depression had higher adjusted relative risk ratios of delayed medical care and not receiving needed non-coronavirus medical care, after adjustment for potential confounders (Table 2) .
cord-260322-b2493coe	2020	title: Initial Experience with a COVID-19 Web-Based Patient Self-assessment Tool As the COVID-19 pandemic spreads, patients experiencing symptoms potentially attributable to the disease require timely assessment. Automated assessment tools-such as digital self-assessment applications-offer a potential strategy for providing guidance to patients without requiring direct attention from healthcare professionals. [2] [3] [4] Our team recently developed a web-based COVID-19 selfassessment tool, available in English and Spanish, offering guidance for patients experiencing potential COVID-19 symptoms. A total of 276,560 assessments were completed, and users reported symptoms potentially attributable to COVID-19 69.6% of the time. Of those with mild symptoms, 7.1% reported direct exposure to someone with confirmed COVID-19; for these users, our tool recommends consideration of telephone consultation with a healthcare professional to determine the need for testing. In our analysis of almost 300,000 digital self-assessments from our COVID-19 self-assessment tool, 69.6% of users reported symptoms potentially attributable to COVID-19.
cord-261173-lnjh56ts	2020	In this study, we aimed to assess whether HCW are at higher risk for COVID-19 infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission compared to non-HCW using advanced statistical methodology to account for various confounders. 23 For the outcomes of hospital and intensive care unit (ICU) admission of COVID-19 testpositive patients, the propensity score covariates are those that were found associated with COVID-19 hospitalization outcome in our previous work including age, race, ethnicity, gender, smoking history, body mass index, median income, population per housing unit, presenting symptoms (including fever, fatigue, shortness of breath, diarrhea, vomiting), comorbidities (including asthma, hypertension, diabetes, immunosuppressive disease), medications (including immunosuppressive treatment, nonsteroidal anti-inflammatory drugs [NSAIDs]), and laboratory values (including pre-testing platelets, aspartate aminotransferase, blood urea nitrogen, chloride, and potassium). [7] [8] [9] [10] 12 The fact that HCW identified as patient facing had a significantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.
cord-266266-ekxnn9bo	2020	title: Lessons from Influenza Outbreaks for Potential Impact of COVID-19 Outbreak on Hospitalizations, Ventilator Use, and Mortality Among Homeless Persons in New York State To address this knowledge gap, using influenza outbreaks as an example, we investigated health care use among the homeless population hospitalized in New York State. 5 Next, we compared the utilization of care and patient outcomes (hospitalization through emergency department [ED], mechanical ventilation use [non-invasive or invasive], and in-hospital death) between homeless versus nonhomeless patients using multivariable modified Poisson regression models. Homeless patients experienced a higher rate of hospitalization for influenza than non-homeless persons throughout the observation period (Fig. 1) . The difference was particularly salient for the pandemic of H1N1 influenza in 2009: hospitalization rates were 2.9 per 1000 for homeless versus 0.1 per 1000 for non-homeless populations. Using the population-based data, including all hospitalizations for influenza in New York, we found that homeless persons had higher utilization of care compared with non-homeless persons.
cord-267114-tvoi6a7q	2020	Among low-income adults with employer-sponsored insurance who had multiple chronic conditions and were enrolled in high-deductible plans, about 14.3% had family out-ofpocket prescription drug expenditures exceeding 10 percent of family disposable income. While out-of-pocket costs for prescription drugs have decreased in recent years, 1 the results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. Adults who reported being diagnosed with high blood pressure on two or more occasions were defined as having hypertension † Base group *,**,***Statistically significantly different, based on two-sample t tests, from the no-deductible plan enrollees at the 5%, 1%, or 0.1%, respectively The sample comprised adults ages 19 to 64 who were enrolled in employer-sponsored health insurance plans and no other coverage throughout the year FPL, federal poverty level Using the self-reported priority conditions in MEPS HC, the following diagnosed conditions were identified: Diabetes, asthma, hypertension, arthritis, heart diseases, cancer, chronic bronchitis, stroke, and emphysema.
cord-270876-kul6bs3w	2020	2 By allowing patients to remotely attend appointments through audiovisual applications, virtual visits bring promise for decreasing outpatient no-shows. Patients can attend virtual visits from anywhere, including their homes, their workplaces, or even their parked cars, decreasing the burdens of making it to in-person appointments. In the study of general surgery outpatients from 2018, 123 (55%) of 223 patients reported they would prefer in-person appointments over virtual ones, even when accounting for the time and cost of coming to in-person appointments. 2 Patients and clinicians might struggle with setting up the technology needed for virtual visits, which might waste time and resources. For example, a 2019 study from Canada of home virtual visits for 75 patients at a stroke prevention clinic reported a no-show rate of 2 (3%) out of 81 appointments, but the study did not include comparisons of no-show rates for in-person clinic visits. Why do patients miss their appointments at primary care clinics?
cord-271599-1yu1yl12	2020	KEY RESULTS: From the onset to the acceleration phase, participants increasingly perceived COVID-19 to be a serious public health threat, reported more changes to their daily routine and plans, and reported greater preparedness. Individuals with low health literacy remained more likely to feel unprepared for the outbreak (RR 1.80, 95% CI 1.11–2.92, p = 0.02) and to express confidence in the federal government response (RR 2.11, 95% CI 1.49–3.00, p < 0.001) CONCLUSIONS: Adults at higher risk for COVID-19 continue to lack critical knowledge about prevention. Our first longitudinal assessment of the C3 study revealed that participants increasingly perceived COVID-19 to be a serious public health threat, reported more changes to their daily routine and plans, and had a greater sense of preparedness from the onset to the acceleration phase of the outbreak.
cord-272679-dobaci5p	2020	We used ordinary least squares linear regression to fit our model and applied BRFSS survey weights to obtain nationally representative estimates while adjusting for respondent''s age group, sex, race/ethnicity, income, educational attainment, state, and 6 months of pre-November trends. In subgroup analysis, the rise in poor mental health days in Clinton states in December 2016 reflected increases in such days by adults aged 65 and older, women, and white individuals (Table 1) . In contrast, depression rates compared to October 2016 first rose statistically in Clinton states in January 2017 (2.1percentage point increase, SE 0.8, p = 0.008), 1 month following the rise in days of reported poor mental health (Fig. 2 ). Although other factors are likely contributory, the sustained mental health worsening in Clinton states in the 6 months following the election suggests that the potential effects of Trump''s victory were not transitory, a hypothesis supported by a closely lagging rise in self-reported diagnoses of depression.
cord-276026-etj5vpg5	2020	The American Psychiatric Association''s DSM-5 Outline for Cultural Formulation notes that "Experiences of racism and discrimination in the larger society may impede establishing trust and safety in the clinical diagnostic encounter. 6 Although no validated intervention for COVID-19-related discrimination exists yet, bystanders may be empowered by current frameworks for bystander intervention, such as from the 4 Ds of Bystander Intervention (Distract, Delegate, Direct, Delay) adapted by the American Friends Service Committee to combat racism, to the Interrupt, Question, Acknowledge, Educate, Echo framework adapted from the Southern Poverty Law Center to promote tolerance in teaching. While there has been an increase in the use of hashtags that encourage violence against Chinese people, there has also been a spike in anti-Semitic hashtags espousing racist tropes about the virus "being used to kill off large portions of the population." 8 As a medical community, we must make it clear to society that the racist rhetoric of blame threatens mental health and even lives-as we have already seen with the stabbing of the Burmese-American family.
cord-280410-j32tuj5s	2020	Growing evidence shows that many non-COVID patients have stayed home with obvious heart attack symptoms rather than coming into the hospital, for fear of catching This has led to patients dying at home, increases in otherwise rare complications such as ventricular wall rupture, 2 and generally to unnecessarily severe complications from events that might have been easily managed under usual circumstances. Cancer treatment has been delayed or disrupted in many cases, despite valiant efforts by healthcare workers to continue it. COVID-19 has not been good for medical care delivery, for patients, or for healthcare workers. While some (or even many) disruptions have been bad for patients and the healthcare system, others seem to have been helpful. Certainly, readers can furnish many examples of how COVID-19 has been bad for care delivery in their area of expertise, their clinic, or their hospital.
cord-283862-k6b4vyut	2020	We have expedited this "From the Editor''s Desk" even though it will not necessarily refer to articles in the same printed issue as has been our habit. Similarly, we have considered papers on materials that are behind the VA firewall and inaccessible to readers who do not work in the VA. For COVID-19 papers, we have considered the question of whether we should publish material that has also been in the lay press. Editorial guidance on the question of secondary publication comes from the International Committee of Medical Journal Editors (ICMJE). While not mentioned in ICMJE guidance, duplicate publication is also misleading in assessing promotion metrics in the overweighting of a body of work. ICMJE does have a proviso for public emergencies, stating that "…information with immediate implications for public health should be disseminated without concern that this will preclude subsequent consideration for publication in a journal." Therefore, while we recognize the risk that COVID-19-themed publications may put forward ideas that have already been disseminated in other settings, we are willing to take this risk and welcome submissions that may fall into that category.
cord-283917-jumgb0hs	2020	The US Centers for Disease Control and Prevention (CDC) announced on July 17, 2020, that conditions including obesity, diabetes mellitus (DM), chronic kidney disease (CKD), heart disease, and chronic obstructive pulmonary disease (COPD) are well-established risk factors predisposing individuals to severe illness from COVID-19. In this analysis, participants in the United States National Health and Nutrition Examination Survey (NHANES) 2011-2016 2 aged ≥ 20 years were included. There were minor differences in the percentage of people with ≥ 1 established and ≥ 1 any risk factor according to sex, ethnicity, education, and income level, but the percentages remained around 60% and 75%, respectively. This is the first study to estimate the proportion of the Americans in the general population at risk from severe COVID-19 illness using data from a nationally representative survey. 4 Our study shows that obesity and hypertension are the leading risk factors for severe COVID-19 illness, especially in those aged < 50 years.
cord-284795-0eoyxz78	2020	For Nipah, the fruit bats contaminated date palm sap, which was then consumed by humans who thus got infected. While public health measures, including surveillance of emerging disease hotspots, can be helpful as near-term strategies, they cannot substitute for a long-term solution that conserves biodiversity. Human activities that drive loss of biodiversity are also directly tied to climate change and increasing water scarcity. This agricultural land expansion has mostly been for farming animals (for meat and other animal products such as dairy), soybean production, and palm oil production. 5 Given the significant contribution of human meat consumption to loss of biodiversity, decreasing such consumption must be recognized as a major priority for decreasing the incidence of EID over the medium to long term. It is estimated that 25% of global GHG emissions are the result of agriculture, most of it from the farming of animals for human consumption. Evolution in action: climate change, biodiversity dynamics and emerging infectious disease
cord-286679-g67ewzlp	2020	4 Community-based methods and partnerships with underrepresented populations can increase trust and study participation; accordingly, we sought to understand potential barriers specific to COVID-19 treatment and prevention in Black Americans using focus groups. Regarding optimized treatments for and prevention of COVID-19 among Black Americans, three major themes emerged: patient autonomy, holism, and structural racism. Emergent themes in our focus groups suggest that community involvement at the outset is critical for proper needs assessments, as well as in subsequent design and implementation of any new approaches aimed at assessing or reducing unfair burden of morbidity and mortality due to conditions disproportionately affecting Black Americans. Overall, findings highlight the importance of understanding community concerns about the orchestration of optimized treatments for COVID-19 among Black Americans, and underscore the health benefits of building community trust through early research involvement.
cord-297935-fk9j7q67	2020	OBJECTIVE: To understand Medicaid and Medicare patient and caregiver experiences with PCMHs participating in the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration. Separate groups were held for Medicare high-risk, Medicare low-risk, Medicaid, and dually eligible beneficiaries, their caregivers, and caregivers of Medicaid children (or, in Vermont, with patients participating in the Support and Services at Home program), in two different geographical areas in each state. In recent years, Centers for Medicare & Medicaid Services (CMS) and other payers have invested significant resources in testing the patient-centered medical home (PCMH) model as a means to improve the organization and delivery of primary health care and reduce health care expenditures. Through CMS''s involvement, Medicare partnered with Medicaid and commercial payers to make payments to participating primary care practices to support PCMH transformation activities, including extending office hours, staffing care teams, coordinating care, and enhancing electronic health record (EHR) capabilities.
cord-301399-s2i6qfjn	2020	Therefore, we examined changes in the number of deaths and age-adjusted mortality rates (AAMR) attributed to the top 10 causes of death between 2011 and 2018, the last year we have data available from the Centers for Disease Control and Prevention. We chose 2011 as the start date because of earlier work showing a transition in 2011 in 2 of the top 10 causes of death (heart disease and stroke) from a long-term decline to increasing numbers of deaths since then. Important patterns of change in AAMR in the past decade have been previously noted, from stalling of the decline in mortality due to heart disease 1 to decrease in life expectancy attributed to drug overdoses and suicides among young and middle-aged adults. Further, the ≥ 65 years population is projected to increase by 39% from 52.4 million in 2018 to 73.1 million in 2030 3 so that the number of deaths from most of the 10 leading causes can be expected to increase unless more effective preventive and therapeutic interventions can be implemented.
cord-304839-lesa5u2n	2020	In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. On January 7, 2020, researchers rapidly isolated a novel coronavirus (SARS-CoV-2, also referred to as 2019-nCoV) from confirmed infected pneumonia patients. 3 We reviewed the published clinical features, symptoms, complications, and treatments of patients with COVID-19 to help health workers around the world combat the current outbreak. Keywords used were "COVID-19," "2019 novel coronavirus," "SARS-CoV-2," "2019-nCoV," "Wuhan coronavirus," and "Wuhan seafood market pneumonia virus." After careful screening, six published articles with confirmed cases were identified and included in this review. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan
cord-305110-mujpekyu	2020	Critical public health tools to mitigate the spread of COVID-19 are medical isolation and quarantine, but use of these tools is complicated in prisons and jails where decades of overuse of punitive solitary confinement is the norm. 10 Many advocates fear that use of isolation to curb transmission of COVID-19 in correctional facilities will complicate the emerging crisis, as incarcerated people become reluctant to report symptoms for fear of being moved to solitary confinement, those who do report symptoms will be forced to endure an experience known to cause psychological and physical harm, and system-wide unrest will be triggered in institutions where fears about being placed in medical isolation could run rampant. Yet, quarantine and medical isolation in response to COVID-19 are necessary to halt the spread of infection; without them, containment of disease transmission will be exceedingly difficult if not impossible, posing significant health risks to incarcerated people, correctional healthcare providers, security staff, and the families and communities to which workers return at the end of each shift.
cord-306352-agppehpz	2020	title: Charlson Comorbidity Index Score and Risk of Severe Outcome and Death in Danish COVID-19 Patients Studies assessing the impact of total comorbidity burden on outcomes of COVID-19 in age-and sex-controlled analyses are lacking. 1 In this nationwide study of Danish COVID-19 patients, we investigated if Charlson Comorbidity Index Score (CCIS) was associated with the risk of severe outcome and death. The models were used to estimate the absolute risk of both outcomes according to CCIS groups across ages 40-85 for both sexes. The estimated absolute risks of severe COVID-19 and death were increased for CCIS 1-2, 3-4, and > 4 compared with those for CCIS 0 across ages and sexes (Fig. 1) . A Charlson Comorbidity Index Score above 0 was associated with an increased risk of severe COVID-19 and death when controlled for age and sex. Figure 1 Estimated risks of severe outcome and death according to sex, age, and Charlson Comorbidity Index Score (CCIS).
cord-307946-1olapsmv	2020	title: Primary Care Practitioners'' Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study Barriers to epidemic control in primary care included inappropriate PCP scheduling and role ambiguity, difficult tasks and inadequate capacities, and inexperienced community workers and insufficient cooperation. PCPs reported potential solutions for improving countermeasures, such as improving management, optimizing workflows, providing additional support, facilitating cooperation, and strengthening the primary care system. To understand PCPs'' perceived barriers to and experience of performing their tasks in epidemic control, we recruited frontline PCPs in China and conducted in-depth interviews using a qualitative design. The government officials and medical experts irregularly visited the community/township health centers and inspected PCPs'' daily practice of epidemic control, including the material preparation and arrangement, and held meetings to discuss the existing problems and potential solutions with PCPs. One participant stated, "It really troubled me that I had to accompany those supervisors, maybe 3 to 5 times a week, and show them what we had done with countless papers and forms and photos." Some instructions distributed to PCPs by supervisors were perceived as "scratching the surface".
cord-317440-898r34h2	2020	title: Charges of COVID-19 Diagnostic Testing and Antibody Testing Across Facility Types and States The CARES Act requires that private plans that do not have a negotiated rate with the provider pay the price publicly listed by the provider for COVID-19 testing, which is usually the same as or a percentage of the charge. In this study, we aim to examine the charges for the most commonly performed COVID-19 diagnostic test (CPT code: 87635) and antibody test (CPT code: 86769) across facility types and states. For COVID-19 diagnostic testing, the mean, median, and standard deviations of charges were $144.06, $100.00 (IQR $67.00-$155.00), and $162.18. A small proportion of COVID-19 diagnostic testing and antibody testing services, provided in selected states, had charges that far exceeded the Medicare rate. Anderson, PhD 1,2 a b Figure 2 Average charges for COVID-19 testing, by state. States that had ten or fewer claims were classified as "No data." The Medicare reimbursement rate is $51.31.
cord-322066-m8dphaml	2020	All of these unknowns often result in doctors uncomfortable in talking about risks and benefits of intubation with their patients until it is clear that the patient has progressed to a point of needing respiratory support. We as primary care doctors have the privilege of knowing our patients the best. We must also ask our patients about what medical interventions they would want if they were to contract COVID-19 and require respiratory support. Given the data we know about COVID-19 and the risks and benefits of intubation, we must use our best medical judgment to help patients understand realistic outcomes and make informed decisions. The role of the primary care doctor is to partner with our patients to help them find their voice in the medical system. It means helping many of our beloved patients understand that "do not intubate" is most likely the best choice for them.
cord-325181-d2cqarep	2020	Providers at community health centers (CHCs) are facing unique challenges in this landscape, serving as essential workers themselves while looking for ways to support some of the most vulnerable patients in the nation-many of whom bear the greatest burden of COVID-19, economic recession, and racial injustice, but whose voices are also often left out of the national political conversation. VotER (https://vot-er.org/) is a nonpartisan voter readiness initiative that specifically seeks to engage healthcare professionals in "inviting (patient) voices into the democratic process." To facilitate this, they offer their Health Democracy Kit, which allows healthcare providers to direct patients to an online voter registration platform that walks patients through voter registration in a state-specific manner. Our experience demonstrated how easily healthcare-based non-partisan voter registration can be coordinated and offered to patients in a way that does not burden providers or interrupt clinic work flows.
cord-326399-ey8g4pom	2020	title: Trends in Ambulatory Electronic Consultations During the COVID-19 Pandemic Hypothesizing that e-consult requests would increase during the pandemic, we sought to define COVID-19associated changes in e-consult requests. We assessed daily volumes from February 1, 2020, through April 1, 2020; the defined date of "intervention" was March 11, 2020, when Massachusetts declared a COVID-19-related state of emergency. We describe a significant increase in e-consult utilization relative to traditional ambulatory referrals following the COVID-19-related state of emergency declaration in Massachusetts. These results suggest an increase in e-consult utilization associated with the COVID-19 pandemic in the USA. This question is electronically transmitted to a specialist physician who reviews the question and clinical information in the EHR and provides clinical guidance including recommendations for further diagnostic testing or therapeutic management via a note entered in the patient''s EHR.
cord-327463-uw3rhkf3	2020	1 Under the CARES Act, private insurers are required to cover in vitro diagnostic testing for COVID-19 without patient cost sharing or other barriers during the public health emergency. To mitigate the risk of out-of-network billing for insurers that had not already negotiated rates, providers such as hospitals were required to publicly disclose the maximum "cash price" for tests online. We systematically reviewed the public websites of all hospitals in the 2019-2020 U.S. News and World Report "Best Regional Hospitals" list to determine whether the following information was available for in vitro COVID-19 tests: cash prices (yes/ no), hospital charges (yes/no), test type (molecular/serology/ unspecified; non-mutually exclusive). Among hospitals disclosing both cash prices and hospital charges, the median lowest bill balances for molecular (N = 27) and serology (N = 14) were $66.96 (IQR: $7.00-$120.00) and $6.00 (IQR: $6.00-$30.00), respectively.
cord-330368-rk31cwl4	2020	Much of the disaster planning in hospitals around the country addresses overcrowded emergency departments and decompressing these locations; however, in the case of COVID-19, intensive care units, emergency departments, and medical wards ran the risk of being overwhelmed by a large influx of patients needing high-level medical care. In a matter of days, our Division of Hospital Medicine, in partnership with our hospital, health system, and academic institution, was able to modify and deploy existing disaster plans to quickly care for an influx of medically complex patients. Starting with preparedness models outlined by Persoff et al., 10 Frank et al., 8 the CHEST consensus statement, 11, 12 and our existing disaster plans, we developed a modified framework for hospital operations management and staffing, anticipating a massive influx of acutely ill, medically complex, and highly contagious patients with COVID-19.
cord-332728-72yq43sw	2020	title: Depression and Anxiety Changes Among Sexual and Gender Minority People Coinciding with Onset of COVID-19 Pandemic Marginalized populations, such as sexual and gender minority people (i.e., non-heterosexual people and transgender or gender-expansive people, respectively) may be particularly at risk for adverse impacts of the pandemic due to preexisting economic and health factors. 1 We set out to document changes in depression and anxiety within The PRIDE Study, a longitudinal cohort of sexual and gender minority people, a vulnerable population. The PRIDE Study, a longitudinal cohort study of sexual and gender minority people, 2 were included if they completed mental health measures in the 2019 Annual Questionnaire (timepoint 1, June 2019-ongoing at time of data extraction) and in a COVID-19 impact ancillary study (timepoint 2, March 23, 2020, through April 19, 2020). A digital health research platform for community engagement, recruitment, and retention of sexual and gender minority adults in a national longitudinal cohort study-The PRIDE Study
cord-332729-f1e334g0	2020	5 The Centers for Disease Control and Prevention (CDC) recently added policy development as a sixth item in its list of the major tasks of epidemiology in public health, but there remains no mention of the impact on the general public. For instance, the Covid Act Now (CAN) model is fully open-source, along with its data inputs (available at https://covidactnow.org). Both the New York Times and Georgetown University''s Center for Global Health, Science, and Security (available at https://covidamp.org/) have begun to collect data on COVID-19 policies by state and effective dates, including shelter-in-place and reopening orders. These eight considerations may enable COVID-19 data and models to become better harbingers of actionable, behavior-changing, and even life-saving information; to bridge the gap between scientific public health expertise and mainstream, layperson Are the data and model''s mechanisms and data sources publicly available for fact-checking and validation?
cord-336577-uvnbgsds	2020	Notification of survivors -Determine the most appropriate patient contact and the team-member best suited to disclose -Use "SPIKES" 2 principles and the words "died" or "death" -Offer assistance in sharing the news with other friends or family -Consider saying a few closing words honoring the patient Care team should include primary physicians and nurses, relevant consultants (e.g., palliative care), spiritual personnel, and decedent affairs team members Death in the context of COVID-19: For specific guidance on the safe management of a dead body in the context of COVID-19 and how it may inform the above framework, please refer to the World Health Organization Interim Guidance 3 *State reporting guidelines can be found at: https://www.cdc.gov/phlp/publications/topic/coroner.html †Local Networks can be found at: https://www.organdonor.gov/awareness/organizations/local-opo.html is important that we work collectively to care for each other, support our survivors, and honor the sunsets of our patients.
cord-337120-irpm5g7g	2007	Therefore, Internists must understand early warning signs of different bioterrorist and infectious agents, proper reporting channels and measures, various ways that they can assist the public health response, and roles of different local, state, and federal agencies. During the past half decade, well-publicized events, including the anthrax mail attacks, 1 Hurricane Katrina, 2 and severe acute respiratory syndrome (SARS) 3, 4 have reminded us that epidemics, disease outbreaks, bioterrorist attacks, and natural disasters can occur. Therefore, Internists must understand early warning signs of bioterrorist and infectious agents, proper reporting channels and measures, and ways that they can help contain and treat the consequences of epidemics, outbreaks, and attacks. Internists suspecting an attack or epidemic should immediately inform the local or state health department and contain any possible threat in their clinics, especially if the agent is contagious. Bioterrorist attacks and epidemics require physicians to quickly transmit patient and case information to other health care personnel and appropriate authorities.
cord-339508-nf6ov39g	2020	In this study, we describe the results of cross-sectional resident and employee SARS-CoV-2 testing, and infection control and personnel policies associated with 16 Seattle area SNFs. Through two testing strategies, a total of 16 SNFs offered testing to either residents, employees, or both. For employees tested through the Seattle Flu Study, data included participant date of birth, date of testing, race and ethnicity, location and nature of work, new symptoms experienced during the last 7 days, and history of SARS-CoV-2 testing (Appendix 1 in the Supplementary Material). For employees, positive or inconclusive SARS-CoV-2 test results were reported directly to participants by phone within 48 h and to the Washington State Department of Health. We report the results of a large cross-sectional study evaluating SARS-CoV-2 prevalence in skilled nursing facilities (SNFs) in the Seattle area during the spring 2020 peak of the COVID-19 pandemic.
cord-339533-r0qsqjus	2020	Pandemics have the unique ability to amplify existing health inequalities, disproportionately affecting socially disadvantaged groups, including racial and ethnic minorities and low-income populations. Racial and ethnic minorities are at both a higher risk of contracting COVID-19 and suffering worse outcomes. 5, 6 Once infected, racial and ethnic minorities are at a greater risk of increased disease severity. 7 Previous epidemiological studies have consistently shown many of these conditions to be more prevalent in racial/ethnic minorities, likely contributing to the worse health outcomes seen from COVID-19. Until recently, there has been minimal comprehensive demographic data reported from the Centers for Disease Control and Prevention (CDC) or other governing bodies around the racial/ethnic characteristics of patients infected with COVID-19. Health disparities have long plagued our country and greatly impacted racial and ethnic minorities. Protection of racial/ethnic minority populations during an influenza pandemic
cord-339701-j0sr3ifq	2020	PARTICIPANTS: 6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47–3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06–1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13–1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56–2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m(2) (HR 1.80, CI 1.60–2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12–2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02–1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23–1.62). In this study, we describe the clinical characteristics of COVID-19 in ambulatory and inpatient settings and identify risk factors associated with mortality in hospitalized patients.
cord-347454-zs909ldm	2020	title: Patients'' Perceptions About Medical Record Privacy and Security: Implications for Withholding of Information During the COVID-19 Pandemic As withholding information can compromise providers'' ability to deliver appropriate care, the accuracy of public health surveillance system data, and even population health efforts to mitigate the spread of COVID-19, we need to understand how patients'' concerns about the privacy and security of their medical information may lead to information-withholding behaviors. One survey section asked about patients'' attitudes toward use of health information technology, including their perceptions about information security risks and privacy. The dependent variable for this study was the answer to the question "Have you ever kept information from your healthcare provider because you were concerned about the privacy or security of your medical record?" (yes/no). Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers
cord-348026-t1jkeu3d	2020	7 As a result, hazard pay offered to medical students willing to risk exposure to COVID-19 now may reduce their debt burden and potentiate the creation of more primary care physicians, a dearth of whom has been a significant health policy concern. However, there are several ways in which hazard pay might be financed based on local considerations and institutional structures: (a) small compulsory contributions from physicians (perhaps exempting those required to take unpaid furloughs) at a given institution not caring for COVID-19 patients by choice or due to risk factors for bad outcomes if infected; (b) public funding, such as the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020; and (c) private foundations offering funding for COVID-19 response efforts. Hazard pay could of course be considered for all physicians risking their health to care for infected patients.
cord-349099-s33nd9hz	2020	3 We compared the demographic characteristics, health insurance status, food insecurity, and prevalence of COVID-19 in their state of residence 4 (divided into quartiles), of those selecting this response to two other groups: (1) those working and (2) persons out-ofwork because of a non-coronavirus-related illness/ disability. We performed univariate logistic regressions to evaluate the association of each factor with being out-sick due to coronavirus symptoms relative to each comparator group. Our sample included 89,490 adults working the past week, 457 out-sick with coronavirus symptoms, and 3503 out-ofwork because of a non-coronavirus illness/disability. Minority race/ethnicity, low income, and residence in a state with high COVID prevalence were associated with work absence because of coronavirus symptoms in April-May 2020. This national-level evidence of the disparate impact of COVID-19 bolsters reports based on diagnoses from regions and hospital systems, 1 as well as our previous findings of an increase in illness-related work absence in April that disproportionately affected minorities.
cord-350321-jy4i403g	2020	title: Associations Between Primary Care Provider Shortage Areas and County-Level COVID-19 Infection and Mortality Rates in the USA 1 However, it is not known whether shortage areas are associated with higher COVID-19 infection or mortality rates. This study investigates the hypothesis that primary care HPSAs are associated with higher rates of COVID-19 infection and mortality. 3 The 2013 rural-urban continuum codes used to classify rurality and whole county primary care HPSAs were separately derived from the 2018 Area Health Resource File. Generalized linear mixed models with negative binomial distribution were used to test the associations of primary care HPSAs and COVID-19 rates, controlling for time, rurality, population, and six county-level socioeconomic variables. Our findings suggest that primary care provider shortage areas with reported COVID-19 cases face a higher burden of COVID-19 infections and death even after adjusting for socioeconomic and other county-level factors.
cord-352726-ep0xfen2	2020	Finally, primary care offices are capable of managing patients flow across home, clinic, hospital, and post-acute care; recent lifting of data sharing restrictions by the U.S. Department of Health and Human Services will enhance this coordination. Robust primary care infrastructure for ILI facilitates access and surge capacity; enables timely diagnosis and treatment; and could reduce health disparities in the incidence of pneumonias, hospitalizations, and related morbidity and mortality. (1) definitions and standards for evaluating and managing cases; (2) outbreak protocols giving primary care offices a central role in early detection, local safety, and surveillance; (3) clinical decision-making tools including rapid tests and prediction rules; and (4) supportive policies. At the national level, higher primary care participation in the CDC''s Outpatient Influenza-like Illness Surveillance Network (ILINet) will help identify regional hotspots where focused testing, contact tracing, and isolation in the next COVID outbreak can support rapid containment. Detection of excess influenza severity: associating respiratory hospitalization and mortality data with reports of influenza-like illness by primary care physicians
cord-355851-t8xh6327	2020	title: Accessibility of Virtual Visits for Urgent Care Among US Hospitals: a Descriptive Analysis 3 Many hospitals now offer real-time "virtual visits" for common urgent care through their websites, which offer an opportunity to assess the accessibility of a typical telehealth service. Many hospitals have begun offering virtual visits for urgent care with real-time connectivity through their websites. Hospitals used different names for these services such as "e-visits," "virtual urgent care," and "virtual visits." We included links to primary care visits if the website clearly indicated quick access for urgent care. We examined hospital websites and their virtual visit sites, focusing on three accessibility characteristics: general availability, language accommodations, and affordability. Even among hospitals with publicly accessible virtual visits, further limitations included geographic limitations (i.e., accessing care across state lines) and exclusions for chronic health conditions. Virtual visits were not easily or equitably accessible; in general, navigation of hospital websites was challenging.