Changing Age Distribution of the COVID-19 Pandemic

What is already known about this topic?

Early in the pandemic, COVID-19 incidence was highest among older adults.

What is added by this report?

During June–August 2020, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. Younger adults likely contribute to community transmission of COVID-19. Across the southern United States in June 2020, increases in percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days.

What are the implications for public health practice?

Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce infection and subsequent transmission to persons at higher risk for severe illness.

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in more than 6,800,000 reported U.S. cases and more than 199,000 associated deaths.* Early in the pandemic, COVID-19 incidence was highest among older adults (1). CDC examined the changing age distribution of the COVID-19 pandemic in the United States during May–August by assessing three indicators: COVID-19–like illness-related emergency department (ED) visits, positive reverse transcription–polymerase chain reaction (RT-PCR) test results for SARS-CoV-2, the virus that causes COVID-19, and confirmed COVID-19 cases. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19–like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. Census regions. During June–August, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range = 4–15 days), suggesting that younger adults likely contributed to community transmission of COVID-19. Given the role of asymptomatic and presymptomatic transmission (2), strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and subsequent transmission of SARS-CoV-2 to persons at higher risk for severe illness. ...

Increased prevalence of SARS-CoV-2 infection among younger adults likely contributes to community transmission of COVID-19, including to persons at higher risk for severe illness, such as older adults. Emphasis should be placed on targeted mitigation strategies to reduce infection and transmission among younger adults, including age-appropriate prevention messages (7), restricting in-person gatherings and events,**** recommending mask use and social distancing in settings where persons socialize,^†††† implementing safe practices at on-site eating and drinking venues (9), and enforcing protection measures for essential and service industry workers.^§§§§ Given the role of asymptomatic and presymptomatic transmission (2), all persons, including young adults, should take extra precautions to avoid transmission to family and community members who are older or who have underlying medical conditions. Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and minimize subsequent transmission of SARS-CoV-2 to persons at higher risk for severe COVID-19.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e1.htm

S.C. restaurants allowed to operate at 100% capacity

South Carolina Governor Henry McMaster is lifting restrictions to allow restaurants to operate at 100 percent capacity statewide.

Gov. McMaster issued Executive Order 2020-63, which lifts all occupancy limitations in restaurants throughout South Carolina, effective immediately.

Because of the coronavirus pandemic, South Carolina’s restaurants were only allowed to operate at 50 percent capacity. Now, they will be able to operate at 100 percent capacity.

Other restaurant safety guidelines - including the required use of face coverings for patrons and staff – remain in place for the time being.

Additionally, the governor’s “last call order,” which doesn’t allow the sale or consumption of alcohol in restaurants after 11 p.m., will remain in place until further notice.

“South Carolina is open for business” Gov. Henry McMaster said. “Our state’s approach has been a measured, deliberate, and targeted one - aimed at keeping our economy open and our people safe.”

Other safety measures that are strongly encouraged, but are no longer required include the following:

• Restaurants should space indoor and outdoor tables 6 feet apart, to the extent possible.
• Restaurants should limit seating each table to no more than 8 customers and patrons, exclusive of family units or members of the same household.
• Restaurants should adopt and enforce a process to ensure that customers and patrons are able to maintain a minimum of 6 feet of separation from other parties while waiting to be seated.
• Restaurants should minimize, modify, or discontinue services that allow customers and patrons to fill or refill their own beverage cups.

The total number of people confirmed to have COVID-19 in South Carolina is 144,366 since the start of the pandemic and 3,211 people have died, officials said.

https://www.wbtv.com/2020/10/02/south-carolina-is-open-business-sc-restaurants-allowed-operate-percent-capacity/

Nearly 70% of Hospital Leaders See Rise in Self-Pay Due to COVID

KEY TAKEAWAYS

Alongside an expected increase in Medicaid beneficiaries, health system executives predict that reimbursements from commercials will slide. 

More than one-third of leaders expect to see their organization's IT budgets increase, while over 25% said their IT budgets will likely decrease.

However, only 12% of surveyed executives said their organizations are currently ready to comply with the price transparency rule that is slated to go into effect on January 1, 2021.

Approximately 70% of hospital leaders expect to see an increase in self-pay patients due to the economic impact of the COVID-19 pandemic, according to a Guidehouse Center for Health Insights analysis of a survey conducted by the Healthcare Financial Management Association (HFMA) released Wednesday morning.

Alongside an expected increase in Medicaid beneficiaries, health system executives predict that reimbursements from commercial insurers will slide.

Guidehouse's analysis underscores the ongoing budget challenges that hospital and health system leaders face because of the coronavirus outbreak.

"With health system margins primarily driven by elective services, the pandemic is gravely impacting provider revenue streams and payer mix," Timothy E. Kinney, partner at Guidehouse, said in a statement. "Healthcare leaders need to closely evaluate their payer mix and develop winning consumer experience strategies to overcome a slow recovery in patient volumes and an uptick in self-pay and Medicaid enrollees."

On the technology side, nearly all leaders said that their organizations have embraced telehealth to treat patients.

Additionally, nearly two-thirds of respondents said they have implemented financial counseling and payment plans, along with over half who have established patient portals to provide price estimates, to "better engage consumers."

Executives also pointed to a greater adoption of electronic health records (EHR) during the pandemic.

Over 40% said EHR adoption benefits are "outweighing challenges," nearly 70% said they "appropriately utilize available EHR functions," and 55% said they "adapted to functional releases," all of which marked increases compared to the results of the 2019 survey.

Only 12% of surveyed executives said their organizations are currently ready to comply with the price transparency rule that is slated to go into effect on January 1, 2021.

Almost 40% of respondents cited concerns about disclosing rates to "payers, media, and consumers" as the biggest obstacle to embracing the rule, while just over a quarter of respondents cited a lack of a data analytics infrastructure.

https://www.healthleadersmedia.com/finance/nearly-70-hospital-leaders-expect-increase-self-pay-due-covid

HHS Releases Update on Ryuk Ransomware Threat

The department is urging healthcare and public sectors to take steps to actively reduce cyberattack risks.

The Department of Health and Human Services' (HHS) Office of the Assistant Secretary for Preparedness & Response has issued updates regarding the Ryuk ransomware threat that has threatened the healthcare and public sectors since 2018.

The Department also shared ransomware insights and protection recommendations from the Cybersecurity & Infrastructure Security Agency (CISA).

"The hospital field faces a COVID-induced 'cyber triple threat,' " said John Riggi, senior advisor for cybersecurity and risk for the American Hospital Association, in a statement.

Riggi outlined the threats:

1. A rapid expansion of the 'attack surface' because of increased remote and network-connected technologies
2. A rise in cyberattacks by criminals who are taking advantage of the expanded attack surface
3. Reduced revenue for hospitals and health systems to bolster cyber defenses
   
   

   "Cyber criminals have increasingly targeted healthcare facilities during the COVID-19 pandemic, and this attack underscores why cybersecurity will continue to be a top priority for the healthcare field during a time when our health information systems are becoming more interconnected.

   "We are most concerned with ransomware attacks that have the potential to disrupt patient care operations and risk patient safety. We believe any cyberattack against a hospital or health system is a threat-to-life crime and should be responded to and pursued as such by the government," Riggi said.

   One health system that was recently attacked was Universal Health Services, Inc. UHS had to temporarily shut down user access to IT applications due to a malware cyberattack last weekend. BleepingComputer has reported the attack was done by the Ryuk ransomware, but UHS has not yet confirmed the source of the attack.

   UHS says it is continuing to "safely and effectively" serve patients through "offline documentation methods." Currently, the health system says there is no evidence that patient or employee data was compromised during the cyberattack.

   https://www.healthleadersmedia.com/innovation/hhs-releases-update-ryuk-ransomware-threat
   

Medicaid & CHIP Enrollments Grew 5.7% Since Pandemic Began

Both Medicaid and CHIP added more than 4 million new enrollments between February and June, according to CMS.

Medicaid and the Children's Health Insurance Program (CHIP) added more than 4 million new enrollments between February and June, according to the Centers for Medicare & Medicaid Services (CMS).

The first monthly Medicaid and CHIP Enrollment Trends Snapshot was released Wednesday afternoon and indicated that enrollments for the two government health programs grew by 5.7% after the public health emergency (PHE) for COVID-19 was issued in March.

By segment, Medicaid enrollment increased 6.2%, totaling almost 4 million new recipients, while CHIP enrollment increased by just over 23,000, representing nearly 0.5% growth.

In the Snapshot, CMS stated that overall enrollment "sharply increased with the COVID-19 PHE," as well as with the passage of the Families First Coronavirus Response Act.

https://www.healthleadersmedia.com/strategy/cms-monthly-snapshot-medicaid-chip-enrollments-grew-57-pandemic-began

Hospitals Shed 6.4K Jobs in September

The last jobs report before the November 2 presidential election signals a cooling economy as the nation heads into winter.

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KEY TAKEAWAYS

The healthcare sector job growth continued to rebound in September, as the nation slowly emerges from the coronavirus pandemic shutdown, but the pace has continued to slow,

In addition to the 6,400 job losses at hospitals, the healthcare sector created 53,000 "payroll additions" in September, down from the 75,000 jobs created in August, 126,000 new jobs in July, and well below the 318,000 jobs created in June.

The September gains included 18,000 jobs in physician offices, 14,000 jobs in other healthcare practitioner care venues, and 16,000 jobs in home health services.

Healthcare employment is down 631,000 jobs in 2020, including 285,000 job losses in the ambulatory sector, and 116,000 jobs losses in hospitals. 

Job growth in the nation's hospitals lost ground in September, with the sector shedding 6,400 jobs, the latest federal jobs report shows.

Overall, the healthcare sector job growth continued to rebound in September, as the nation slowly emerges from the coronavirus pandemic shutdown, but the pace has continued to slow,

In addition to the 6,400 job losses at hospitals, the Bureau of Labor Statistics on Friday reported that the healthcare sector created 53,000 "payroll additions" in September, down from the 75,000 jobs created in August, 126,000 new jobs in July, and well below the 318,000 jobs created in June.

The September gains included 18,000 jobs in physician offices, 14,000 jobs in other healthcare practitioner care venues, and 16,000 jobs in home health services.

Healthcare employment is down 631,000 jobs in 2020, including 285,000 job losses in the ambulatory sector, and 116,000 jobs losses in hospitals. The healthcare sector accounted for 15.8 million jobs in September, BLS data show.

September marks the fifth consecutive month of job growth for the healthcare sector, which suffered epic job losses in the spring owing to the coronavirus pandemic. In May, the sector saw 312,000 payroll additions, mostly in outpatient care venues.

The September job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.

In the overall economy, BLS reported that payroll employment grew by 661,000 in September, down from 1.4 million in in August, and 1.8 million in July. The nation's unemployment rate fell to 7.9%, mostly because many people had stopped looking for work.

The overall U.S. economy has shed 10.4 million jobs in 2020.

https://www.healthleadersmedia.com/strategy/hospitals-shed-64k-jobs-september

New COVID test doesn't use scarce reagents, catches all but least infectious

A major roadblock to large scale testing for coronavirus infection in the developing world is a shortage of key chemicals, or reagents, needed for the test, specifically the ones used to extract the virus's genetic material, or RNA. 

A team of scientists at the University of Vermont, working in partnership with a group at the University of Washington, has developed a method of testing for the COVID-19 virus that doesn't make use of these chemicals but still delivers an accurate result, paving the way for inexpensive, widely available testing in both developing countries and industrialized nations like the United States, where reagent supplies are again in short supply.

The method for the test, published Oct. 2 in PLOS Biology, omits the step in the widely used reverse transcription polymerase chain reaction (RT-PCR) test where the scarce reagents are needed.

92% accuracy, missing only lowest viral loads

The accuracy of the new test was evaluated by a team of researchers at the University of Washington led by Keith Jerome, director of the university's Molecular Virology Lab, using 215 COVID-19 samples that RT-PCR tests had shown were positive, with a range of viral loads, and 30 that were negative.

It correctly identified 92% of the positive samples and 100% of the negatives.

The positive samples the new test failed to catch had very low levels of the virus. Public health experts increasingly believe that ultra-sensitive tests that identify individuals with even the smallest viral loads are not needed to slow spread of the disease.

"It was a very positive result," said Jason Botten, an expert on pathogenic RNA viruses at the University of Vermont's Larner College of Medicine and senior author on the PLOS Biology paper. Botten's colleague Emily A. Bruce is the paper's first author.

"You can go for the perfect test, or you can use the one that's going to pick up the great majority of people and stop transmission," Botten said. "If the game now is focused on trying to find people who are infectious, there's no reason why this test shouldn't be front and center, especially in developing countries where there are often limited testing programs because of reagent and other supply shortages."

Skipping a step

The standard PCR test has three steps, while this simpler version of the standard test has only two, Botten said.

"In step 1 of the RT-PCR test, you take the swab with the nasal sample, clip the end and place it in a vial of liquid, or medium. Any virus on the swab will transfer from the swab into the medium," he said. "In step 2, you take a small sample of the virus-containing medium and use chemical reagents, the ones that are often in short supply, to extract the viral RNA. In step 3, you use other chemicals to greatly amplify any viral genetic material that might be there. If virus was present, you'll get a positive signal."

The new test skips the second step.

"It takes a sample of the medium that held the nasal swab and goes directly to the third, amplification step," Botten said, removing the need for scarce RNA extraction reagents as well as significantly reducing the time, labor and costs required to extract viral RNA from the medium in step 2.

Botten said the test is ideally suited to screening programs, in both developed and developing countries, since it is inexpensive, takes much less processing time and reliably identifies those who are likely to spread the disease.

Its low cost and efficiency could extend testing capacity to groups not currently being tested, Botten said, including the asymptomatic, nursing home residents, essential workers and school children. The standard RT-PCR test could be reserved for groups, like health care workers, where close to 100% accuracy is essential.

An influential pre-print points way to widespread adoption of test

The two-step test developed by the University of Vermont team first caught the attention of the scientific community in March, when preliminary results that accurately identified six positive and three negative Vermont samples were published as a preprint in bioRxiv, an open access repository for the biological sciences. The preprint was downloaded 18,000 times—in its first week, it ranked 17th among 15 million papers the site had published—and the abstract was viewed 40,000 times.

Botten heard from labs around the world who had seen the preprint and wanted to learn more about the new test.

"They said, 'I'm from Nigeria or the West Indies. We can't test, and people's lives are at stake. Can you help us?'"

Botten also heard from Syril Pettit, the director of HESI, the Health and Environmental Sciences Institute, a non-profit that marshals scientific expertise and methods to address a range of global health challenges, who had also seen the preprint.

Pettit asked Botten to join a think tank of likeminded scientists she was organizing whose goal was to increase global testing capacity for COVID-19. The test developed by the University of Vermont and University of Washington teams would serve as a centerpiece. To catalyze a global response, the group published a call to action in EMBO Molecular Medicine.

And it took action, reaching out to 10 laboratories in seven countries, including Brazil, Chile, Malawi, Nigeria and Trinidad/Tobago, as well as the U.S. and France, to see if they would be interested in giving the two-step test a trial run."Universally, the response was yes," Pettit said.

The outreach led to a new HESI program called PROPAGATE. Each of the labs in the PROPAGATE Network will use the two-step test on a series of positive and negative samples sent to them by the University of Washington to see if they can replicate the results the university achieved.

The study has already shown promising results. One of the labs in Chile has also used the test on its own samples from the community and got accurate results.

Assuming all goes well, Pettit and her colleagues at the University of Vermont and the University of Washington as well as scientists from the 10 partner sites plan to publish the results.

"The goal is the make the two-step test accessible to any lab in the world facing these hurdles and see a broad uptake," she said.

https://medicalxpress.com/news/2020-10-covid-doesnt-scarce-reagents-infectious.html