There is limited data on longitudinal outcomes for COVID-19 hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a St. Louis-region hospital network, we performed multi-state analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to fifteen mutually-exclusive clinical states. Between March 15 and July 25, 2020, 1,577 patients were hospitalized with COVID-19 (49.9% male, median age 63 years [IQR 50, 75], 58.8% Black). Overall, 34.1% (95% confidence interval [CI] 26.4%, 41.8%) had an ICU admission and 12.3% (CI 8.5%, 16.1%) received invasive mechanical ventilation (IMV). The risk of decompensation peaked immediately after admission, discharges peaked around day 3 to 5, and deaths plateaued between days 7 and 16. At 28 days, 12.6% (CI 9.6%, 15.6%) of patients had died (4.2% [CI 3.2%, 5.2%] received IMV) and 80.8% (CI 75.4%, 86.1%) were discharged. Among those receiving IMV, 39.1% (CI 32.0%, 46.2%) remained intubated after 14 days; after 28 days, 37.6% (CI 30.4%, 44.7%) had died and only 37.7% (CI 30.6%, 44.7%) were discharged. Multi-state methods offer granular characterizations of the clinical course of COVID-19 and provide essential information for guiding both clinical decision-making and public health planning.

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Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020–October 2021; > 69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

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Purpose To evaluate the trend of harm perception for e-cigarettes and the trend of the association between harm perception for e-cigarettes and for cigarettes among US youth from 2014 to 2019. Design, setting and subjects The National Youth Tobacco Survey is an annual, cross-sectional, school-based survey done among youth selected using three-stage probability sampling. Analysis Data were drawn from the 2014 to 2019 Surveys. A Multinomial logistic regression model was used to assess the association between harm perception for e-cigarettes and harm perception for cigarettes for each year. Results The percentage of youth who perceived e-cigarettes as harmless decreased from 2014 to 2019 (17.2% to 5.8%). From 2015 to 2018, the percentage of smokers who perceived e-cigarettes as a little harmful increased (33.6% to 41.2%). The positive association between harm perception for e-cigarettes and harm perception for cigarettes became stronger with time. In 2014, the odds of perceiving e-cigarettes as harmless relative to very harmful were 19.55 times greater for youth who perceived cigarettes as harmless, compared to those who perceived cigarettes as very harmful (OR = 19.55; 95% CI: 14.19–26.94). These odds increased to 77.65 times in 2019 (OR = 77.65; 95% CI: 41.48–107.85). Conclusion This study suggests a stronger relationship between perceived harm of cigarettes and e-cigarettes with time. Interventions to prevent smoking have the potential to change e-cigarette use.