The relationship between SARS-CoV-2 viral load and risk of disease progression remains largely undefined in coronavirus disease 2019 (COVID-19). Here, we quantify SARS-CoV-2 viral load from participants with a diverse range of COVID-19 disease severity, including those requiring hospitalization, outpatients with mild disease, and individuals with resolved infection. We detected SARS-CoV-2 plasma RNA in 27% of hospitalized participants, and 13% of outpatients diagnosed with COVID-19. Amongst the participants hospitalized with COVID-19, we report that a higher prevalence of detectable SARS-CoV-2 plasma viral load is associated with worse respiratory disease severity, lower absolute lymphocyte counts, and increased markers of inflammation, including C-reactive protein and IL-6. SARS-CoV-2 viral loads, especially plasma viremia, are associated with increased risk of mortality. Our data show that SARS-CoV-2 viral loads may aid in the risk stratification of patients with COVID-19, and therefore its role in disease pathogenesis should be further explored.

REAST CANCER SCREENING, ESpecially with mammography, has been recommended for many decades, 1 and the majority of women older than 40 years in the United States participate in screening activities. 2,3 Meanwhile, new screening modalities have been introduced, and some of these have been increasingly incorporated into community practice. However, none of the new technologies has been evaluated for its effect on breast cancer mortality. Community practice of screening may differ from the care provided within randomized clinical trials and is less often discussed in review articles. Reviews of breast cancer screening usually emphasize efficacy and results of randomized trials, particularly those involving screen-film mammography. 4-7 Efficacy of a screening tool is measured in experimental studies under ideal circumstances. 8 In contrast, effectiveness is defined as the extent to which a specific intervention "when deployed in the field in routine circumstances, does what it is intended to do for a specific population." 8 We systematically reviewed what is known about the community practice of mammography, clinical breast examination, and breast self-examination, when possible, comparing the results from community studies with CME available online at www.jama.com

Context Given the current context of racial disparities in health and health care and the historical context of eugenics, racial disparities in the use of genetic susceptibility testing have been widely anticipated. However, to our knowledge there are no published studies examining the magnitude and determinants of racial differences in the use of genetic susceptibility testing. Objectives To investigate the relationship between race and the use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and to determine the contribution of socioeconomic characteristics, cancer risk perception and worry, attitudes about genetic testing, and interactions with primary care physicians to racial differences in utilization. Design, Setting, and Participants Case-control study (December 1999-August 2003) of 408 women with a family history of breast or ovarian cancer, of whom 217 underwent genetic counseling for BRCA1/2 testing (cases) and 191 women did not (controls). Participants received primary care within a large health system in greater Philadelphia, Pa. Main Outcome Measures Probability of carrying a BRCA1/2 mutation, socioeconomic characteristics, perception of breast and ovarian cancer risk, worry about breast and ovarian cancer, attitudes about BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing were measured prior to undergoing BRCA1/2 counseling for cases and at the time of enrollment for controls. Results African American women with a family history of breast or ovarian cancer were significantly less likely to undergo genetic counseling for BRCA1/2 testing than were white women with a family history of breast or ovarian cancer (odds ratio, 0.22; 95% confidence interval, 0.12-0.40). This association persisted after adjustment for probability of BRCA1/2 mutation, socioeconomic characteristics, breast and ovarian cancer risk perception and worry, attitudes about the risks and benefits of BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing (adjusted odds ratio for African American vs white, 0.28; 95% confidence interval, 0.09-0.89). Conclusions Racial disparities in the use of BRCA1/2 counseling are large and do not appear to be explained by differences in risk factors for carrying a BRCA1/2 mutation, socioeconomic factors, risk perception, attitudes, or primary care physician recommendations. The benefit of predictive genetic testing will not be fully realized unless these disparities can be addressed.

Background: Although trust in health care providers (physicians, nurses, and others) may be lower among African Americans compared with whites, limited information is available on factors that are associated with low trust in these populations. This study evaluated the association between trust in health care providers and prior health care experiences, structural characteristics of health care, and sociodemographic factors among African Americans and whites. Methods: National survey of 954 non-Hispanic adult African Americans (n = 432) and whites (n = 522). Results: African Americans (44.7%) were more likely than whites (33.5%) to report low levels of trust in health care providers (2 =12.40, PϽ.001). Fewer quality interactions with health care providers had a significant effect on low trust among African Americans (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.97-5.29; PϽ.001) and whites (OR, 3.99; 95% CI, 2.44-6.50; PϽ.001). Among African Americans, respondents whose usual source of care was not a physician's office were most likely to report low trust (OR, 1.73; 95% CI, 1.15-2.61; P = .02), whereas among whites, women (OR, 1.54; 95% CI, 1.04-2.30; P =.03) and respondents with fewer annual health care visits (OR, 1.52; 95% CI, 1.02-2.28; P=.04) were most likely to report low trust. Conclusions: Compared with whites, African Americans were most likely to report low trust in health care providers. While fewer quality interactions with health care providers were associated significantly with low trust in both populations, usual source of medical care was only associated with low trust among African Americans, whereas sex and the number of annual health care visits were associated with low trust among whites. Different factors may influence trust in health care providers among African Americans and whites.