Exposures Before Issuance of Stay-at-Home Orders Among Persons with Laboratory-Confirmed COVID-19 — Colorado, March 2020

Abstract

Colorado instituted stay-at-home orders to reduce community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). To inform public health messaging and measures that could be used after reopening, persons with laboratory-confirmed COVID-19 during March 9-26 from nine Colorado counties comprising approximately 80% of the state's population † (Adams, Arapahoe, Boulder, Denver, Douglas, El Paso, Jefferson, Larimer, and Weld) were asked about possible exposures to SARS-CoV-2 before implementation of stay-at-home orders. Among 1,738 persons meeting the inclusion criteria § in the Colorado Electronic Disease Surveillance System, 600 were randomly selected and interviewed using a standardized questionnaire by telephone. Data collection during April 10-30 included information about demographic characteristics, occupations, and selected activities in the 2 weeks preceding symptom onset. During the period examined, SARS-CoV-2 molecular testing was widely available in Colorado; community transmission was documented before implementation of the stay-at-home order. At least three attempts were made to contact all selected patients or their proxy (for deceased patients, minors, and persons unable to be interviewed [e.g., those with dementia]) on at least 2 separate days, at different times of day. Data were entered into a Research Electronic Data Capture (version 9.5.13; Vanderbilt University) database, and descriptive analyses used R statistical software (version 3.6.3; The R Foundation). Among the 600 randomly selected COVID-19 patients, 133 (22%) were unreachable, 57 (10%) declined to participate, and 46 (8%) were ineligible (e.g., the onset date was too early or the patient was asymptomatic), leaving 364 (61%) participants. The median age of participants was 50 years (interquartile range = 34-64 years), and 187 (51%) were male. Overall, 206 (57%) participants identified as non-Hispanic white and 75 (21%) as Hispanic. Among all participants, 345 (95%) reported having health insurance, 128 (35%) were hospitalized and 18 (5%) died. Occupations reported by the 264 (73%) * These authors contributed equally. † https://demography.dola.colorado.gov/population/population-totals-counties/. § Inclusion criteria consisted of laboratory-confirmed SARS-CoV-2 infection, presence of ≥1 symptom to establish illness onset date, and known hospitalization status.

Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September–November 2020

“…Among children and adolescents with COVID-19, 69% reported close contact with a person with COVID-19, similar to previous findings among children and adults (3)(4)(5). Most close contact exposures were to family members, consistent with household transmission of SARS-CoV-2 (6-8).…”

Selectively caring for the most severe COVID-19 patients delays ICU bed shortages more than increasing hospital capacity

“…The lack of lockdown effects is arguably SEAHIRD model’s most obviously violated assumption. WA lockdowns began on March 23rd 2020 [15], not long into the simulation, closely followed by CO on March 26th [23]. However, there is some pre-print work suggesting that US individuals were already relaxing physical distancing measures by mid-April, perhaps limiting the lockdown effect in our data [44].…”

“…Newspapers at the time reported a reasonable fear that there would not be enough hospital beds in the whole state to care for the coming wave of COVID-19 infected patients [4]. WA enacted stay-at-home orders in mid-March and many other states like CO soon followed, as uncontrolled community-level transmission was already occurring in other states [23]. In fact, early in the pandemic, CO had one of the highest death counts in the US, just behind California [30].…”

Estimation of Individual Probabilities of COVID-19 Infection, Hospitalization, and Death From A County-level Contact of Unknown infection Status

“…Among confirmed cases identified before ‘stay-at-home’ orders in nine Colorado counties participating in a retrospective survey, only 27% reported a contact with an infected individual. [26]…”