MMWR News Synopsis

Articles

Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults — United States, 2017

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In 2017, only about two-thirds (67.5%) of U.S. adults had recommended stroke knowledge, which was defined as recognizing five signs and symptoms of stroke and the immediate need to call 9-1-1. Promoting awareness of the signs and symptoms of stroke (including sudden numbness or weakness of the face, arm, or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance; and a sudden severe headache with no known cause), continues to be a national priority. Stroke is the fifth-leading cause of death in the United States and is a key contributor to long-term disability. There were significant differences in awareness of stroke signs and symptoms across population subgroups, including by race, Hispanic origin, and education status. Increasing awareness of signs and symptoms of stroke and the need to call 9-1-1 is vital for early initiation of stroke care, which can improve stroke outcomes. Promoting awareness of the signs and symptoms of stroke continues to be a national priority and estimates from this report might be used to inform communication strategies.

Computerized Capability of Office-Based Physicians to Identify Patients Who Need Preventive or Follow-up Care — United States, 2017

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In 2017, nearly two-thirds of U.S. office-based physicians had computerized capability to identify patients due for preventive/follow-up care. However, a lower proportion of surgeons and non-primary care physicians had this capability compared with primary care physicians. Having an electronic health records (EHR) system is associated with the ability to send electronic reminders to increase attendance for receipt of preventive/follow-up care, which has been shown to improve patient health outcomes. Data from the 2017 National Electronic Health Records Survey (NEHRS) show that over 70% of physicians with an EHR system had computerized capability to identify patients due for preventive/follow-up care. Primary care physicians were most likely to have this capability (72.9%), compared with surgeons (54.8%) and non-primary care physicians (58.5%), and physicians without an EHR system (23.4%). These results provide insight into characteristics associated with physicians’ capability for computerized identification of patients due for preventive/follow-up care which may inform efforts to increase patient follow up, decrease missed appointments, and ultimately improve health outcomes.

Network Characteristics and Visualization of COVID-19 Outbreak in a Large Detention Facility in the United States — Cook County, Illinois, 2020

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A CDC study conducted in the Cook County Jail (CCJ) in Chicago, Illinois, found that correctional and detention facilities can significantly reduce the spread of COVID-19 among detained people and staff by implementing appropriate and timely interventions. Correctional and detention facilities have been disproportionately affected by COVID-19 because of shared space and movement of staff and detained people within facilities. From March 1 to April 30, more than 900 detained people and staff at CCJ had been infected with the virus that causes COVID-19: a large outbreak of COVID-19 in a congregate setting. The jail implemented interventions to reduce transmission and limit introduction of the virus, which were expanded after the first case was detected. However, by limiting movement of detained persons, stopping visitation, suspending programmatic activities, establishing physical distancing through converting cells to single occupancy, and requiring universal masking for staff members and detained persons, the jail was able to significantly reduce the spread of COVID-19 even as cases in the surrounding community surged. This is the first known report using network science and visualization techniques to describe a COVID-19 outbreak in a U.S. correctional or detention facility. This study demonstrates that medical isolation of detained people and limiting movement between divisions are effective in lowering transmission of COVID-19. Higher-than-expected connections were identified in staff member networks, suggesting occurrence of additional transmission and areas of focus for transmission interruption. This approach can identify likely points of high-transmission and allow for targeted intervention strategies, such as strategic grouping of people with COVID-19.

Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020 (Early release October 30, 2020)

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Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020 (Early release November 2, 2020)

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Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020 (Early release November 2, 2020)

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Telework Before Illness Onset Among Symptomatic Adults Aged ≥18 Years With and Without COVID-19 in 11 Outpatient Health Care Facilities — United States, July 2020

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Findings from an investigation comparing employed adults with and without COVID-19 showed that a lower percentage of adults with COVID-19 reported teleworking before getting sick. These findings show that continuing to provide the option to use alternate work sites, such as teleworking, might be an important way to slow the spread of COVID-19. Since March 2020, large-scale measures to reduce the workplace spread of COVID-19 have been implemented, including workplace closures and providing telework options. Investigators assessed differences in teleworking compared to going to an office/school regularly among adults with COVID-19 symptoms from 11 outpatient health care clinics during July 2020. Among 248 employed participants who reported on their telework status during the two weeks before getting sick, the percentage who were able to telework on a full- or part-time basis was lower among patients who tested positive (35%) than among patients who tested negative (53%). Adults with COVID-19 were more likely than those without COVID-19 to report going exclusively to an office or school setting in the two weeks before getting sick compared to those who teleworked at least part of the time. Participants who reported teleworking were more likely to be non-Hispanic white, have a college degree or higher, have health insurance, and report an income of $75,000 or more. Businesses and employers should continue to promote alternative work site options, where possible, to reduce workplace COVID-19 exposures. Within the critical infrastructure and other workplaces where telework options are not possible, worker safety measures should continue to be scaled up by creating COVID-19 preparedness response plans, implementing prevention and control measures (such as social distancing, mask-wearing, providing personal protective equipment, daily health checks, hand hygiene, sanitation and disinfection), and enhancing industry-specific policies to protect employees and the community.

A SARS-CoV-2 Outbreak Illustrating the Challenges in Limiting the Spread of the Virus — Hopi Tribe, May–June 2020

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Frequent and regular social interactions among extended families, a characteristic of the Hopi Tribe, may have provided multiple opportunities for COVID-19 to spread. In communities with similar interactions among extended families, it is important to emphasize ways to reduce the risk for infection, including wearing masks, washing hands often, and staying six feet apart from non-household members. The Hopi are a Native American tribe and a sovereign nation, primarily residing on a reservation in northeastern Arizona. On June 3, 2020, a 73-year old woman with COVID-19 symptoms was evaluated at the emergency department of Hopi Health Care Center and tested positive for the virus that causes COVID-19. The patient’s symptoms began on May 27, and a sibling of the patient developed symptoms the following day. Because of their similar exposures, dates that they began showing symptoms, and overlapping close contacts, these patients were both considered the first cases identified, or index patients. Two gatherings of extended family members and workplace exposure likely led to spread of COVID-19 to 27 other people. A unique characteristic of Hopi lifestyle highlighted by this investigation was the frequent social interaction among extended family members, leading to repeated exposure of contacts to the index patients. Both index patients showed symptoms for a week or more before being tested, during which time they interacted with others in the community. About 4 out of 10 patients with COVID-19 did not show symptoms at all (asymptomatic) or did not show symptoms at the time of testing (presymptomatic). The majority of asymptomatic and presymptomatic patients were children and young adults.

• Development of an Enhanced Community-Focused COVID-19 Surveillance Program — Hopi Tribe, June‒July 2020

The Hopi Tribe collaborated with the Hopi Health Care Center (HHCC) and CDC to develop a community-focused program to enhance COVID-19 surveillance and deliver health communications to the communities. In this rural, low-resource setting, house-to-house COVID-19 surveillance and education was feasible. Each Hopi village has since been visited at least once, and resources will be sought to expand the frequency with which this program is delivered. The Hopi Tribe, a sovereign nation in northeastern Arizona, includes approximately 7,500 people within 12 rural villages. During April to June 2020, HHCC reported 136 COVID-19 cases among Hopi residents with 27 requiring hospitalization. Contact tracing found that residents delayed care and testing, inconsistently practiced mask-wearing and social distancing, and had limited knowledge of testing, isolation, and quarantine procedures. Due to these findings, the Hopi Tribe collaborated with HHCC to expand their community health program to implement enhanced COVID-19 surveillance and deliver systematic health communications to the communities. Five two-person teams, each composed of one community health representative and one volunteer (from the village, Hopi Tribal government, or CDC field team) canvassed each village within five hours. In the two villages, teams approached 101 households. Seventy-eight of these households provided basic information on 259 people, and 141 people received screening. In this rural, low-resource setting, house-to-house COVID-19 surveillance and education was feasible, as evidenced by the use of 10 staff to screen about 140 people in fewer than 10 hours. Given positive feedback from the communities, community health representatives, HHCC, and the Hopi Tribe, all Hopi villages have now been visited at least once, and resources will be sought to expand the frequency with which this program is delivered.

• Age-Adjusted Death Rates for Alzheimer’s Disease Among Adults Aged ≥65 Years, by Sex and Race/Hispanic Origin — National Vital Statistics System, 2018

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.