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Surveillance Summaries: Homicides of American Indians/Alaska Natives — National Violent Death Reporting System, United States, 2003–2018

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National Violent Death Reporting System homicide data on American Indian/Alaska Native (AI/AN) people have been analyzed and reported for the first time. The analysis offers much-needed insight into the characteristics of AI/AN homicide victims and suspects, and the need for tailored prevention strategies to reduce violence against AI/AN people. These data insights can also help dispel misconceptions about homicide in the AI/AN community. Investigators analyzed 2,226 AI/AN homicides reported in the National Violent Death Reporting System in 34 states and the District of Columbia from 2003-2018. Among victims, the rate of homicide was three times higher in AI/AN males than females (12 versus 4 per 100,000), and approximately half of victims lived (48%) or were killed (53%) in metropolitan areas. A firearm was used in nearly half (48%) of homicides. Data on suspects showed that most (80%) were male and 42% were age 18-34 years. Nearly one-third (32%) of suspects were AI/AN; most knew their victims  — over 60% of victims knew the suspect in their homicides; and for female victims, nearly 40% of suspects were current or former intimate partners. The issue of missing and murdered indigenous people has gained national attention in recent years. There are many efforts focused on addressing this issue. This report includes data that can inform prevention efforts. Efforts to stop violence within AI/AN communities can have a greater impact when they use and adapt approaches and values inherent in AI/AN communities.

Prevalence and Characteristics of Subjective Cognitive Decline Among Unpaid Caregivers Aged ≥45 Years — 22 States, 2015–2019

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Subjective cognitive decline (worsening memory loss or more frequent confusion) is more common among caregivers (12.6%) than non-caregivers (10.2%). Many caregiving tasks have cognitive aspects, such as medication management. It is important to support caregivers and recognize they also might have limitations. About 1 in 5 US adults are unpaid caregivers who care for family members or friends with a health condition or disability. Caregivers rely on their cognitive abilities for some caregiving tasks, such as managing medication and finances. Subjective cognitive decline (SCD) can affect the future health of caregivers as well as the quality of care they provide. More than 12% of caregivers reported that their memory had worsened in the past year compared to 10% of non-caregivers. Caregivers with SCD were more likely to have chronic health conditions, frequent mental distress, a history of depression, and frequent activity limitations than non-caregivers with SCD and were more likely to be employed. Supporting caregivers is essential for not only maintaining their health and well-being but also for the quality of care provided to a family member or friend.

Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

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Diabetes requires regular medical care to prevent complications. People with diabetes are also at higher risk for COVID-19 complications. Compared with older adults, younger adults with diabetes (aged 18-29 years) were more likely to report missing medical care and less likely to report plans to get a COVID-19 vaccine. Access to medical care for diabetes management and prevention of COVID-19 are both important for people with diabetes. Respondents were invited to participate in the COVID-19 Outbreak Public Evaluation Initiative Internet-based surveys during February–March 2021. Researchers analyzed respondents’ self-reported responses about having diagnosed diabetes and their answers to questions about demographics, experiences, attitudes, and behaviors related to the COVID-19 pandemic, including access to and use of medical care. Younger adults (aged 18–29) with diabetes were more likely to have delayed routine or urgent medical care (9 in 10) and to face difficulty accessing diabetes medications (2 in 5) than older adults with diabetes. Additionally, 1 in 4 younger adults with diabetes reported no intention of receiving the COVID-19 vaccine (26%) and were less likely to adhere to COVID-19 prevention guidelines and behaviors such as masking, hand washing, and avoiding gatherings. Given these findings, public health professionals intending to reach younger adults with diabetes may consider highlighting the importance of diabetes management and continued diabetes care during the pandemic as well as COVID-19 vaccination and prevention. Continuing diabetes care during the COVID-19 pandemic, getting vaccinated, and practicing COVID-19 prevention guidelines (e.g., mask wearing, hand washing, etc.) are needed to lower the risk of severe COVID-19 illness among people with diabetes of all ages. Likewise, daily diabetes management and regular checkups are essential for effective lifetime diabetes care. Learn more about living well with diabetes and preventing diabetes complications.

Automated Digital Notification of COVID-19 Diagnoses Through Text and Email Messaging — North Carolina, December 2020–January 2021

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North Carolina state and local health departments moved from sole use of telephone-call notification to telephone-call plus automated text and email notification (digital notification) for individuals with a positive COVID-19 test result in late December 2020. Implementation of digital notification enabled more timely notification of test results. After introduction of the new system, more than half of people were notified by North Carolina state and local health departments within 24 hours of case report, compared with about 1 in 6 notified within 24 hours by sole use of telephone-call notification. During October 3, 2020—January 9, 2021, North Carolina experienced a 400% increase in daily reported COVID-19 cases. Before December 24, 2020, North Carolina case investigation staff made telephone calls to notify patients of a positive result. Because of a surge in cases and a shortage of case investigation staff, notification of people with positive test results by telephone was delayed. To handle the increased number of cases and rapidly notify patients, North Carolina state and local health departments moved from sole use of telephone-call notification to telephone or digital notification beginning on December 24, 2020. Overall, 112,543 of 200,258 (56%) people with positive COVID-19 test results received notification by telephone call and/or digital messages within 24 hours of report to North Carolina state and local health departments during January 2021. This represented a higher proportion than the 25,905 of 175,979 (15%) people notified within 24 hours during the previous month. Automated digital notification is a feasible, rapid, and efficient method to provide timely outreach to people with COVID-19. This system can also provide guidance to people with positive COVID-19 test results on how to isolate, access resources, and inform close contacts.

Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations Because of COVID-19 Among Persons Aged ≥12 Years, by COVID-19 Vaccination Status — Oregon and Washington, July 4–September 25, 2021

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A new CDC analysis among members of a large health system ages 12 years and older found unvaccinated people were at least three times more likely to be infected by COVID-19 than were fully vaccinated people. Among those with COVID-19, unvaccinated patients were twice as likely to need emergency care and to be hospitalized and seven times more likely to die compared with fully vaccinated patients. Researchers looked at rates of COVID-19 infection, emergency department (ED) visits, and hospitalizations among more than 482,000 people ages 12 years and older within Kaiser Permanente Northwest, a large integrated health care delivery system in Oregon and Washington, during July 4–September 11, 2021. They found unvaccinated people were at least three times more likely to be infected with COVID-19 than vaccinated people. Among those with COVID-19, unvaccinated patients were twice as likely to receive ED care (19%) or to be hospitalized (9%) than vaccinated patients with COVID-19 (8% and 4%, respectively). Rates of infections, ED care, hospital admissions, and deaths were highest for unvaccinated people compared to vaccinated people across all age groups, races, and ethnicities, even during a period of Delta variant circulation. COVID-19 vaccines remain an effective method to protect against infection and severe COVID-19 illness.

Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021

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A modeling study looking at the impact that surges in COVID-19 cases had on hospital systems found that as strain increased — measured by percent of intensive care unit (ICU) beds occupied — the estimated number of excess deaths increased 2, 4, and 6 weeks later. The Cybersecurity and Infrastructure Security Agency (CISA) COVID Task Force used data from July 2020 through July 2021 to assess the impact of COVID-19 surges on hospital system operations and potential effects on other critical infrastructure sectors and national critical functions. They found that as ICU bed use increased, there were exponential increases in the estimated number of excess deaths from all causes (expected versus number observed) in the weeks that followed. This study suggests that ICU bed use is a key indicator for — but not the sole contributing factor to — strain within health care and public health infrastructures. Very high ICU occupancy indicates system strain, which can directly and indirectly result in excess deaths in the weeks following a surge in COVID-19 hospitalizations. This analysis indicates the importance of controlling case growth and subsequent hospitalizations prior to severe strain. State and local leaders could evaluate ways to reduce strains on these infrastructures by implementing interventions, such as vaccination and other prevention strategies, and finding ways to expand or enhance capacity during times of high disease prevalence.

• Acute Nonviral Hepatitis Linked to a Brand of Alkaline Bottled Water — Clark County, Nevada and California, 2020A public health investigation uncovered a potential link between reports of acute nonviral hepatitis and drinking “Re2al Water” brand alkaline water. This investigation illustrates the importance of reporting unusual illnesses to public health authorities. During November and December 2020, five children in Clark County, Nevada were hospitalized with severe hepatitis without a known cause. The Southern Nevada Health District (SNHD) was notified of the unusual cluster and began an investigation. The investigation revealed that all children had consumed “Re2al Water” brand alkaline water; no other common exposures were reported. On March 13, 2021, SNHD, the Nevada Department of Health and Human Services, CDC, and the Food and Drug Administration (FDA) launched a public health investigation to assess the extent of the outbreak, identify what was causing the illnesses, and lessen the risk to the public. There have been 21 probable cases and four suspect cases of acute nonviral hepatitis linked to the consumption of Re2al Water. Eighteen probable cases and four suspect cases were identified in Nevada and three probable cases were identified in California. Clinical findings are consistent with a possible toxic exposure. As is common in many toxicological outbreak investigations, the substance likely to have caused the illnesses has not been identified.

• Age-Adjusted Death Rates from Heart Disease Among Adults Aged 45–64 Years, by Urbanization Level and Sex — National Vital Statistics System, United States, 2019

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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.