Evidence suggests COVID-19 isn’t sexually transmitted

COVID-19 is unlikely to be spread through semen, according to University of Utah Health scientists who participated in an international study of Chinese men who recently had the disease. The researchers found no evidence of the virus that causes COVID-19 in the semen or testes of the men.

The study was not comprehensive enough to fully rule out the possibility that the disease could be sexually transmitted. However, the chances of it occurring, based on this limited finding, appear to be remote.

“The fact that in this small, preliminary study that it appears the virus that causes COVID-19 doesn’t show up in the testes or semen could be an important finding,” says James M. Hotaling, M.D., a co-author of the study and a U of U Health associate professor of urology specializing in male fertility. “If a disease like COVID-19 were sexually transmittable that would have major implications for disease prevention and could have serious consequences for a man’s long-term reproductive health.”

The study appears in Fertility & Sterility, a peer-reviewed journal published by the American Society of Reproductive Medicine.

The international team of researchers from China and the United States launched the study in response to concerns that SARS-CoV-2, the virus that causes COVID-19, could be sexually transmitted like Ebola, Zika and other emerging viral pathogens. To find out, they collected semen samples from 34 Chinese men one month (on average) after they were diagnosed with mild to moderate cases of COVID-19. Laboratory tests did not detect SARS-CoV-2 in any of the semen samples.

But just because the virus wasn’t present in the existing semen didn’t necessary rule out that it hadn’t entered the testes where sperm cells are formed.

“If the virus is in the testes but not the sperm it can’t be sexually transmitted,” says Jingtao Guo, Ph.D., a postdoctoral scientist at the Huntsman Cancer Institute at the University of Utah who also co-authored the study. “But if it is in the testes, it can cause long-term damage to semen and sperm production.”

To sort this part of the puzzle out, the researchers analyzed a dataset generated from a single cell mRNA atlas from healthy young organ donors that was available from prior work. This atlas allows them to examine mRNA, the genetic material used to make proteins, in any single testicular cell. In this case, scientist used it to examine the expression of a pair of genes associated with SARS-CoV-2. These two genes, angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) act as receptors, allowing SARS-CoV2 to penetrate cells and replicate. In order for the virus to access cells effectively, both receptors must be present in the same cell.

When the scientists examined the dataset, they found that genes encoding these two proteins were only found in four of the 6,500 testicular cells, suggesting that SARS-CoV-2 is unlikely to invade human testicular cells, Guo says

Despite these findings, the researchers acknowledge that their study has several important limitations including a small sample size and the fact that none of the donors had been severely ill with COVID-19.

“It could be that a man who is critically ill with COVID-19 might have a higher viral load, which could lead to a greater likelihood of infecting the semen. We just don’t have the answer to that right now,” Hotaling says. “But knowing that we didn’t find that kind of activity among the patients in this study who were recovering from mild to moderate forms of the disease is reassuring.”

However, Hotaling warns that intimate contact can still increase the risk of spreading the disease through coughing, sneezing and kissing. In addition, some infected people are asymptomatic and can appear healthy, even as they pass the virus along to others.

In addition to Drs. Hotaling and Guo, other U of U Health researchers involved in this study titled, “No Evidence of SARS-CoV-2 in Semen of Males Recovering from COVID-19,” were Darshan  Patel, MD, and Adam Spivak, MD. The research was supported by the National Natural Science Foundation of China and the Huazhong University of Science & Technology.

See original press release here.

University of Utah embarks on ambitious COVID-19 testing effort

The David Eccles School of Business at the University of Utah and University of Utah Health announce the start of Utah HERO (Health & Economic Recovery Outreach), a massive undertaking that will begin with the testing of 10,000 Utahns across four counties. The data gathered will inform decision-makers in the state as they work to help keep residents safe and get people back to work.

As part of Utah HERO, households in Utah, Davis, Salt Lake and Summit counties will be randomly selected for participation in the study. Random sampling is a way to accurately determine how much COVID-19 has spread in Utah without testing every person in the state.

Utah HERO team members will tag these households with a flyer or door hanger explaining the project. Field teams will then follow up with an in-person visit to gather information about those living in the residence and provide instruction on how to get tested. All those living in the residence who are 12 years and older will be asked to visit a testing site where they will receive two tests: PCR (swab test to detect the presence of coronavirus) and serology (blood draw to detect antibodies). Antibodies to the coronavirus indicate probable past infection.

“A survey of this magnitude would normally take months to organize, but we’ve been able to move things forward in a couple of weeks thanks to all of our collaborators,” said Stephen Alder, director of field operations for Utah HERO and professor in the Department of Family and Preventative Medicine. “The University of Utah is committed to serving the state during this difficult time and we hope this information will help our leaders make informed public health and business decisions.”

High levels of voluntary participation will enhance the accuracy of the study and will improve the ability to interpret results of COVID-19 testing. Testing is completely confidential and no information on immigration status will be collected.

U of U Health’s Wellness Bus and Huntsman Cancer Institute’s Cancer Screening bus—both of which have been redeployed to perform COVID-19 testing—will be set up in designated neighborhoods to serve as Utah HERO test sites. Testing will also take place at existing U of U Health evaluation tents, as well as pop-up locations at various church parking lots. Testing will be performed at ARUP Laboratories, which does all COVID-19 testing for U of U Health along with other clients in Utah and nationwide.

Utah HERO data will be used to more accurately establish the rate of infection in Utah and rates of infection in various age groups and job categories. The data are important because they will indicate where COVID-19 has spread, which occupations and other groups are most impacted and how many undetected infections are occurring. Undetected infections can occur because people have mild symptoms or no symptoms, or because of differences in testing. This can inform the safest way to relax public health restrictions and get Utah back to work.

“Utah HERO represents the critical balance between protecting public health and moving the economy forward,” said Taylor Randall, dean of the David Eccles School of Business. “This information will help us better understand how COVID-19 has spread through our community and inform business leaders on the best, data-driven ways to get people back into the workforce safely.”

The Governor’s Office of Management and Budget contracted with the U to design and implement Utah HERO. “This study is important because it is the first initiative to gain an understanding of statewide COVID-19 prevalence in Utah,” said Angela Dunn, state epidemiologist for the Utah Department of Health. “This random sampling allows us to see a representative picture of the extent to which COVID-19 has spread in our community. This will enable us to make informed decisions about how to best move forward,” she said.

Other Utah HERO collaborators include:

  • ARUP
  • Utah Department of Health
  • Salt Lake County Health Department
  • Summit County Health Department
  • Davis County Health Department
  • Utah County Health Department

Staffing for Utah HERO field teams is made possible by Hope Corps, a nonprofit organization that connects students to opportunities to serve in the state of Utah and help support the economy.

Here are a few additional details about Utah HERO:

  • The project will begin sampling small numbers of households then scale up over a period of weeks.
  • Survey participants do not pay for testing and do not need to show proof of insurance.
  • Survey participants do not need to show ID or proof of residency.
  • Those reporting symptoms will be instructed on safe practices to prevent the spread of COVID-19.
  • Those with positive test results will be notified and given instructions on how to quarantine and prevent the spread of the disease within households.
  • The Church of Jesus Christ of Latter-day Saints has generously provided parking lot space for additional testing sites.

For more information visit eccles.link/utahhero

ARUP/U of U Health find self-collected saliva, deep nasal swabs are equally effective for diagnosing COVID-19

Self-collected saliva and deep nasal swabs collected by healthcare providers are equally effective for detecting SARS-CoV-2, the virus that causes COVID-19, according to a new study conducted by ARUP Laboratories and University of Utah (U of U) Health.

The study, published in the Journal of Clinical Microbiology, represents one of the largest prospective specimen type comparisons to date, said Julio Delgado, ARUP chief medical officer. Other studies, including one from the Yale School of Public Health, have reached similar conclusions but with markedly fewer patients and specimens.

Researchers also found that specimens self-collected from the front of the nose are less effective than deep nasal swabs for virus detection. This finding prompted a subsequent study that has not yet been published in which researchers learned they could improve the sensitivity of anterior nasal swab testing to 98% by combining an anterior nasal swab with a swab collected from the back of the throat.

The results have important implications for patients and providers. The collection process for saliva and anterior nasal specimens is less invasive than the deep nasal, or nasopharyngeal, swab. In addition, both specimen types can be self-collected, reducing the risk of exposure for healthcare workers who collect nasopharyngeal specimens, said Kimberly Hanson, section chief of clinical microbiology at ARUP and the primary author of the study.

“Saliva and nasal swab self-collection can resolve many of the resource and safety issues involved in SARS-CoV-2 diagnostic testing,” Delgado said.

ARUP and U of U Health anticipate being able to start offering testing on saliva in some U of U Health clinical settings in early September. They already are using anterior nasal swabs in combination with throat swabs to test some asymptomatic individuals.

COVID-19 testing on these alternatives to nasopharyngeal swabs will increase with time, Delgado said. “From the start of the COVID-19 pandemic, ARUP has worked to build capacity for high-quality COVID-19 testing,” he said. “Our goal is to make this testing available to hospitals and healthcare systems nationwide.”

Hanson and her colleagues analyzed more than 1,100 specimens from 368 volunteers at the U of U Health Redwood Health Center drive-through testing site from late May through June. Volunteers self-collected saliva that they spit into a tube and swabbed from the front of both nostrils to produce specimens for testing. The researchers compared test results from these specimen types with test results from nasopharyngeal swabs healthcare providers collected from the volunteers. Discrepant results across specimens collected from the same patient triggered repeat testing using a second polymerase chain reaction (PCR)-based platform.

The study showed that SARS-CoV-2 was detected in at least two specimen types in 90% of the patients who tested positive for the virus.

As a standalone alternative specimen to nasopharyngeal swabs, saliva proved to be an excellent option, Hanson said. Positivity rates for saliva specimens were nearly the same as those for nasopharyngeal specimens.

The research showed that self-collected nasal swabs, when used alone, can miss nearly 15% of infections, which prompted researchers’ further study combining them with oropharyngeal, or throat swabs.

The research is an example of how ARUP and U of U Health continue to explore new methods to serve patients and the community as well as keep healthcare workers safe, said Richard Orlandi, chief medical officer for ambulatory health at U of U Health. “We appreciate the researchers at ARUP, as well as the staff and patients at our Redwood testing center who have participated in this discovery,” he said. “This exciting advance reflects ARUP’s and U of U Health’s innovative spirit and the benefits of our partnership.”

About ARUP Laboratories

Founded in 1984, ARUP Laboratories is a leading national reference laboratory and a nonprofit enterprise of the University of Utah and its Department of Pathology. ARUP offers more than 3,000 tests and test combinations, ranging from routine screening tests to esoteric molecular and genetic assays. ARUP serves clients across the United States, including many of the nation’s top university teaching hospitals and children’s hospitals, as well as multihospital groups, major commercial laboratories, group purchasing organizations, military and other government facilities, and major clinics. In addition, ARUP is a worldwide leader in innovative laboratory research and development, led by the efforts of the ARUP Institute for Clinical and Experimental Pathology®. ARUP is ISO 15189 CAP accredited.

See original post here.

Amniotic fluid could reduce symptoms, long-term risks of COVID-19

Amniotic fluid, the clear liquid that helps nourish and protect fetuses before birth, isn’t just for babies. In fact, for nearly 100 years, doctors have used the mixture to help heal skin wounds, burns, and leg ulcers as well as provide protection for surgical adhesions.

Now, in a first-of-its-kind effort, University of Utah Health researchers are investigating whether human amniotic fluid (HAF) can reduce lung inflammation caused by COVID-19 and promote the recovery of patients who have contracted the disease.

“If successful, our research could shorten or mitigate the intensity of COVID-19 and have a lot of downstream effects including reducing the need for critical care, improving patient outcomes, and getting them home faster,” says Craig Selzman, MD, the study’s senior investigator and chief of U of U Health’s Division of Cardiothoracic Surgery.

Selzman and his colleagues first became interested in amniotic fluid as a possible treatment for COVID-19 after reading about a small study conducted in China. The study found that four pregnant women who were ill with the virus gave birth to healthy babies who didn’t have any covid-19 symptoms.

Intrigued, Selzman’s team, working in conjunction with the School of Medicine’s Cell Therapy and Regenerative Medicine program, treated 10 COVID-19 patients with HAF. Preliminary results in this small group suggest there was a 40% reduction of inflammation in some patients’ lungs. This reduction was measured by changes in C-reactive protein (CRP), a substance produced in the liver that is considered a biomarker of body’s inflammatory response.

“Theoretically, amniotic fluid is probably halting the progression of the disease by impeding its ability to cause inflammatory responses in the heart, lungs and other organs,” Selzman says.

But why HAF, which is composed of a mixture of electrolytes (salts), proteins, carbohydrates, lipids and urea, triggered this effect still isn’t clear and will required additional study.

In the meantime, Selzman and his colleagues are getting ready to conduct a phase 2 clinical trial involving 60 COVID-19 patients with varying severity of the illness. Half will receive HAF treatment; the other 30 will get standard care.

In addition to monitoring the patients for acute symptoms, the researchers hope HAF treatment will diminish the risk that these patients will develop pulmonary fibrosis (scarring and stiffening of the lungs) and other chronic respiratory conditions.

“If we can halt this inflammatory process early on, we could actually prevent the onset of advance lung disease in the months and years ahead,” Selzman says. “So, it’s not just trying to get people better right now. It’s also trying to stave off what could be long-term consequences of this viral infection.”

This research is supported, in part, by the University of Utah’s Immunology, Inflammation & Infectious Disease Initiative (3i) See original press release here. 

Vaping injuries more difficult to diagnose during time of COVID-19 pandemic

Diagnosing respiratory illness associated with vaping has always been challenging. But add the current COVID-19 pandemic to the mix and it becomes extremely difficult since both illnesses share many symptoms.

There are no tests for e-cigarette, or vaping, product use-associated lung injury, known by the acronym, EVALI, which has sickened 2,800 people and killed 68 Americans as of February. Physicians can only diagnose EVALI by first ruling out other conditions that it’s not, a task that is further complicated by patients not always disclosing that they vape.

While cases of EVALI have dropped since their peak in September 2019, they are now once again climbing, and the COVID-19 pandemic has made diagnosing the condition even more difficult since both illnesses share symptoms.

“EVALI is still happening, and on the rise again as people use vaping to cope with pandemic stress,” said Denitza Blagev, a pulmonary medicine physician at Intermountain Healthcare. “It’s important for clinicians to keep EVALI in mind as they are considering COVID. EVALI has a different prognosis and therapies that we can use to treat these patients, as long as we can diagnose them.”

This comes on the heels of a new study by researchers at Stanford University this week that found vaping is linked to a substantially increased risk of COVID-19 among teenagers and young adults, according to a new study led by researchers at the Stanford University School of Medicine.

The study, which published online Aug. 11 in the Journal of Adolescent Health, is the first to examine connections between youth vaping and COVID-19 using U.S. population-based data collected during the pandemic.

The study found that among young people who were tested for the virus that causes COVID-19, those who vaped were five to seven times more likely to be infected than those who did not use e-cigarettes.

“Patients who contract EVALI or COVID and suffer the same levels of respiratory failure tend to have divergent outcomes,” said Sean J. Callahan, assistant professor of pulmonary and critical care medicine at University of Utah Health. “Patients with EVALI require a high level of oxygen, but still tend to do well, whereas someone with COVID needing the same level of oxygen support may not do as well. Getting the diagnosis right is vital.”

In a new study published in the journal CHEST, researchers from Intermountain Healthcare and University of Utah Health looked at all patients diagnosed with EVALI at their institutions since March 2020, when COVID tests were readily available in Utah. They found a total of 12 people, who were diagnosed with EVALI who had a negative flu test and at least one negative COVID-19 test between March 1 and May 15.

They found that both illnesses showed similar symptoms: respiratory failure, gastrointestinal distress and/or ground glass opacities in the lungs.

Making accurate EVALI diagnoses even more difficult are patients who didn’t admit that they vaped, even after being asked repeatedly. In some cases, clinicians didn’t know someone’s true vaping history until well into the hospital course.

“This is a situation in which you’ve got to ask the patient repeatedly and hope they eventually volunteer the truth,” said Dr. Callahan. “It’s crucial for diagnosis.”

Researchers did, however, find two important differences that can help differentiate between EVALI and COVID-19.

First, COVID-19 often leads to normal or low white blood cell counts, while 11 of the 12 EVALI patients showed an increased white blood cell count. Second, patients with severe EVALI tended to be young, with a mean age of 30.8 years old. While COVID-19 can severely affect younger adults, it’s relatively uncommon.

While treatments for COVID-19 are being evaluated, EVALI patients typically respond well to established treatments, such as to corticosteroids. Drs. Blagev and Callahan said this is why physicians should consider EVALI when evaluating patients who test negative for COVID-19.

“The risk of missing other diseases that can present with similar and non-specific symptoms, such as a cough or shortness of breath, remains during this time,” said Dr. Blagev.

She said while it’s more challenging to diagnose in the time of COVID, EVALI remains an important diagnosis to consider in patients, particularly after an initial negative COVID test.

“First, and foremost, it’s important to keep EVALI in mind because that diagnosis has different treatment and prognosis than COVID. Equally important during a pandemic is ruling out COVID before making the diagnosis of EVALI,” she added.

See original post here.

SCALE-UP Utah awarded $5 million to improve COVID-19 testing among underserved and vulnerable populations

Across the US, COVID-19 is hitting some communities harder than others, and Utah is no exception. In our state, Latinos make up 14 percent of the population but represent 40 percent of cases. Similarly, there are disproportionately high case and death rates among Pacific Islanders, African-Americans, Native Americans, and Utahns living in low-income neighborhoods.

With a goal of reducing health disparities in Utah, the National Institutes of Health (NIH) has awarded $5 million to Rachel Hess, and Guilherme Del Fiol of University of Utah Health, and David Wetter of Huntsman Cancer Institute and U of U Health. The team leads SCALE-UP Utah, an initiative that aims to increase the acceptance, reach, uptake, and long-term sustainability of COVID-19 screening and testing. The initiative will be carried out in partnership with 12 community health center systems across the state that run 39 primary care clinics serving more than 115,000 patients—most of whom live in rural and underserved communities.

“SCALE-UP Utah brings together partners from across Utah to ensure that there is adequate screening and testing for all population groups with a specific emphasis on those experiencing higher rates of COVID-19 infection,” Wetter says. “No one should be left behind in being protected from COVID-19.”

U of U Health is one of 32 institutions that received an NIH award through the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative. The program supports both projects designed to rapidly implement COVID-19 testing strategies in populations disproportionately affected by the pandemic and research that aims to better understand COVID-19 testing patterns among these populations.

“It is critical that all Americans have access to rapid, accurate diagnostics for COVID-19, especially underserved and vulnerable populations who are bearing the brunt of this disease,” says Francis S. Collins, director of NIH. “The RADx-UP program will help us better understand and alleviate the barriers to testing for those most vulnerable and reduce the burden of this disease.”

SCALE-UP Utah takes advantage of pre-existing, evidence-based interventions developed by the team at the Center for Health Outcomes and Population Equity (HOPE), led by Wetter at Huntsman Cancer Institute and the Center for Clinical and Translational Science at U of U Health. These include:

  • Initiating text messaging dialogues about testing and testing logistics between health care providers and patients who are at high risk for infection or severe disease.
  • Designing information technology tools that prompt health care providers to ask, advise, and connect patients to COVID-19 screening and testing.
  • Engaging patient navigators to motivate patients and address logistics and barriers that could otherwise prevent them from being tested for COVID-19.

The program is designed to roll out quickly and adapt as needed in order to reduce COVID-19-related health inequities. Wetter says an important goal of SCALE-UP Utah is to serve as a model for other health care systems that serve vulnerable and underserved populations.

Long-standing partnerships between the Center for Clinical and Translational Science, Huntsman Cancer Institute, Association for Utah Community Health, statewide community health centers, and the Utah Department of Health provide additional infrastructure and resources that will improve the reach of COVID-19 screening and testing.

In the future, the program can be readily adjusted and redeployed to meet additional health needs that arise during the pandemic. “SCALE-UP Utah will build an infrastructure that can be used for equitable dissemination of a COVID-19 vaccine once it becomes available,” Wetter says.

See original post here.

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About Huntsman Cancer Institute at the University of Utah

Huntsman Cancer Institute (HCI) at the University of Utah is the official cancer center of Utah. The cancer campus includes a state-of-the-art cancer specialty hospital as well as two buildings dedicated to cancer research. HCI treats patients with all forms of cancer and is recognized among the best cancer hospitals in the country by U.S. News and World Report. As the only National Cancer Institute (NCI)-Designated Comprehensive Cancer Center in the Mountain West, HCI serves the largest geographic region in the country, drawing patients from Utah, Nevada, Idaho, Wyoming, and Montana. More genes for inherited cancers have been discovered at HCI than at any other cancer center in the world, including genes responsible for hereditary breast, ovarian, colon, head, and neck cancers, along with melanoma. HCI manages the Utah Population Database, the largest genetic database in the world, with information on more than 11 million people linked to genealogies, health records, and vital statistics. HCI was founded by Jon M. and Karen Huntsman.

About University of Utah Health

University of Utah Health is the state’s only academic health care system, providing leading-edge and compassionate care for a referral area that encompasses 10 percent of the US, including Idaho, Wyoming, Montana, and much of Nevada. A hub for health sciences research and education in the region, U of U Health touts a $408 million research enterprise and trains the majority of Utah’s physicians, including more than 1,460 health care providers each year at its Colleges of Health, Nursing, and Pharmacy and Schools of Dentistry and Medicine. With more than 20,000 employees, the system includes 12 community clinics and five hospitals: University Hospital, Huntsman Mental Health Institute, Huntsman Cancer Hospital, University Orthopaedic Center, and the Craig H. Neilsen Rehabilitation Hospital. For 11 straight years, U of U Health has ranked among the top 10 US academic medical centers in the rigorous Vizient Quality and Accountability Study.

Severity of COVID-19 determines likelihood of pregnancy complications

Pregnant women who contract SARS-CoV-2, the strain of the virus that causes COVID-19, are at greater risk of dying and experiencing serious complications compared to nonpregnant women who contract the disease, according to a recent report by the Centers for Disease Control and Prevention (CDC).

Now, in a new study, researchers unveil findings that suggest that pregnant women who become severely or critically ill due to COVID-19 are at greater risk of dying and experiencing serious pregnancy complications compared to pregnant women who have COVID-19 but were asymptomatic, or without symptoms. In contrast, pregnant women with mild or moderate illness were not at higher risk of pregnancy complications than those without symptoms. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The study examined medical records of 1,219 pregnant women from 33 hospitals in 14 states from March 1, 2020 to July 31, 2020. All patients tested positive for COVID-19; 47 percent were asymptomatic, 27 percent were mild, 14 percent were moderate, 8 percent were severe, and 4 percent were critical.

Findings showed that pregnant women who become severely or critically ill due to COVID-19 were older, had a higher body mass index, and were more likely to have underlying medical conditions, such as asthma/chronic obstructive pulmonary disease (COPD), diabetes, and high blood pressure. These women were more likely to die or have serious complications, such as cesarean delivery; heavy bleeding after giving birth, known as postpartum hemorrhage; high blood pressure during pregnancy; and preterm birth. High blood pressure and preterm birth also have the potential to cause long-term health problems in women or their infants.

A total of four women (0.3%) died due to COVID-19, a figure that is higher than the death rate for pregnant women without COVID-19. The death rate for pregnant women without COVID-19 is 17.4 deaths per 100,000 live births, according to the latest data from the CDC.

“Our research shows that serious pregnancy complications appear to occur in women who have severe or critical cases of COVID and not those who have mild or moderate cases,” said the study’s lead author, Torri D. Metz, a maternal-fetal medicine subspecialist and associate professor at the University of Utah Health.

“This information helps us to counsel our patients more effectively. For pregnant women who have contracted a mild or moderate case of COVID-19, these findings can help to alleviate their fears that they are at an increased risk of having serious pregnancy complications due to the disease.”

Find original post here.

Learn more about the study.

Learn more about the Society for Fetal Medicine here.

Most COVID-19 maps fail to improve public understanding of pandemic

Since COVID-19 first arose as a worldwide health threat, millions of websites with maps charting the spread and prevalence of the virus have appeared on the internet. However, most of these maps do not improve public understanding of the potential risk of contracting COVID-19 or promote compliance with health guidelines meant to slow its spread, according to a new study led by University of Utah Health scientists in collaboration with other institutions.

In fact, the researchers found that study participants who didn’t see a map were more knowledgeable about the total number of COVID-19 cases in the United States than those who viewed one. They also found that maps did not influence a person’s perception of their own risk of contracting the disease.

A map of the U.S. with red circles that represent COVID-19 outbreaks.

Most COVID-19 maps, such as this bubble map, fail to improve public understanding of the pandemic and its risks.

“We know that people’s behavior and intentions are influenced by how well informed they are and how they perceive risk,” says Alistair Thorpe, lead author of the study and a U of U Health postdoctoral research fellow. “Prevalence maps are designed to help with that and so many have appeared during the COVID-19 pandemic. However, we found that simply presenting COVID-19 information in a map doesn’t necessarily have the intended influence on knowledge, perception, or behavior.”

The study appears in JAMA Network Open.

In a May 2020 online survey, the researchers asked 2,676 people, aged 18 to 91, to view one of six randomly selected maps of COVID-19 prevalence in the United States. Then, they were questioned about their knowledge of confirmed COVID-19 cases, their perceived risk of getting the disease, and whether they intended to adhere to COVID-19 prevention guidelines. A control group was not shown any of the maps and was simply asked to answer the questions based on their own knowledge without visual aids.

“The goal of this study was to try to find the best method for having people understand how common COVID-19 is nationwide as well as where they live,” says Angela Fagerlin, senior author of the paper, a U of U Health professor of population health sciences, and a research scientist at the Veterans Affairs Salt Lake City Health Care System. “We were hoping that understanding the prevalence of this disease would inspire them to take action to prevent the spread of COVID-19.”

A map of the U.S. where states are colored on a gradient from light beige to red to represent COVID-19 outbreak densities.

Heat maps, such as this one, that display COVID-19 cases per capita by state appear to be more effective than others.

Overall, those who saw maps were no more knowledgeable about the COVID-19 pandemic than those who didn’t see them. Participants who saw a map had lower perceptions of the risk to society; they were also more optimistic that the pandemic would be better in two weeks compared to those who didn’t see a map. None of the maps appeared to influence how participants perceived their personal susceptibility to the virus or whether they intended to follow public health guidelines.

However, heat maps that depicted per capita cases by state in varying hues and intensities depending on localized prevalence appeared to be more effective than others.

“The features of these maps appear to be the most effective for improving or at least maintaining public knowledge of COVID-19 cases,” Thorpe says.

Among the study’s limitations are its reliance on self-reported information and potential barriers to participation, including lower English proficiency and limited or no internet access.

Moving forward, the researchers believe this finding could have significant long-term implications.

“There’s a lot of data coming out during this outbreak about how to effectively communicate health information that will help us in the next pandemic,” Fagerlin says. “I hope we can learn from this experience so we don’t have to recreate the wheel every time we experience a pandemic.”

Find original post here.

Utah HERO project announces phase one findings

The Utah Health and Economic Recovery (HERO) Project— a collaboration between the David Eccles School of Business at the University of Utah, University of Utah Health, Study Design and Biostatistics Core of the Center for Clinical and Translational Science, the Governor’s Office of Management and Budget, Utah Department of Health and the Hope Corps—has concluded phase one of a large-scale undertaking to test 10,000 Utahns from across four counties. In phase one, field workers collected data from 8,500 Utahns aged 12 and older from Davis, Salt Lake, Summit and Utah counties. The data gathered will inform decision-makers in the state as they work to help keep residents safe and get people back to work.

Phase One of the two-phase project aims to measure the proportion of people who have antibody to SARS-CoV-2, the virus that causes COVID-19 infection, in order to understand prevalence within the population (that is the total number of infections that have occurred over time) and other factors associated with the virus . Phase Two will extend the same work to Utah’s other counties, assess communities that may have high viral activity, focus on students/children to help guide best practices for returning to school, and monitor changes in antibody prevalence over time.

Phase One Main Findings:

Results were analyzed for blood samples and nasopharyngeal tests collected between May 4th and June 10th, 2020. This project used the best available tests to yield accurate estimates. A random sampling scheme called cluster sampling was used to get a representative sample. The estimated seroprevalence accounts for sampling design, non-response, and test error.

  • It is estimated that the overall 4-county seroprevalence (or the proportion of members of the population with detectable antibodies to SARS-CoV-2) is 0.96% (95% confidence interval: 0.42% – 1.81%). This means that about 1 in 100 residents of these counties showed evidence of prior infection.
  • For every case that was detected by some other means, there were approximately another 2.4 cases that were not detected.This is lower than case count ratios reported in community seroprevalence studies conducted in other states and suggests that testing was comparatively comprehensive during the early months of the pandemic In Utah.
  • Roughly 30% of participants who were seropositive (i.e., had COVID-19 antibodies) reported having a prior positive COVID test, which is consistent with the detected fraction estimated at the population level, as reported above. To re-emphasize, more people have had COVID-19 infection than what clinical diagnosis, contact tracing, and screening indicate.
  • We estimate the infection fatality rate (or ratio) in Utah to be approximately 0.29% (with an approximate 95% confidence interval of 0.16% to 0.67%). The case fatality rate, the proportion of fatalities among diagnosed cases, is approximately 0% in Utah. Note: the term “case fatality rate (ratio)” refers to COVID-19 related deaths among reported cases of COVID-19 infection while the term “infection fatality rate (ratio)” includes both detected and undetected COVID-19 infections. Hence, the case fatality rate can be expected to be larger than the infection fatality rate, proportional to the seroprevalence to case count ratio.
  • When one member of a household had antibody to SARS-CoV-2, the proportion of other members of the household that were seropositive was 12.4%. This figure is a rough estimate of the secondary attack rate of COVID-19 infection within households.
  • Overall, 0.2% of nasopharyngeal swabs were positive by viral PCR testing.

Implications: Phase One has two implications. First, the low seroprevalence and the relatively high detection fraction indicate that Utah’s early efforts to monitor and limit SARS-CoV-2 infections were successful. Second, the low seroprevalence indicates our population is highly susceptible to COVID-19. As efforts to restore economic and social activities are underway, it is imperative that recommended preventive measures are followed to retain the benefits achieved through substantial statewide efforts over the past few months. NOTE: the data in this report largely reflect infections that occurred up until the beginning of June, before current increases in detected cases.

Overview of project design: Utah HERO provides the first randomized, representative estimate of seroprevalence in Utah using two different systematic sampling designs. The project’s primary sampling design targeted 10,694 randomly selected households and used an intensive sampling process including both in-person visits and mailings to maximize the response rate across these households. Because of the need to conduct in-person visits and obtain laboratory testing, the primary design used a clustered sampling approach in which the targeted households were sampled from 23 of 229 compact geographic areas (defined by two or more adjacent Census tracts) which were themselves randomly selected across the four-county area. An additional 10,040 households across the same four counties were recruited by mailings, but did not receive in-person visits.

This “letter only” sampling design was able to broadly sample across all geographic areas within the four counties, but the less intensive sampling led to a higher rate of non-response. Both the primary and secondary designs utilized stratified random sampling based on 15 strata defined by combinations of  the COVID-19 cumulative case count at the start of the study, median age, and the proportion of individuals self-identifying as Hispanic to the Census. The stratified sampling plan assured adequate representation in the project across the different ethnicity, age, and COVID-19 case-count groups. By taking into account the relative proportions of individuals within each stratum, our data analyses are able to make inferences to the full population across these strata, as well as to important subgroups of individuals.

See original press release here.

Watching wastewater

The U is monitoring samples of municipal wastewater for signs of COVID-19 in a joint project started by the School of Medicine and the College of Engineering. Jennifer Weidhass, assistant professor in Civil and Environmental Engineering, and Jim Vanderslice, associate professor in Family & Preventive Medicine, lead the study to track the presence of the virus in sewage so that local health officials can recommend behavior changes—masking and social distancing—to slow the spread of COVID-19. After an initial pilot program, the state is funding a large-scale study of more than 40 facilities in Utah, covering about 80 percent of the population, in partnership with BYU, Utah State University, Utah Department of Environmental Quality, and the Utah Department of Health.

Find current data online.