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Healthcare, first response (e.g., firefighters, paramedics, emergency medical technicians), and public safety (e.g., law enforcement officers) personnel have served on the front lines of the coronavirus disease (COVID-19) pandemic response [...]

Background Reports suggest that some persons previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack detectable immunoglobulin G (IgG) antibodies. We aimed to determine the proportion IgG seronegative and predictors for seronegativity among persons previously infected with SARS-CoV-2. Methods We analyzed serologic data collected from healthcare workers and first responders in New York City and the Detroit metropolitan area with a history of a positive SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) test result and who were tested for IgG antibodies to SARS-CoV-2 spike protein at least 2 weeks after symptom onset. Results Of 2547 persons with previously confirmed SARS-CoV-2 infection, 160 (6.3%) were seronegative. Of 2112 previously symptomatic persons, the proportion seronegative slightly increased from 14 to 90 days post symptom onset (P  = .06). The proportion seronegative ranged from 0% among 79 persons previously hospitalized to 11.0% among 308 persons with asymptomatic infections. In a multivariable model, persons who took immunosuppressive medications were more likely to be seronegative (31.9%; 95% confidence interval [CI], 10.7%–64.7%), while participants of non-Hispanic Black race/ethnicity (vs non-Hispanic White; 2.7%; 95% CI, 1.5%–4.8%), with severe obesity (vs under/normal weight; 3.9%; 95% CI, 1.7%–8.6%), or with more symptoms were less likely to be seronegative. Conclusions In our population with previous RT-PCR–confirmed infection, approximately 1 in 16 persons lacked IgG antibodies. Absence of antibodies varied independently by illness severity, race/ethnicity, obesity, and immunosuppressive drug therapy. The proportion seronegative remained relatively stable among persons tested up to 90 days post symptom onset. [ABSTRACT FROM AUTHOR]

A severe acute respiratory syndrome coronavirus 2 serosurvey among first responder/healthcare personnel showed that loss of taste/smell was most predictive of seropositivity; percent seropositivity increased with number of coronavirus disease 2019 symptoms. However, 22.9% with 9 symptoms were seronegative, and 8.3% with no symptoms were seropositive. These findings demonstrate limitations of symptom-based surveillance and importance of testing. [ABSTRACT FROM AUTHOR]

The ongoing spread of H5N1 avian influenza in Southeast Asia has raised concern about a worldwide influenza pandemic and has made clear the need to plan in advance for such an event. The federal government has stressed the importance of planning and, in particular, has asked hospitals and public health agencies to develop plans to care for patients outside of traditional healthcare settings. These alternative or acute care centers (ACCs) would be opened when hospitals, emergency departments (EDs), and clinics are overwhelmed by an influenza pandemic. The University of Michigan Hospital System (UMHS), a large tertiary care center in southeast Michigan, has been developing a model for offsite care of patients during an influenza pandemic. This article summarizes our planning efforts and the lessons learned from 2 functional exercises over the past 3 years.

Introduction: Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral)., Objective: The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs., Methods: Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact., Results: During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs., Conclusion: An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.