Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis

Background As the COVID-19 pandemic continues to unfold, the infection-fatality risk (ie, risk of death among all infected individuals including those with asymptomatic and mild infections) is crucial for gauging the burden of death due to COVID-19 in the coming months or years. Here, we estimate the infection-fatality risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New York City, NY, USA, the first epidemic centre in the USA, where the infection-fatality risk remains unclear. Methods In this model-based analysis, we developed a meta-population network model-inference system to estimate the underlying SARS-CoV-2 infection rate in New York City during the 2020 spring pandemic wave using available case, mortality, and mobility data. Based on these estimates, we further estimated the infection-fatality risk for all ages overall and for five age groups (<25, 25–44, 45–64, 65–74, and ≥75 years) separately, during the period March 1 to June 6, 2020 (ie, before the city began a phased reopening). Findings During the period March 1 to June 6, 2020, 205 639 people had a laboratory-confirmed infection with SARS-CoV-2 and 21 447 confirmed and probable COVID-19-related deaths occurred among residents of New York City. We estimated an overall infection-fatality risk of 1·39% (95% credible interval 1·04–1·77) in New York City. Our estimated infection-fatality risk for the two oldest age groups (65–74 and ≥75 years) was much higher than the younger age groups, with a cumulative estimated infection-fatality risk of 0·116% (0·0729–0·148) for those aged 25–44 years and 0·939% (0·729–1·19) for those aged 45–64 years versus 4·87% (3·37–6·89) for those aged 65–74 years and 14·2% (10·2–18·1) for those aged 75 years and older. In particular, weekly infection-fatality risk was estimated to be as high as 6·72% (5·52–8·01) for those aged 65–74 years and 19·1% (14·7–21·9) for those aged 75 years and older. Interpretation Our results are based on more complete ascertainment of COVID-19-related deaths in New York City than other places and thus probably reflect the true higher burden of death due to COVID-19 than that previously reported elsewhere. Given the high infection-fatality risk of SARS-CoV-2, governments must account for and closely monitor the infection rate and population health outcomes and enact prompt public health responses accordingly as the COVID-19 pandemic unfolds

Are Racial and Ethnic Minorities Less Willing to Participate in Health Research?

BACKGROUND: It is widely claimed that racial and ethnic minorities, especially in the US, are less willing than non-minority individuals to participate in health research. Yet, there is a paucity of empirical data to substantiate this claim. METHODS AND FINDINGS: We performed a comprehensive literature search to identify all published health research studies that report consent rates by race or ethnicity. We found 20 health research studies that reported consent rates by race or ethnicity. These 20 studies reported the enrollment decisions of over 70,000 individuals for a broad range of research, from interviews to drug treatment to surgical trials. Eighteen of the twenty studies were single-site studies conducted exclusively in the US or multi-site studies where the majority of sites (i.e., at least 2/3) were in the US. Of the remaining two studies, the Concorde study was conducted at 74 sites in the United Kingdom, Ireland, and France, while the Delta study was conducted at 152 sites in Europe and 23 sites in Australia and New Zealand. For the three interview or non-intervention studies, African-Americans had a nonsignificantly lower overall consent rate than non-Hispanic whites (82.2% versus 83.5%; odds ratio [OR] = 0.92; 95% confidence interval [CI] 0.84–1.02). For these same three studies, Hispanics had a nonsignificantly higher overall consent rate than non-Hispanic whites (86.1% versus 83.5%; OR = 1.37; 95% CI 0.94–1.98). For the ten clinical intervention studies, African-Americans' overall consent rate was nonsignificantly higher than that of non-Hispanic whites (45.3% versus 41.8%; OR = 1.06; 95% CI 0.78–1.45). For these same ten studies, Hispanics had a statistically significant higher overall consent rate than non-Hispanic whites (55.9% versus 41.8%; OR = 1.33; 95% CI 1.08–1.65). For the seven surgery trials, which report all minority groups together, minorities as a group had a nonsignificantly higher overall consent rate than non-Hispanic whites (65.8% versus 47.8%; OR = 1.26; 95% CI 0.89–1.77). Given the preponderance of US sites, the vast majority of these individuals from minority groups were African-Americans or Hispanics from the US. CONCLUSIONS: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes

Does Random Treatment Assignment Cause Harm to Research Participants?

BACKGROUND: Some argue that by precluding individualized treatment, randomized clinical trials (RCTs) provide substandard medical care, while others claim that participation in clinical research is associated with improved patient outcomes. However, there are few data to assess the impact of random treatment assignment on RCT participants. We therefore performed a systematic review to quantify the differences in health outcomes between randomized trial participants and eligible non-participants. METHODS AND FINDINGS: Studies were identified by searching Medline, the Web of Science citation database, and manuscript references. Studies were eligible if they documented baseline characteristics and clinical outcomes of RCT participants and eligible non-participants, and allowed non-participants access to the same interventions available to trial participants. Primary study outcomes according to patient group (randomized trial participants versus eligible non-participants) were extracted from all eligible manuscripts. For 22 of the 25 studies (88%) meeting eligibility criteria, there were no significant differences in clinical outcomes between patients who received random assignment of treatment (RCT participants) and those who received individualized treatment assignment (eligible non-participants). In addition, there was no relation between random treatment assignment and clinical outcome in 15 of the 17 studies (88%) in which randomized and nonrandomized patients had similar health status at baseline. CONCLUSIONS: These findings suggest that randomized treatment assignment as part of a clinical trial does not harm research participants

Relative Risk of Experiencing Primary Outcome According to RCT Participation

<p>Asterisks indicate statistical significance. The relevant references for the studies listed along the <i>x-</i>axis are as follows: AVID [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b050" target="_blank">50</a>, <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b068" target="_blank">68</a>], EAST [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b051" target="_blank">51</a>], Cooper [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b052" target="_blank">52</a>], BARI [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b024" target="_blank">24</a>], Chilvers [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b053" target="_blank">53</a>], Bain [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b054" target="_blank">54</a>], CASS [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b055" target="_blank">55</a>], Link [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b057" target="_blank">57</a>], Blichert-Toft [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b030" target="_blank">30</a>], Henshaw [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b058" target="_blank">58</a>], Nicolaides [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b059" target="_blank">59</a>], SMASH [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b063" target="_blank">63</a>], Mosekilde [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b064" target="_blank">64</a>], Kerry [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b067" target="_blank">67</a>], Bijker [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b025" target="_blank">25</a>], Melchart [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b029" target="_blank">29</a>], and Antman [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030188#pmed-0030188-b031" target="_blank">31</a>]. </p

Obesity and Diabetes in New York City, 2002 and 2004

Introduction Obesity and diabetes have increased rapidly nationwide, yet reliable information on these disease trends in local urban settings is unavailable. We undertook this study to characterize trends in obesity and diagnosed diabetes from 2002 to 2004 among white, black, and Hispanic adult residents of New York City.Methods We used data from the Community Health Survey, an annual random-digit–dial telephone survey of approximately 10,000 New York City adults aged 18 years or older, and from the Behavioral Risk Factor Surveillance System, a similar nationwide survey. Main outcome measures were body mass index (BMI), calculated from self-reported height and weight, and self-reported diabetes.Results In 2 years, the prevalence of obesity increased 17% in New York City, from 19.5% in 2002 to 22.8% in 2004 (P < .0001). The prevalence of diagnosed diabetes also increased 17%, from 8.1% in 2002 to 9.5% in 2004 (P < .01). Nationally, the prevalence of obesity increased by 6% during this same time period (P < .05), and diabetes prevalence did not increase significantly. The median BMI among white adults in New York City was 25.1 kg/m2, significantly lower than among Hispanics (26.4 kg/m2) and blacks (26.6 kg/m2, P < .05). The prevalence of diabetes increased across all BMI categories.Discussion The rapid increase in obesity and diabetes in New York City suggests the severity of these twin epidemics and the importance of collecting and analyzing local data for local programming and policy making

Comparison of African-American versus non-Hispanic White Consent Rates

<p>Circle diameter is proportional to the sample size of the individual studies. The diamond represents the overall OR. The vertical line indicates the 95% confidence interval on the OR. Blue indicates interview and non-intervention studies; red indicates clinical intervention studies.</p